Humana and UnitedHealth Plead the Filed-Rate Doctrine as the nH Predict Suits Turn on Medicare Advantage Bid Assumptions

The lawsuits over nH Predict began as a question about whether an algorithm replaced doctors. Three years in, they have become a question about what Medicare Advantage bid actuaries assumed. Humana's amended answer in Barrows, filed August 26, pleads that damages are barred "by the filed rate doctrine to the extent any premium or other payments" were "approved pursuant to CMS-dictated processes." UnitedHealth moved to add the same defense in Lokken on August 10 (Barrows Doc. 152 and Lokken Doc. 188, Georgetown Litigation Tracker).

The plaintiffs' reply, filed October 14, shows what the defense has set in motion. In Lokken they have demanded every bid UnitedHealth submitted to CMS since 2017. In Barrows they have moved to add naviHealth, the UnitedHealth unit that operates the model, as a defendant. Humana's counsel told them in August that most of the relevant records were in naviHealth's "sole possession."

Key Takeaways

Two carriers, one defense: Humana pleaded the filed-rate doctrine as its 29th affirmative defense on August 26, and UnitedHealth moved to add it on August 10, in cases filed in 2023.
Bids since 2017: the Lokken plaintiffs served requests in March 2026 for every Medicare Advantage bid and the post-acute data behind it, on the theory the bids "contained inaccurate predictions regarding the amount of health care members would use."
22 document productions by Humana as of October 2, one of fourteen corporate-witness topics deposed, and class discovery open through December 10, 2026.
Sixteen weeks was the schedule extension Humana says the plaintiffs got in exchange for consenting to the filed-rate amendment; it now offers two more.
February 16, 2027 is the Lokken class-certification deadline, with fact discovery closing April 26, 2027, so bid assumptions reach expert reports next year.

What the Filings Say

nH Predict is a model that estimates how long a patient will need post-acute care, such as a skilled nursing stay. The complaints allege the insurers used its output to cut off coverage "in place of real doctors." Humana's answer denies this outright: it "did not use nH Predict to make adverse coverage determinations," and any denials were made "by physician Medical Directors."

The filed-rate doctrine is a separate line of defense. It holds that a rate approved by a regulator cannot be attacked in a damages suit, because a court awarding damages would in effect be setting a different rate. For Medicare Advantage, the approved rate is the annual bid, which CMS accepts after review.

UnitedHealth's motion describes the plaintiffs' response. They "now posit that Defendants received artificially high rates" from CMS "based on misrepresentations allegedly made to CMS during the bidding process." Their theory, in UnitedHealth's words, is that the bids "contained inaccurate predictions regarding the amount of health care members would use (in order to secure regulatory approval of improperly high rates)." UnitedHealth calls that theory "unpled (and baseless)" and unrelated to the surviving contract claims.

Why the Bid Assumptions Decide the Defense

A Medicare Advantage bid projects what the plan's members will cost, service by service, under the plan's benefit design and its utilization management. An actuary certifies it. Post-acute care is a line in that projection, and the projection assumes a level of utilization that the plan's own policies will allow.

That is where the two arguments meet. If the bid assumed post-acute days that the algorithm was then used to deny, CMS paid for care that was not delivered. The plaintiffs want to show exactly that, which is why the bids and the "underlying documents and data related to post-acute care" are now in discovery. The carriers want the bids treated as approved rates that no court can revisit.

The defense therefore rests on the accuracy of the bid's assumptions, not just its approval. A filed-rate shield covers a rate the regulator understood. It is weaker for a rate the regulator approved on projections the filer knew its own claims process would not honor. The plaintiffs' reply frames Humana's conduct as having "abdicated its claims process to that vendor, and the records to match."

For an actuary who certifies bids, the practical consequence is that the utilization assumptions, the utilization-management policies and the vendor's model now have to agree with each other on paper. A bid that assumes one thing while the model enforces another is the fact pattern both cases are now built around.

A Defense That Opens the Discovery It Was Meant to Close

The filed-rate doctrine is usually pleaded to end a case early. Here it has extended one. Humana asked the plaintiffs to consent to the amendment on April 29 and got it on June 5, along with what Humana describes as a sixteen-week extension of the class schedule. The plaintiffs now say that extension "could not have accounted for Humana's defense," because the defense made the bids relevant and the bids led to naviHealth.

Humana's position is that the plaintiffs knew the vendor existed from the start and are raising it late. The plaintiffs' answer is that knowing a vendor exists is one thing, and learning the defendant's records sit with it is another. Their motion to add naviHealth is pending, with a 21-day fallback if it is denied, and class-certification discovery runs through December 10.

In Lokken, the schedule is longer. Plaintiffs' expert declarations on class certification were due October 14. UnitedHealth's are due January 25, the motion itself February 16, and fact discovery closes April 26, 2027. By then the 2027 bids will have been filed, with the same assumptions under the same scrutiny.

Humana and UnitedHealth Plead the Filed-Rate Doctrine as the nH Predict Suits Turn on Medicare Advantage Bid Assumptions

Key Takeaways

What the Filings Say

Why the Bid Assumptions Decide the Defense

A Defense That Opens the Discovery It Was Meant to Close

Further Reading

Sources