Artificial Intelligence and Discrimination in Health Care

50 Pages Posted: 16 Dec 2020

See all articles by Sharona Hoffman

Sharona Hoffman

Case Western Reserve University School of Law

Andy Podgurski

Case Western Reserve University

Date Written: 2020


Artificial intelligence (AI) holds great promise for improved health-care outcomes. It has been used to analyze tumor images, to help doctors choose among different treatment options, and to combat the COVID-19 pandemic. But AI also poses new hazards. This Article focuses on a particular type of health-care harm that has thus far evaded significant legal scrutiny. The harm is algorithmic discrimination.

Algorithmic discrimination in healthcare occurs with surprising frequency. A well-known example is an algorithm used to identify candidates for “high risk care management” programs that routinely failed to refer racial minorities for these beneficial services. Some algorithms deliberately adjust for race in ways that hurt minority patients. For example, such algorithms have regularly underestimated African Americans’ risks of kidney stones, death from heart failure, and other medical problems.

The Article argues that algorithmic discrimination in medicine can violate civil rights laws such as Title VI and Section 1557 of the Affordable Care Act when it exacerbates health disparities or perpetuates inequities. It urges that algorithmic fairness constitute a key element in designing, validating, and implementing AI and that both legal and technical tools be deployed to promote fairness. To that end, we call for the reintroduction of the disparate impact theory as a robust litigation tool in the health-care arena and for the passage of an algorithmic accountability act. We also detail technical measures that AI developers and users should implement.

Keywords: artificial intelligence, discrimination, algorithmic fairness, Section 1557, algorithmic bias, disparate impact, health disparities, Title VI, algorithm, and health care

JEL Classification: K32

Suggested Citation

Hoffman, Sharona and Podgurski, Andy, Artificial Intelligence and Discrimination in Health Care (2020). 19(3) Yale Journal of Health Policy, Law, and Ethics 1 (2020), Case Legal Studies Research Paper No. 2020-29, Available at SSRN:

Sharona Hoffman (Contact Author)

Case Western Reserve University School of Law ( email )

11075 East Boulevard
Cleveland, OH 44106-7148
United States
216-368-3860 (Phone)


Andy Podgurski

Case Western Reserve University ( email )

10900 Euclid Ave.
Cleveland, OH 44106
United States

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