A recent lawsuit in the Southern District of New York has alleged that the health insurance company Anthem Blue and Cross Blue Shield violated state laws and committed fraud by maintaining “ghost networks” of mental health providers. Ghost networks are directories for insurance companies that contain outdated or inaccurate information about providers covered by the insurance plan. The lawsuit alleges that only seven of the first 100 providers on the Anthem directory for the state of the New York were contactable, in network, or accepting patients. This aligns with findings by the New York Attorney General that 86% of mental health care providers listed on New York health plans’ networks were ghosts. Getting stuck in a ghost network, unable to find a covered provider, can stymie a patient’s efforts to find mental healthcare, producing dire consequences.
Category: Rebekah Ninan
Health Care, AI, and the Law: An Emerging Regulatory Landscape in California
This past month, California Governor Gavin Newsom signed a wave of artificial intelligence-related legislation into law. Much public debate has been focused on SB 1047, a proposal ultimately vetoed by Governor Newsom, which would have held AI companies liable for “catastrophic harms” from AI models. Comparatively little attention has been paid to three new laws aimed at health care-related AI and data privacy. Three laws are AB-3030, SB-1223, and SB-1120. AB 3030 requires that health care providers disclose when they have used generative AI to create communications with patients. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit. Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. This article seeks to summarize these developments in the law.