92 incidents closest to “Medicaid eligibility redetermination and call-centre services” · matched on meaning · public reporting
NHS QCovid algorithm incorrectly labels young patients as high risk, causing vaccine call-up
The article reports that scientists are questioning the reliability of the QCovid risk prediction algorithm used by the NHS to prioritise COVID-19 vaccinations. Due to missing data on weight or ethnicity, the algorithm automatically assigns a high BMI and high-risk ethnicity, leading to young, healthy patients being incorrectly labelled as high risk and called for early vaccination. GPs have identified hundreds of such cases, causing anxiety and potentially delaying vaccinations for more vulnerable individuals. NHS Digital acknowledged the issue and said clinicians can remove patients from the shielding list.
- Company involved
- NHS
- AI system involved
- QCovid
10 source articles · read the reporting →
EviCore denied heart catheterization for patient using algorithm
In fall 2021, Little John Cupp's doctor requested a left heart catheterization exam. EviCore, a company hired by UnitedHealthcare, denied the request twice using an algorithm called 'the dial' that adjusts thresholds for review. The algorithm flagged the request for review, and EviCore's doctors determined it was not medically necessary. Cupp did not receive the procedure and his symptoms continued.
- Company involved
- EviCore (a Cigna company)
- AI system involved
- the dial
6 source articles · read the reporting →
IRCC uses AI triage for Temporary Resident Visa applications
Immigration, Refugees and Citizenship Canada (IRCC) uses an AI system called Advanced Analytics to triage Temporary Resident Visa applications from India and China. The system categorizes applications into tiers, with Tier 1 approved automatically and others sent to human officers. Critics allege the system lacks transparency and may introduce bias, leading to visa refusals without clear rationale. The author, a Canadian immigration lawyer, is filing Federal Court cases on behalf of clients affected by refusals.
- Company involved
- Immigration, Refugees and Citizenship Canada (IRCC)
- AI system involved
- Advanced Analytics Triage of Overseas Temporary Resident Visa Applications
10 source articles · read the reporting →
Humana sued for using AI to deny seniors rehabilitation care
Health insurer Humana is accused in a class-action lawsuit of using an AI algorithm to systematically deny rehabilitation care to Medicare Advantage patients, despite recommendations from their doctors. The lawsuit, filed on December 12, 2023, alleges that the AI tool restricted medically necessary care. This is the second major health insurer to face legal action over its use of AI to deny care.
- Company involved
- Humana
9 source articles · read the reporting →
Judge rules lawsuit over UnitedHealth’s AI care denials can move forward - STAT
The system denied necessary medical care to Medicare Advantage beneficiaries.
- Company involved
- UnitedHealth Group
1 source article · read the reporting →
California EDD's automated fraud detection wrongly suspended 600,000 legitimate unemployment claims
In January 2021, the California Employment Development Department used Thompson Reuters automated batch review software to flag 1.1 million unemployment claims as potentially fraudulent. EDD stopped payments on those claims without prior notice. Later, over 600,000 were confirmed as legitimate after claimants used ID.me to verify their identity. The incident highlights the trade-off between fraud prevention and timely benefit access.
- Company involved
- California Employment Development Department (EDD)
- AI system involved
- Thompson Reuters Automated Batch Review
7 source articles · read the reporting →
Haryana government's algorithm wrongly declares thousands dead, stops pensions
The Haryana state government's Family Identity Data Repository (PPP) algorithm wrongly declared thousands of elderly and widowed citizens as dead, stopping their pensions. Dhuli Chand, a 102-year-old man, had to stage a mock wedding procession to prove he was alive after his pension was cut for six months. The government acknowledged the errors and corrected some records, but many still face difficulties.
- Company involved
- Haryana state government
- AI system involved
- Family Identity Data Repository (Parivar Pehchan Patra or PPP)
6 source articles · read the reporting →
Teleperformance deploys AI to neutralise Indian call centre agents' accents
Teleperformance, the world's largest call centre operator, has announced it is using AI from Sanas to modify the accents of its Indian employees in real time. The technology, called accent translation, aims to make agents sound more neutral to native English speakers. The company invested $13 million in Sanas and gained exclusive rights. No specific incident of harm has been reported.
- Company involved
- Teleperformance
- AI system involved
- Sanas AI
6 source articles · read the reporting →
UNOS liver allocation policy reduces transplants in poorer states
The United Network for Organ Sharing (UNOS) implemented a new liver allocation policy in 2020 called the acuity circles system, which prioritizes the sickest patients regardless of location. An analysis by The Markup and The Washington Post found that the policy led to sharp declines in liver transplants in several Southern and Midwestern states and Puerto Rico, while increasing transplants in New York and California. Patients in affected states allege the system disadvantages poorer regions, and hospitals have sued to overturn the policy.
- Company involved
- United Network for Organ Sharing (UNOS)
- AI system involved
- Acuity circles liver allocation policy
10 source articles · read the reporting →
Teething problems in Mater Dei's medicine robots addressed
The Malta Union for Midwives and Nurses claimed that a €23 million investment in two computerised drug administration robots, Mario and Sophia, at Mater Dei Hospital had resulted in a complete failure. However, sources within the Health Ministry said that most teething problems have been addressed and that the supplier has not been paid yet. They reported that out of over 1,700 medication rounds, only four required a contingency plan.
- Company involved
- Mater Dei Hospital
- AI system involved
- Mario and Sophia
6 source articles · read the reporting →
NHS plans AI to listen to appointments and generate notes
The UK's National Health Service announced plans to use AI to automatically generate notes from patient appointments. Health Secretary Victoria Atkins said the scheme would reduce admin time. Privacy campaigners raised concerns about data security and accuracy, citing an incident where AI misheard the chief medical officer's name. The Department of Health and Social Care stated that patient confidentiality remains a top priority.
- Company involved
- National Health Service (NHS)
3 source articles · read the reporting →
Swedish welfare agency's AI system flags marginalized groups for fraud investigations
Försäkringskassan, Sweden's Social Insurance Agency, uses an AI risk-scoring system to flag welfare applicants for fraud investigations. The system disproportionately targets women, individuals with foreign backgrounds, low-income earners, and those without university degrees, according to an investigation by Lighthouse Reports and Svenska Dagbladet. Amnesty International has called for the system to be discontinued, citing violations of the right to equality and non-discrimination.
- Company involved
- Försäkringskassan (Swedish Social Insurance Agency)
6 source articles · read the reporting →
Dutch government to refund over 10,000 students over discriminatory DUO fraud algorithm
The Dutch government has pledged to refund over 10,000 students who were unjustly flagged for student finance fraud by a discriminatory algorithm used by the Education Executive Agency (DUO). The algorithm, implemented in 2012, used criteria that disproportionately targeted students from immigrant backgrounds, particularly those of Turkish and Moroccan descent. Following investigations by the Dutch Data Protection Authority and an independent report by PwC, the algorithm was suspended in July 2023 and replaced with a random-sampling system. The government has allocated 61 million euro for refunds.
- Company involved
- Education Executive Agency (DUO)
- AI system involved
- DUO fraud detection system
9 source articles · read the reporting →
AEMPS withdraws AI medicines tool MeQA after detecting errors
AEMPS launched MeQA, an artificial intelligence tool for answering public questions about medicines, on 13 May 2025. Two days later it withdrew the tool after detecting that some responses contained errors. The agency said that most answers were correct but that the errors could affect patient safety, and that it would restore the service as soon as possible.
- Company involved
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)
- AI system involved
- MeQA
4 source articles · read the reporting →
Woman denied state welfare card groceries after face scan fails
A grandmother rode her motorcycle several kilometres to a shop in Sapphaya district, Chai Nat province, to use her state welfare card to buy groceries for her family. After selecting items, she failed repeated facial recognition scans because her ID card photo was years old and no longer matched her appearance. She left the shop empty-handed and in tears.
- Company involved
- Government of Thailand (state welfare card system)
2 source articles · read the reporting →
DWP algorithm mistakenly flags 200,000 Housing Benefit claimants for fraud review
The UK Department for Work and Pensions (DWP) uses an algorithm to flag Housing Benefit claimants for possible fraud or error. According to a Big Brother Watch investigation, the algorithm has mistakenly flagged 200,000 innocent people, subjecting them to intrusive reviews. Only one in three flagged cases actually had errors, compared to two in three during the pilot. The DWP has spent £4.4 million on these pointless checks.
- Company involved
- Department for Work and Pensions (DWP)
6 source articles · read the reporting →
DWP algorithm approved Kickstart gateways with no trading history or based abroad
An FE Week investigation found that the Department for Work and Pensions (DWP) approved dozens of companies as Kickstart gateways through automated due diligence checks using the Cabinet Office Spotlight Tool, although some had little or no trading history or were based abroad. The DWP said gateways were subject to stringent checks and later said human checks were also used. After the findings were shared with the Treasury and the DWP, the department stopped taking gateway applications and scrapped the requirement for small employers to use gateways from 3 February.
- Company involved
- Department for Work and Pensions
- AI system involved
- Cabinet Office Spotlight Tool
3 source articles · read the reporting →
Tennessee's TennCare Connect algorithm illegally denied thousands Medicaid benefits
A U.S. District Court judge ruled that Tennessee's TennCare Connect system, built by Deloitte for over $400 million, illegally denied thousands of low-income residents and people with disabilities Medicaid and disability benefits due to programming and data errors. The system automatically terminated coverage without properly considering eligibility for all available programs. A class action lawsuit filed in 2020 resulted in the ruling.
- Company involved
- TennCare (Tennessee Medicaid)
- AI system involved
- TennCare Connect
10 source articles · read the reporting →
Deloitte software glitches wrongly remove Texans from Medicaid
Advocacy groups filed a complaint with the Federal Trade Commission alleging that Deloitte's eligibility software, TIERS, used by Texas Medicaid, wrongly disenrolled qualified recipients due to glitches. Nearly 1.8 million Texans lost coverage after the pandemic pause ended, with many errors attributed to procedural issues but some linked to system malfunctions. Deloitte denies the claims, while the state says it restored care for at least 90,000 people. The FTC has not yet responded to the complaint.
- Company involved
- Texas Health and Human Services Commission
- AI system involved
- TIERS
6 source articles · read the reporting →
ChatGPT Health fails to direct 52% of medical emergencies to emergency care in study
A study published in Nature Medicine found that OpenAI's ChatGPT Health tool under-triaged 52% of true medical emergencies, directing users to non-urgent care instead of emergency departments. The AI also misclassified 35% of non-urgent cases. Researchers at Mount Sinai conducted 960 tests across 60 clinical scenarios, noting the tool's susceptibility to anchoring bias when symptoms were minimized. The study highlights potential safety concerns as millions use AI for health guidance.
- Company involved
- OpenAI
- AI system involved
- ChatGPT Health
4 source articles · read the reporting →
Citizens Advice finds ethnicity penalty in car insurance pricing
Citizens Advice conducted exploratory research into car insurance pricing and found that people of colour may be paying £250 more per year than White people. The research suggests that areas with large communities of colour may be identified as more risky by algorithms, even when objective risk factors are controlled. Citizens Advice has called on the Financial Conduct Authority to investigate the issue.
9 source articles · read the reporting →
TransUnion AI tenant screening denied 75-year-old man apartment due to mistaken littering conviction
Chris Robinson, then 75, applied for a senior living apartment in California. The property manager used an AI screening program from TransUnion, which assigned him a low score based on a mistaken conviction for littering that belonged to a different person with the same name in Texas. Robinson lost the apartment and his application fee. A federal class-action lawsuit against TransUnion moved toward a $11.5 million settlement in 2023.
10 source articles · read the reporting →
DWP suspends benefits for Bulgarian nationals using risk review system
The Department for Work and Pensions (DWP) used a 'risk review' unit to suspend universal credit benefits for dozens of Bulgarian nationals, many of whom are single mothers working part-time. The suspensions were made without explanation, leaving claimants without income, forcing some to use food banks and face eviction. An MP raised concerns that the system unfairly targets claimants based on their nationality, but the DWP denied the allegations, stating the risk review team investigates potential criminal activity and is not linked to nationality.
- Company involved
- Department for Work and Pensions
6 source articles · read the reporting →
Security Health Plan used AI to cut off nursing home care for 85-year-old woman
Frances Walter, an 85-year-old woman with a shattered shoulder, had her nursing home care payment cut off by Security Health Plan after an algorithm predicted she would recover in 16.6 days. The algorithm, nH Predict from NaviHealth, did not account for her severe pain and allergy to pain medicine. She was forced to spend her life savings and enroll in Medicaid while fighting the denial. A federal judge later ruled the denial was speculative and she was owed thousands of dollars.
- Company involved
- Security Health Plan
- AI system involved
- nH Predict
1 source article · read the reporting →
