Tag: Humana

AI cannot be used to deny health care coverage, feds clarify to insurers

CMS decreed that health insurance companies can’t use AI tools to determine Medical Advantage coverage decisions for Medicare Advantage plans. nH Predict, an AI solution developed by NaviHealth and embraced by the likes of UnitedHealth and Humana, is accused of generating doomsday predictions about post-acute care that don’t quite align with medical reality. The CMS […]

Humana also using AI tool with 90% error rate to deny care, lawsuit claims

Humana, a major health insurance provider, is facing a lawsuit for allegedly utilizing an AI model with a 90 percent error rate to deny care to elderly people under their Medicare Advantage plans. The lawsuit claims that the use of this AI model constitutes a fraudulent scheme that results in financial gain for the company […]

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