On February 6th, the US government issued a memo to Medicare insurers, clarifying that AI cannot be used as the sole basis for denying claims. While machine-learning algorithms can assist in making determinations, they cannot make decisions on their own.
This memo comes in response to lawsuits against health insurers, such as United Healthcare and Humana, who have been accused of using AI to wrongly deny coverage. Patients claim that the AI model nHPredict has a 90% error rate, highlighting a dangerous aspect of the technology that is receiving increased attention.
In light of these issues, the Centers for Medicare & Medicaid Services expressed concern about the potential for algorithms to exacerbate discrimination and bias and have urged insurers to ensure their models comply with anti-discrimination requirements. Several states, including New York and California, have also warned insurance companies to verify the fairness of their algorithms.
It’s important for patients like you who have experienced denied claims due to AI decision-making to understand your rights and seek legal recourse if necessary. As technology continues to advance in healthcare, it’s crucial that we ensure that it is being used responsibly and ethically.