Feds: Insurers Can’t Use AI To Deny Medicare Coverage

Ars Technica reports:

Health insurance companies cannot use algorithms or artificial intelligence to determine care or deny coverage to members on Medicare Advantage plans, the Centers for Medicare & Medicaid Services (CMS) clarified in a memo sent to all Medicare Advantage insurers.

The memo—formatted like an FAQ on Medicare Advantage (MA) plan rules—comes just months after patients filed lawsuits claiming that UnitedHealth and Humana have been using a deeply flawed AI-powered tool to deny care to elderly patients on MA plans.

The lawsuits, which seek class-action status, center on the same AI tool, called nH Predict, used by both insurers and developed by NaviHealth, a UnitedHealth subsidiary.

Read the full article.

AI cannot be used to deny health care coverage, feds clarify to insurers https://t.co/WZrhJs2Kgj

— Ars Technica (@arstechnica) February 8, 2024