As corporate insurance companies continue to bank record profits at the expense of patients, federal regulators are taking an important step to hold them accountable for using artificial intelligence (AI) to unfairly delay and deny patient care for Medicare Advantage beneficiaries.
As STAT reports, “In recent months, the federal government has repeatedly told Medicare Advantage insurers that they cannot use artificial intelligence or algorithms to deny medical services the government routinely covers … A STAT investigation last year found Medicare Advantage insurers routinely rejected care based on the suggestions calculated by algorithmic programs, prompting lawmakers to probe the industry. UnitedHealth Group, the largest Medicare Advantage plan in the country, pressured its employees to adhere to algorithmic predictions for length of stay — even for patients who could barely walk and required more rehab care. UnitedHealth and Humana, which use an algorithm developed by the same company, a UnitedHealth subsidiary called NaviHealth, now face class-action lawsuits over their use of AI in their Medicare Advantage coverage decisions.”
In a new notice to corporate insurers, the Centers for Medicare & Medicaid Services (CMS) warns again that corporate insurers are not permitted to use artificial intelligence (AI) or algorithms alone as the basis for continuing to deny or downgrade hospital admissions for Medicare Advantage beneficiaries – and that MA Plans must consider the patient’s individual circumstances as it relates to Medicare coverage criteria as required.
Additionally, CMS expressed concern in the notice that corporate insurers’ practices may disproportionately harm marginalized communities. CMS writes that it is “concerned that algorithms and many new artificial intelligence technologies can exacerbate discrimination and bias.”
At a time when corporate insurers continue to prioritize profits over patients by routinely delaying and denying necessary care, including through the use of AI, policymakers must continue taking steps to protect patients from corporate insurers’ abusive practices.