Artificial intelligence (AI) has proliferated the health care sector, sparking litigation and increased regulatory activity. This article analyzes the impact of AI in health care and regulatory agencies’ efforts to keep up—all against the backdrop of a potentially weakened (or even gutted) Chevron deference framework. Health care entities, particularly in the Medicare Advantage space, may need to calibrate their business technologies and compliance structures to adapt to this evolving legal landscape.
Pending Litigation Against Medicare Advantage Plans: Uncharted Territory?
In late 2023, two class action complaints (the complaints) were filed against two large Medicare Advantage organizations, Humana Inc. and UnitedHealthcare Inc. (together, MAOs) in federal court. The complaints’ core allegations and theories of recovery are largely the same, centering on the MAOs using AI to make allegedly improper coverage determinations for Medicare Advantage (MA) enrollees.
