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Issue / Topic: Medicare Advantage

Coverage Denials

Tracker Trends
Trends Overview ›
340B Program21
Equity54
  • Affordable Care Act (Section 1557)27
Federal Health Funding61
  • Funding Termination/Cuts32
  • Health Information2
  • Indirect Cost Rate Cuts7
  • Medicaid12
  • Reproductive Health12
Health Care Affordability64
  • Anticompetitive Practices29
    • Anticompetitive Contracting10
    • Insurer Practices6
    • Provider Consolidation11
  • Cost Containment15
  • Medical Debt4
  • Site-Neutral Payments9
  • Staffing Standards7
Medicare Advantage38
  • Artificial Intelligence2
  • Coding Practices10
  • Coverage Denials6
  • Enrollment Practices1
  • Star Ratings21
Prescription Drug Pricing43
  • Drug Specific Access Laws5
  • Drug Transparency Laws2
  • Medicare Drug Price Negotiation24
  • Prescription Drug Affordability Boards4
  • Price Gouging Laws7
Private Health Insurance116
  • Affordable Care Act46
    • Copay Accumulators3
    • Employer Mandate2
    • Marketplace Rules11
    • Non-ACA Coverage12
    • Preventive Services16
  • Artificial Intelligence1
  • Ghost Networks7
  • No Surprises Act60
    • Arbitration Awards/Conduct41
    • Arbitration Regulations10
    • Constitutional Challenges5
    • Qualifying Payment Amount5
Reproductive Health54
  • EMTALA7
  • Federal Health Funding12
  • HIPAA Privacy Protections5
  • Medication Abortion18
  • Right to Travel7
Transparency and Quality9
6 tracked cases
Sub Issues
  • Overview
  • Star Ratings (21)
  • Coding Practices (10)
  • Coverage Denials (6)
  • Artificial Intelligence (2)
  • Enrollment Practices (1)

Litigation trends for Coverage Denials

Spotlight

Key quotes shaping this topic

“Plaintiffs’ [sic] assert that Humana omitted that it uses AI to make coverage determinations. Applying the same Lokken analysis to Plaintiffs’ common law fraud claim, the Court finds that it is not preempted.”

Barrows et al. v. Humana Inc.

Federal District Court for the Western District of Kentucky, 2025

Who's Suing

Plaintiff by Type

Who's Being Sued

Defendant by Type

Who's Suing

Plaintiff by Type

Who's Being Sued

Defendant by Type

Key Dates

Important dates in Coverage Denials cases

October 14, 2026 | Estate of Gene B. Lokken et al. v. UnitedHealth Group Inc. et al.

Plaintiffs' Expert Disclosure Due

October 15, 2026 | Barrows et al. v. Humana Inc.

Plaintiffs' Motion for Class Certification Due

Legal Issues

Statutes & Doctrines Cited

Legal Issues

Statutes & Doctrines Cited

Geographic Trends

5 active district courts

1 active circuit court

  • 1st Circuit
  • 2nd Circuit
  • 3rd Circuit
  • 4th Circuit
  • 5th Circuit
  • 6th Circuit
  • 7th Circuit
  • 8th Circuit
  • 9th Circuit
  • 10th Circuit
  • 11th Circuit
  • D.C. Circuit
  • Fed. Circuit

Not shown: Puerto Rico (First Circuit), the U.S. Virgin Islands (Third Circuit), and Guam and the Northern Mariana Islands (Ninth Circuit).

Court Level

Appellate District
1 (17%) 5 (83%)

Status

Who's Presiding

District Court Cases by Appointing President

Reflects district court judges only.

All trend data is based solely on the cases on this website; if you want to recommend a new case to include, please let us know at hpli@georgetown.edu.

Coverage Denials Cases We're Tracking

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3:23-cv-00654

Barrows et al. v. Humana Inc.

Filed:
December 12, 2023
Status
Briefing is ongoing
Court
Kentucky Western
Goal
Award damages +2 additional goal(s)
  • Medicare Advantage
  • Artificial Intelligence
  • Coverage Denials

0:23-cv-03514

Estate of Gene B. Lokken et al. v. UnitedHealth Group Inc. et al.

Filed:
November 14, 2023
Status
Briefing is ongoing

Motion to Dismiss Granted in Part

Court
Minnesota — Fourth
Goal
Award damages +1 additional goal(s)
  • Medicare Advantage
  • Artificial Intelligence
  • Coverage Denials

2:25-cv-00176

Ballad Health et al. v. UnitedHealth Group Inc. et al.

Filed:
October 21, 2025
Status
Case Dismissed
Court
Tennessee Eastern — Northeastern
Goal
Award damages +1 additional goal(s)
  • Medicare Advantage
  • Coverage Denials
Inactive Case

1:19-cv-02501

United States et al. ex rel. SW Challenger LLC. et al. v. Evicore Healthcare MSI LLC

Filed:
March 20, 2019
Status
Decision issued
Court
New York Southern
Goal
Award damages +1 additional goal(s)
  • Medicare Advantage
  • Coverage Denials
Inactive Case

22-530

United States et al. ex rel. SW Challenger LLC. et al. v. Evicore Healthcare MSI LLC

Filed:
March 14, 2022
Status
Decision issued
Court
Second Circuit
Goal
Award damages +1 additional goal(s)
  • Medicare Advantage
  • Coverage Denials
Inactive Case

1:15-cv-06937

United States ex rel. Nezda v. American Imaging Management Inc. et al.

Filed:
August 7, 2015
Status
Case Dismissed
Court
Illinois Northern — Eastern
Goal
Award damages
  • Medicare Advantage
  • Coverage Denials

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