Stop AI Medicare Death Panels

In June, the Center for Medicare and Medicaid Services (CMS) announced it was creating a pilot program, dubbed the “Wasteful and Inappropriate Service Reduction” (WISeR) model, which will use artificial intelligence (AI) to determine if prescribed medical procedures are eligible for Medicare coverage. The program, which is slated to begin in January of 2026 in six states, eliminates one of the key benefits of original Medicare in favor of adopting a prior authorization process. Prior authorization is one of the most unpopular practices of private insurers and Medicare Advantage plans and often leads to delays or denial of necessary medical care.

The federal government plans to hire private AI companies to determine whether patients would be covered for certain procedures. These AI companies would have a considerable financial incentive to deny claims, as Medicare plans to pay them a share of the savings generated from rejections, creating an obvious conflict of interest. People enrolled in original Medicare (also known as traditional Medicare) who reside in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington state will be included in this pilot program, with no option to opt out. Original Medicare recipients in these states will likely face delay or denial of essential treatments that once required no prior approval.

An American Medical Association survey of physicians found that prior authorization can cause delays in care and abandonment of treatment and called it “one of the most burdensome and disruptive administrative requirements they face in providing quality care to patients.” Allowing computer algorithms to determine the need for care is a dangerous path for Medicare to take and will likely lead to worsened health outcomes. Demand your representatives push for the cancellation of the WISeR pilot program to ensure quality healthcare to Medicare recipients.