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Incident 501: Length of Stay False Diagnosis Cut Off Insurer's Payment for Treatment of Elderly Woman

Description: An elderly Wisconsin woman was algorithmically determined to have a rapid recovery, an output which the insurer based on to cut off payment for her treatment despite medical notes showing her still experiencing debilitating pain.

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Alleged: NaviHealth developed an AI system deployed by Security Health Plan and NaviHealth, which harmed Frances Walter and elderly patients.

Incident Stats

Incident ID
501
Report Count
1
Incident Date
2019-06-03
Editors
Khoa Lam
Applied Taxonomies
CSETv1, MIT

CSETv1 Taxonomy Classifications

Taxonomy Details

Incident Number

The number of the incident in the AI Incident Database.
 

501

Notes (special interest intangible harm)

Input any notes that may help explain your answers.
 

This may be a civil rights violation because there maybe unequal access to Medicare benefits (a government-provided service) with older people being at a disadvantage.

Special Interest Intangible Harm

An assessment of whether a special interest intangible harm occurred. This assessment does not consider the context of the intangible harm, if an AI was involved, or if there is characterizable class or subgroup of harmed entities. It is also not assessing if an intangible harm occurred. It is only asking if a special interest intangible harm occurred.
 

yes

Date of Incident Year

The year in which the incident occurred. If there are multiple harms or occurrences of the incident, list the earliest. If a precise date is unavailable, but the available sources provide a basis for estimating the year, estimate. Otherwise, leave blank. Enter in the format of YYYY
 

2023

MIT Taxonomy Classifications

Machine-Classified
Taxonomy Details

Risk Subdomain

A further 23 subdomains create an accessible and understandable classification of hazards and harms associated with AI
 

7.3. Lack of capability or robustness

Risk Domain

The Domain Taxonomy of AI Risks classifies risks into seven AI risk domains: (1) Discrimination & toxicity, (2) Privacy & security, (3) Misinformation, (4) Malicious actors & misuse, (5) Human-computer interaction, (6) Socioeconomic & environmental harms, and (7) AI system safety, failures & limitations.
 
  1. AI system safety, failures, and limitations

Entity

Which, if any, entity is presented as the main cause of the risk
 

AI

Timing

The stage in the AI lifecycle at which the risk is presented as occurring
 

Post-deployment

Intent

Whether the risk is presented as occurring as an expected or unexpected outcome from pursuing a goal
 

Intentional

Incident Reports

Reports Timeline

Incident OccurrenceDenied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

statnews.com

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
statnews.com · 2023

An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin woman with a shattered left shoulder and an allergy to pain medicine. In 16.6 days, it estimated, she would be ready to leave her nursing ho…

Variants

A "variant" is an incident that shares the same causative factors, produces similar harms, and involves the same intelligent systems as a known AI incident. Rather than index variants as entirely separate incidents, we list variations of incidents under the first similar incident submitted to the database. Unlike other submission types to the incident database, variants are not required to have reporting in evidence external to the Incident Database. Learn more from the research paper.

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