A new Medicare pilot program, the Wasteful and Inappropriate Service Reduction (WISeR) Model, is set to launch next year in Arizona, Ohio, Oklahoma, Texas, New Jersey, and Washington. The model, designed in theory to cut down on “fraud” and “unnecessary” services, would introduce AI-powered Prior Authorization requirements for about a dozen procedures into Traditional Medicare. What the model would likely do – as has been the case with Prior Authorization in Medicare Advantage – is complicate, delay and even outright deny necessary care.
In a recent article on Cleveland.com CMA Founder & Senior Advisor Judy Stein said that the program “creates a barrier between what physicians and other healthcare providers order… and what can be provided based on algorithms.” Adding prior authorization requirements to traditional Medicare will create costly problems and barriers to necessary care. Instead, to truly address waste and abuse in Medicare, CMS should look to the dramatic overpayments and unreasonable denials in Medicare Advantage.
September 18, 2025 – M. Shepard