Trump rolls out AI to deny Medicare care

In January, the Trump administration launched WISeR, a pilot program using artificial intelligence to require prior authorization for certain Medicare services in six states. This marks the first time Medicare has required doctors to get pre-approval for these procedures.

Early reports reveal widespread problems

Within weeks, media outlets documented technical failures, long delays in decisions, puzzling denials, frustrated doctors, and patients suffering in pain. Healthcare providers called the program "a disgrace to the human race."

“a disgrace to the human race”

Federal documents confirm the chaos

The Electronic Frontier Foundation released federal documents about WISeR obtained through litigation, including feedback from healthcare providers describing patients crying in pain while waiting for care decisions.

Government accountability office questions legality

The Government Accountability Office determined in May that Trump officials did not follow proper procedure in setting up WISeR, calling its legality into question. The program continues expanding despite these concerns.

Congress blocked from getting answers

Rep. Suzan DelBene called a committee vote to force the Trump administration to release more WISeR documents, but Republicans voted the effort down, preventing lawmakers from investigating further.

WISeR targets a dozen medical services

The program requires prior authorization for nerve stimulation, epidural steroid injections, cervical fusions, skin substitutes for wounds, and treatments for incontinence and impotence. It launched in six states and runs until the end of 2031.

Vendors unprepared for rollout

Vendor Innovaccer was so unprepared it asked the government to delay the rollout. When refused, it set up its system to automatically approve all requests temporarily to avoid creating a backlog.

Vendor Zyter confused Medicare parts

Zyter had data discrepancies for months because it apparently did not understand the difference between Medicare Part A, which covers inpatient hospital care, and Part B, which covers outpatient services.

Virtix denies more than it approves

Vendor Virtix reviewed 6,096 prior authorization requests and approved only 2,863 while denying 3,233, a 53 percent denial rate. The company was later placed on a corrective action plan for missing the 72-hour decision deadline.

Decisions take weeks or months

WISeR is supposed to provide authorization decisions within 72 hours, but many have taken weeks or months. At least one request was still pending after 83 days, and one provider reported a surgery pushed back almost two months due to zero communication.

Providers describe patients crying in pain

An Ohio provider reported watching three patients cry at bedside while waiting for prior authorization for kyphoplasty surgery to treat spine compression fractures. They could not reach anyone at Innovaccer for weeks.

“I HAVE HAD TO WATCH 3 PATIENTS CRY AT BEDSIDE FOR NOT HEARING BACK ON THEIR PRIOR AUTH”

Contractors profit from denying care

CMS documents reveal that companies implementing WISeR are financially rewarded for denying requests. For every denied request, CMS pays the contractor 25 percent of the regional benchmark cost for that care.

Contractors have incentive to deny claims

The CMS Office of the Actuary stated bluntly in a memo that "model participants will have an incentive to deny as many claims as possible." In the first three months of 2026, the Washington state contractor denied more requests than it approved.

“model participants will have an incentive to deny as many claims as possible”

Penalties for wrongful denials are tiny

Companies earning a quality score between 100 and 85 percent get paid all 25 percent of denied claim costs. Those scoring 60 to 84 percent lose only 5 percent of profits. Even failing companies get 90 percent of their denial profits.

Few patients appeal wrongful denials

While 80 percent of appeals result in denials being overturned, only 11.5 percent of Medicaid Advantage denials are appealed. This means contractors keep most profits from wrongful denials because patients rarely challenge them.

Administration plans major expansion

CMS documents show plans to expand WISeR from its current services to cancer treatments, air ambulance transport, advanced imaging like MRIs, cardiac catheterization, pacemakers, and genetic testing.

Senator vows to stop oncology expansion

Sen. Patty Murray said she already knows CMS is planning to expand WISeR to oncology and vowed to do everything she can to stop it. Hospitals in her state report the situation has not improved since the January rollout.

“I am going to do everything I can to stop this. It is really hurting patients.”