Lawmaker calls for pause of pilot program adding prior authorization for traditional Medicare services
A member of Congress from Ohio is calling for a pilot program that would add prior authorization for some traditional fee-for-service Medicare services to be halted until an independent review board is established, Politico reported Sept. 4.
Six states have been selected to test the Wasteful and Inappropriate Service Reduction model, which begins in January. Under the model, CMS will partner with companies specializing in AI and machine learning to test ways to provide an improved and expedited prior authorization process for certain Medicare services. Companies hired to manage the initiative will be paid based on how much money they save the federal government by stopping payment for unnecessary or noncovered services.
Rep. Greg Landsman, D-Ohio, represents one of the states selected to test the program. He said the program has been referred to as the “AI death panel,” according to the report.
“You get more money if you’re that AI tech company if you deny more claims,” he said during a Sept. 4 hearing on AI use in healthcare. “That is going to lead to people getting hurt.”
Mr. Landsman is calling for an independent review board to be established to review liability questions and ensure that the AI prior authorization pilot doesn’t harm patients, according to the report.
Rep. Frank Pallone, D-N.J., who represents another state chosen for the pilot, said he is concerned that the AI model will “result in denials of lifesaving care and incentivize companies to restrict care,” according to the report.
Under the model, certain services that have been “vulnerable” to fraud, waste and abuse will require prior authorization, according to the report. Those include skin and tissue substitutions, electrical nerve stimulator implants and knee arthroscopy for osteoarthritis. Arizona, Oklahoma, Texas and Washington are the other states chosen for the pilot.
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