AI prior authorization program in Medicare led to delayed care in Ohio, CMS records show

Some Ohioans enrolled in Medicare were left waiting months for needed medical care due to issues within a federal pilot program that uses artificial intelligence to help decide what care to approve or deny, according to records from the Centers for Medicare and Medicaid Services (Source: “AI Medicare program delayed medical care for Ohioans, records show,” Columbus Dispatch, Oct. 22).
 
Records from a Freedom of Information Act lawsuit brought against CMS show that Ohio and five other states saw myriad issues in the first months of the Wasteful and Inappropriate Services Reduction (WISeR) model. The pilot program launched in January 2026, just six months after it was announced.
 
The program requires doctors to seek prior authorization for services considered by federal officials to be vulnerable for fraud, waste and abuse in the Medicare system. But over 1,000 pages of documents from the Electronic Frontier Foundation detail issues like patients left in pain due to months-long delays in care, thousands of questionably denied claims and one program pushed to go live before it was ready.
 
Physicians and provider organizations have criticized the program for a rushed implementation, inappropriate denials of care and the hurdles prior authorization can create for providers.