Artificial intelligence (AI) has proliferated the health care sector, sparking litigation and increased regulatory activity. The impact of AI in health care has catapulted regulatory agencies' efforts to keep up. 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 were filed against two large Medicare Advantage organizations, Humana Inc. and UnitedHealthcare Inc. in federal court. The complaints' core allegations and theories of recovery are largely the same, centering on the insurers using AI to make allegedly improper coverage determinations for Medicare Advantage enrollees.