Remove Artificial Intelligence from my healthcare

Beyond Bias: US Government Clarifies AI Cannot be Used as Sole Basis for Claim Denial in Medicare Insurance

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. This move 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 have claimed that the AI model nHPredict has a 90% error rate, highlighting a dangerous aspect of the technology that is receiving increased attention.

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.

The memo emphasizes that machine-learning algorithms can assist in making determinations but cannot make decisions on their own. This means that human judgment and oversight are still necessary when it comes to making decisions about coverage and reimbursement. As such, patients who find themselves denied coverage should not assume that an AI made the decision but rather investigate further into the reasons behind their claim denial.

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