The Trump administration's WISeR programme is using AI to deny Medicare claims for seniors, and senators from both parties want it stopped

[AlphaOscar89]

The Centers for Medicare and Medicaid Services, under administrator Mehmet Oz, launched a programme called WISeR, short for Wasteful and Inappropriate Service Reduction, at the start of 2026, using artificial intelligence and machine learning tools to apply prior authorization requirements to a range of procedures under Traditional Medicare across six states. Procedures subjected to this new AI driven review include knee arthroscopies, nerve stimulation, steroid injections and cervical fusion surgery, with third party administrators running the AI systems reportedly financially incentivized to deny claims.

The practical impact has already shown up in wait times, with procedure completion in Washington state taking two to four times longer than before the programme began, according to critics citing the rollout's effects. The administration has defended the experiment by pointing to a rapid rise in so called skin substitute procedures, even though CMS had already separately lowered payment rates for those specific procedures, and despite skin substitute procedures actually representing less than 1 percent of the services subject to prior authorization under the model in Washington state.

Senator Kirsten Gillibrand, the top Democrat on the Senate Aging Committee, has led a push alongside 21 fellow Democratic senators to introduce a resolution ending the programme, joined by a House companion resolution from Representatives Greg Landsman and Suzan DelBene, and a 60 day Congressional Review Act window that opened to allow a formal disapproval vote. Gillibrand called using AI to delay and deny seniors' medical care immoral and unacceptable, while Senator Ron Wyden has separately criticised prior authorization more broadly as a bureaucratic hurdle designed to discourage seniors and their doctors from pursuing treatment that might affect insurer profits, citing separate data showing Medicare Advantage insurers denied over 4 million prior authorization requests in 2024 alone, of which only 1 in 10 were ever appealed, though 8 in 10 of those appeals ultimately succeeded.

Trump admin using AI to deny medical care for seniors in disastrous experimentarstechnica.com

[Electric Holly]

Skin substitute procedures making up less than 1 percent of the services actually subjected to prior authorization completely undermines the administration's own stated justification for launching this programme in the first place.

[Patrick94]

Bipartisan discomfort with this specific programme, even if the resolution itself is being led by Democrats, suggests this is not purely a partisan flashpoint, using AI to gatekeep medical care for seniors seems to cross party lines fairly easily as a concern.

[Shane]

8 in 10 successful appeals out of the small fraction of denials that even get appealed is a genuinely damning statistic, it strongly suggests a large number of the original denials should probably never have happened in the first place.

[Pat]

CMS already having lowered payment rates for skin substitute procedures before launching a whole new AI prior authorization programme aimed partly at addressing the same issue makes the administration's stated rationale look considerably weaker than it was probably intended to.

[Phoenix56]

Third party administrators being financially incentivized to deny claims is the detail that should worry people most here, that is a structural conflict of interest baked directly into how the AI system itself gets used.

[Patrick93]

Wait times running two to four times longer in Washington state alone shows this is not some abstract policy debate, that is a very real and immediate impact on seniors actually waiting for medical procedures right now