Medicare is using AI to approve claims. The result has been ‘alarmingly high denial rates.’
A Medicare pilot program that used artificial intelligence to approve care for beneficiaries has produced high denial rates and delayed decisions, according to a lawsuit seeking documents about the effort. The suit also says a vendor involved in the pilot warned that the program was not ready for deployment.
Why It Matters
The program directly affects how quickly and reliably Medicare beneficiaries receive authorization for care; allegations of widespread denials, delays, and vendor warnings raise concerns about the safety and oversight of automating claim approvals. The lawsuit seeks information that could clarify how the system was tested and implemented.
Key Facts
- Program type: Medicare pilot using artificial intelligence to approve care
- Allegations: High levels of denials and delayed decisions
- Vendor concern: Vendor warned the program lacked readiness
- Legal action: Lawsuit filed seeking information about the program
A pilot program run by Medicare that relied on artificial intelligence to approve beneficiaries’ care has come under scrutiny after a lawsuit alleged the system produced unusually high denial rates and caused delays in decisions. The complaint seeks documents and other information about how the AI-driven approval process was designed and operated.
According to the lawsuit, the AI pilot not only generated elevated levels of denials but also led to slower determinations on coverage. Those outcomes prompted a vendor involved in the project to warn that the system was not prepared for use, the filing says.
The suit requests disclosure of records about the program’s development, testing, and deployment so that policymakers, providers, and beneficiaries can better understand how the AI tool was implemented and why it yielded the reported problems. The filing frames the alleged denials, delays, and vendor warning as central reasons for seeking the information.
Medicare’s use of automated systems to approve care is now the subject of legal scrutiny focused on whether the pilot was sufficiently vetted before use and whether oversight was adequate to protect beneficiaries from erroneous denials or slowed access to care.
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