For Profit 'Medicare Advantage' Plans Using AI, Artificial Intelligence for Denials - 'Not A Doctor' [View all]

- 'This Should Be a National Scandal': For-Profit Medicare Advantage Plans Using AI for Denials,' Common Dreams, Nov. 3, 2023. - "They're using AI to predict when to cut off payment for treatments," said one watchdog group. "AI. Not a doctor." - Edited

As Medicare Advantage plans rely increasingly upon artificial intelligence to determine—and often deny—payment for patient care, a group of Democratic U.S. lawmakers on Friday urged Medicare's top official to strengthen oversight of AI and algorithmic tools used to make coverage determinations.

"In recent years, problems posed by prior authorization have been exacerbated by MA plans' increasing use of AI or algorithmic software to assist in their coverage determinations in certain care settings, including inpatient hospitals, skilled nursing facilities, and home health," 32 House Democrats wrote in a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Books LaSure.

"Advocates and the media report that the use of such software has led to coverage decisions that are more restrictive than allowed under traditional Medicare rules, as well as more frequent and repeated denials of care," lawmakers wrote. They are calling on CMS to take steps including, but not limited to: Requiring MA plans to report prior authorization data including reason for denial; Comparing "guidance" generated by AI with actual MA coverage decisions..

MA plans are not part of Medicare. They are a private health insurance "scam" created by a GOP - controlled Congress and signed into law 20 years ago by Pres. George W. Bush. The letter is endorsed by advocacy groups. "The use of AI by Medicare Advantage insurers to deny needed care to seniors and people with disabilities represents the most recent and dangerous step by greedy companies focused on profit instead of patients," Public Citizen Exec. VP Lisa Gilbert said...
https://www.commondreams.org/news/medicare-advantage-2666143830