Lance's Corner

OCR Issues Guidance on AI in Health Care

Jan 11, 2025

Per the notice below, the United States Office for Civil Rights (OCR) has issued guidance on the use of artificial intelligence (AI) in health care.  The guidance can be read here: OCR Artificial Intelligence Guidance.

Ensuring Nondiscrimination in the Use of AI is Good Medicine

Artificial intelligence (AI) has the potential to revolutionize health care - bringing efficiency, innovation, and cost savings to one of the nation’s most critical sectors that impacts every person.  By automating routine tasks, enhancing diagnostic accuracy, and streamlining patient care, AI can alleviate the burden on health care providers while improving patient outcomes.  A practical, market-driven approach to AI in health care — one that protects against discrimination and safeguards patient privacy — aligns with values of fairness, accountability, and responsible innovation.  To support fairness, accountability, and responsible innovation, the HHS Office for Civil Rights’ (OCR) Section 1557 of the Affordable Care Act (Section 1557) final rule prohibits health care providers, health plans, and other covered entities from discriminating against individuals through their use of patient care decision support tools, including AI.  This is consistent with HHS’s Strategic Plan for the Use of Artificial Intelligence to Enhance and Protect the Health and Well-Being of Americans.  That’s why OCR issued a “Dear Colleague” letter - PDF explaining how covered entities, including health care practitioners and insurers, can safely introduce and use AI tools into their operations.1  The letter reminds covered entities of their ongoing duty make reasonable efforts to identify uses of AI tools that create discrimination risks by relying upon input variables that measure race, color, national origin, sex, age, and disability, and of their ongoing duty to make reasonable efforts to mitigate those discriminatory risks.2

Ensuring that organizations operate AI tools without unlawful discrimination is not just an ethical imperative — it’s a pragmatic approach.  Discrimination in AI-driven health care tools — whether intentional or unintentional — can lead to uneven care, diminished trust, and financial risks, such as lawsuits or regulatory interventions.  Addressing these issues head-on by designing systems that work equitably across diverse populations enhances public confidence and expands market potential.  By ensuring AI solutions reach and serve every person equitably, companies and healthcare providers can tap into broader demographics and to broaden their client services while reflecting core ideals of equal opportunity and personal responsibility.  Privacy and security are equally vital.  Protecting sensitive health data is paramount when it comes to AI in health care.  Patients need to trust that their information is secure, and health care entities that demonstrate a commitment to privacy and compliance with laws such as the Health Insurance Portability and Accountability Act (HIPAA) will thrive.  Robust data safeguards protect patients and reduce the risk of damaging and costly data breaches – a significant matter for health information privacy for patients, a costly mitigation endeavor for health care entities, and a major cybersecurity threat to patient care.  Implementing standards to ensure fairness and protect privacy is a common-sense approach that encourages health care entities to modernize responsibly.  Transparency in how AI systems are developed and deployed in the clinical setting can drive patient confidence without stifling innovation.  This approach supports health care innovation where ethically developed AI tools rise to the top, benefitting patients and providers.

Section 1557’s nondiscrimination requirements through the use of patient care decision support tools, including AI, strikes the right balance — one that supports innovation, promotes free enterprise, and respects individual rights.  Ensuring AI in health care is fair, privacy-conscious, and secure achieves all these goals.  By championing responsible AI practices, leaders can advance a vision of healthcare that is both cutting-edge and aligned with American values, creating a system where AI businesses and the health care industry flourishes and patients thrive.  If you believe that you or someone you know has been subjected to unlawful discrimination due to a health care provider’s or health insurance plan’s use of AI, please let us know by submitting a complaint to my office: https://ocrportal.hhs.gov.

Blog Post: Ensuring Nondiscrimination in the Use of AI is Good Medicine | HHS.gov

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Endnotes

1 On December 5, 2024, OCR issued a “Dear Colleague” letter on Language Access Provisions of the Final Rule Implementing Section 1557 - PDF, addressing requirements and use of machine translation, including artificial intelligence and emerging technologies, and requirements for review by a qualified human translator to ensure accuracy.

2 These specific requirements go into effect on May 1, 2025.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc