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. While machine-learning algorithms can assist in making determinations, they cannot make decisions on their own. This memo was issued 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 urged insurers to ensure their models comply with anti-discrimination requirements. Several states including New York and California also warned insurance companies to verify the fairness of their algorithms.
This incident serves as a reminder that while technology can be helpful in many ways, it is not infallible and must be used with caution when making important decisions such as determining eligibility for medical treatment or insurance coverage. It is important for individuals who have been denied coverage to understand their rights and seek legal advice if necessary.