Trump admin using AI to deny medical care for seniors in disastrous experiment

The Department of Health and Human Services under the Trump administration began a pilot in January that uses artificial intelligence and machine-learning systems to require prior authorization for a select set of Medicare services. The program, named WISeR (Wasteful and Inappropriate Service Reduction), is active in six states and is intended to run through 2031. Officials describe the initiative as a way to ensure appropriate Medicare payments and reduce fraud, waste and abuse.

Public reporting and a tranche of documents obtained and released by the Electronic Frontier Foundation describe significant implementation problems. Vendors and providers reported technical issues, decision delays and process errors; one provider quoted in the documents called the program “a disgrace to the human race” and reported patients waiting in pain. The Government Accountability Office concluded in May that agency officials did not follow proper procedures in establishing the program, raising questions about its legality.

Multiple contracted vendors encountered setbacks. Innovaccer asked for a postponed rollout and temporarily configured its system to auto-approve requests to avoid backlogs. Zyter experienced data-mapping errors for months tied to confusion between Medicare Part A and Part B claims but says it is now functioning across both claim types. Virtix’s March 30 weekly report showed it reviewed 6,096 prior authorization requests, approving 2,863 and denying 3,233 (53 percent). The EFF documents also show some authorization decisions took far longer than the intended 72-hour window, with at least one request still pending after 83 days.

Lawmakers and advocates have sought more transparency and oversight. Representative Suzan DelBene called a committee vote attempting to force the administration to release additional WISeR documents; that effort was blocked by Republicans. CMS placed Virtix on a Corrective Action Plan for noncompliance with the 72-hour standard; Virtix told Ars Technica the CAP ended August 14 and said it had reduced average turnaround times to about 1.18 days. CMS and HHS did not provide immediate comment to Ars Technica for the reporting.

Providers and patient advocates have described care disruptions, including delayed surgeries and prolonged pain as teams waited for authorizations. Federal documents and media accounts portray a rushed rollout in which some vendors signaled they were not ready, and at least one temporarily bypassed expected controls to prevent processing backlogs. Administrators plan to expand the model over coming years despite the reported problems and legal and oversight challenges.