News & Analysis as of

Health Insurance Artificial Intelligence Insurance Industry

Cooley LLP

Will AI Be Your New Doctor? Probably Not, Thanks to Recent Trends in State Regulation

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As the use of artificial intelligence (AI) becomes increasingly commonplace, some have raised concerns about its use in medicine, particularly when AI assumes a role that is traditionally held by a physician or other licensed...more

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

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

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

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

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

Fennemore on

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

ArentFox Schiff

California Claps Back on Insurer Use of AI to Deny Needed Medical Care Decisions

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California is leading the way in ensuring that determinations of medically necessary health care services are made by licensed physicians and not artificial intelligence (AI) algorithms....more

WilmerHale

California AG Issues AI Advisories

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On January 13, 2025, the California AG’s Office (“AGO”) issued two legal advisories regarding the application of existing California law to AI generally as well as the use of AI specifically in healthcare....more

Mitchell, Williams, Selig, Gates & Woodyard,...

National Association of Insurance Commissioners (NAIC) Fall 2024 Meeting Summary

The Mitchell Williams Insurance Regulatory team of attorneys recently attended the National Association of Insurance Commissioners (NAIC) Fall 2024 National Meeting which was held in Denver, Colorado. We have prepared a...more

DLA Piper

California Implements New AI and Software Regulations for Insurers

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On September 28, 2024, California enacted SB 1120, which regulates the use of artificial intelligence (AI), an algorithm, or “other software tool” in utilization review and utilization management (UR/UM) functions by...more

Goodwin

Reliance on Third-Party “Pricing” Facilitators Under Increasing Antitrust Scrutiny

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In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more

Eversheds Sutherland (US) LLP

AI Litigation Insights - Jeremy Jong, individually and on behalf of similarly situated individuals v. Blue Shield of California

Plaintiff Jeremy Jong filed a putative class-action complaint against Blue Shield of California (Blue Shield), one of the largest medical insurance companies in the United States....more

Troutman Pepper Locke

Colorado Division of Insurance Holds Second Health Insurance Stakeholder Meeting for ‎Implementing AI Requirements

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On Tuesday, April 2, 2024, the Colorado Division of Insurance (“Division”) held its second Unfair Discrimination in Insurance Practices – Health Insurance Stakeholder meeting where the Division discussed efforts to develop...more

Hall Benefits Law

Lawsuit Claims UnitedHealthcare Uses AI to Deny Majority of Medicare Advantage Extended-Care Facility Claims

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As the healthcare industry has begun to use artificial intelligence (AI) algorithms in its claims determination process, litigation has ensued. In a recent class action lawsuit, plaintiffs claim that UnitedHealthcare used its...more

Mitchell, Williams, Selig, Gates & Woodyard,...

National Association of Insurance Commissioners (NAIC) 2022 Summer Meeting Summary

The Mitchell Williams Insurance Regulatory team of lawyers recently attended the National Association of Insurance Commissioners (NAIC) 2022 Summer National Meeting which was held in Portland, Oregon on August 9-13th. We have...more

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