AI Companies Stand to Gain From Medicare Savings as Patients Fear Care Cuts
Letters made public through a lawsuit show Medicare warned AI contractors over backlogs and denials within weeks of launch.
Medicare AI-enabled review program aims to cut wasteful care costs
Medicare has expanded its list of procedures that require prior authorization, with private technology companies now handling the reviews. The program, called WISeR, is run by six contractors in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. These companies are paid based on the savings they help generate, essentially earning a share of Medicare's potential savings when claims are denied.
However, contractors have faced significant challenges, with backlogs, missing paperwork, and denial patterns raising concerns about the program's effectiveness and potential impact on patient care. Despite these issues, CMS built safeguards into the program, requiring human clinicians to review every denial and threatening to withhold payments for contractors that miss deadlines or fail to follow program guidelines.
Written by urgent.news from Newsweek's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
