CMA’s David Lipschutz was quoted in a Rolling Stone article by Andrew Perez titled, “Republicans’ Health Care Plan: Dr. AI Will See You Now.”
“The track record of using AI or algorithms in Medicare Advantage prior authorization and coverage decisions does not inspire confidence that such technology is ready to apply to assessing the propriety of payments in other parts of Medicare,” says David Lipschutz, a co-director at the Center for Medicare Advocacy.
“A good deal of improper payment in Medicare is due to incomplete paperwork,” he says, referencing a KFF report that notes the most common reason for improper payments is insufficient or lack of documentation from providers. “What would be the opportunities or mechanisms to correct erroneous decisions from AI? Would beneficiaries be held harmless if an AI tool determines that services they already received were improper? Oftentimes, whether a given item or service is proper or medically necessary is a nuanced analysis that can include clinical judgment and application of complex coverage criteria, and should be an individualized assessment for a specific individual. It would be dangerous to leave this important analysis to an algorithm.”
- Read the full article here.