Author Archives
-
Proposed 2026 MA Rule: Changes to Internal Coverage Criteria and Prior Authorization Requirements
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would significantly enhance regulations around how Medicare Advantage (MA) organizations use internal coverage criteria, particularly relating to prior authorization and utilization management. The proposed changes, part… Read More ›
-
California Law Requires Disclosure of AI Use in Healthcare Communications
New legislation in California regulates communications by health care providers who use artificial intelligence in communications with patients. Specifically, an addition to the state’s Health and Safety Code entitled “Artificial Intelligence in Health Care Services” requires a disclaimer that… Read More ›
-
Senate Investigation Reveals How Medicare Advantage Plans Use Artificial Intelligence to Deny Post-Acute Care
Medicare Advantage insurers are using prior authorization requirements to systematically deny seniors access to post-acute care facilities, according to a recent U.S. Senate investigative report. Dated October 17, 2024, the Majority staff report of the Senate Permanent Subcommittee on Investigations… Read More ›
-
HHS Information Security Program Rated ‘Not Effective’ for FY 2024
The Department of Health and Human Services’ (HHS) information security program failed to meet federal effectiveness standards according to a November 14, 2024, audit report, signaling important cybersecurity lessons for healthcare entities and digital health companies. Specifically, the report stated… Read More ›
-
Fate of Cigna PXDX Lawsuit Hangs in Balance as Court Weighs Motion to Dismiss
Earlier this year on September 20, 2024, Plaintiffs filed their Opposition papers to Cigna Corporation’s and Cigna Health and Life Insurance Company’s (collectively, “Cigna”) motion to dismiss their lawsuit challenging Cigna’s use of an AI algorithm to allegedly automatically deny… Read More ›
-
Proposed 2026 MA Rule: Changes to Prior Authorization Rules to Advance Health Equity
CMS is proposing revisions to the required metrics for the annual health equity analysis of the use of prior authorization. Under the proposed changes, MA organizations would have to report the metrics for the analysis by each item or service,… Read More ›
-
CMS Proposes New Rules for AI Use in Medicare Advantage Plans
New regulations requiring Medicare Advantage (MA) organizations to ensure non-discriminatory use of artificial intelligence and automated systems have been proposed by the Centers for Medicare & Medicaid Services (CMS). These AI provisions are part of a broader proposed rule titled… Read More ›
-
UnitedHealth Group Reinforces Dismissal Arguments in Medicare AI Case Reply Brief
On July 15, 2024, UnitedHealth Group (“UHG”) and its co-defendants filed a reply brief supporting their motion to dismiss a class action lawsuit alleging improper use of artificial intelligence to deny Medicare Advantage claims. Filed in the United States District… Read More ›
-
HHS Takes Next Step in Promoting Health Data Exchange with HTI-2
On August 5, 2024, the U.S. Department of Health and Human Services (HHS) published the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule to enhance healthcare data interoperability. According to the agency,… Read More ›
-
HHS Reshapes IT Leadership: Major Reorganization Emphasizes AI, Data, and Cybersecurity
On July 25, 2024, the U.S. Department of Health and Human Services (HHS) announced a reorganization that emphasizes artificial intelligence, cybersecurity, data, and technology. Specifically, this involves moving technology and data policy and strategy functions from the Office of the Assistant Secretary… Read More ›