AI in Healthcare Is Quietly Denying Care and Making Biased Decisions with January Montaño

In this episode of When Health Freezes Over, Host Omar Haq is joined by guest January Montaño, MPS, CEO and Founder at January's Advisory Group, to unpack the foundations of artificial intelligence in healthcare. From understanding the difference between automation and AI to exploring algorithmic bias, liability, governance, fraud detection, and patient impact, this conversation examines both the promise and the risks of AI adoption across health plans, providers, and healthcare operations. January explains why equity auditing is becoming a critical component of AI governance and what healthcare leaders must do before deploying AI at scale. January’s Advisory Group, a Denver-based AI governance consultancy specializing in equitable, auditable, and revenue-generating AI systems. With nearly three decades of experience in healthcare policy, Medicaid, public health, and healthcare operations, January has advised health plans, hospitals, and government agencies on healthcare transformation, algorithmic accountability, and health equity. January has testified before the Colorado General Assembly on AI bias and serves as a leading voice on responsible AI adoption in healthcare. **Expect to Learn:** \- The difference between automation, machine learning, generative AI, and agentic AI \- How AI is currently being used by health plans and healthcare providers \- Why algorithmic bias occurs and how it impacts patient care \- The role of AI in prior authorization, claims adjudication, and risk adjustment \- How AI is helping detect fraud, waste, and abuse in healthcare \- The growing legal and regulatory risks surrounding AI-driven healthcare decisions \- What CEOs, CIOs, compliance teams, and actuaries should evaluate before implementing AI solutions **Timestamps:** 00:00 – Teaser 01:05 – Introducing January Montaño, MPS and the AI Equity Challenge 04:42 – Why Healthcare Needs a Strong Foundation for AI Governance 07:37 – Understanding Automation vs. Artificial Intelligence 10:12 – The Rise of Agentic AI and Multi-Agent Healthcare Systems 15:23 – Will AI Replace Jobs or Reduce Workforce Burnout? 19:59 – Where AI Is Already Operating Inside Health Plans and Hospitals 23:07 – How Algorithmic Bias Impacts Minority and Underserved Populations 31:23 – Is Managed Care Actually Managing Care in the AI Era? 33:06 – Understanding the Root Causes of AI Bias 35:07 – What AI Is Already Doing to Patients Behind the Scenes 41:38 – Can AI Improve Outcomes While Advancing Health Equity? 50:03 – AI’s Role in Fighting Fraud, Waste, and Abuse 55:10 – Who Is Liable When AI Makes the Wrong Decision? 57:08 – Questions Every CIO Should Ask Before Buying AI 58:09 – Governance Structures Every CEO Must Have in Place 01:06:58 – Why Actuaries Are the Last Line of Defense 01:13:45 – Measuring Differential Error Rates and Equity Risk 01:14:22 – Final Thoughts **Follow Guest January Montaño, MPS:** LinkedIn: https://www.linkedin.com/in/januarymontano/ Instagram: https://www.instagram.com/january.montano/ Company LinkedIn: https://www.linkedin.com/company/januarysadvisorygroup/ Company Website: https://www.januarysadvisorygroupllc.org/ **Follow Host Omar Haq:** LinkedIn: https://www.linkedin.com/in/omar-haq1/ Company Website: https://www.mushincg.com/ Instagram: https://www.instagram.com/mushincgllc Tiktok: https://www.tiktok.com/@uberactuary **Follow Us On:** YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951