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, problems posed by prior authorization [PA] have been exacerbated by MA