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

A Trump administration pilot called WISeR (Wasteful and Inappropriate Service Reduction) began in January to use AI and contractor-run prior authorization for about a dozen Medicare-covered services - including nerve stimulation, epidural steroid injections, cervical fusions, skin substitutes, and treatments for incontinence and impotence - across six states through 2031. The rollout was rushed and technically flawed: a vendor (Innovaccer) temporarily auto-approved requests to avoid backlogs, another (Zyter) misclassified Part A vs. Part B claims for months, and a third (Virtix) denied more than half of reviewed requests in one weekly report. Authorization decisions often missed the 72-hour target, sometimes stretching to weeks or over 80 days, producing delayed surgeries and patients in acute pain. Documents obtained by the EFF and provider surveys record widespread provider frustration, lack of vendor responsiveness, and clinicians reporting patients crying at bedside while waiting for approvals.

Federal watchdogs and lawmakers have questioned WISeR’s legality and design. The GAO found procedural lapses in setup, Democratic lawmakers sought more documents and to suspend the program, and Republican opposition blocked some probes. CMS planning documents reveal a payment model that rewards contractors with a share (about 25%) of averted benchmark expenditures, creating a financial incentive to deny care despite CMS claims of penalties and oversight for inappropriate denials. Vendors tell regulators they’ve improved performance, but providers and advocates say systemic incentives and weak accountability risk privatizing Medicare decision-making and harming patients.