Cigna Sued Over Algorithm Allegedly Used To Deny Coverage To Patients

Abstraction: Cigna PXDX algorithm automatically denied insurance claims without physician review

Key points:

• Cigna's PXDX system flags discrepancies between diagnoses and approved tests/procedures, enabling batch claim denials without doctors opening patient records
• Over two months in 2022, Cigna denied more than 300,000 claims at an average of 1.2 seconds per claim, per a ProPublica investigation
• California class-action lawsuit alleges PXDX violates state competition law and insurance code requiring a "reasonable standard" for processing claims
• Cigna defended the system as a tool to "accelerate physician payments" that was mischaracterized
• Google Cloud unveiled similar AI-based healthcare claims processing tools in April 2023; Blue Shield of California and Bupa are among users
• Law firm Clarkson Law (filing the suit) also filed AI data-scraping lawsuits against OpenAI and Google the same month

Connections: Cigna · AI Ethics · Algorithmic Decision Making · Healthcare AI

Source: https://www.forbes.com/sites/richardnieva/2023/07/24/cigna-sued-over-algorithm-allegedly-used-to-deny-coverage-to-hundreds-of-thousands-of-patients/