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FEBRUARY 27, 2024

Congress eyes action

AI May Not Be So Smart When Payors Use It To Deny Medical Claims


Originally published by our sister publication Specialty Pharmacy Continuum

By Gina Shaw

Concerns are growing about the increasing use of artificial intelligence to review—and in many cases deny—healthcare claims, sparking a congressional inquiry and lawsuits. Thirty-two legislators sent a letter to the Centers for Medicare & Medicaid Services (CMS) on Nov. 3, 2023, urging increased oversight of the use of these tools in Medicare Advantage (MA) plans.

“In recent years,