Newly released records show Medicare’s WISeR program used AI-assisted prior authorization in six states and was linked to delayed responses, improper denials, and reports of patient harm. EFF obtained about 1,000 pages from the Centers for Medicare & Medicaid Services through a Freedom of Information Act lawsuit, including vendor contracts, internal status reports, and provider complaints. The records say some requests missed CMS’s 72-hour target, with one reportedly unanswered for 83 days, and confirm vendors were paid for denied requests unless the denial was overturned on appeal.
Why it matters: This matters to Medicare patients and healthcare providers because an opaque government AI system appears to have delayed or blocked medically necessary care. It also raises immediate accountability and oversight questions for CMS and its contractors, especially around bias testing, human review, and financial incentives to deny treatment.
Lena Cohen
2026.09.08
100% relevant
This article establishes the story by introducing newly disclosed government records that concretely document harms, delays, vendor incentives, and oversight gaps in the WISeR Medicare AI prior-authorization experiment.
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