Medicare Advantage Insurers Face Scrutiny Over AI and Care Denials
Sens. Richard Blumenthal (D-Conn.) and Josh Hawley (R-Mo.) are calling on the nation's largest Medicare Advantage insurers to provide internal records and detailed information on their use of artificial intelligence to block rehabilitative care.[4112146]
A government investigation found a continuing pattern of denials within Medicare Advantage, with recent findings undercutting companies' claims to have reduced barriers to crucial medical services.[4112146]
The Office of the Inspector General for the Health and Human Services Department uncovered a pattern of denials that contradicts companies' assertions about their efforts to improve access to care.[4010533]
More insurers, including SCAN Health Plan and Alignment Healthcare, have sued CMS over Medicare Advantage stars after regulators refused to recalculate industry-wide MA scores using the same methodology as for Clover Health.[4010533]