# US Medicare Tests AI to Review Care

> AI system may deny medical coverage for older Americans under Medicare trial.
- Title: US Medicare Tests AI to Review Care · Financialexpress
- Summary: AI system may deny medical coverage for older Americans under Medicare trial. US Medicare's AI trial could delay or deny care for 1.1 million beneficiaries…
- Keywords: us medicare, wasteful and inappropriate service reduc, cms, original medicare, skin substitutes, knee arthroscopy, medicare part b, eff, prior authorization, denial rates, medicare appeals, Medicare
- Source: Financialexpress — https://financialexpress.com/world-news/us-news/us-medicare-is-testing-ai-to-review-care-what-happens-when-algorithm-decides-coverage/4352919
- Author: Dimple Singh
- Published: 2026-10-03T10:59:03+00:00
- Read time: 2 min
- Topics: us medicare, ai, wasteful and inappropriate service reduc, cms, original medicare, skin substitutes, knee arthroscopy, medicare part b, eff, prior authorization, denial rates, medicare appeals
## US Medicare launches AI trial
The US government started a major experiment with artificial intelligence in Medicare on January 1, 2026.
## WISeR covers six states
The six-year programme covers Original Medicare beneficiaries in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
## WISeR targets specific services
The model covers skin substitutes, electrical nerve stimulator implants and knee arthroscopy for knee osteoarthritis.
## AI-assisted review process
Providers submit prior-authorization requests before services or undergo post-service pre-payment review using AI and machine learning.
## Human oversight required
AI does not make final non-payment decisions; recommendations must come from licensed clinicians using evidence-based procedures.
## CMS selects six vendors
Cohere Health - Texas, Genzeon - New Jersey, Humata Health - Oklahoma, Innovaccer - Ohio, Virtix Health - Washington, Zyter - Arizona.
## Skin substitutes cost $10.3bn
Skin substitutes accounted for $10.3 billion, or 83%, of spending on services covered by WISeR in 2024.
## Spending on skin substitutes rose
Average spending per skin substitute service increased from $2,300 in 2019 to $21,200 in 2024, an 820% increase.
## 1.1 million beneficiaries affected
About 1.1 million traditional Medicare beneficiaries nationwide received at least one WISeR service in 2024.
## EFF reports delays
EFF found cases taking 83 days for decisions and providers reporting patients 'crying in pain' while waiting.
## High denial rates
Two WISeR vendors denied 5,944 prior-authorization requests in the first three months of the programme.
## Payment structure concerns
CMS pays vendors for denied requests, but payments do not apply to denials later overturned on appeal.
## Innovaccer warned of issues
Innovaccer told CMS it had not had enough time for full end-to-end testing with providers before launch.
## What happens next?
The programme runs through 2031 and could expand to additional services and states if it reduces waste without creating access problems.
## Key takeaway

US Medicare's AI trial could delay or deny care for 1.1 million beneficiaries in six states by flagging unnecessary services.