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AI Cannot Be Used To Deny Health Care Coverage, Feds Clarify To Insurers
An anonymous reader quotes a report from Ars Technica: 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 (PDF) sent to all M...
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. It ended its notice by telling insurers that it is increasing its audit activities and "will be monitoring closely whether MA plans are utilizing and applying internal coverage criteria that are not found in Medicare laws."
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