Conaway and Murphy Introduce Bill to Protect Patients from AI-Assisted Insurance Denials

Washington D.C. - Today, Congressman Herb Conaway Jr., MD and Congressman Gregory Murphy, MD introduced the Protecting Patients from Automated Denials Act. This bipartisan bill would establish safeguards on the use of artificial intelligence in Medicare Advantage prior authorization decisions.

Under the bill, any AI-assisted denial must be reviewed and approved by a qualified physician under the supervision of the plan's medical director. It also requires physicians to attest that they exercised independent medical judgement and that the denial was not generated or dictated by AI. Additionally, the bill grants the Department of Health and Human Services the authority to audit and inspect AI use in prior authorization decisions, including reviewing denial data, internal policies, algorithms, employee practices, and overturn rates.

"Artificial intelligence is dramatically changing the technology and healthcare industries, but we need to ensure that patients aren't being left behind," said Congressman Conaway, MD. "This legislation establishes necessary physician oversight and will increase transparency with the federal audit requirements to make sure patient claims aren't being wrongfully denied."

"Artificial intelligence (AI) is revolutionizing healthcare at the speed of light, but we must protect the physician-in-the-loop," said Congressman Greg Murphy, MD. "While advancements in diagnostics, research, and administrative work will advance medicine in incredible ways, the value of a trained physician and sentient influence cannot be eroded. This is especially important for prior authorization decisions - patients are not merely numbers on a spreadsheet. We cannot allow greedy health insurers to utilize AI to deny healthcare to those in need. I am proud to lead on this issue by establishing sensible guardrails that ensure the proliferation of AI in the field of medicine does no harm."

"Artificial intelligence is no substitute for a highly trained physician. Medicare Advantage plans should not be permitted to empower AI to make prior authorization decisions, especially denials of medically necessary treatment. We strongly support the provision requiring that physicians oversee any initial prior authorization denial that stems from the use of artificial intelligence. Our patients are being denied care by AI that doesn't know them, their circumstances, or the nuances of their treatment - and doesn't care! We applaud Reps. Herb Conaway, MD (D-NJ) and Greg Murphy, MD (R-NC) for introducing the Protecting Patients From Automated Denials Act, and our patients will be grateful and healthier when it becomes law." AMA President Willie Underwood III, MD, MSc, MPH

For a copy of the Protecting Patients from Automated Denials Act, click here.