STAT+: Medicare’s AI prior authorization pilot was rushed and full of problems, new documents reveal

More than a thousand pages of recently released documents and data indicate that the rollout of a Medicare program using artificial intelligence to approve or deny care was hasty and error-ridden. The pilot, called the Wasteful and Inappropriate Service Reduction model, or WISeR, launched in January and requires health care providers to seek approvals before providing certain procedures and products, such as skin substitutes and epidural injections for pain management.

The experiment operates in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington and is scheduled to run until 2031. The documents were obtained by the Electronic Frontier Foundation through a Freedom of Information Act lawsuit.

Among the issues documented, one WISeR vendor warned the Centers for Medicare and Medicaid Services that it was unrealistic to expect a working product by the time the federal agency wanted to launch the program. The disclosure raises concerns about the reliability and oversight of AI-based prior authorization in Medicare.