The Centers for Medicare & Medicaid Services (CMS) raised an alarm that artificial intelligence (AI) software used by Medicare Advantage (MA) insurers, UnitedHealthcare and Humana, has been mistakenly denying care to elderly patients. The AI-powered tool, nH Predict developed by NaviHealth, has been producing flawed estimates and denying coverage. In a memo, the CMS warned insurers and patients that AI-tools being used in this manner are not compliant with the rules for MA plans. The memo, published as a FAQ on the MA plan website was released just months after patients filed lawsuits, alleging that both UnitedHealthcare and Humana have been using the deeply flawed generative AI-tool to improperly deny care to elderly MA plan patients. Additionally, the CMS expressed concerns about the use of potentially biased and discriminatory AI-tools. The agency is planning to increase audit activities and closely monitor the use generative AI-tools that administer and adjudge internal coverage criteria for MA plans.
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