Medicare Will Start Paying AI Companies a Share of Any Claims They Automatically Reject
Medicare Will Start Paying AI Companies a Share of Any Claims They Automatically Reject
It should be illegal for anyone but a doctor to deny a claim. This isn't even going to be AI, its just going to be a program that denies everything.
if(true) { return deny } else { return deny }
I’m so tired of living under capitalism. Can you all please get some fucking class consciousness so we can get out of this hellscape?
Well that's the worst headline I have read in a while
The fact that there's shares to be had for denying care is crazy. They know denying care is their business! Meaning that the money they didn't spend on your care doesn't go back into the pot for everyone in your group, they are pocketing some of the money whenever they deny someone. That's it. They don't help anyone but themselves. There should be a requirement that insurance companies publicly announce how much money they made from denying care
Literally and with no exaggeration, death panels. You know, the ones Republicans were yelling about a few years ago. Those exact fucking ones.
More than that: fully automated death panels.
Every accusation is a confession, right? That's how conservatives work. They're unimaginative people with poor empathy. They think about what they would do and assume that's what everyone else would do, too. They are trash. Failures. Disappointments.
These don't count because they're just software and the designers can feign complete innocence because of the black-box nature of AI decision-making.
There are reasons they want AI in charge of so many things. It's not because they think AI can do a better job.
And also, AI makes pictures of Trump riding tanks and fist-bumping Jesus so it has to be perfect and awesome, right?
Evangelical Christianity. They have always claimed that “absolute evil” exists. They have won the philosophical debate, by demonstrating the Platonic form of evil.
I guess "death panels" are fine if they are machines?
They're fine if they make money for the right billionaires.
Death panels always existed they just wanted them to be employees at a for-profit.
It's the lack of profit that scares them I guess.
As I get older and need the healthcare system more, I have had this realization that except for cosmetic surgery no one uses healthcare that they don’t need. Like, no one is out there trying to scam their insurance company out of a free colonoscopy. They get that procedure because they don’t want to die. Rejecting claims should be illegal. The goal of the healthcare system should be to treat people. Insurance is the wrong paradigm to manage healthcare because implicitly it’s built around rationing resources.
We don’t do this with food, and yet healthcare is a basic need. What do we do as a society to meet our food needs? We scale up. We plant megatons of crops. We build new technologies to be able to produce more. Why with healthcare do we not do the same? Med schools should accept more than 2% of applicants. The number of doctors in the US is kept artificially low. Also, let people interested in medicine attend abbreviated university programs. Skip the 4 year bachelors and get your med school degree directly in 5-6 years like they do in the UK. Redirect all the overhead and money spent on insurance to building hospitals and hiring doctors.
The goal of the healthcare system should be to treat people.
The goal of a good healthcare system is to treat people. The goal of ours is to treat the rich to another yacht. Healthcare providers bill far above cost for profit, knowing that either the insurance or the patient will have no choice but to eat the cost. Insurance providers use high healthcare costs to justify high policy prices and then do unethical shit to avoid paying out.
The hospitals make money. The insurance company makes money. The shareholders and corporate owners make money. The people needing healthcare get screwed.
The system is, unfortunately, working as intended for those who benefit from it being the way it is.
Med schools should accept more than 2% of applicants.
The problem is a lack of residencies, and there’s been lobbying to keep the number of residencies low, to keep doctor wages high.
Also true and indefensible.
Rejecting claims does have some legitimate purposes.
Invalid ID numbers, people aren’t actually a customer of the insurance company, unreadable data, and actual medical fraud to name a few.
Denials should trigger a government review that the insurance company must justify to a neutral 3rd party that has a medical degree
Cystic acne treatment is frequently covered by insurance and the same treatment is desirable to those that suffer from normal acne. Emotional support animals required doctors notes and were desirable for free admittance on planes. Ozempic as a weight loss drug. Topical steroid treatments for treating inflammation. Glasses to see better than 20/20.
There are all kinds of medical treatments (relatively) healthy people would want if they were affordable and knew they existed.
Perhaps so, but it should be up to a medical professional (doctor) whether or not those treatments are appropriate for the patient. Not for-profit companies run by sociopathic executives. (Although in this case we are talking about state-run Medicare using private companies’ AI to make the determination.)
You don’t need AI for that….
#!/usr/bin/env python3
def main():
try:
_ = input("Enter reasoning for claim: ") # read but ignore the input
print("denied") # always respond "denied"
except (EOFError, KeyboardInterrupt):
# Even if input is interrupted, still respond "denied"
print("denied")
if __name__ == "__main__":
main()
So bribe the private sector to deny all claims routed through them first for government healthcare and then claim 'gUbmEnT dEAtH pANEls!' are the problem.
So bribe the private sector to deny all claims routed through them first
The AI models getting paid most the most they deny is private sector grift built in here.
Well I'm sure it'll be all fair and definitely not
DENIED
DENIED
DENIED
DENIED
DENIED CHACHING
DENIED CHACHING
CHACHING
CHACHING
CHACHING
Oh no, that'll deffo not happen. No way!!!
This is just wealth transfer to keep another AI company afloat. Most of them live and die on investor cash, and never turn a profit.
Given the answers we know they want this should be a pretty profitable business.
print "denied"
Done, and my entire company infastructure is a raspberry pi.
Officials assert that the AI tools will only be used to judge claims for about a dozen different types of procedures it deems to be wasteful and providing little benefit, including steroid shots to relieve pain, per the NYT.
Yeah cause people on medicare aren't likely to need steroid shots for things like joint pain or anything. Anyone 65 and older should start saving their money now to pay for their steroid shots that are going to start costing them a couple hundred bucks a pop.
As someone who lives with constant pain, calling pain relief of any kind "wasteful" enrages me. See if pain relief has "little benefit" when im done with you, mufucka
If payments out of pocket were reasonable maybe we are charged like a hundred times what everybody elsein the world pays.
Investors like private equity have taken over Health Care and are extracting the life savings of baby boomers for medical care that used to cost a reasonable amount of money.
so no healthcare for anyone anymore? just insurance companies paying themselves now.
So basically the opposite of what Obama or Biden did as usual https://arstechnica.com/health/2024/11/biden-proposes-guardrails-on-health-care-ai-upping-weight-loss-drug-access/
This is the point. They want to erase any legacy either of them left. Trump is a petty little asshole who is still mad that Obama made fun of him once.
AI companies going to start generating fake claims and denying them for rewards, I guarantee it.
That's the best possible outcome.
The more likely outcome is a lot of people are going to die or suffer needlessly.
something something video game character from a nintendo game who's colors are from mixing blue+yellow... 😏
Luigi has allegedly already done his part. Mario needs to step up and help his bro out.
Need multiplayer.
In the radio business they call that "payola", and it is very much illegal.
Ah! Americans need to be willing to dig deep—really tough it out—to cut costs and save as much money as AI makes possible so that the government can give just 1 more penny to the billionaires. Won't someone please think of the billionaires?
Here's your head of Medicare.
Good Ol' Doctor Oz.
Big profile you should be able to track him down easy in the wee hours of the morning to ask some questions as any good citizen of someone representing their interests.
So they will approve more claims to avoid paying, right... Right?
Yes, I said, lying.
The machine won't let me get treatment for the thing that makes me narrate my actions, I explained with a weary sigh.
Your sex life must be documented. Especially if you have kinks!
I've wondered this for a while: Insurance is a contractual obligation on the insurer's part, right? What's stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
Probably some terms and conditions you signed as part of the contract
What's stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
The cost of a lawyer that can hope to match theirs. They don't care if it loses them money as long as it deters others from trying the same.
What’s stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
Medicaid is a government provision that has no contract that underpins it. With something like United Healthcare, there is a bargained for exchange of mutual consideration (you give $ and UHC provides insurance subject to all the terms and conditions in the contract).
That is not something in Medicaid because Medicaid isn't getting anything in exchange for its health coverage. The government can put whatever restrictions on it that it wants. The benefit comes from the government having one more contribution to the ecconomic system. However, that is too attenuated of a benefit to say that there was a bargained-for exchange.
This is definitely the wrong "motive structure" for administrative decisions from agency supposed to provide healthcare. Proof of grift as a goal.
By all means, use AI assistance to determine claims validity. But the AI service should be paid per query, or to licence whole model for unlimited use with medicare paying for the computers/gpus. Medicare should be choosing a model that is accurate instead of one that is paid to deny everything, because Homer Simpson's birdy automation can do that ultra cheap.
Taking claim validity away from the doctor that's actually in charge of the patient's care is already fucked. AI cost cutting doesn't belong in medicine full stop. It shouldn't be a for-profit "industry" in the first place. We're so fucked nobody can even think about this without insane, anti-human framing coloring everything
Private medical insurance is corrupt as starting point. A public health insurance/payer system can still be subject to ineligible or fraudulent claims. Every medical provider demand for money automatically accepted is not the perfect model either. Systems, AI or not, should avoid improper denials is a standard only possible in public health systems.
If it makes anyone feel better, they denied everything when it was humans running the show too
I know insurance adjusters, they are under strict rules but whenever they get a chance they do try to approve benefits if it comes to a matter of personal decision making. It's not that often, but it does happen in the loads and loads of cases that pass through every day.
Few people realize the scale of these operations.
An AI system can process all those claims in moments and not only follow guidelines to deny as many as possible, they will do it without feeling a twinge of conscience, and this seemingly small margin of extra denials will likely save the insurance company vast sums of wealth, and all it will cost us, the paying customers, is needless death and suffering.
What’s the fucking point of paying for it anymore? Might as well not even have it at this point…
I didn't know I still had any faith to lose in the insurance industry. At this point anyone in a management position is undeniably evil, in all senses of the word. I wish nothing but the worst for them.
what the fuck kind of country looks to save billions of dollars spent on healthcare for their own citizens instead of waste fraud & abuse by the uber wealthy, or the military?
you can have an insanely strong military without the waste & fraud that exists in the US
Because the military is for "protection" and the uber wealthy earned it (by some definition of earned)
ID every executive who works for the company. Nothing is gonna happen unless we know who they are.
I think someone else mentioned that doc oz is the head of medicare now.
That's a fucking idiotic idea.
No, it's fine and makes total sense if your goal is to incentivize your company's suppliers and affiliates to KILL PEOPLE.
Garbage humans in, garbage AI out
This is FUCKING enraging.
Gross
The term 'perverse incentive' springs to mind, except there'll be nothing unexpected about the consequences.
the incentives perfectly match the goal
So what's the point of having insurance if you can't claim what you need?
The point is fraud. They give you just enough to think they will cover you when you really need it. And by then, they've already extracted the optimum amount they were gonna get from you.
What I time to be alive
The only way to actually get decent coverage is to get it though an employer.
Wasnt incentivising robots to kill humans supoosed to be prevented by those Azimov laws?
Fucking bots, they started disallowing us from browsing the web. Sure they'll be more careful with our lives.
Evil.
Has anyone checked out the fact sheet from CMS: https://www.cms.gov/files/document/wiser-fact-sheet.pdf ?
We really need to move to a single payer system when Trump kicks the covfefe bucket.
Will it then be fined when it gets it wrong after manual review? Will the person be compensated too?
Of course what they forget is other AI companies will game it on the other end to add new codes to claim that won't be denied.
Well i guess we need digital Luigi that can DDOS or prompt injecting the hell out of them.