Cigna uses algorithm to deny medical claims without doctor review
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.
- Company involved
- Cigna
- AI system involved
- PXDX
10 source articles · read the reporting →
Michigan's MiDAS system falsely accused 34,000 of unemployment fraud
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.
- Company involved
- Michigan Unemployment Insurance Agency
- AI system involved
- Michigan Integrated Data Automated System (MiDAS)
10 source articles · read the reporting →
Montefiore Allegedly Plans to Replace Nurses with AI for Insurance Reviews
The New York State Nurses Association alleges that Montefiore Health System plans to lay off 12 utilization review nurses and replace them with AI-powered software from Datavant. The union warns that the move could compromise patient care by having AI review insurance denials without clinical judgement. Montefiore denies the claims, stating they are investing in technology for better outcomes. The plan has sparked a town hall and calls from elected officials to halt the layoffs.
- Company involved
- Montefiore Health System
3 source articles · read the reporting →
Trelleborg municipality's welfare robot leaks personal data of hundreds
Trelleborg municipality in Sweden introduced a fully automated system named Ernst to handle welfare applications. An analysis of the system's source code, obtained via a freedom of information request, revealed that the names and social security numbers of approximately 250 people were included in the code since its introduction, making them visible to anyone who filed a request. The municipality is investigating the leak, which is also the subject of a complaint to the Swedish Parliamentary Ombudsman.
- Company involved
- Trelleborg municipality
- AI system involved
- Ernst
10 source articles · read the reporting →
CMS warns insurers against using AI to deny Medicare Advantage care
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.
- Company involved
- UnitedHealth, Humana
- AI system involved
- nH Predict
10 source articles · read the reporting →
Prisons use Verus software to scan inmate calls for coronavirus keywords
Jail and prison officials in at least three states deployed Verus, a software by LEO Technologies, to scan inmate phone calls for keywords related to COVID-19. The system transcribes and analyzes calls, flagging mentions of symptoms or the virus. Advocacy groups argue the surveillance is an abuse of privacy and could lead to retaliation against inmates raising concerns about conditions. The software is funded by Republican fundraiser Elliott Broidy and has been deployed in Georgia, Alabama, and California.
- Company involved
- Multiple correctional facilities in Georgia, Alabama, and California
- AI system involved
- Verus
10 source articles · read the reporting →
Met Police's Gang Violence Matrix accused of racial discrimination
The Metropolitan Police Service's Gang Violence Matrix, a database scoring individuals on gang involvement risk, has been accused by Amnesty International of being racially discriminatory and breaching human rights law. The matrix, set up after the 2011 London riots, holds data on about 3,800 people, with 78% being black. The Information Commissioner's Office is investigating the database.
- Company involved
- Metropolitan Police Service
- AI system involved
- Gang Violence Matrix
9 source articles · read the reporting →
Idaho Medicaid used secret formula to cut assistance for disabled adults
The Idaho Department of Health and Welfare used a secret formula to drastically cut Medicaid assistance for adults with developmental disabilities, claiming the formula was a trade secret. The ACLU of Idaho filed a class action lawsuit, K.W. v. Armstrong, in 2012, alleging the cuts violated due process. A federal court struck down the formula in 2016 and ordered a new system, but as of 2024, a fair system has not yet been implemented.
- Company involved
- Idaho Department of Health and Welfare
10 source articles · read the reporting →
ICO finds Met Police's Gangs Matrix breached data protection laws
The Information Commissioner's Office found that the Metropolitan Police Service's Gangs Matrix breached data protection laws, including by assigning automated harm scores to people suspected of gang involvement without proper impact assessments or safeguards. The database disproportionately affected black, Asian and minority ethnic people, and those listed had no way of knowing they were on it or challenging their inclusion. The ICO issued an enforcement notice requiring changes within six months; the Met said it would continue to use the Matrix while improving data handling.
- Company involved
- Metropolitan Police Service
- AI system involved
- Gangs Matrix
8 source articles · read the reporting →
AMS algorithm lacks transparency and may discriminate against job seekers
The Austrian Public Employment Service (AMS) uses an algorithm to classify job seekers into categories A, B, and C, determining their access to benefits and training. Scientists from TU Wien, WU Wien, and University of Vienna have criticised the algorithm for lacking transparency, as only two of 96 model variants have been published. They allege that the system may discriminate against women and people with migration background, and that job seekers are not informed about how the algorithm works or given a chance to appeal.
- Company involved
- AMS (Arbeitsmarktservice Österreich)
- AI system involved
- AMS-Algorithmus
10 source articles · read the reporting →
Cense exposed 2.5 million records of auto accident victims online
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.
- Company involved
- Cense
- AI system involved
- Cense
5 source articles · read the reporting →
Epic sepsis prediction algorithm misses two-thirds of cases, study finds
A study of nearly 30,000 patients at University of Michigan hospitals found that Epic Systems' sepsis prediction algorithm missed two-thirds of sepsis cases and frequently issued false alarms. The algorithm, used by over 100 US health systems, is designed to alert staff to potential sepsis, but the study suggests it provides little value and may contribute to alert fatigue. Epic disputed the study's conclusions, claiming its system has helped save lives.
- Company involved
- Epic Systems
- AI system involved
- Epic sepsis prediction model
6 source articles · read the reporting →
Deepfake bot submitted 1,001 comments to Idaho Medicaid waiver website
A researcher created a bot that generated and submitted 1,001 deepfake comments to the federal public comment website for the Idaho Medicaid reform waiver in October 2019. The comments were indistinguishable from human submissions, and survey respondents could not tell them apart from real comments. The researcher later withdrew the comments. The study highlights the vulnerability of federal comment processes to automated manipulation.
8 source articles · read the reporting →
Allstate's proposed retention model charged big spenders more in Maryland
Allstate proposed an auto insurance rate adjustment plan in Maryland using a retention model algorithm that varied premium changes based on existing premiums. The algorithm would have increased rates up to 20% for customers already paying the highest premiums while capping increases at 5% for others, and would have denied meaningful discounts to thousands owed reductions. The Maryland Insurance Administration rejected the plan as discriminatory, but Allstate claims it was withdrawn and has continued proposing similar models elsewhere. The proposal never took effect in Maryland.
- Company involved
- Allstate Corporation
- AI system involved
- retention model
9 source articles · read the reporting →
Serbia's Social Card law could harm marginalized groups
Serbia's Social Card law, which entered into force on 1 March 2022, establishes a centralized government database to assess eligibility for social security support. Amnesty International and seven other rights organizations submitted a legal opinion to the Constitutional Court, alleging that the automated system is an intrusive surveillance system that could discriminate against Roma communities and people with disabilities. The system processes 130 categories of personal data and lacks transparency, potentially leading to errors and denial of benefits.
- Company involved
- Serbian government
- AI system involved
- Social Card system
10 source articles · read the reporting →
Dartmouth Medical School charges 17 students with cheating based on tracking system.
Dartmouth College's Geisel School of Medicine charged 17 students with cheating on remote exams during the pandemic. The charges were based on secret tracking of student activity on the learning management system. Critics say the system is prone to errors and inappropriate for monitoring students.
- Company involved
- Dartmouth College Geisel School of Medicine
10 source articles · read the reporting →
Denmark's Udbetaling Danmark welfare algorithm illegally surveilled millions
Udbetaling Danmark (UDK), Denmark's centralized welfare payment agency, used automated algorithms to check eligibility and detect fraud. The system collected personal data on millions of beneficiaries and their relatives, including non-beneficiaries, in what a think-tank called 'systematic surveillance'. A complaint to the Danish Data Protection Authority led to a ruling that the data collection violated GDPR, and UDK eventually deleted the illegally obtained data. The system also caused erroneous payments, including underpaying 300,000 pensioners by 94 million euros annually.
- Company involved
- Udbetaling Danmark
10 source articles · read the reporting →
UnitedHealthcare sued for using AI to deny Medicare Advantage patients care
A class action complaint alleges that UnitedHealthcare and its subsidiary naviHealth deployed an artificial intelligence model to override treating physicians' determinations of medically necessary care for elderly Medicare Advantage patients. The complaint claims the AI model has a known 90% error rate and wrongfully denied patients care. The lawsuit, filed in the U.S. District Court for the District of Minnesota, seeks damages on behalf of the estates of two deceased patients and all others similarly situated.
- Company involved
- UnitedHealthcare, Inc.
10 source articles · read the reporting →
UnitedHealth used ALERT algorithm to limit mental health coverage, regulators found
ProPublica reports that UnitedHealth Group's Optum subsidiary used the ALERT algorithm to flag mental health patients and therapists as outliers, leading to therapy coverage denials. Regulators in California, Massachusetts and New York alleged this breached the federal Mental Health Parity and Addiction Equity Act, and UnitedHealth agreed to restrict the system in those jurisdictions. The company denies wrongdoing and says its programmes are compliant. Affected patients, including Medicaid enrollees, were left to pay out-of-pocket or go without care.
- Company involved
- UnitedHealth Group
- AI system involved
- ALERT
5 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 →
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 →
