EFF Criticizes US Government's Use of AI For Evaluating Senior Health Insurance Requests

The Electronic Frontier Foundation (EFF) has criticized the U.S. government's use of AI to evaluate senior health insurance requests through Medicare. The government launched a program called WISeR, which uses AI to review authorization requests for certain procedures. However, the EFF discovered that WISeR has led to widespread delays and denials of care, operational chaos, and reports of patient harm.

The records revealed a rushed rollout and operational issues, highlighting the dangers of treating AI as a solution for complex problems. The EFF has published hundreds of pages of documents obtained through a lawsuit, emphasizing the need for transparency about safeguards against inappropriate AI-driven denials. The organization has previously argued against the use of AI in consequential government decisions, such as immigration and policing, due to the risk of violating people's rights or providing biased decisions without proper due process or accountability.

The new documents obtained by the EFF raise concerns about the lack of transparency, testing, and legal limits surrounding the use of automated decision-making in Medicare. The government's payment structure incentivizes vendors to deny as many claims as possible, and some vendors denied more requests than they approved in the early stages of the program.

The records also show that clinical reviewers spent minimal time on each case and were pressured to accept AI recommendations. These findings highlight the potential for consequential mistakes and the need for stronger legal limits to protect seniors' access to medical care.