A controversial new Medicare pilot program will introduce AI-driven prior authorization, with contractors paid to disclaim claims. Beginning January 2026, the Wasteful and Inappropriate Companies Discount (WISeR) mannequin would require suppliers in six states to acquire pre-approval for sure companies, utilizing AI to display screen requests.
Critics warn that this mix of economic incentives and opaque know-how may result in unfair denials. As Morgan Lewis, a worldwide legislation agency, notes: “Whereas its position can be to make sure compliance, the WISeR Mannequin provides a layer of oversight that will complicate the billing course of for a lot of healthcare professionals and creates danger that contractors will act as modern-day bounty hunters.”
CMS argues that the mannequin will scale back wasteful spending and consists of safeguards to stop incentives to disclaim companies. Nonetheless, critics argue that it may introduce issues much like these in Medicare Benefit, the place excessive charges of overturned denials reveal inappropriate care restrictions.
Over 40 members of Congress have urged the Facilities for Medicare & Medicaid Companies, headed by Dr. Mehmet Oz, to halt this system. Consultant Alexandria Ocasio-Cortez warned it “opens the door to additional erosion of our Medicare system.”
Beforehand:
• ‘We are going to discover you: How a flawed algorithm terrorized welfare recipients
