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.

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


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.