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February 16, 2024
CMS puts private Medicare insurers on notice about their use of algorithms to deny care. In a memo issued last week, the Centers for Medicare and Medicaid Services (CMS) clarified that private insurance companies that administer Medicare Advantage, recently subject to multiple lawsuits for automatic denials of coverage, should only use algorithms to ensure alignment with coverage criteria and must base decisions on individual circumstances. The memo further specifies that insurers must make their coverage criteria publicly available online and that they can’t use automated systems to shift or add criteria.