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AI cannot be the sole basis for denying claims: U.S. government issues memo on responsible use of machine learning in healthcare


Feb 13, 2024
Remove Artificial Intelligence from my healthcare

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. This comes 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 have urged insurers to ensure their models comply with anti-discrimination requirements. Several states, including New York and California, have also warned insurance companies to verify the fairness of their algorithms.

While machine-learning algorithms can assist in making determinations, they cannot make decisions on their own. This memo serves as a reminder that human oversight is necessary when it comes to making medical decisions based on technology. It also highlights the need for increased transparency and accountability in the use of AI in healthcare.

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