Deloitte systems accused of making inaccurate, unreliable Medicaid eligibility deteminations

Deloitte-built Medicaid eligibility systems in Texas and other US states have been plagued by widespread errors, resulting in incorrect coverage determinations and the loss of essential healthcare for eligible individuals. What happened Deloitte's automated eligibility systems, notably the Texas Integrated Eligibility Redesign System (TIERS), generated numerous errors, leading to inaccurate Medicaid eligibility determinations for hundreds of thousands of Texans. These errors have caused loss of critical health care coverage for eligible individuals, including people with disabilities, incorrect notices sent to beneficiaries, paperwork sent to wrong addresses, and violations of state Medicaid rules. Similar issues have also been reported with Deloitte-run systems in Texas, Rhode Island, Illinois, New Mexico, Tennessee, and elsewhere. Why it happened According to a legal complaint filed by the National Health Law Program, online privacy group EPIC and technology justice group Upturn, the errors in the system stem from several factors, including: Flaws in system design and programming errors Rushed implementation of software before it was ready Insufficient monitoring, oversight, testing, and harm mitigation strategies Failure to address known issues across multiple states over time. What it means The errors in Deloitte's systems have far-reaching consequences. Eligible individuals lose access to necessary medical care, potentially leading to serious health consequences, and result in unexpected medical expenses. Additionally, beneficiaries must spend time and energy appealing incorrect determinations and navigating complex bureaucratic processes. The inequities caused are described as systemic, disproportionately affecting low-income individuals and those with disabilities who rely on Medicaid for essential healthcare. In addition, US s tates have spent billions on this and simi lar systems and fixes to them often exceed their entire original budgets. The many technological, operational, financial and other problems associated with TIERS is seen to erode confidence and trust in US government-run healthcare systems and private sector involvement in public services. These ongoing issues highlight the critical need for improved oversight, accountability, and system design in the administration of vital public health programs like Medicaid System 🤖 Texas Integrated Eligibility Redesign System (TIERS) Developer: Deloitte Country: USA Sector: Hea lth Purpose: Determine Medicaid eligibility Technology: Anomaly d etection; Computer vision; Optical c haracter r ecognition; Machine learning Issue: Accountability; Accuracy/reliability; Human/civil rights; Transparency Legal, regulatory 👩🏼‍⚖️ Complaint and Request for Investigation, Injunction, and Other Relief Submitted by National Health Law Program (NHeLP), Electronic Privacy Information Center (EPIC), and Upturn, Inc. Re: Supplemental information concerning In re: Deloitte Consulting LLP

Date it happened

2024-01-01

Product, system or model

Texas Integrated Eligibility Redesign System (TIERS)

This is a record of what was reported, not a finding that anyone broke the law. If it names your organisation and you believe it is wrong, the corrections process is free and open to everyone.