AI Program Denying Seniors Healthcare in Six States
A federal pilot program using artificial intelligence to approve or deny Medicare services has led to higher denial rates and concerns about transparency and bias.
Seniors in Texas, New Jersey, Oklahoma, Ohio, Washington, and Arizona are experiencing higher rates of denied medical care due to a federal program utilizing artificial intelligence to review Medicare requests. The program, known as the Wasteful and Inappropriate Service Reduction (WISeR), began in January 2026 and has drawn criticism and legal challenges.
A lawsuit filed against the Centers for Medicare and Medicaid Services (CMS) revealed significant issues within the program's initial months. According to the lawsuit, AI models in Texas approved care for only 62% of patients, a stark contrast to the 84% approval rate by human reviewers. This has led to delays in necessary medical treatments and services for beneficiaries.
Critics argue that relying on algorithms to make healthcare determinations can create unwarranted and potentially discriminatory delays or denials of care. The Electronic Frontier Foundation (EFF), which filed the lawsuit, is seeking transparency regarding how the AI models are used, tested for accuracy and bias, and monitored.
"Tasking an algorithm with making determinations about treatment can create unwarranted — and even discriminatory — delays or denials of necessary medical care," stated Kit Walsh, EFF's director of AI and access-to-knowledge legal projects. "Given these serious risks, the public requires transparency that it hasn’t gotten. We’re suing to get badly needed answers about how Medicare’s AI experiment works."
Further complicating matters, the lawsuit uncovered that contracted companies involved in the program have financial incentives to deny prior authorization. These vendors reportedly receive nearly 20% of the costs saved by denying services, creating a conflict of interest that may not align with patients' best interests.
Physicians and healthcare providers have reported high denial rates, treatment approval delays, technical failures, communication breakdowns, and administrative burdens since the program's inception. The government's stated goal is to reduce unnecessary medical services and curb wasteful spending, but concerns remain about the lack of information on the AI's training data and decision-making processes.
CMS has indicated it plans to release a six-month performance report on the WISeR program, which will include comparative metrics. However, an exact release date for this report has not yet been announced.