Starting Jan. 1, the Trump administration is rolling out WISeR, a pilot that hands AI algorithms a say in which Medicare services get greenlit. On paper, it’s about cutting “wasteful care.” In practice? Critics say it’s a dressed-up version of prior authorization the same delay-and-deny tactic that patients and doctors already hate.
The program will run through 2031 in six states including Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington and target procedures the government calls vulnerable to “fraud, waste, and abuse.” Think skin and tissue substitutes or nerve stimulator implants. CMS insists every denial will still get a “human clinician review,” but vendors stand to profit when less care is delivered, a setup that experts warn creates a dangerous incentive to block treatment.
Lawmakers across the aisle are pushing back, saying the plan feels half-baked and risks harming seniors who can’t afford delays in care. Even physicians who support AI in theory are questioning whether this model prioritizes patient outcomes or just Medicare’s bottom line.
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