Summary
Starting January 1, six U.S. states will begin using artificial intelligence (AI) for some Medicare coverage decisions. This new program aims to reduce waste and fraud but has raised concerns about potentially increasing the number of denials for treatments. The pilot program will affect traditional Medicare recipients in Washington, Arizona, Ohio, Oklahoma, New Jersey, and Texas.
Key Facts
- AI will be used in Medicare coverage decisions in six states: Washington, Arizona, Ohio, Oklahoma, New Jersey, and Texas.
- The program is called Wasteful and Inappropriate Service Reduction (WISeR).
- The goal is to reduce fraud and waste by using AI for prior authorization of certain outpatient procedures.
- There are concerns that the program could increase the number of denied claims and lead to longer wait times.
- Medicare has traditionally not required prior authorization, unlike its privatized version, Medicare Advantage.
- Procedures affected include nerve stimulation, steroid injections, and certain surgeries.
- AI companies involved may earn money based on cost savings from denied claims, raising concerns about their motivation.
- Medicare beneficiaries may face challenges transitioning to this new prior authorization process.
