Incidents gathered from public reporting around the world. Each one links to the articles it came from. None of it is a finding that anyone broke the law.
Reports people file about their own experience are not shown here and never will be without their agreement. Tell us what happened to you.
44 incidents closest to “FRISS Fraud Detection at Claims” · matched on meaning · public reporting
AI generated false legal citations that were submitted in court, affecting the plaintiff in an insurance dispute.
1 source article · read the reporting →
The system flagged student assignments as AI-generated, potentially leading to academic misconduct accusations.
1 source article · read the reporting →
Cigna, one of the largest health insurers, used an algorithm called PXDX to automatically deny medical claims. The system flagged mismatches between diagnoses and procedures, and company doctors signed off on denials in batches without reviewing patient files. One patient, Nick van Terheyden, was denied coverage for a $350 vitamin D test that his doctor had ordered. Former employees said the system saved Cigna billions of dollars but left patients with unexpected bills.
10 source articles · read the reporting →
AI-generated deepfakes and voice cloning convinced a 63-year-old woman to send $150,000 to a scammer posing as a romantic partner
1 source article · read the reporting →
The AI platform screened job applicants, affecting their hiring prospects.
1 source article · read the reporting →
During the pandemic, insurers accelerated the use of AI and photo-based tools to estimate car repair costs. Body shop owners say the estimates are often inaccurate, missing hidden damage and leading to more time haggling over prices. The insurance industry acknowledges the technology is new and evolving, but repairers argue it cannot replace in-person inspections.
1 source article · read the reporting →
Checkr's system misreported criminal records belonging to someone else on Natasha Davis's consumer report, impeding her ability to gain employment.
1 source article · read the reporting →
A fraud analyst, Leon, was targeted by scammers who used AI to create convincing fake websites for non-existent investment firms. The scammers posed as employees of Assent Advisory and directed him to elaborate sites for APPC Capital Singapore and Thackeray Mines and Minerals Inc., complete with AI-generated images and fake details. Leon recognised the scam, but the sophistication of the AI-generated content made him second-guess his own judgment. The incident highlights how AI is enabling more convincing investment scams.
1 source article · read the reporting →
The Galileu AI system, developed by the Tribunal Regional do Trabalho da 4ª Região (TRT-RS) and nationalised by the Conselho Superior da Justiça do Trabalho (CSJT), detected a prompt injection attempt in a petition filed at the 3rd Labour Court of Parauapebas, Pará. The system alerted the magistrate, who reviewed the content and made a decision based on human verification, in line with judicial AI supervision requirements. The court reported that the system prevented the malicious content from being processed and highlighted the importance of institutional AI tools with security measures.
1 source article · read the reporting →
In June 2024, a scam group posing as FTX debt claimants allegedly used AI-generated identities and manipulated facial appearances to defraud two companies of more than $5.6 million. The perpetrators accessed FTX customer data through public bankruptcy filings or a 2023 data breach at Kroll. Blockchain analysis traced the stolen funds through Binance, CoinEx, and Gate.io. The incident remains unresolved.
6 source articles · read the reporting →
The city of Rotterdam deployed a machine learning algorithm built by Accenture to flag welfare recipients for fraud investigation. The system used personal data including gender, language, and subjective caseworker notes to generate risk scores, leading to investigations that disproportionately targeted women and migrants. An external review found the algorithm discriminatory and inaccurate, prompting the city to suspend its use in 2021. The system's opacity made it nearly impossible for those flagged to challenge the decisions.
6 source articles · read the reporting →
The SEC charged Delphia (USA) Inc. and Global Predictions Inc. for making false and misleading statements about their use of artificial intelligence. Delphia claimed from 2019 to 2023 that it used AI and machine learning to predict investments, while Global Predictions falsely claimed in 2023 to be the 'first regulated AI financial advisor'. Both firms settled the charges without admitting or denying the findings, agreeing to pay a total of $400,000 in civil penalties and to cease and desist from further violations.
1 source article · read the reporting →
Michigan's Unemployment Insurance Agency (UIA) deployed the Michigan Integrated Data Automated System (MiDAS) to automate fraud detection. The system algorithmically adjudicated over 40,000 fraud cases between October 2013 and September 2015, with 85 percent of those resulting in incorrect fraud determinations. The false accusations led to severe financial penalties, ruined credit, and homelessness for many victims. A class-action lawsuit was filed, and while the state has apologised and returned fines, it has fought against compensation claims, though legislators have promised to seek at least $30 million for those affected.
10 source articles · read the reporting →
An investigation by SPIEGEL and BR Data reveals that Schufa's credit scoring algorithm often assigns poor risk scores to consumers with only positive credit information. One consumer, Sven Drewert, was denied a credit card limit increase despite having no negative entries. The algorithm uses limited data, and its secret formula can lead to arbitrary categorisations, affecting access to loans, phone contracts, and housing. The system's opacity and potential biases raise concerns about fairness and accountability.
2 source articles · read the reporting →
The Centers for Medicare & Medicaid Services (CMS) clarified that health insurers cannot use algorithms or AI to deny care to Medicare Advantage members. This follows lawsuits alleging UnitedHealth and Humana used an AI tool, nH Predict, to wrongfully deny post-acute care to elderly patients. The tool reportedly produced rigid estimates ignoring individual patient needs, leading to premature denials. CMS warned that non-compliance could result in penalties and increased audits.
10 source articles · read the reporting →
Amnesty International and coalition partners filed a complaint with the Council of State against CNAF's risk-scoring algorithm used to detect benefit overpayments. The algorithm assigns risk scores based on criteria that discriminate against vulnerable groups, including those with disabilities, single parents, and low-income households. The complaint alleges the system violates human rights to equality and privacy. The EU AI Act's social scoring ban may apply, but its definition remains unclear.
2 source articles · read the reporting →
The Texas Attorney General investigated Pieces Technologies, a Dallas-based healthcare AI company, for making false and misleading statements about the accuracy of its generative AI product used in hospitals. The company claimed an error rate of less than 1 per 100,000, but the investigation found these metrics were likely inaccurate. As part of the settlement, Pieces agreed to accurately disclose its product's accuracy and ensure hospital staff understand the appropriate reliance on its AI. The case marks the first-of-its-kind healthcare generative AI investigation by the AG.
4 source articles · read the reporting →
In March 2019, criminals used commercially available AI voice-generation software to impersonate the CEO of a German parent company. They tricked the CEO of a UK-based energy firm into urgently wiring $243,000 to a Hungarian supplier. The fraud was discovered when the fraudsters attempted a second transfer, which the CEO refused. The company was insured and the loss was covered.
10 source articles · read the reporting →
On July 7, 2020, a security researcher discovered 2.5 million records containing personal and medical data of auto accident victims exposed online. The records, belonging to New York-based AI company Cense, included names, insurance policy numbers, claim numbers, and medical diagnosis notes. The data was labeled as staging data, possibly intended for temporary storage before being loaded into an AI system. After the researcher sent a responsible disclosure notice, Cense restricted public access to the database.
5 source articles · read the reporting →
The Dutch government deployed the SyRI algorithm to profile welfare recipients in low-income neighborhoods, despite a 2020 court ruling that the system violated EU human rights. The algorithm flagged thousands of parents for fraud based on illegal risk factors such as dual nationality, leading to false accusations, bankruptcy, and trauma. The government has announced an external review of the practices.
10 source articles · read the reporting →
A study by the Universities of Padua, Udine and Carnegie Mellon found that Italian car insurers, including Genertel, Mps, Quixa and Con.Te, use birthplace and citizenship in pricing algorithms, charging some drivers over €1,000 more. The practice was ruled against in a 2018 decree involving Linear, but the study says it continues. The companies contacted denied or explained the findings.
8 source articles · read the reporting →
DeepScore, a Tokyo-based company, is marketing an app that uses facial and voice recognition to score people's trustworthiness for lenders and insurers in Japan, Indonesia, Vietnam and the Philippines. The company says the app can detect deception with 70 per cent accuracy, but researchers and privacy advocates say there is no reliable scientific basis for such judgments and warn of discrimination and privacy harms. The chief executive said the system is only one part of lenders' and insurers' decision-making and that people can choose not to use it. Critics respond that an unequal balance of power makes consent difficult.
6 source articles · read the reporting →
Lemonade, an insurance firm, posted a tweet claiming it uses AI to detect non-verbal cues in customer videos to deny claims. After backlash comparing the practice to phrenology, the company deleted the tweet and denied using AI to deny claims based on facial characteristics. Lemonade stated it uses facial recognition only to flag claims submitted under different identities, which are then reviewed by human investigators.
10 source articles · read the reporting →
The AI-generated hallucinated citations in an expert report led to the exclusion of the expert and dismissal of the plaintiff's case.
1 source article · read the reporting →
