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Incident #591·AI Safety & Failures

Cigna Algorithm PXDX Allegedly Rejected Thousands of Patient Claims En Masse in Breach of California Law

July 24, 20232 reportsView on AIID

Explainability

Description

Cigna health insurer faces a class-action lawsuit for allegedly using the PXDX ("procedure-to-diagnosis") algorithm to automatically reject over 300,000 patient claims in violation of California law, prompting two members to file the lawsuit seeking damages and a jury trial. Cigna disputes the allegations, claiming the process expedites physician reimbursement and does not result in care denials.

Actors

Alleged Deployers

cigna

Alleged Developers

cigna

Harmed Parties

patients

Classification

Risk Domain

AI Safety & Failures

Risk Subdomain

7.3. Lack of capability or robustness

MIT Risk Profile

AIIntentionalPost-deployment

Topics

Explainability

Source

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Research Papers on This Topic

Concrete Problems in AI Safety

3,612 citationsJun 2016

A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI

2,338 citationsJul 2019

Representation Engineering: A Top-Down Approach to AI Transparency

1,499 citationsOct 2023

Explainable artificial intelligence (XAI) in deep learning-based medical image analysis

1,178 citationsJul 2021

Mitigation Tools

Tools related to this risk domain, via shared responsible AI topics.

Open Source

lime

marcotcr/lime

Lime: Explaining the predictions of any machine learning classifier

⭐ 12,100

facets

PAIR-code/facets

Visualizations for machine learning datasets

⭐ 7,374

interpret

interpretml/interpret

Fit interpretable models. Explain blackbox machine learning.

⭐ 6,788

captum

Source Reports(2 total)

Cigna Health Giant Accused of Improperly Rejecting Thousands of Patient Claims Using an Algorithm

apnews.com· Jul 2023

Cigna Sued Over Algorithm Allegedly Used To Deny Coverage To Hundreds Of Thousands Of Patients

forbes.com· Jul 2023

AI Incident Database (AIID), MIT AI Risk Initiative. Data from the AI Incident Database (AIID), MIT AI Risk Initiative. Licensed under CC BY-SA 4.0.

Databaseaiid

LicenseCC BY-SA 4.0

Dec 2015

pytorch/captum

Model interpretability and understanding for PyTorch

⭐ 5,548

Commercial

Datomize

Synthetic data generation for privacy compliance

Protect AI

Helping organizations build and use AI safely.

Censius

AI observability for model governance.

HiddenLayer

Model detection and response (MDR) for AI model protection.