AI incident ·
Length of Stay False Diagnosis Cut Off Insurer's Payment for Treatment of Elderly Woman
In brief
An AI system built by NaviHealth and deployed by Security Health Plan and NaviHealth allegedly harmed Frances Walter and Elderly patients.
- Risk domain
- AI system safety, failures, and limitations
- Occurred
- Coverage
- 1 report
What happened
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.
Laws that address this harm
Policy angle: Classified under AI system safety, failures, and limitations (Lack of capability or robustness) in the MIT AI Risk Repository taxonomy; 5 recorded instruments address this use case in the United States.
- Texas Responsible AI Governance Act (TRAIGA)
- California SB 53
- Tennessee ELVIS Act
- EO 14179
- New York RAISE Act (frontier model safety)
Matched from the record's risk domain and country to the instruments recorded here. A reviewer can correct the match in the repository (data/external/incident_overrides.yaml).
News reports (1)
Titles link to the original publisher; report text is not reproduced here.
Who was involved
- Alleged deployer
- Security Health Plan NaviHealth
- Alleged developer
- NaviHealth
- Alleged harmed party
- Frances Walter Elderly patients
AI systems implicated
Classification (MIT AI Risk Repository taxonomy)
- Risk domain
- AI system safety, failures, and limitations
- Risk subdomain
- 7.3 Lack of capability or robustness
- Causal entity
- AI
- Intent
- Intentional
- Timing
- Post-deployment
- Harm level
- AI tangible harm event
- Sectors
- human health and social work activities
- Countries
- US
Risk entries describing this failure mode
Entries from the MIT AI Risk Repository coded to subdomain 7.3.
- Reliability issues
"Relying on general-purpose AI products that fail to fulfil their intended function can lead to harm. For example, general- purpose AI systems can make up facts (‘hallucination’), generate erroneous computer code, or pro...
- Type 2: Bigger than expected
Harm can result from AI that was not expected to have a large impact at all, such as a lab leak, a surprisingly addictive open-source product, or an unexpected repurposing of a research prototype.
- Type 3: Worse than expected
AI intended to have a large societal impact can turn out harmful by mistake, such as a popular product that creates problems and partially solves them only for its users.
- Ethics and Morality Issues
LMs need to pay more attention to universally accepted societal values at the level of ethics and morality, including the judgement of right and wrong, and its relationship with social norms and laws.
- Safe learning
"AGIs should avoid making fatal mistakes during the learning phase. Subproblems include safe exploration and distributional shift (DeepMind, OpenAI), and continual learning (Berkeley)."
- Malign belief distributions
"Christiano (2016) argues that the universal distribution M (Hutter, 2005; Solomonoff, 1964a,b, 1978) is malign. The argument is somewhat intricate, and is based on the idea that a hypothesis about the world often includ...
- Meta-cognition
"Agents that reason about their own computational resources and logically uncertain events can encounter strange paradoxes due to Godelian limitations (Fallenstein and Soares, 2015; Soares and Fallenstein, 2014, 2017) an...
- Technical and operational risks
"To date, technical limitations and vulnerabilities are present in most generative AI models in various contexts. Consequently, malicious users find it easier to breach an AI system’s safety and ethical guardrails to e...
Related incidents
Linked by editors or by text similarity in the source dataset.
Incidents in the same risk subdomain
- Purported AI Name-Reading System Reportedly Skipped and Misannounced Graduates at Arizona's Glendale Community College Commencement
- PocketOS Production Database Was Reportedly Deleted by Cursor AI Agent Running Claude Opus 4.6
- Baidu Apollo Go Robotaxis Stopped in Traffic During Reported System Failure in Wuhan, Stranding Some Passengers
- Purportedly AI-Enabled Targeting System Was Reportedly Implicated in Deadly U.S. Strike on Iranian Primary School
- Claude Code Agent Reportedly Deleted DataTalks.Club Production Infrastructure, Database, and Snapshots via Terraform
- Purportedly AI-Generated Sepsis Alert Reportedly Prompted Potentially Inappropriate IV Fluid Administration for a Dialysis Patient, Averted by Clinician Intervention
Source record: incident #501 on the AI Incident Database · all 1 report