The Insurgency Will Be Automated: How AI Will Destroy Big Healthcare

The coming of AI will be the end of unenforced regulations.

It’s only a matter of time. I’ve seen the future.

So, I was gonna write this whole article. Then I had a better idea. I just asked chatGPT to do it for me.

See below what came of it—remember ”it” has no idea what it’s generating…but it’s so convincing that I think Big Healthcare is about to get a brutal wake up call.

The laws to protect patents exist. Laws such as Fiduciary Rule under Ca 2021. Said law mandates “plan sponsors” act as fiduciaries in the best interest of members are not broadly enforced. Let’s amplify the notion that this will change very soon with AI.

Many of us have played with ChatGPT and its fun, open source code. It can be trained on any large language data set. For example, oh, every legal filing ever. Just like successful won cases for the ERISA fiduciary breech. Furthermore, one could automate legal complaints and filings v. dinosaurs of healthcare who have human lawyers reviewing this stuff. The ability to do this at a level that creates a denial of service attack on Big Health legal departments is here. It’s probably already in QA by the time I finish typing this.

To prove my point, I used ChatGPT 3.5 to create the following text with light editing for length. This will be a huge timesaver for avengers like

Wendell Potter

Like a grain of sand in an hourglass, the future of legal challenges to Big Health appear before us, hidden in plain sight. These automated, mandatory actions which covers the asses of employers might be on the line. Buckle up. Everything you are about to read is bull plop. The point is that it was ready to come up with this at a keystroke. It is terrifying if you're United Healthcare and/or any Pharmacy Benefit Manager.

Owen: please write a story in a matter of fact tone from the perspective of a historian from 20 years in the future about how AI was used to destroy the current healthcare business by creating bots that drafted legal filings to enforce laws like the fiduciary rule of CA2021 and IRS regulation 501r

OpenAI: In the early 2020s, healthcare businesses faced challenges from new laws and regulations, particularly the fiduciary rule of CA2021 and IRS regulation 501r. These laws were designed to protect patients and promote transparency in the healthcare industry.

To address the problem, innovative companies began developing AI-powered bots which could both draft legal filings. These bots were able to quickly and efficiently analyze large amounts of data, identify potential compliance issues, and draft legal documents.

Owen: please expand on the above, specifically using the example of the fiduciary duty to plan members as enforceable against anthem when it demanded consumers use more expensive medicines that are still on patent like vortioxetine as opposed to paying cost plus prices for medications like vilazadone

AI: The use of AI-powered bots became ubiquitous for enforcement.

One example is was promoting more expensive, still-patented medications, like vortioxetine, over cheaper, generic alternatives, like vilazadone for the benefit of PBM rebates.

Owen: please write an example of what a reasonable claim for relief in the above might look like. Reference all appropriate penalties for the breech of fiduciary duty

Sure, here is an example of a claim for relief that could be included in a legal filing to enforce the fiduciary duty to a plan member:

"WHEREFORE, the Plaintiff respectfully requests that the Court enter judgment in its favor and against Defendant Anthem, Inc. and award the following relief:

A. A declaratory judgment that Defendant Anthem, Inc. has breached its fiduciary duty to Plaintiff and other plan members by promoting more expensive, still-patented medications over cost-effective generics.

B. An injunction requiring Defendant Anthem, Inc. to change its practices and promote more cost-effective medications to its plan members;

C. An award of damages to Plaintiff and other plan members for any additional costs incurred as a result of Defendant Anthem, Inc.'s breach of fiduciary duty;

D. An award of attorney's fees and costs incurred in connection with this action;

E. Any other relief that the Court may deem just and proper.

Owen: Please draft an argument finding administrators at Anthem personally liable for practicing medicine without a license in the case that a patient was harmed from the denial of their medication in the breech of duty of the plan that led to bad outcome like a suicide attempt.

"The administrators at Anthem, Inc. acted as unlicensed medical practitioners by making decisions about the medical treatment of the Plaintiff and other plan members. By denying the Plaintiff's medication and promoting more expensive, still-patented medications, like vorioxetine, over cheaper, generic alternatives, like vilazadone, the administrators at Anthem, Inc. were making medical decisions that should only be made by licensed medical professionals.

Furthermore, the actions of the administrators at Anthem, Inc. led to a bad outcome for the Plaintiff, such as a suicide attempt, demonstrating that their actions were not only unlicensed but also negligent and showed a clear disregard for the health and well-being of the plan members.

The law in this jurisdiction is clear that individuals who practice medicine without a license can be held liable for any harm caused by their actions. By acting as unlicensed medical practitioners, the administrators at Anthem, Inc. have exposed themselves to personal liability for the harm caused to the Plaintiff and other plan members.

Additionally, the administrators at Anthem, Inc. are also personally liable for the breach of fiduciary duty as they were acting within their role as fiduciary and their actions were in violation of the fiduciary duty to the plan members that they have a legal responsibility to protect.

Therefore, it is respectfully submitted that the Court should find the administrators at Anthem, Inc. personally liable for the harm caused to the Plaintiff and other plan members as a result of their actions in practicing medicine without a license and in violation of their fiduciary duty."

Consider this the “first shot” in the revolution…who is with me?

—O. Scott Muir, M.D.