Remove Artificial Intelligence from Healthcare

AI Cannot Deny Healthcare Claims: Human Examiners Still in Charge, Regulators Urge Compliance

On February 6th, the US government issued a memo to certain Medicare insurers, making it clear that they cannot use artificial intelligence (AI) to deny claims. While machine-learning algorithms can assist in making determinations, they cannot be the sole basis for denying care.

Following this memo from the Centers for Medicare & Medicaid Services (CMS), there has been much debate about whether claims examiners or AI is responsible for denying claims. However, it is important to note that while AI can assist in decision-making processes, it ultimately falls on human claims examiners to review and make final decisions.

This memo comes in response to lawsuits against health insurers for allegedly using AI to wrongfully deny care to patients. These lawsuits involve patients claiming that companies like United Healthcare and Humana utilized an AI model with a 90% error rate. The dangers of such technology are evident, with many regulators and critics focusing on potential discriminatory implications of AI.

CMS expressed concern about algorithms exacerbating discrimination and bias, emphasizing that the onus is on insurers to ensure compliance with the anti-discrimination requirements of the Affordable Care Act. Several states, including New York and California, have also issued warnings to insurance companies, urging them to verify that their algorithms are not discriminatory.

In conclusion, while AI can assist in decision-making processes, it ultimately falls on human claims examiners to review and make final decisions when it comes to denying claims. Insurers must ensure compliance with anti-discrimination requirements and work towards creating fair and equitable systems for all patients.

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