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The Problem Room The Lawsuits

The Thread · The Courts

The Lawsuits

When a denial happens once, it's a dispute. When it happens by design, it ends up in front of a judge. These are the cases where the courts — not just patients — are weighing in.

The Documented Record

Class Action · nH Predict

Estate of Gene B. Lokken et al. v. UnitedHealth Group

UHG's NaviHealth used a prediction algorithm with a reported 90% error rate to deny medically necessary care to Medicare Advantage seniors. Now a class action.

Lawsuit · Medicare Advantage

Ballad Health sues UnitedHealth Group

Alleging Medicare Advantage manipulation and harm to patients.

Ruling · Cancer Denials

A judge calls cancer denials "immoral, barbaric"

The court's own words for the conduct.

Ruling · $91.2M

Envision Healthcare v. UnitedHealthcare

UnitedHealthcare ordered to pay $91.2M for underpaying a physician group below their in-network agreement.

Settlement · $20M+

DOL v. UMR (UnitedHealth subsidiary)

Accused of denying thousands of claims based solely on diagnosis codes rather than medical necessity; agreed to pay $20M+ to settle.

Settlement · $2.1M

United Behavioral Health — DOL & NY AG

Underpaying out-of-network mental health providers, overcharging patients, and excessively denying treatment, in violation of ERISA.

Penalty · $165M

Massachusetts v. UHG-owned insurers

Ordered to pay $165M+ for a deceptive sales scheme that pushed vulnerable consumers into low-value supplemental products.

Investigation · Autism

ProPublica: UHG culling ABA-therapy providers

Restricting the gold-standard therapy for autistic children to limit spending on rising demand.

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