AI cannot be used to deny health care coverage, feds clarify to insurers

AI cannot be used to deny health care coverage, feds clarify to insurers

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Enlarge / A nursing home resident is pushed along a corridor by a nurse. 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 . Further Reading UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges 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 […]

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