The nonprofit health plan, which serves nearly 6 million members across California, published a data breach notification on its website stating that member data was exposed between April 2021 and January 2024.
Several states are taking measures to protect patients from what some say is a dangerous trend to use AI algorithms only to review and deny medical claims for critical healthcare and clinical laboratory testing.
AI companies are producing tools to help automate the revenue cycle, one of the most expensive and complicated departments of a hospital. These tools have demonstrated promise in collections, but many healthcare leaders remain skeptical that these tools can mend their troubled relationships with insurance companies.
Understaffing in the healthcare industry has been widely studied, and technology stands out as a good solution for certain workflows. Emerging tools seamlessly integrate into the workflows that make up this human-centered environment. These tools provide data that enhance efficiency and allow staff to focus more on patient care, including monitoring high-risk situations to keep them from escalating.
Semler Scientific has offered to pay the Department of Justice nearly $30 million to settle federal healthcare fraud claims related to its peripheral artery disease test, QuantaFlo — a product used by UnitedHealth Group and other large insurers.