"Feds Issue Guidance on AI Use in Medicare Advantage Health Care Coverage"

The Centers for Medicare & Medicaid Services (CMS) has clarified that health insurance companies cannot use algorithms or artificial intelligence (AI) to determine care or deny coverage for members on Medicare Advantage plans. This comes after lawsuits claimed that insurers were using a flawed AI tool to deny care to elderly patients. The CMS warned insurers that AI tools can only be used to ensure compliance with coverage criteria and must not be used to make coverage decisions based on a larger data set instead of the individual patient's medical history. Non-compliance can result in penalties and sanctions.