California is leading the way in ensuring that determinations of medically necessary health care services are made by licensed physicians and not artificial intelligence (AI) algorithms....more
1/31/2025
/ Artificial Intelligence ,
California ,
Class Action ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
New Legislation ,
Physicians ,
Regulatory Agenda
Now is the time for health care providers to consider participating in the recent Blue Cross Blue Shield (BCBS) antitrust class action settlement and the newly filed antitrust cases alleging widespread price fixing for...more
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
12/22/2023
/ Algorithms ,
Artificial Intelligence ,
Automated Decision Systems (ADS) ,
Beneficiaries ,
Breach of Duty ,
CIGNA ,
Class Action ,
Health Care Providers ,
Health Insurance ,
Insurance Claims ,
Patients ,
United Healthcare Insurance Co.
In the year following the implementation of the arbitration process established under the federal No Surprises Act (NSA), more than 330,000 disputes have been submitted for resolution. This figure far outpaces the predictions...more
Below are six reimbursement issues that health care providers should be on “high alert” for as the COVID-19 crisis persists.
An increasing number of patients will be losing their health insurance coverage....more
On February 5, 2020, the Centers for Medicare and Medicaid Services (CMS) proposed removing long-standing prohibitions and eligibility restrictions that had barred many individuals with End-Stage Renal Disease (ESRD) from...more
2/11/2020
/ 21st Century Cures Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Eligibility ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Medicare ,
Medicare Advantage ,
Proposed Rules ,
Public Comment