UnitedHealth Group

Following its $2.5 billion acquisition of naviHealth in 2020, UnitedHealth's Optum subsidiary deployed the nH Predict AI algorithm to determine when elderly Medicare Advantage patients should be discharged from skilled nursing facilities, inpatient rehabilitation, or long-term acute care. The algorithm set predicted discharge dates and triggered automatic coverage denials when actual stays exceeded predictions. UnitedHealth's internal target: keep patient stays within 1% of the algorithm's prediction — regardless of clinical reality.

• —UnitedHealthcare's post-acute care denial rate rose from 8.7% (2019) to 22.7% (2022) — the period following naviHealth's acquisition. The skilled nursing home denial rate rose ninefold in the same period.
• —The Senate Permanent Subcommittee on Investigations obtained 280,000+ pages of internal UnitedHealth documents and found employees were directed to "follow the algorithms and basically not use your clinical judgment."
• —Employees were required to compile clinical notes and file progress reports three days before the algorithm's predicted discharge date — not when the patient's clinical condition indicated readiness.
• —STAT News reported in 2023 that five former naviHealth employees described being instructed to abide by algorithm predictions even when clinical staff knew patients were not ready to leave.
• —In February 2024, the Biden administration's Centers for Medicare & Medicaid Services issued guidance clarifying that AI cannot be used as the basis to deny coverage — a direct regulatory response to nH Predict.

Source: Senate PSI Report, October 2024 — 280,000+ pages of internal documents

The federal class action Estate of Lokken v. UnitedHealth Group (D. Minn., Nov. 2023) names two plaintiffs whose estates are pursuing the company after coverage was cut by the nH Predict algorithm over physician objection. Both patients are now dead. Their cases are not aberrations — the complaint alleges the algorithm operates as a systematic scheme to deny care to patients whose continued stay was medically necessary.

• —Gene Lokken, 91, fractured his leg and ankle in May 2022. His physician approved physical therapy. Coverage was denied after 19 days — while records documented his muscles as "paralyzed and weak." His family paid approximately $150,000 out of pocket over the following year. Lokken died in July 2023.
• —Dale Tetzloff, 74, suffered a stroke in October 2022. His physician recommended long-term nursing care. Coverage was cut after 20 days. When his family requested an explanation, the company cited confidentiality. Out-of-pocket costs: $70,000. Tetzloff died in October 2023.
• —The complaint alleges that only 0.2% of patients denied under the algorithm ever file an appeal — and that of those who do, 90% of denials are reversed through appeals or administrative law judge rulings.
• —February 2025: Federal court denied UnitedHealth's motion to dismiss; breach of contract and good-faith claims proceed.
• —March 2025: Federal magistrate judge ordered broad discovery — UnitedHealth must produce documents on nH Predict reaching back to January 2017, including internal cost-savings projections from the naviHealth acquisition and all government investigations into its AI use.

Source: Class action complaint, Estate of Lokken v. UnitedHealth Group, D. Minn. Nov. 2023

ProPublica's 2023 investigation into Christopher McNaughton, a 31-year-old student with severe ulcerative colitis, documented an extraordinary record of internal UnitedHealth communications showing deliberate suppression of a favorable independent medical review, internal calculations of cost savings from denying treatment, and a recorded phone call in which a UHC employee laughed at an appeal and stated the company was "still gonna say no."

• —McNaughton's Mayo Clinic specialist prescribed a dual-biologic regimen (cost: $2 million/year). UnitedHealth's student health division denied coverage multiple times as "not medically necessary."
• —A favorable independent medical review from Dr. Nitin Kumar was actively suppressed. Nurse Kavanaugh stated in deposition: "I didn't [save the Kumar report] because it shouldn't have existed."
• —Internal emails showed UnitedHealth executives calculated that reducing McNaughton's doses would cut costs from $1.1 million to $260,218.
• —Dr. Nady Cates, a UHC internal medical director, admitted under oath that he gave McNaughton's treating physician's opinion "zero weight."
• —A recorded call captured UHC employee Dave Opperman laughing at an appeal and stating: "We're still gonna say no."
• —McNaughton filed a federal lawsuit in August 2021. After he sought a temporary restraining order in September 2021, UnitedHealth capitulated. The case settled confidentially in February 2023.

Source: ProPublica: "UnitedHealthcare Denied Coverage to a Chronically Ill Patient. He's Suing."

The Department of Justice launched a civil fraud investigation into UnitedHealth Group's Medicare Advantage billing practices, first reported by the Wall Street Journal. The DOJ investigation focuses on the systematic addition of high-value diagnoses to patient records without physician confirmation — a practice that inflates "risk scores" and drives higher federal payments from the Centers for Medicare & Medicaid Services. UnitedHealth confirmed it was cooperating with both criminal and civil DOJ requests.

• —Medicare Advantage is funded by the federal government at a per-member rate set by risk score: the sicker the patient profile, the higher the federal payment. Inflating diagnoses inflates the payment.
• —On October 10, 2023, UnitedHealth received formal notice of a separate DOJ antitrust investigation into whether the integration of its insurance arm with Optum's 90,000+ physician group creates anticompetitive effects — including the ability to steer patients and control treatment decisions.
• —In May 2024, a class action lawsuit was filed by the City of Hollywood Firefighters' Pension Fund alleging that CEO Witty and two other executives sold a combined $120 million in UHG stock four months before the antitrust investigation became public.
• —CEO Andrew Witty's abrupt departure in May 2025 — officially for "personal reasons" — preceded the public reporting on the full scope of federal investigations.
• —Stephen Hemsley, the former CEO (2006–2017) who oversaw the company's explosive growth, was immediately installed as replacement.

Source: Healthcare Dive: "UnitedHealth under investigation by the Department of Justice"

UnitedHealth Group's financial performance rose in lockstep with its denial rates. While the nH Predict algorithm was cutting coverage for elderly Medicare Advantage patients, UnitedHealth was posting record profits, authorizing billions in stock buybacks, and paying its executives at historic rates. The company insured 49 million Americans. Its denial rates for post-acute care more than doubled. No individual has been charged with a crime.

• —2023 net income: $22.4 billion. 2024 revenue: $400.3 billion — making UnitedHealth Group among the largest revenue-generating companies in the United States.
• —CEO Andrew Witty's total compensation: $23.5 million (2023), $26.3 million (2024). CEO-to-median-worker pay ratio: 352-to-1.
• —Brian Thompson, CEO of UnitedHealthcare (the insurance subsidiary), earned $10.2 million annually while overseeing the unit where denial rates doubled.
• —Stock buybacks since 2010: approximately $54 billion — 44% of the entire health insurance industry's $120 billion in buybacks over the same period.
• —UnitedHealthcare's ACA marketplace claim denial rate was 33% in 2023 — highest of any major U.S. insurer. It dropped to 20% in 2024 following the Thompson assassination and resulting public fury.
• —Of appealed Medicare Advantage prior authorization denials, 80.7% are partially or fully overturned — meaning the algorithm is not just harsh, it is frequently wrong.

Source: Jacobin: "$120 Billion in Health Insurer Buybacks" | UnitedHealth 2024 annual results

On December 4, 2024, Brian Thompson — CEO of UnitedHealthcare — was shot and killed outside the New York Hilton Midtown while walking to an investor conference. Luigi Mangione, 26, was arrested five days later in Pennsylvania. The shell casings found at the scene were inscribed with the words "delay," "deny," and "depose" — a reference to the insurance industry critique phrase "Delay, Deny, Defend." The public reaction was historically notable: instead of uniform condemnation, polling showed substantial segments of the public expressed sympathy for the shooter's stated grievance, if not his act.

• —A 262-word handwritten document recovered with Mangione stated that the U.S. healthcare system has "the #1 most expensive healthcare system in the world" while ranking "roughly #42 in life expectancy," and described UnitedHealth as having engaged in "abuse for immense profit."
• —Emerson College poll (Dec 11–13, 2024): 68% found the killing unacceptable; among 18–29 year-olds, 41% found it acceptable or somewhat acceptable.
• —NORC poll (Dec 12–16, 2024): 78% said Mangione bore responsibility; 69% said insurance claim denials bore "a great deal or moderate" responsibility for Thompson's death; 67% cited company profits.
• —Generation Lab college student poll (Dec 19–23, 2024): 45% sympathized with Mangione; 81% had negative views of Thompson.
• —Under Thompson's leadership, UnitedHealthcare profits grew from $12 billion (2021) to $16 billion (2023). Its denial rates for post-acute care doubled in the same period.
• —Within weeks of the assassination, UnitedHealthcare announced reductions in prior authorization requirements covering an additional 30% of services — changes it had resisted for years.

Source: Wikipedia: Killing of Brian Thompson (polling citations) | Northeastern University analysis