FOIA Records Show Medicare's AI Prior-Authorization Pilot Left Patients Waiting, One Request Sat 83 Days

Medicare's push to use artificial intelligence to screen prior authorization requests has produced exactly what critics warned about: delays, denials, and patients stuck waiting for care, according to roughly 1,000 pages of records the Electronic Frontier Foundation obtained from the Centers for Medicare & Medicaid Services through a Freedom of Information Act lawsuit.

The Wasteful and Inappropriate Service Reduction model, known as WISeR, launched in January 2026 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. CMS designed it to target 13 medical services the agency flagged as vulnerable to fraud, waste or abuse, including nerve stimulators and steroid injections for pain management, according to Medscape.

CMS contracts with private technology vendors, one per state, to review the requests. The vendors use AI tools alongside human clinicians to decide whether a procedure meets Medicare coverage rules. CMS says a qualified clinician must review every denial before it's final.

The 72-Hour Promise That Wasn't

CMS publicly states vendors should respond to prior authorization requests within 72 hours. The records EFF obtained show something different. Internal status reports from the program's early months show vendors missed that window on a significant number of requests, and one request went unanswered for 83 days, according to both EFF and Medscape, which cite the same internal document.

"The problem isn't just the algorithm. Medicare inserted AI into prior authorization before parts of the technology and the surrounding process were fully tested and working together," Michael Ryan, founder of MichaelRyanMoney.com, told Newsweek. "When a request that is supposed to take 72 hours can sit unanswered for weeks, that is no longer administrative efficiency. For the beneficiary, it is delayed treatment."

Kevin Thompson, CEO of 9i Capital Group and host of the 9innings podcast, told Newsweek the incentive structure explains the outcome. "If you show me the incentive, I'll show you the outcome, and that is what you are seeing here: increased denials and longer prior authorization timelines," Thompson said.

A Vendor Warned CMS Before Launch

The most damning document in the release, according to Medscape, is a December 12, 2025 letter from Innovaccer, the vendor assigned to Ohio. Innovaccer told CMS its system lacked full functionality and hadn't undergone sufficient end-to-end testing, warning this "increases the potential for provider abrasion and disruption to beneficiary services."

Innovaccer said it would temporarily auto-affirm all prior authorization requests while finishing the buildout, and expected full capability within 60 days of going live, calling that the "only path available that avoids creating a backlog." But EFF says documents show some features remained unfinished or untested as of April, months after the program started, meaning the stopgap ran longer than promised.

The Financial Incentive Question

EFF's writeup raises a structural concern: WISeR vendors are paid based on averted expenditures, meaning they get compensated for denials, not approvals. EFF argues this creates a built-in incentive to deny care, and says research shows AI-generated recommendations often shape the human clinicians who are supposed to be an independent check. This is EFF's characterization of the incentive structure. CMS did not respond to Medscape's request for comment on the program, and Newsweek said it reached out to CMS as well without noting a response.

The Case for the Program

A fair reading has to acknowledge what CMS is actually trying to do. Medicare fraud and wasteful spending on procedures like nerve stimulators and unnecessary steroid injections cost taxpayers real money every year, and prior authorization reviews are a standard tool insurers already use to catch that. A pilot limited to six states and 13 services, with a human clinician required to sign off on every denial, is a narrower and more cautious rollout than a blanket AI mandate would be. Early operational bugs in any new government IT system aren't automatically evidence of bad faith.

The problem the records expose isn't the goal, it's the execution. CMS moved forward with a January launch date after at least one contractor told the agency in writing that its system wasn't ready. That's not a hypothetical risk EFF is speculating about. It's the vendor's own words, in a letter CMS received five weeks before go-live.

CMS's program page describes WISeR as voluntary, but Medscape notes providers in participating states can't simply skip it. They either seek prior authorization through the AI-reviewed system or deliver the service anyway and face a post-service, prepayment medical review instead. Either path runs through the same government process the records say wasn't ready on day one.

EFF's FOIA lawsuit against CMS remains the mechanism forcing this information into public view. CMS has not said whether it will pause the program, extend Innovaccer's auto-affirm stopgap in Ohio, or run an independent audit of vendor accuracy and bias, the kind of testing EFF's original records request specifically sought and says it still hasn't fully received.