Moral Dilemma Analysis Report

This Moral Dilemma Analysis Report discusses the ethical implications of implementing AI in health insurance companies. It explores the benefits and harms of using AI and its impact on employees, clients, and the public. The report also examines the violation of rights and the power dynamics involved in the decision-making process.

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Moral Dilemma Analysis report
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Table of Contents
Introduction:....................................................................................................................................2
Discussion:.......................................................................................................................................3
Harms and Benefits:........................................................................................................................3
Harms and benefits of universalized actions of Implementing AI:.................................................6
AI Used as mean to end:..................................................................................................................7
Violation of rights considered as unjust and the action taken has more power?.............................8
Conclusion:......................................................................................................................................9
References:....................................................................................................................................10

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Introduction:
Health Insurance Companies in today’s world are associated with the usage of eth
artificial intelligence along with the machine learning in the ways which were not used even five
years ago. AI has been considered to be one of the current megatrends of today’s world which is
seen to be emerging from the broader digitalization of the society as well as the economy
(Sharma et al. 2018). The private sectors have long been associated with taking interest in to the
potential inheriting of the new technologies amongst which AI is one of the most famous
technology. The Smart audit algorithms are associated with enabling of the reliable identification
of the claims which are seen to be incorrect. The usage of the AI in the health insurance
company is seen to be aimed at identification of the claims which are seen to be having the high
likelihood of successful intervention along with conversely being associated with the routing of
the unobjectionable cases and those which are unlikely to result in successful intervention
towards the fully automated background processing (Wang et al. 2017). This is done so as to
help the staffs of the administration department to effectively focus upon the capacity of the
cases which are essential need of a review.
Claims which are deemed unusual would be prioritized automatically and this is done by
considering the amount of reduction which can be expected along with the likelihood of
interventions which would be successful (Shi et al. 2016). Due to all this the system is associated
with reliving the auditors from those needs related to the making of as many time sensitive
intervention decisions, initially freeing up their capacity related to those cases where the
intervention is considered to be certain for yielding of the results or for handling the other tasks.
Followed by this the system is additionally associated with providing the auditors with the
guidance related to the approach towards the intervention for example by providing them with

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suggestions related to the grounds for rejection of the claims, the initial results are simpler along
with helping in faster management of the claiming process (Riikkinen et al. 2018). This report
would be associated with evaluation of the implementation of the artificial intelligence by the
insurance company which is seen to be associated with effecting numerous sections of the
society along with discussing the importance of this by usage of the framework of ethical
decision making.
Discussion:
Ethical decision making framework is associated with helping in the process of identifying the
ethical values related to decision which is associated with helping in the identification of the
benefits as well as the harms that are seen to be caused because of the different actions towards
the parties available like the employees, organization, public and many more in short time of 1-3
years or medium time of 5-10 years or long time of 50+ years.
Harms and Benefits:
Ethical
Framework
The
Organizatio
n associated
with selling
of products
or services
Staff Business
Clients of
the
Organizatio
n
Public The
Profession
or the
Industry
Action
Benefits?
Short Term:
Might be
capable of
delivering the
service or the
product in
time to the
clients
Short Term:
Might be
capable of
having a good
impression in
front of the
higher
management.
Medium/
Short Term:
On time
receiving of
the products.
Short Term:
The public
would not be
benefitted
from this.
Medium/
Long Term:
The demand
of industry
increases.

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Medium/
Long Term :
Production of
higher
revenue at a
lower cost by
the firm
Long Term:
Gaining the
ability of
learning more
skills at a
much faster
speed.
Harm
caused by
this action?
Medium/
Long Term :
The
productivity
of the
employees is
decreased
Short Term:
The time for
rest and
getting
involved with
the social life
is seen to be
less.
Medium/
Long Term :
Associated
with effecting
the mental as
well as
physical
conditions
Medium/
Long Term :
Possibility of
failures in the
system while
working
Short Term:
The public is
not harmed
Medium/
Long Term :
Employees
might be
associated
with leaving
the industry
Working with the artificial intelligence without thinking about the claims helps in
delivery of the best solution, but it is seen that individuals are associated with putting their best
efforts in meeting the objectives rather that meeting the client requirements (Lamberton, Brigo
and Hoy 2017). This type of situation would be helping in production of higher revenue at a
lower cost in different situations without any need of hiring extra employees. Employees in turn
would be capable of showing their dedication towards the work to the higher management
(Garvey 2018). Besides this in the long term the employees would be capable of increasing the

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skills at a speed much faster by means of working under huge pressure so as to manage the
maximum number of claims.
The clients receive their claims in time because of the hard working employees assisted
by the making the clients happy (Diwani and Sam 2013). However no such evidences exists
which show that working with the AI is dis-advantageous for the public. But the employees
working with the AI in a proper way would be provided with rewards which would make the
employees more dedicated towards their work (Bauder et al. 2016). This in turn would be
increasing the customer satisfaction. Besides this the demand in the insurance industry would
also be increasing because of the plus points which would be gaining more number of employees
towards the industry.
Considering the long term, there would be increase in productivity which in turn would
be responsible for the success of the company. The productivity of well-rested and happy
employees is seen to more that the dissatisfied employees (Fashoto et al. 2016). The reason
behind this working without the AI makes them tired initially work a lot making them not
capable of focusing upon the work. This initially makes the company face a need of appointing
an extra team so as to distribute the workload.
So it is essential for the industry to understand that the employees also requires rest in
case of projects the project managers should be actively associated with managing the timelines
actively so as to manage the employees (Ansari and Riasi 2016). Increased workload might be
associated with having a impact upon the reputation of the organization and it is also not ethical
to make the employees work for a longer time that the scheduled time.

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Less resting time and less social involvement are some of the major impacts of increased
claims. There might be a drastic fall in performance when the time management skills are
questioned while employees are working overtime in absence of the AI (Shin et al. 2012). This
would also be associated with becoming something that would be expected by the management
rather than appreciating them.
Harms and benefits of universalized actions of Implementing AI:
Ethical
Framework
The
Organization
associated
with selling
of products
or services
Staff Business
Clients of
the
Organizatio
n
Public The
Profession
or the
Industry
Benefits if
action is
universalized
?
No,
employees
may united
No,
management
may not
notice
No, will
receive their
product on
time with
defects
No benefits
for the public
None
Harm if
action is
universalized
?
Employee
management
becomes
difficult
Tracking of
the employee
working time
would
become
difficult
Occurrence
of failure of
the Major
system
Losing the of
Social
connection of
the general
public
Employees
leaving the
industry
Contradictio
n if
universalized
?
Might be
responsible
for
organization
closure
Destruction
of the social
relationships
Destruction
of the social
relationships
Destruction of
the social
relationships
Industry is
non-viable
In case when the entire population would be working overtime would make the
employees united which in turn would be making the process of managing the employees very

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complex (Faseela and Thangam 2015). In addition to this the reporting management also might
not also be finding who is not working overtime and this would be leading to numerous type of
defects. Competitiveness of the industry would increase if everyone is hard working or it can be
sated that the employees should not get rid of hard work.
Managing employees would become difficult if the AI is usage is made universalized.
Most employees working with the AI would be leading to uniting of the employees which would
be in turn making the management work in accordance to their desire. Track of the employees
would be lost and this would be leaving the employees non-rewarded (Muhammad 2014).
Besides this system failure would be responsible for harming the clients. Social involvement
such as family gathering and many more would also be reduced hence being responsible for the
losing of connection with the general public as well.
AI Used as mean to end:
Ethical
Framework
The
Organizatio
n associated
with selling
of products
or services
Staff Business
Clients of
the
Organizatio
n
Public The
Profession
or the
Industry
Used as
means to
end,
violating
their rights?
This is more
applicable for
the staffs,
clients and
public more
than the
organization.
They cannot
use
themselves as
a means to an
end
Yes, this is
used as a
means to
company’s
end, right to
freedom of
speech, do
anything to
secure the job
Yes, used as
means to
company’s
end, against
right to
receive the
best product
Yes, used as
means to
company’s
end, against
right to their
sociality
Argue right to
freedom of
speech, but
this right is
not absolute
and
applicable to
individuals
more than to
companies

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The implementation of the AI is not associated with violating the right of the organization
and the reason behind this is the action and they cannot use this by themselves as means to an
end however this might be causing the violation of the rights of the staffs, clients and the public
as well (Ngai et al. 2011). This action might be associated with leading to the violation of right
of speech. The AI would be working as per the desire of the organization. Even after being aware
of the situations they organization needs to use the AI so as to make the work done which would
be taking time. This type of action would be associated with violation the right of the business
clients in a similar way by which the violation of the rights of the clients takes place while
getting the insurance (Shin et al. 2012). The insurance amount which the clients would be getting
would not be enough. The social relationships also cannot be built under this condition as the
right to getting engaged with the clients would be harmed by means of using the AI (Kim and
Jean Kwon 2006). Besides this the industry also might argue with the right related to freedom of
speech but this type of right is not absolute and is applicable to the individuals rather the
organization itself.
Violation of rights considered as unjust and the action taken has more power?
Ethical
Framework
The
Organizatio
n associated
with selling
of products
or services
Staff Business
Clients of
the
Organizatio
n
Public The
Profession
or the
Industry
Violating
rights, seen
as unjust (to
powerless),
Does not
happen as the
usage of AI is
associated
Company is
seen to be
having more
power,
Company is
seen to be
having more
power,
Company is
seen to be
having more
power,
Does not
happen as the
usage of AI is
associated

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action taker
has more
power?
with helping
the one with
more power
to uphold
rights of less
powerful
because the
person who
would be
receiving the
insurance is
powerless in
stopping it.
because the
person who
would be
receiving the
insurance is
powerless in
stopping it.
because the
person who
would be
receiving the
insurance is
powerless in
stopping it.
with helping
the one with
more power
to uphold
rights of less
powerful
The company is seen to be having more power than the clients or the employees and the
public to the actions and in addition to this they are having the duty of upholding the rights as
well (Hassan and Abraham 2013). The organization is the one who is associated with making of
decisions like reporting of health conditions and many more. In addition this they can be one
who is associated with making of such decisions without any kind of violation of the rights of
public. The company can make use of the AI so as to make the processes become easier which
also needs to be followed by the organization strictly.
Conclusion:
Generally it is considered that the usage of the AI is associated with favoring each and
every process of the insurance of company. However there are many instances when the usage of
AI is seen to be becoming devastating. The usage of the AI is associated with making the process
of managing the insurance claims very easy. The AI would be associated with making the
processing of the claims easier along with validating them. The ACS codes of Ethics have been
associated with helping in the identification of the most important stakeholder group which is the
client of the organization or the insurance claimers. For this reason it is necessarily to be made
sure that the insurance company is more associated with focusing upon the clients rather than
focusing upon their own benefits. Usage of the AI for validating the claims might lead to many

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kind of wrong decisions and this might turn out to be a disastrous for the one who is making the
health insurance claim so it can be concluded that the usage of the AI by the health insurance
company for automating the health insurer decision to offer someone with a new health
insurance policy is not moral and for this reason the company should be associated with become
more ethical while making the decisions.

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References:
Ansari, A. and Riasi, A., 2016. Modelling and evaluating customer loyalty using neural
networks: Evidence from startup insurance companies. Future Business Journal, 2(1), pp.15-30.
Bauder, R.A., Khoshgoftaar, T.M., Richter, A. and Herland, M., 2016, November. Predicting
medical provider specialties to detect anomalous insurance claims. In 2016 IEEE 28th
international conference on tools with artificial intelligence (ICTAI) (pp. 784-790). IEEE.
Diwani, S.A. and Sam, A., 2013. Framework for Data Mining In Healthcare Information System
in Developing Countries: A Case of Tanzania. International Journal of Computational
Engineering Research, 3(10).
Faseela, V.S. and Thangam, D.P., 2015. A Review on Health Insurance Claim Fraud
Detection. International Journal of Engineering Research Science (IJOER), 1.
Fashoto, S.G., Adekoya, A., Gbadeyan, J.A., Sadiku, J.S. and Yahya, W.B., 2016.
DEVELOPMENT OF IMPROVED K-MEANS CLUSTERING TO PARTITION HEALTH
INSURANCE CLAIMS. Annals. Computer Science Series, 14(1).
Garvey, C., 2018. Interview with Colin Garvey, Rensselaer Polytechnic Institute. Artificial
Intelligence and Systems Medicine Convergence. Omics: a journal of integrative biology, 22(2),
pp.130-132.
Hassan, A.K.I. and Abraham, A., 2013. Computational intelligence models for insurance fraud
detection: a review of a decade of research. Journal of Network and Innovative
Computing, 1(2013), pp.341-347.

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Kim, H. and Jean Kwon, W., 2006. a Multi‐Line Insurance Fraud Recognition System: a
Government‐Led Approach in Korea. Risk Management and Insurance Review, 9(2), pp.131-
147.
Lamberton, C., Brigo, D. and Hoy, D., 2017. Impact of Robotics, RPA and AI on the insurance
industry: challenges and opportunities. Journal of Financial Perspectives, 4(1).
Muhammad, S.A., 2014. Fraud: the affinity of classification techniques to insurance fraud
detection. International Journal of Innovative Technology and Exploring Engineering, pp.62-66.
Ngai, E.W., Hu, Y., Wong, Y.H., Chen, Y. and Sun, X., 2011. The application of data mining
techniques in financial fraud detection: A classification framework and an academic review of
literature. Decision support systems, 50(3), pp.559-569.
Riikkinen, M., Saarijärvi, H., Sarlin, P. and Lähteenmäki, I., 2018. Using artificial intelligence to
create value in insurance. International Journal of Bank Marketing, 36(6), pp.1145-1168.
Sharma, A., Harrington, R.A., McClellan, M.B., Turakhia, M.P., Eapen, Z.J., Steinhubl, S.,
Mault, J.R., Majmudar, M.D., Roessig, L., Chandross, K.J. and Green, E.M., 2018. Using digital
health technology to better generate evidence and deliver evidence-based care. Journal of the
American College of Cardiology, 71(23), pp.2680-2690.
Shi, Y., Sun, C., Li, Q., Cui, L., Yu, H. and Miao, C., 2016, March. A fraud resilient medical
insurance claim system. In Thirtieth AAAI Conference on Artificial Intelligence.
Shin, H., Park, H., Lee, J. and Jhee, W.C., 2012. A scoring model to detect abusive billing
patterns in health insurance claims. Expert Systems with Applications, 39(8), pp.7441-7450.

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Shin, H., Park, H., Lee, J. and Jhee, W.C., 2012. A scoring model to detect abusive billing
patterns in health insurance claims. Expert Systems with Applications, 39(8), pp.7441-7450.
Wang, S.L., Pai, H.T., Wu, M.F., Wu, F. and Li, C.L., 2017. The evaluation of trustworthiness to
identify health insurance fraud in dentistry. Artificial intelligence in medicine, 75, pp.40-50.