Medicare Is Using AI for Prior Authorization; Democrats Want It to Stop
Summary
Medicare has started a new pilot program called WISeR that uses artificial intelligence (AI) to approve or deny some medical services for traditional Medicare patients. Some Democratic lawmakers want to stop the program because they worry it could delay or deny care for seniors and give companies financial reasons to cut costs over patient needs.Key Facts
- The WISeR model uses AI-assisted prior authorization to review and decide on certain medical service requests within traditional Medicare.
- The program launched in 2024 and currently operates in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
- Private contractors use AI to determine if a medical service is necessary and are paid based on the money saved by denying services.
- Democrats argue that this setup may delay care, deny necessary treatments, and add bureaucratic hurdles for seniors.
- Lawmakers have introduced resolutions in Congress to repeal the WISeR program.
- Medicare’s goal with WISeR is to reduce wasteful or low-value medical services and lower overall healthcare costs.
- Critics fear AI could override doctors’ judgments and prioritize saving money over patient health.
- The pilot program is planned to run until 2031 unless stopped by lawmakers.
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