A Medicare pilot that uses AI to approve or deny care was supposed to run smoothly, and internal records released through litigation show a different program.
The Electronic Frontier Foundation obtained the documents, published this month, covering WISeR, short for Wasteful and Inappropriate Service Reduction. The model began in January across New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington, and requires prior authorization for about a dozen services that previously needed none. It is scheduled to run through 2031.
The roll-out was rushed and the software was not ready. One vendor, Innovaccer, asked the government to delay and then set its system to auto-approve every request so it would not create a backlog. Another, Zyter, spent months producing inconsistent data because it had confused Medicare Part A with Part B. A third, Virtix, denied 53 percent of the 6,096 requests it reviewed in a single March week.
Timing slipped badly against the advertised 72-hour window. One request was still pending after 83 days, and a provider said a surgery was pushed back nearly two months. Federal regulators put Virtix on a corrective action plan in June. The company says its turnaround now sits near 1.2 days.
Congress has not let the matter rest. A House committee vote sought more documents last week, and Republicans blocked it.
