New Records Reveal Problems with Medicare’s AI Prior Authorization Experiment

EFF sued the government back in March for information about the Wasteful and Inappropriate Service Reduction (WISeR) model, a new Medicare program that uses AI to evaluate prior authorization requests for certain medical services. Today, we’re releasing approximately 1,000 pages of records obtained from the Centers for Medicare & Medicaid Services (CMS) through this litigation, including contracts with tech companies, internal status reports and providers’ complaints about the program. The documents (available here) show that WISeR has resulted in widespread delays and denials of care, operational chaos, and reports of patient harm.

Why We Sued for Records about WISeR

EFF filed the FOIA lawsuit to gain badly needed transparency into an experimental AI program that could jeopardize Medicare beneficiaries' access to care. In January 2026, CMS launched the WISeR model, subjecting seniors in six states to AI-driven prior authorization decisions. Medical providers must now request permission before delivering certain medical treatments if they want assurance that Medicare will cover them. Private companies contracted by CMS evaluate the requests using AI. In the absence of rigorous safeguards, AI-driven prior authorization determinations can lead to unwarranted—and even discriminatory—delays or denials of necessary medical care. 

Little is known about the AI systems that WISeR vendors are using to process prior authorization requests. Although CMS says that a qualified human clinician must review all denials, research has shown that AI-generated recommendations often influence human decisions. And the design of the WISeR program creates a financial incentive for vendors to deny care, since they are paid for averted expenditures. Just months after the program launched, medical providers reported improper denials, administrative friction, and lengthy delays that have left patients waiting in pain.

EFF’s FOIA request sought records pertaining to the CMS contracts with WISeR software vendors; any tests for accuracy, bias, or hallucinations in vendors' technology; and any audits, monitoring, or evaluation of WISeR and participating vendors.

CMS Documents Highlight Issues with the WISeR Model

CMS records obtained by EFF echo issues that medical providers, patient advocates, and lawmakers have warned about since WISeR began. This includes long wait times, rampant technical failures, inappropriate denials, and harm to patients.

Delayed Responses to Prior Authorization Requests

CMS publicly states that WISeR vendors should respond to prior authorization requests within 72 hours, but records received by EFF show widespread delays. Internal status reports from the first few months of the program show that WISeR vendors failed to respond within 72 hours for a significant number of requests. One status report cites a prior authorization request that went unanswered for 83 days ("WISeR FOIA Response - Combined Records," page 234). These delayed responses can have serious consequences for patients. Medical providers reported that WISeR has delayed medically necessary care and left patients in pain as they waited for approvals.

Timeliness data for two WISeR vendors in January 2026 show that a significant number of requests did not receive a response within 72 hours (WISeR FOIA Response - Combined Records, page 410)

Payment Methodology Provides Financial Incentive to Deny Care