Medicare's new AI experiment sparks alarm among doctors, lawmakers

[Silent Type]

18. Medicare has used private contractors to review claims since at least 1980. The pilot program is limited to 6 states

and was originally mentioned during Biden's admin, though not formally adopted.

It's also limited to procedures with a high probability of overutilization and failure to meet Medicare's guidelines like-- Was conservative therapy tried first, etc.

They've been doing that for decades, but after payment in most cases. That's why you see fraud cases that go on for years before Medicare realizes it's someone offshore who never even provided the service or some doc who makes big money off questionabe wound tissue.

Within 6 months of the pilot, I bet some procedures are removed from prior approval list and they'll find ways to indicate coverage guidelines have been met, perhaps with certain modifiers to indicate conservative therapy and other coverage guidelines.

If you don't think providers -- including doctors -- don't cheat, you haven't been paying attention.