New Records Obtained by EFF Expose More Problems with Medicare’s AI Experiment

New records obtained by EFF expose additional issues with Medicare’s AI-driven prior authorization program and show why we need stronger legal limits around government use of automated decision-making. 

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. We previously released records showing that WISeR has resulted in delays and denials of care, operational chaos, and reports of patient harm. Today, we’re publishing over 800 new pages of records, including:

• Requests for information (RFIs) or requests for corrective action plans (CAPs) sent from the Centers for Medicare & Medicaid Services (CMS) to four of the six WISeR vendors, along with the vendors’ responses.
• Applications of 66 companies to the WISeR model, including those of the 6 selected companies. 
• Task orders and contracts for the evaluation, implementation, and monitoring of the WISeR model.

Documents obtained through EFF’s lawsuit are available here.

These newly released documents show that the WISeR rollout was rushed and rocky from the start, highlighting the dangers that arise when governments treat AI like a silver bullet for complex problems. The documents also highlight the need for more transparency about safeguards against inappropriate, AI-driven denials. The public still lacks the information needed to assess whether clinician review is providing meaningful oversight of AI systems and whether appropriate data is being used to evaluate prior authorization requests. 

EFF has long argued that AI has no place in consequential government decisions about peoples’ rights or access to benefits, such as immigration enforcement and policing decisions. That’s because using automated decision-making in these contexts risks decisions that violate people’s rights or deprive them of benefits they’re entitled to based on biased or inappropriate considerations and without proper due process or accountability if there is an error. 

By outsourcing decision-making to private AI companies without sufficient transparency, testing, or legal limits, WISeR jeopardizes seniors’ access to medical care. Congress should step in to place greater legal limits on the use of automated decision-making in Medicare. 

WISeR’s Rollout Was Rushed and Rocky 

CMS launched the WISeR program just six months after announcing it, ignoring calls from medical providers to delay its rollout. In records previously released by EFF, CMS acknowledged this “extremely condensed timeline.” 

New records suggest that WISeR’s unusually rapid rollout contributed to widespread problems in the first few months of the program. CMS did not disclose the extent of these issues to the public, even as agency employees privately contacted vendors about potential noncompliance with program requirements. 

In the first three months of the program, CMS sent RFIs or requests for CAPs to at least four of the six WISeR vendors. These requests, which describe delays, technical failures, and a lack of communication with providers, suggest that widespread problems during the program’s rollout were not limited to one vendor or state. 

These letters underscore the severity of the problems with the program. For example