As outlined a prior CMA Alert (Sept. 18, 2025), a new Medicare pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) Model, launched this year in Arizona, Ohio, Oklahoma, Texas, New Jersey, and Washington. The model is designed, in theory, to cut down on “fraud” and “unnecessary” services in traditional Medicare. As a result, about a dozen procedures will now be subject to AI-powered prior authorization requirements. Prior to implementation, advocates feared that as has been the case with prior authorization in Medicare Advantage, the WISeR model would complicate, delay and even outright deny medically necessary care. The model uses outside vendors that are compensated, in part, by “savings” they help achieve for the Medicare program. In January 2026, the Center for Medicare Advocacy testified at a hearing held by the House Energy & Commerce Committee, including in support of a bill that would prohibit the WISeR model from proceeding (see CMA Alert (Jan. 15, 2026)).
Almost three months into the demonstration program, reports coming from providers and beneficiaries are not encouraging. The Washington Post’s Intelligence Report recently published an article titled “Exclusive: Medicare’s AI experiment leads to delayed care for some seniors” by Rebecca Adams (March 17, 2026). Some of the “key takeaways” from the report include:
Original Medicare’s new prior authorization program, which uses artificial intelligence to review initial requests for medical services, is causing delays for some patients and physicians. Physicians are facing challenges with the approval process, and some patients are experiencing pain as they wait for care.
Technical glitches and communication breakdowns compound the concerns. Doctors in some states report problems with online portals, as well as struggles with coordination and communication with technology firms and Medicare contractors that process claims [emphasis in original].
The report states that the rollout of the WISeR model “has caused confusion and concerns in several states” and “providers say that they have sometimes not been authorized for care that falls within coverage guidelines and that decisions in some states take longer than federal deadlines allow.”
Physicians in all six states told the Post “that the addition of AI-driven prior authorization means their patients are navigating a more complex and cumbersome system than they did a few months ago.”
Noting that providers’ experience differs because the model is run by different vendors in each of the six states, the article points out that “procedure approval rate is lower than in Medicare Advantage” and “[t]he challenges are so intense in Ohio that doctors may stop offering seniors a set of complex treatments they say flummox the AI model, leaving older patients without that treatment option.”
The WISeR model incorporates some of the most burdensome and unpopular elements of Medicare Advantage. As the report notes:
Many seniors intentionally choose to enroll in the original version of Medicare rather than the Medicare Advantage run by private plans – even though Advantage offers extra benefits such as vision care – because they want to avoid insurance hassles such as prior authorization and sticking to doctors within an insurer’s network.
Rather troublingly, the article notes that the WISeR model likely serves as a test case, and states that “federal officials have indicated it could be expanded in the future.” Based on our experiences with AI-driven prior authorization in the Medicare Advantage program, along with early experiences with the WISeR model, the Center for Medicare Advocacy is opposed to either maintaining or expanding such program.
March 26, 2026 – D. Lipschutz