Deloitte systems accused of making inaccurate, unreliable Medicaid eligibility deteminations
Occurred: January 2024
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Deloitte-built Medicaid eligibility systems in Texas and other US states have been plagued by widespread errors, resulting in incorrect coverage determinations and the loss of essential healthcare for eligible individuals.
What happened
Deloitte's automated eligibility systems, notably the Texas Integrated Eligibility Redesign System (TIERS), generated numerous errors, leading to inaccurate Medicaid eligibility determinations for hundreds of thousands of Texans.
These errors have caused loss of critical health care coverage for eligible individuals, including people with disabilities, incorrect notices sent to beneficiaries, paperwork sent to wrong addresses, and violations of state Medicaid rules.
Similar issues have also been reported with Deloitte-run systems in Texas, Rhode Island, Illinois, New Mexico, Tennessee, and elsewhere.
Why it happened
According to a legal complaint filed by the National Health Law Program, online privacy group EPIC and technology justice group Upturn, the errors in the system stem from several factors, including:ย
Flaws in system design and programming errors
Rushed implementation of software before it was ready
Insufficient monitoring, oversight, testing, and harm mitigation strategies
Failure to address known issues across multiple states over time.
What it means
The errors in Deloitte's systems have far-reaching consequences. Eligible individuals lose access to necessary medical care, potentially leading to serious health consequences, and result in unexpected medical expenses. Additionally, beneficiaries must spend time and energy appealing incorrect determinations and navigating complex bureaucratic processes.
The inequities caused are described as systemic, disproportionately affecting low-income individuals and those with disabilities who rely on Medicaid for essential healthcare.
In addition, US states have spent billions on this and similar systems and fixes to them often exceed their entire original budgets.
The many technological, operational, financial and other problems associated with TIERS is seen to erode confidence and trust in US government-run healthcare systems and private sector involvement in public services.
These ongoing issues highlight the critical need for improved oversight, accountability, and system design in the administration of vital public health programs like Medicaid
System ๐ค
Texas Integrated Eligibility Redesign System (TIERS)
Operator:ย
Developer: Deloitte
Country: USA
Sector: Health
Purpose: Determine Medicaid eligibility
Technology: Anomaly detection; Computer vision; Optical character recognition; Machine learning
Issue: Accountability; Accuracy/reliability; Human/civil rights; Transparency
Page info
Type: Issue
Published: February 2025