Trump admin using AI to deny medical care for seniors in disastrous experiment

A new Medicare pilot called WISeR uses AI-driven prior authorization to approve or deny a dozen procedures for seniors - things like epidural steroid injections, nerve stimulation, certain spine fusions, skin substitutes, and incontinence treatments - but its rushed rollout produced widespread technical failures, long delays, and puzzling denials that harmed patients. Federal documents obtained by advocacy groups show vendors struggled from the start: one temporarily auto-approved requests to avoid backlogs, another misclassified Part A vs. Part B claims for months, and a third denied more than half of requests in a week-long report (3,233 denials out of 6,096 reviews). Decisions that were supposed to arrive in 72 hours sometimes took weeks or months, with at least one case pending 83 days; providers reported surgeries postponed and patients left in severe pain. The Government Accountability Office found proper procedures weren’t followed in setting up WISeR, and critics say the program lacks adequate vendor support and accountability.

The design creates perverse financial incentives: CMS planning documents reveal contractors receive a share of “averted expenditures,” with guidance describing a 25% payment based on regional benchmark costs for each denied request, which the CMS Office of the Actuary warned will encourage maximum denials. Officials defending the program point to corrective action plans and an aggregate quality score with penalties, but lawmakers and providers say penalties appear weak, oversight has been limited, and expansion plans through 2031 risk scaling a privatized, profit-driven model that has already delayed care and caused patient suffering.