CMS Medicare Advantage AI Rule — AI in Prior Authorization (Proposed Apr 2025)
The CMS proposed rule would restrict Medicare Advantage insurers from using AI or algorithmic tools as the primary basis for denying prior authorization for medical services. Requires human clinical review of AI-generated coverage denials. Proposed in April 2025 as part of CMS's response to documented algorithmic denials.
Related Incidents
Same harm domain, actors and location may differ
Orlando man wrongfully arrested after facial recognition misidentification by Orlando police
50-year-old woman wrongfully arrested after facial recognition misidentification in Tennessee leading to six-month custody without compensation
26-year-old South Asian software engineer wrongfully arrested after facial recognition misidentification in Milton Keynes theft case
Innocent South Asian man wrongfully arrested after AI facial recognition misidentification in Milton Keynes, leading to legal action and criticism of racial bias
Adult patron wrongfully arrested after facial recognition misidentification at Peppermill Casino
Related Legislation
Other policies covering the same harm domain