The move comes after lawsuits were filed against health insurance providers Humana and UnitedHealth for allegedly using an AI model to determine care, overriding physician recommendations and disproportionately harming elderly beneficiaries. The CMS has reminded Medicare Advantage organizations of the nondiscrimination requirements of the Affordable Care Act and urged them to ensure that any algorithm or software tool does not perpetuate or exacerbate existing bias, or introduce new biases.
Key takeaways:
- The Centers for Medicare and Medicaid Services (CMS) has issued new rules prohibiting health insurance companies from relying solely on AI or algorithmic systems to determine patient care or coverage.
- The CMS has warned insurers against using algorithms that determine coverage based on a larger data set, rather than the individual patient's medical history, physician’s recommendations, or clinical notes.
- There have been lawsuits filed against health insurance providers, including Humana and UnitedHealth, alleging fraudulent use of AI models to determine care, overriding physician recommendations and disproportionately harming elderly beneficiaries.
- Concerns have been raised about the potential for AI and algorithms to exacerbate discrimination and bias, and the CMS has reminded Medicare Advantage organizations of the nondiscrimination requirements of the Affordable Care Act.