Medicare AI Prior Authorization Pilot Causes Care Delays and Patient Harm
Medicare's new WISeR pilot program began using AI-assisted prior authorization reviews in six states in January 2026, but has reportedly caused significant delays in patient care and increased administrative burdens for both patients and providers. Patients are waiting three weeks instead of days for approvals, and procedures that once took two weeks now take four to eight weeks, forcing patients to reschedule and prolonging pain.
What happened
In January 2026, the Centers for Medicare and Medicaid Services launched a six-year pilot program called the Wasteful and Inappropriate Service Reduction (WISeR) model in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington), affecting roughly 6.4 million traditional Medicare beneficiaries. The program uses AI-assisted prior authorization reviews for procedures including epidural steroid injections, treatments for spinal stenosis and knee osteoarthritis, and nerve stimulation for conditions such as tremors and Parkinson's disease.
CMS contracts with private companies to use 'enhanced technologies, including artificial intelligence,' to conduct the reviews. Traditional Medicare previously did not require prior authorization, unlike Medicare Advantage.
Reported impact
In Washington state, patients are waiting up to three weeks instead of days for authorization decisions, and procedures that typically took two weeks before WISeR now take four to eight weeks, according to Sen. Maria Cantwell. This forces patients to reschedule care multiple times, prolonging pain and allowing underlying conditions to worsen.
Patients like Bill Curry, a 65-year-old in Oklahoma, experienced unexpected preapproval requirements for routine epidural procedures, leading to additional travel and clinic visits. The Center for Medicare Advocacy reported the pilot is frustrating both beneficiaries and providers in every state.
Index analysis
The program was designed to reduce fraud, waste, and abuse in traditional Medicare, but critics contend it is creating the same delays and denials that have frustrated Medicare Advantage enrollees for years. Health and Human Services Secretary Robert F. Kennedy Jr. acknowledged at a Senate Finance Committee hearing in April that there were 'probably kinks in the system.'
Governance controls
CMS administrator Mehmet Oz stated the aim of WISeR is to slash fraud, waste, and abuse and root out waste in Original Medicare. The program operates under a six-year pilot structure in designated states.
Classification
Sources and evidence
This record was researched and written by the Index, based on the following original reporting.