Senate committee grapples with AI challenges in health care, focusing on bias, care denials

Artificial intelligence has far-reaching implications for health care, and Congress is trying to make sure regulations are keeping pace with the rapid changes. Last week, the U.S. Senate Finance Committee addressed how to prevent algorithmic bias and unfair care denials by health plans.

“It is very clear that not enough is being done to protect patients from bias in AI,” Sen. Ron Wyden, D-Ore., said. “Congress now has an obligation to ensure the good outcomes from AI set the rules of the road for new innovations in American health care.”

Despite the potential for AI to improve efficiency, alleviate burnout among stressed providers and lower costs, he said, it also could replicate racial, gender or disability bias and potentially worsen existing health-care disparities.

Ziad Obermeyer, an associate professor at the University of California, agreed. His research on a family of algorithms meant to flag patients who are at higher risk of future health problems found significant racial biases. The algorithms use cost data to predict future care needs, but underserved patients contributed to less spending because of access issues or discrimination. As a result. black patients were less likely to be identified for extra care.

“The AI saw that fact clearly, it predicted the cost accurately,” he said. “But instead of undoing that inequality, it reinforced it and enshrined it in policy.”

Other witnesses discussed a number of ways to keep an eye on AI’s use in the health-care sector. They include creating groups of experts to hash out standards and enforce them through federal agencies such as Medicare, or regulating the tools in the same way that the Food and Drug Administration evaluates medicines. Courts might be able to play a role, but they also may struggle to understand complex AI when cases come before them. Health-care professional organizations also could help evaluate AI products,

Senators also raised concerns about insurers using predictive algorithms to inform coverage decisions, particularly in the Medicare Advantage program. Some payers, such as Humana, UnitedHealth and Cigna, have faced lawsuits alleging they use algorithms to improperly deny claims.

Related: Humana is 2nd insurer to face lawsuit for AI-based denials of Medicare Advantage claims

“Until CMS can verify that AI algorithms reliably adhere to Medicare coverage standards by law, then my view on this is CMS should prohibit insurance companies from using them in their MA plans for coverage decisions,” said Sen. Elizabeth Warren, D-Mass. “They’ve got to prove they work before they put them in place.”