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CMS's WISeR pilot uses AI for prior auth in 6 states. Critics fear care denials, but Humata Health CEO Jeremy Friese clarifies their AI only flags "yes" with licensed clinicians making any final "no" decisions.
January 26, 2026
Lawmakers and Medicare rights groups say the Trump administration is withholding details of a pilot program that will use artificial intelligence to decide whether Medicare will pre-approve coverage for a limited group of procedures, a move they warn could lead to an increased risk of coverage denials.
The Centers for Medicare & Medicaid Services on Jan. 1 quietly launched its Wasteful and Inappropriate Service Reduction (WISeR) model, a six-year trial that will see AI algorithms determine the medical necessity of procedures ranging from skin substitutes to diagnostic knee surgeries that the agency believes pose a high risk for fraud, waste, and abuse.
The prior authorization pilot, which will run through 2031, is rolling out across Texas, New Jersey, Oklahoma, Ohio, Washington, and Arizona, and could affect nearly 6.5 million patients on traditional Medicare. Under the new trial, services that the Centers for Medicare & Medicaid Services have determined to lack “little to no clinical benefit” would see coverage reviewed in advance by six artificial intelligence contractors.
Read more on Bloomberg Law here.
