New Records Obtained by EFF Expose More Problems with Medicare’s AI Experiment
New records obtained by EFF expose additional issues with Medicare’s AI-driven prior authorization program and show why we need stronger legal limits around government use of automated decision-making . EFF sued the government back in March for information about the Wasteful and Inappropriate Service Reduction (WISeR) model , a new Medicare program that uses AI to evaluate prior authorization…
New records obtained by the Electronic Frontier Foundation (EFF) reveal further complications with Medicare's AI-powered prior authorization process called WISeR (Wasteful and Inappropriate Service Reduction). The EFF, which previously sued the government to obtain information about the program, has now released over 800 new pages of documents detailing the issues surrounding WISeR's implementation.
The rollout of WISeR was described as "extremely condensed" by former officials, and the documents suggest that this rushed process led to numerous operational failures. Requests for information from the Centers for Medicare & Medicaid Services (CMS) to vendors, as well as vendor responses, show delays, technical failures, and inadequate communication with healthcare providers.
One vendor, Virtix, was prompted by CMS to provide information regarding excessive determination turnaround times, inaccurate denials, and poor customer service. Zyter, another vendor, received complaints about timely determination letters and a potential lack of processes for handling provider concerns. Innovaccer faced a Performance Notice of Non-Compliance due to its failure to implement a fully functional portal for WISeR providers.
These problems suggest that the AI-driven system was not adequately tested before being rushed into deployment. While vendors' responses contain some fixes, they cannot erase the harm that patients and providers experienced during WISeR's hasty rollout. The EFF emphasizes the need for more transparency regarding safeguards against inappropriate AI-driven denials, particularly because vendors stand to benefit from denying claims.
Critics, including the EFF, have long argued against AI's role in consequential decisions that impact people's rights or access to benefits. In this case, outsourcing decision-making to private AI companies without sufficient transparency and legal limits endangers seniors' access to medical care. Congress should consider imposing stricter legal limits on the use of automated decision-making in Medicare.
Written by urgent.news from EFF Deeplinks's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
