AI Watch: Who’s Monitoring Health Insurers’ Use of Technology?

Health insurers are increasingly turning to artificial intelligence to streamline claims, detect fraud, and predict patient needs. But who keeps an eye on how these powerful tools are being applied? A growing number of regulators and watchdog groups are stepping up their scrutiny. The Centers for Medicare & Medicaid Services, for instance, has begun testing AI models that flag suspicious billing patterns. Meanwhile, state insurance commissions are drafting new guidelines to ensure algorithms do not discriminate against vulnerable populations. Industry insiders say that internal audit teams now routinely evaluate the fairness and accuracy of AI systems before they go live. Some companies even hire external data scientists to conduct blind reviews, comparing algorithmic decisions against human judgments.Beyond the corporate sphere, independent research labs and nonprofit think tanks are publishing reports that highlight both successes and pitfalls of AI in insurance. These studies often reveal hidden biases, such as higher denial rates for patients from certain zip codes or with specific medical histories. Consumers are also gaining a voice through digital advocacy platforms, where they can report adverse experiences with automated claim decisions. This grassroots pressure is pushing insurers to adopt transparent explainability practices, allowing policyholders to understand why a claim was denied or approved. In the near future, we may see an industry‑wide certification program for AI tools in health insurance. Such a program would set standards for data quality, algorithmic fairness, and ongoing performance monitoring—helping to build trust among all stakeholders. Overall, the landscape is shifting toward greater accountability. As AI becomes a core component of insurance operations, continuous oversight will be essential to protect patients and ensure equitable access to care.