Reps. Nadler, Chu, and Sen. Warren, along with 49 other lawmakers, have urged the Centers for Medicare and Medicaid Services (CMS) to tighten oversight on the use of artificial intelligence (AI) and algorithmic tools in Medicare Advantage (MA) coverage decisions. Concerns have been raised that these technologies are being used to deny care unjustifiably, often conflicting with healthcare providers’ assessments. The bipartisan letter points to lawsuits against insurers who allegedly used AI to cut costs by denying coverage. Lawmakers recommend CMS establish clear guidelines for AI and algorithm usage, conduct systematic reviews, and enforce stricter regulations on coverage decisions that rely on these tools. The goal is to ensure MA plans provide medically necessary care based on individual circumstances rather than cost-driven, generalized AI outputs. The letter also calls for transparency in denial notices and a prohibition on AI-driven coverage decisions until thorough evaluations are completed.
Congress Pushes CMS for Stricter Oversight on AI in Medicare Advantage
Lawmakers urge CMS to tighten AI oversight in Medicare Advantage to prevent unjust care denials.
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