Judge Rules $400M Algorithmic System Illegally Denied People's Medicaid Benefits

It took four years for me to be accepted into TennCare with one denial. That seems average, from what I can tell. This system definitely contributed to some suicides.

With many of those decisions as incorrect as they were, with people as poor as they are here... This is a tragedy that has had people hiding the cause of their suicides for an insurance payout to their families.

I am guessing that the healthcare costs for those denied are generally larger now than they would have been had they been accepted; that the hospital system is still paying the price tag, not the destitute. - A layered tragedy in that the finances are worse for everyone but Deloitte.

In australia, we have a recent ‘robodebt’ where Centrelink (welfare) payments were evaluated by a debt recovery system, deeming (MANY) incorrect bills of thousands of tens of thousands.

Suicides happened.

As a result of a royal commission into the legality of the debt recovery scheme, it was deemed illegal, and I think all debts were rescinded. Many people in charge were recommended to be prosecuted by the anti corruption commission within the royal commission, the recommendations were made by (afaik) a Supreme Court judge. The anti corruption commission chose not to prosecute.

I doubt Deloitte did this without direct guidance and approval from state governments.

The unemployment system here in FL was also built to spec to be incredibly hard to use and that was the goal of the administration. I have no love lost for consultancies, but if no government agents are penalized for this and they take the fall alone it will happen again with some other consultancy.

> When an enrollee is entitled to state-administered Medicaid, it should not require luck, perseverance, and zealous lawyering for him or her to receive that healthcare coverage

That's such a powerful statement. If they are entitled, they are entitled. Simple as that. And anything that systematically prevents that is absolutely wrong.

What's more important is the approval process. Deloitte might have build this, but the State approved it's use. People signed off on this.

Further, this isn't an easy fix. Loosing coverage like this is not something you can just fix. This has affected people's entire life going forward, and not in a good way.

Yes, mistakes happen, but this isn't a simple one-of mistake. This is something rotten, and while Deloitte wrote it, they wrote it for a client who asked for it and put it out there. And that's who is ultimately responsible.

> The TennCare Connect system—built by Deloitte and other contractors for more than $400 million

There you have the reason. The government software should be open source because

- People need to be able to make public officers accountable (Article XV – The society has the right of requesting an account from any public agent of its administration. https://en.m.wikipedia.org/wiki/Declaration_of_the_Rights_of...)

- You should be able to fire incompetent contractors, and replace them with someone else, for which open source code base makes it much more practical and the contractor cannot use any trade secrets clauses to make this impossible

> Deloitte was a major beneficiary of the nationwide modernization effort, winning contracts to build automated eligibility systems in more than 20 states, including Tennessee and Texas.

So much tax payers money wasted.

A plug for everyone in this thread to read `Recoding America` by Jennifer Pahlka, founder of Code For America. Extremely good book which goes into detail about why software is such a crapshow in government... there are many more reasons than "bad software engineers", and they're all fascinating.

> by Deloitte and other contractors for more than $400 million—is supposed to analyze income and health information to automatically determine eligibility for benefits program applicants.

Ultimately this needs to be weighed against 1. How accurately, corruption free, and expediently would $400M of humans performed compared to the software, and 2. How much better software could have been delivered by Code for America had they been given the $400M in resources.

My gut suspicions are 1. Much worse, and 2. Much better

> The TennCare Connect system—built by Deloitte and other contractors for more than $400 million—is supposed to analyze income and health information to automatically determine eligibility for benefits program applicants. But in practice, the system often doesn’t load the appropriate data, assigns beneficiaries to the wrong households, and makes incorrect eligibility determinations, according to the decision from Middle District of Tennessee Judge Waverly Crenshaw Jr.

Not at all surprised to see the name of a big consulting firm like Deloitte in something like this. How much money and productivity is lost to these leeches across our entire economy?

Leaving aside this particular case: how can potential recipients of benefits even know how or why they were denied to bring such lawsuits in the first place? Especially if they are forced into arbitration? For example I feel like private health insurance companies, particularly Aetna, deny many claims falsely as a typical approach to avoid having to pay out as much. And patients are then subjected to a long drawn out process with hours of wait times, hours of calls, and constant vigilance. This method of avoiding payouts by creating expenses for patients should be illegal. But how can anyone see what’s happening and be in a position to challenge it without even a basic level of transparency?

Imagine you get together a team of really good developers, who really want to help government work better for people, pay them semi-competitively [*], and just task them with building and deploying the software aspects of this system.

Maybe the software is fully delivered within a year, at a cost of $10M? (Excluding non-software costs of this project.)

Then those team members can move on to the next project(s).

[*] I'm thinking: don't pay as much as FAANG, but maybe 50% FAANG-TC, as straight salary. Meaning FAANG mercenary types motivated only by money filter out themselves for you, but it's still doable for top-tier people who want to do beneficial work, with enough income and job stability that they shouldn't be distracted from work by those stresses. You'd really need to keep the hiring bar up, though, carefully hand-picking small teams, and not compromising if your formula is successful. (And be able to say no to agencies want to scale to too many projects in parallel, or to some politician wants to make it a jobs program, or stuff it with patronage/nepo hires.)

It's hard to ignore the fact that the prior governor of Florida was convicted of medicare fraud. There is something to that.

If it was an algorithmic system, why did denials take months?

This makes a great case for UBI.

Years to get a benefit that should be dispersed in days or even minutes. Shame.

How many of the software engineers, project managers, and sparkle-shoe consultants from Deloitte are on Medicaid?

In banking it is mandated that a group validates any model that is used and reports the results to the FED. I wonder if something similar should exist for public institutions.

Probably another case of technology blamed by politicians who behind closed doors ordered to deny the claims

That's justice served. Big algorithm deserves Medicaid benefits too

Private healthcare/medical services should be illegal. Nationalise it. So broken to be in 2024 and people still have to pay for Healthcare. Thank God I don't live in the US. Our healthcare ain't great but it shits on theirs (Aus).

There are zero arguments that private Healthcare should exist.