So, there’s been some stuff going down with Medicare Advantage (MA) insurers and their use of AI technology. The CMS has sent out a memo warning these insurers about using algorithms and artificial intelligence to help make coverage decisions. They’re concerned that these new technologies could end up causing discrimination and bias.
The CMS memo spells out a few key things, like the difference between an algorithm and an AI model. It also lays down some strict rules for using these technologies to make decisions about patient care. The agency is basically saying that these insurers need to make sure they’re not using AI in a way that goes against the agency’s coverage decision requirements.
But why is all of this happening? Well, in 2023, the feds told MA insurers that they can’t use AI to deny care. And it’s not just talk – three big insurers, Cigna, Humana, and UnitedHealthcare, have been hit with lawsuits for allegedly using AI to reject claims.
There’s even been some attention from senators. Senator Elizabeth Warren called out these insurers for using AI to boost their profits at the expense of patient care. And she’s right to be worried. CMS needs to step up and make sure that these insurers aren’t abusing AI to make coverage decisions. They’ll need to beef up their audits and keep a close eye on these denials.
Long story short, MA insurers need to pay attention to the rules and make sure they’re not facing any backlash over their use of AI. And for those who need it, CMS has created a website as an AI resource. So, keep your eyes peeled for more shake-ups in the MA space.