After suffering a fall and breaking an arm, you underwent medical treatment and rehabilitation. However, your insurance claim was denied, leaving you uncertain if it was a person or an AI that made the decision.
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. While machine-learning algorithms can assist in making determinations, they cannot make decisions on their own. This memo came 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 claimed that the AI model nHPredict had 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 urged insurers to ensure their models comply with anti-discrimination requirements. Several states, including New York and California, also warned insurance companies to verify the fairness of their algorithms.