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AI cannot be used to deny health care coverage, feds clarify to insurers | CMS worries AI could wrongfully deny care for those on Medicare Advantage plans.
CMS worries AI could wrongfully deny care for those on Medicare Advantage 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. According to the lawsuits, nH Predict produces draconian estimates for how long a patient will need post-acute care in facilities like skilled nursing homes and rehabilitation centers after an acute injury, illness, or event, like a fall or a stroke. Artificial intelligence has been defined as a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments.
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