Medicare's AI-Driven Prior Authorization Pilot Faces Scrutiny Over High Denial Rates and Delays

New records released by the Electronic Frontier Foundation, obtained through a Freedom of Information Act lawsuit, reveal that the Centers for Medicare & Medicaid Services' (CMS) AI-driven prior authorization pilot, known as WISeR, has resulted in widespread care denials, significant delays, and technical failures since its launch in January. Two vendors collectively denied 5,944 prior authorization requests in the first three months, with one vendor denying more requests than it approved, necessitating a corrective action plan from CMS. Providers reported patients experiencing pain due to delayed approvals.