Artificial Intelligence holds the potential to generate critical insights and drive efficiencies across the healthcare system. As AI tools and related technologies become increasingly sophisticated, the MCOs and downstream entities that use them will need to develop a deep understanding of how to harness the power and the promise of these inventions—as well as the risks.

Litigation is already starting to bubble up, making it important to examine the current regulatory environment, and exposure created by AI use.

• Monitoring how regulatory frameworks for the use of AI in healthcare are developing and the potential requirements and implications for payors
• Identifying risks stemming from payors using AI and algorithms and resulting litigation to date
  • Analyzing claims of AI or AI assisted technology being used to ‘wrongfully’ deny coverage of health services
  • Assessing plaintiff claims of fraud and bad faith against insurers using AI
  • Addressing risks related to bias in AI models
  • Cyber security and privacy considerations
• Conducting due diligence when selecting AI vendors
  • How plans should vet companies that use AI models to perform critical tasks like prior authorization
• Exploring the potential for AI to be used in formulating legal arguments and predicting case outcomes