TL;DR: The Centers for Medicare & Medicaid Services (CMS) has explicitly stated that health insurance companies are prohibited from using algorithms or artificial intelligence (AI) to deny coverage or determine care for members on Medicare Advantage plans. The CMS memo emphasizes that coverage decisions must be based on the individual patient's circumstances, and AI tools can only be used to ensure compliance with coverage criteria.

https://arstechnica.com/science/2024/02/ai-cannot-be-used-to-deny-health-care-coverage-feds-clarify-to-insurers/

#AI #healthcare #MedicareAdvantage