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 memo came 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 claim 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.
This memo serves as a reminder that while machine-learning algorithms can assist in making determinations, they cannot make decisions on their own. Insurance should cover the cost of claims, regardless of whether they are made by a person or an AI. However, if an insurance company denies a claim based solely on an AI decision, it raises questions about the fairness and accuracy of the algorithm used. It is important for patients to understand their rights and seek legal action if they feel their claim has been unfairly denied.