News & Analysis as of

Health Insurance Artificial Intelligence

Goodwin

Reliance on Third-Party “Pricing” Facilitators Under Increasing Antitrust Scrutiny

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In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more

Holland & Knight LLP

Holland & Knight Health Dose: September 10, 2024

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector....more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - August 2024 #2

News Briefs - State Governments Taking Steps to Make Rules on Healthcare AI - In the absence of federal guardrails on artificial intelligence in healthcare, state governments are figuring out their own rules of the road....more

Eversheds Sutherland (US) LLP

AI Litigation Insights - Barrows et al. v. Humana, Inc.

Health insurer Humana was sued in a class action challenging the process by which it made claim determinations and alleging that it knowingly used a “highly inaccurate” artificial intelligence model, nH Predict, to improperly...more

Husch Blackwell LLP

Colorado's New Employment Laws: What to Know

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The 2024 Colorado legislative session concluded on May 8, 2024. Consistent with last year’s session, the 74th General Assembly ended with a number of new employment-related laws passing. Enacted legislation will enhance...more

Carlton Fields

NAIC Groups Carve Up the Mountain at the Winter Meeting

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After strapping on their skis and riding up the lifts, the NAIC groups reported to their events. The results of the events of note for life insurers are as follows...more

Seyfarth Shaw LLP

HHS Issues New Affordable Care Act Section 1557 Nondiscrimination Regulations

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Seyfarth Synopsis: New regulations effective August 6, 2024 restore and expand scope of civil rights protections under Section 1557 of the Affordable Care Act....more

Dinsmore & Shohl LLP

New Affordable Care Act Final Rule Prohibits Discriminatory Use of AI

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The Department for Health and Human Services Office for Civil Rights (“OCR”) recently issued a final rule under Section 1557 of the Affordable Care Act, which prohibits federally funded health programs from discriminating on...more

Manatt, Phelps & Phillips, LLP

HHS Finalizes Antidiscrimination Rules On Patient Care Decision Tools, Including AI

Last week, the Department of Health and Human Services (HHS) finalized antidiscrimination regulations implementing Section 1557 of the Affordable Care Act (ACA Section 1557). The final rule expands upon the proposed rule’s...more

Epstein Becker & Green

HHS Extends the Antidiscrimination Provisions of the Affordable Care Act to Patient Care Decision Support Tools, Including...

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Turns out, ignorance really is bliss, at least according to the Office of Civil Rights (“OCR”) within the Department of Health and Human Services (“HHS”), in publishing its final rule on algorithmic discrimination by payers...more

Eversheds Sutherland (US) LLP

AI Litigation Insights - Jeremy Jong, individually and on behalf of similarly situated individuals v. Blue Shield of California

Plaintiff Jeremy Jong filed a putative class-action complaint against Blue Shield of California (Blue Shield), one of the largest medical insurance companies in the United States....more

Locke Lord LLP

Colorado Division of Insurance Holds Second Health Insurance Stakeholder Meeting for ‎Implementing AI Requirements

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On Tuesday, April 2, 2024, the Colorado Division of Insurance (“Division”) held its second Unfair Discrimination in Insurance Practices – Health Insurance Stakeholder meeting where the Division discussed efforts to develop...more

Foley Hoag LLP - Security, Privacy and the...

Transforming Care Strategies -- Integration of AI in Healthcare: Summary of Legal/Regulatory Issues

I was pleased to take part in the “Transforming Care – Strategies for Integration of Artificial Intelligence in Healthcare” discussion, hosted by the New England Healthcare Executive Network at Foley Hoag on April 1. The...more

Holland & Knight LLP

Holland & Knight Health Dose: March 5, 2024

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. ...more

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - March 2024

Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more

Whiteford

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

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Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more

Benesch

Dental/DSO Intelligence Monthly Report: February 2024

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Conceived and founded by 16 doctors, EPIC4 is a unique entity—a Specialty Partnership Organization where dental specialists can maximize potential at all stages of their life and practice. Forming EPIC4 was something of an...more

Faegre Drinker Biddle & Reath LLP

Artificial Intelligence Briefing: House Launches Bipartisan AI Task Force

The House of Representatives aims to keep the U.S. at the leading edge of AI policy and innovation with a bipartisan task force while the FTC considers expanding a rule to crack down on AI impersonation. Meanwhile, a recent...more

Manatt, Phelps & Phillips, LLP

CMS Weighs in on the Use of Algorithms and Artificial Intelligence in Coverage Determinations

Apparently in light of recent litigation against Medicare Advantage (MA) plans, on February 6, 2024, CMS published responses to frequently asked questions (FAQs) regarding the use of algorithms and artificial intelligence in...more

McDermott Will & Emery

CMS Releases Guidance on Coverage Criteria, Use of AI and More

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On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization management (UM) requirements....more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - February 2024 #1

News Briefs - Poll Finds Americans Cautiously Optimistic About AI in Healthcare Americans are cautiously optimistic that AI will be able to improve the healthcare they receive, a new Cleveland Clinic survey finds. About three...more

McDermott Will & Emery

Georgia Bills Target AI in Healthcare

Within the last year, many states have presented or passed bills regulating artificial intelligence (AI), and Georgia is no exception. Georgia has drafted two pieces of legislation focused on the intersection of...more

Hall Benefits Law

Lawsuit Claims UnitedHealthcare Uses AI to Deny Majority of Medicare Advantage Extended-Care Facility Claims

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As the healthcare industry has begun to use artificial intelligence (AI) algorithms in its claims determination process, litigation has ensued. In a recent class action lawsuit, plaintiffs claim that UnitedHealthcare used its...more

Benesch

2024 Outlook: Behavioral Health Trends

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Healthcare systems are facing significant challenges in recruiting and retaining talent within the burgeoning field of behavioral health services, primarily due to competition from telehealth providers and inconsistent...more

ArentFox Schiff

Health Insurers Sued Over Use of Artificial Intelligence to Deny Medical Claims

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With the surge of interest in artificial intelligence (AI), it should be no surprise that health insurers have come under scrutiny concerning their use of AI predictive tools to deny medical insurance claims. The question...more

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