Bipartisan lawmakers call for increased AI oversight in Medicare Advantage coverage decisions

A bipartisan group of 51 lawmakers in both the House and Senate is calling for increased oversight of artificial intelligence (AI) in Medicare Advantage (MA) coverage decisions.

In the letter addressed to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS), the group of lawmakers said that they are “concerned about MA plans’ use of prior authorization, specifically their ongoing use of artificial intelligence (AI) and algorithmic software to guide coverage decisions.”

“Plans continue to use AI tools to erroneously deny care and contradict provider assessment findings,” reads the letter, signed by several lawmakers including Rep. Judy Chu (D-Calif.), Rep. Jerry Nadler (D-N.Y.), Sen. Elizabeth Warren (D-Mass.) and Sen. Mike Braun (R-Ind.).

The lawmakers push for CMS to take action including creating “an approval process to review AI and algorithmic tools and their inputs to ensure the integrity of their use, and conduct a review of algorithm and AI tools currently being used."

“We believe CMS must be more proactive in monitoring plans’ use of AI and algorithm-driven tools,” the letter reads. “MA plans cannot be allowed to side-step oversight by claiming that these tools are mere ‘guidance.’ Given that we do not know what inputs are used for the algorithms and AI tools currently being used, it is difficult to know the accuracy of the information they generate and whether the inputs comply with the regulations.”

“Absent a prohibition on the use of such tools altogether, CMS should limit their use until a systematic evaluation can be conducted on how these tools are impacting care,” the letter continues.

The Hill has reached out to CMS.