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Artificial Intelligence Health Insurance

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Phelps Dunbar

Medicare’s New AI Payment Review Model: What Providers Need to Know

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CMS announced the rollout of the WISeR (Wasteful and Inappropriate Service Reduction) model in June. It aims to use technologies like artificial intelligence (AI) to “ensure timely and appropriate Medicare payment for select...more

Epstein Becker & Green

The First National Health Care Fraud Takedown of the Second Trump Administration: What Stayed the Same and What is New?

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On June 30, 2025, the U.S. Department of Justice (“DOJ”), together with the U.S. Department of Health and Human Services Office of Inspector General (“HHS OIG”) and other law enforcement partners, announced the results of the...more

Katten Muchin Rosenman LLP

CMS Unveils New Prior Authorization “WISeR Model” for Electrical Nerve Stimulators, Skin and Tissue Substitutes and Knee...

CMS recently announced a new model it will be using to pilot the use of artificial intelligence and machine learning in reviewing prior authorizations submitted for certain services CMS has identified as being at greater risk...more

Holland & Knight LLP

Upcoming Utilization Review Restrictions in Light of Emerging Artificial Intelligence

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With the rapid development of artificial intelligence (AI), state legislatures have been attempting to keep up with the technological advancing surge. Most recently, Texas enacted Senate Bill (SB) 815, a law imposing greater...more

Arnall Golden Gregory LLP

Locked Out: How a Federal Moratorium on AI Regulation Could Reshape Healthcare Oversight

On May 22, 2025, the U.S. House of Representatives passed the “One Big Beautiful Bill Act” (H.R. 1) by a vote of 215-214, which includes a significant provision imposing a 10-year moratorium on state and local regulation of...more

Hogan Lovells

AI Summit panelists offer tips for obtaining reimbursement for innovative health care technology

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Hogan Lovells and the AI Health Care Coalition recently hosted their fourth annual AI Health Law & Policy Summit, where thought leaders and policymakers gathered to discuss a variety of topics including reimbursement issues...more

Offit Kurman

CareYaya: A Revolutionary Approach to Elder Care

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In this episode of the Sandwich Generation Survival Guide, host Candace Dellacona is joined by Neal Shah and Sydney Rosbury from CareYaya, an innovative platform transforming the elder care industry. Neal shares his journey...more

Health Care Compliance Association (HCCA)

Top Healthcare Compliance Priorities for 2025

Recently Protiviti released an intriguing report: Top Compliance Priorities for U.S. Healthcare Organizations in 2025. In this podcast their Global Healthcare Compliance Leader, Leyla Erkan, CHC, CHP, CHRC, shares some of the...more

Morgan Lewis

(AI)n’t Done Yet: States Continue to Craft Rules to Manage AI Tools in Healthcare

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As the regulation of artificial intelligence (AI) tools in healthcare settings rapidly evolves, state medical boards and related agencies are at the forefront of development and enforcement. While some states have taken...more

Hogan Lovells

AI Health Law & Policy: Remote patient monitoring reimbursement & coding concerns

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Remote patient monitoring (RPM) (oftentimes incorporating artificial intelligence (AI) to analyze data) uses technology to track a patient's physiologic data, such as vital signs, medication adherence, and activity levels,...more

The Volkov Law Group

DOJ Adopts Aggressive Stance Against Algorithmic Coordination in Multiplan Antitrust Filing

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Recently, the Antitrust Division of the United States Department of Justice submitted a Statement of Interest in In re: Multiplan Health Insurance Provider Litigation, a class action presently pending before the United States...more

Ropes & Gray LLP

Key Trends in Dual-Eligible Health Insurance: Takeaways from the Medicarians Conference

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Attorneys from Ropes & Gray attended the Medicarians Conference from March 31 to April 2, a premier event for Medicare Advantage (MA) and other health insurance brokers, agents, and distribution arms, as well as regional and...more

Maynard Nexsen

NAIC Spring Meeting Update Part Two

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As discussed in last week’s article, along with almost 3,000 regulators and insurance industry leaders, the Maynard Nexsen Insurance Regulatory team of attorneys attended the National Association of Insurance Commissioners...more

Mayer Brown

US NAIC Spring 2025 National Meeting Highlights: Innovation, Cybersecurity, and Technology (H) Committee

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On March 26, 2025, the Innovation, Cybersecurity, and Technology (H) Committee (“H Committee”) met at the Spring 2025 US National Meeting of the National Association of Insurance Commissioners (“NAIC”). The meeting covered...more

Maynard Nexsen

Key Health Care Issues to Track in 2025 in the Carolinas

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Following a year of significant regulatory changes and market realignments, the health care landscape in North and South Carolina continues to undergo significant transformation driven by federal policy shifts, state...more

American Conference Institute (ACI)

[Event] 16th Annual Advanced Forum on Managed Care Disputes and Litigation - May 1st - 2nd, Chicago, IL

Join the industry’s top litigators and leading plan counsel at ACI’s 16th Annual Advanced Forum on Managed Care Disputes and Litigation, for two days of discussions designed to address emerging areas of concern for MCOs in...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - March 2025 #1

News Briefs - Trump Signs Executive Order to Improve Health Price Transparency - U.S. President Donald Trump signed an executive order aiming to improve price transparency on healthcare costs by directing federal agencies to...more

Arnall Golden Gregory LLP

UnitedHealthcare Must Face State Law Claims in Class Action Suit for AI Driven Coverage Denials of Medicare Advantage Claims

Daytime television inundates American seniors with advertisements for UnitedHealthcare’s (“UHC”) Medicare Advantage Plans. On its website, UHC claims its Medicare Advantage Plans “stand out from the rest,” providing...more

Holland & Knight LLP

Holland & Knight Health Dose: February 19, 2025

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector....more

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

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ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Nelson Mullins Riley & Scarborough LLP

Gold Dome Report - Legislative Day 11 - February 2025

Many of the skirmishes fought under the Gold Dome each year are turf wars, sometimes literally. A perennial favorite is the dispute over Georgia’s northern border, which Representative Martin Momtahan (R-Dallas) is seeking to...more

Sheppard Mullin Richter & Hampton LLP

Healthcare Industry Leaders Predict Four Areas to Watch After the U.S. Election: Takeaways from the Business of Health Care...

The recent U.S. election has had profound implications for the healthcare industry, prompting industry leaders to reexamine their strategies and day-to-day operations. At the Miami Herbert Business School’s annual “The...more

Maynard Nexsen

The Legal Landscape for AI-Enabled Decisions for Health Care Claims and Coverage Continues to Evolve:  From Litigation to Emerging...

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With all the hype around AI, business partners and legal professionals are scrambling to understand, adapt, and possibly implement the rapidly changing technology. From a business perspective, the excitement around AI with...more

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

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In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more

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