New Medicare records show WISeR's rushed AI rollout delayed care and produced disputed denials.

WISeR paid vendors for rejected care, so Medicare made denial profitable and delay nearly free.

A Medicare patient waits while WISeR, Medicare’s AI prior-authorization program, routes care decisions through private vendors. Records show delays, technical failures, inaccurate denials, and weak communication. The contract made rejection profitable, paying vendors up to a quarter of a service’s typical Medicare payment while slow answers faced no comparable penalty.

• What it could changeCongress could treat automated Medicare decisions as regulated exercises of public power, requiring transparent rules, audit trails, meaningful appeals, and penalties for harmful delay.
• How it touches todayClinicians and patients can demand the record behind a denial, while CMS can tie vendor pay to timely, accurate approvals instead of rewarding rejection.
• Our futureIf contracts keep rewarding refusal, more public decisions could become private software pipelines. The question is whether automation serves patients, or merely makes rationing harder to see.

• WISeR vendors were reportedly paid up to a quarter of a service’s typical Medicare payment when a rejection stood, while approvals generated no comparable payment.thesynthesisai
• One vendor reportedly rejected more than half of its decisions in the first quarter, while speed was not included in the payment-adjusting score through September.thesynthesisai
• EFF’s records show private companies were given consequential Medicare decision-making responsibilities amid questions about testing, safeguards, transparency, and corrective action.eff +2