Life-Health-Dental Insurance · Health Insurance · Private litigation
Humana
Headline
Humana was sued in 2023 over the same nH Predict algorithm at issue in the UnitedHealth case - the naviHealth-built tool that estimates how long a Medicare Advantage patient 'should' need post-acute rehabilitation and…
Humana was sued in 2023 over the same nH Predict algorithm at issue in the UnitedHealth case - the naviHealth-built tool that estimates how long a Medicare Advantage patient 'should' need post-acute rehabilitation and then supports cutting coverage when they hit that estimate. Its core claims survived Humana's dismissal bid in August 2025 (motion granted in part and denied in part). What makes this row worth reading next to the UnitedHealth one rather than as a duplicate is what it demonstrates: the tool was not one company's bad idea, it was a product, sold and deployed across competing insurers, which means a patient shopping between Medicare Advantage plans could have been switching brands while landing under the same algorithm either way. The industry context sharpens it - AM Best reported in September 2025 that Medicare Advantage posted a $5.7 billion underwriting loss in 2024, after five years of underwriting gains, because patients used more care than plans had priced in.
- Severity
- Evidence tierUnassigned
- Claims confirmed
- Last verified2026-08-04
Case status. Private litigation; the legal tier of its sources has not been assigned yet.
Primary source. www.statnews.com/2023/12/12/humana-algorithm-medicare-advantage-patients-lawsuit/ — Verified - primary source confirmed.
Terms
Arbitration
Not independently confirmed this pass — standard binding arbitration + class action waiver expected.
Data sharing
Not itemized separately from the DOJ/antitrust findings below.
Fees and billing
SAME DOJ MEDICARE ADVANTAGE KICKBACK/DISABILITY-DISCRIMINATION LAWSUIT as Elevance/Aetna (see Elevance row for full detail) — Humana is a named co-defendant. SAME antitrust/Zelis out-of-network reimbursement conspiracy case as Elevance/UnitedHealth/Aetna/Cigna (see Elevance row).
Contacts
Privacy contact. Not recorded.
Legal notice. PUBLIC COMPANY (HUM). Service route: c/o General Counsel / Corporate Secretary, Louisville, Kentucky — the corporate address on the SEC Form 10-K cover page is the official address of record. Confirm the exact street address on the current 10-K at sec.gov/edgar, and check the state-of-incorporation registered agent (usually Delaware; most large filers use The Corporation Trust Company or Corporation Service Company) via the Secretary of State business-entity search. A registered agent MUST accept service, which is why it is the reliable channel when a company publishes no privacy address.
Mailing address. Not recorded.
Evidence
| Claim | Kind | Support | Sources |
|---|---|---|---|
| 1. Humana was sued in 2023 over the nH Predict algorithm. | fact | supported | none recorded |
| 2. nH Predict is the same algorithm at issue in the UnitedHealth case. | fact | unknown | none recorded |
| 3. nH Predict was built by naviHealth and estimates how long a Medicare Advantage patient should need post-acute rehab, supporting coverage cuts. | fact | unknown | none recorded |
| 4. Its core claims survived Humana's dismissal bid in August 2025 (motion granted in part and denied in part). | fact | unsupported | 1 (1 confirmed) |
| 5. The tool was a product sold and deployed across competing insurers. | characterization | n/a | none recorded |
| 6. AM Best reportedly found (figure not re-verified this pass) that Medicare Advantage posted a $5.7 billion underwriting loss in 2024. | fact | unsupported | 1 (0 confirmed) |
| 7. The 2024 loss was the first in years and resulted from patients using more care than plans priced in. | fact | unsupported | 1 (0 confirmed) |
1 of 7 claims have a confirmed source of their own.
Sources
| Source | Claim | Tier | Status | Quote |
|---|---|---|---|---|
| court · 2025-08-15 | Claim 4 | Unassigned | confirmed | “granting in part and denying in part 40 Humana's Motion to Dismiss” Quote basis: not recorded. |
| none | Claim 6 | Unassigned | not found | No quote recorded. Quote basis: not recorded. |
| none | Claim 7 | Unassigned | not found | No quote recorded. Quote basis: not recorded. |
Source vault
Link status: Candidate - not yet fetched
| Document | Last fetch | |
|---|---|---|
| Privacy policy humana.com/legal/privacy-policy | Not fetched yet | NO (HTML only) |
| Terms of service humana.com/legal/website-terms-of-use | Not fetched yet | NO (HTML only) |
| Website humana.com | Not fetched yet | — |
| Primary source https://www.statnews.com/2023/12/12/humana-algorithm-medicare-advantage-patients-lawsuit/ Verification: Verified - primary source confirmed | Not fetched yet | — |
Enforcement
No enforcement actions are linked to this row.
State statute
Headquarters on file: Kentucky. Provisions of KCDPA on file:
| Provision | Type | Source |
|---|---|---|
| Applicability Threshold Ky. Rev. Stat. § 367.3613 | threshold | source |
| Consumer Rights — Includes Correction Right Ky. Rev. Stat. § 367.3614 | hard | source |
| Enforcement — AG; 30-Day Cure Ky. Rev. Stat. § 367.3623 | hard | source |