AdventHealth Sues BCBC of Kansas City Over AI-Driven Claims Denial

AdventHealth Shawnee Mission has filed a lawsuit against Blue Cross and Blue Shield of Kansas City for allegedly withholding over $2 million in payments by rejecting hundreds of medically valid diagnoses made by its physicians. The insurer's audits, conducted by the AI firm Apixio, are claimed to target inpatient claims with comorbidities to reduce payment liabilities. This legal action underscores potential challenges in the integration of AI in healthcare, particularly regarding the qualifications of audit personnel and the implications for reimbursement processes. If successful, the lawsuit could set a precedent for how insurers utilize AI in diagnosing claims and affect healthcare practices across the industry.

Opens on Kansas City Star