AI algorithms used to determine eligibility for US government healthcare coverage are increasingly verboten, the federal agency Centers for Medicare & Medicaid Services (CMS) told health insurance companies in a memo this week.
The 14-page memo touches on a wide variety of issues related to the Department of Health and Human Services subsidiary’s Medicare Advantage rules published in April last year.
Passages in the memo about algorithms being used to make healthcare decisions, however, seem tailor-made to address controversy over the use of such software in denying Medicare Advantage coverage, which has led to multiple lawsuits.
“An algorithm that determines coverage based on a larger data set instead of the individual patient’s medical history, the physician’s recommendations, or clinical notes would not be compliant [with Medicare rules enacted in April],” CMS said in the memo.
UnitedHealthcare, which offers Medicare Advantage plans, was sued in November by the estates of two elderly men who accused the company of using a faulty AI system to deny care to patients, including reducing the length of hospital recovery stays.
Health insurance firm Humana was also sued on the same grounds in December, and the CMS memo calls out the exact issues raised in the lawsuits – denying inpatient care – as against the law.
The original article contains 545 words, the summary contains 210 words. Saved 61%. I’m a bot and I’m open source!
This is the best summary I could come up with:
AI algorithms used to determine eligibility for US government healthcare coverage are increasingly verboten, the federal agency Centers for Medicare & Medicaid Services (CMS) told health insurance companies in a memo this week.
The 14-page memo touches on a wide variety of issues related to the Department of Health and Human Services subsidiary’s Medicare Advantage rules published in April last year.
Passages in the memo about algorithms being used to make healthcare decisions, however, seem tailor-made to address controversy over the use of such software in denying Medicare Advantage coverage, which has led to multiple lawsuits.
“An algorithm that determines coverage based on a larger data set instead of the individual patient’s medical history, the physician’s recommendations, or clinical notes would not be compliant [with Medicare rules enacted in April],” CMS said in the memo.
UnitedHealthcare, which offers Medicare Advantage plans, was sued in November by the estates of two elderly men who accused the company of using a faulty AI system to deny care to patients, including reducing the length of hospital recovery stays.
Health insurance firm Humana was also sued on the same grounds in December, and the CMS memo calls out the exact issues raised in the lawsuits – denying inpatient care – as against the law.
The original article contains 545 words, the summary contains 210 words. Saved 61%. I’m a bot and I’m open source!