Thirty-one House Democrats sent a letter to CMS Administrator Dr. Mehmet Oz on June 24, 2026, demanding more transparency regarding the Wasteful and Inappropriate Service Reduction (WISeR) pilot program. This initiative, which incorporates AI-backed prior authorization for specific Medicare services such as skin substitutes and epidural steroid injections, is currently active in six states and scheduled to operate through 2031. Lawmakers contend the program causes care delays and adds administrative burdens for providers.

The letter specifically requests data on the time required for technology vendors to reach determinations and the frequency of request approvals, denials, and beneficiary appeals. While the CMS previously stated that prior authorization determinations would range from one to three days, lawmakers argue this timeframe excludes the duration between the vendor decision and the actual receipt of a tracking number by a physician. The signatories, including Reps. Ami Bera (D-Calif.) and Alexandria Ocasio-Cortez (D-N.Y.), also seek information on the top reasons for request dismissals and the average time from initial submission to final claim payment.

Furthermore, the inquiry seeks details on the oversight of peer-to-peer review, including wait times for clinical assessments after treatment denials and the number of overturned decisions. The letter asks for explicit metrics on how the CMS evaluates vendor success and the criteria for removing participants from the program. According to Rep. Suzan DelBene (D-Wash.), the firm Virtix, which handles claims in Washington, has already been ordered to submit a corrective action plan for failing to meet the pilot's 72-hour review requirement. While Virtix has denied receiving such an order, a CMS spokesperson affirmed the agency audits participants to ensure accountability against established performance metrics.

This push for data follows previous congressional efforts to challenge the WISeR model. Earlier this month, a House committee unanimously voted to include an amendment in the 2027 HHS spending legislation that would block funding for the pilot. Democrats in both the House and Senate have introduced resolutions this spring aimed at rolling back the program entirely, citing concerns that it was implemented without proper vetting or sufficient patient safeguards.

Thirty-one House Democrats sent a letter to CMS Administrator Dr. Mehmet Oz on June 24, 2026, demanding more transparency regarding the Wasteful and Inappropriate Service Reduction (WISeR) pilot program. This initiative, which incorporates AI-backed prior authorization for specific Medicare services such as skin substitutes and epidural steroid injections, is currently active in six states and scheduled to operate through 2031. Lawmakers contend the program causes care delays and adds administrative burdens for providers.

The letter specifically requests data on the time required for technology vendors to reach determinations and the frequency of request approvals, denials, and beneficiary appeals. While the CMS previously stated that prior authorization determinations would range from one to three days, lawmakers argue this timeframe excludes the duration between the vendor decision and the actual receipt of a tracking number by a physician. The signatories, including Reps. Ami Bera (D-Calif.) and Alexandria Ocasio-Cortez (D-N.Y.), also seek information on the top reasons for request dismissals and the average time from initial submission to final claim payment.

Furthermore, the inquiry seeks details on the oversight of peer-to-peer review, including wait times for clinical assessments after treatment denials and the number of overturned decisions. The letter asks for explicit metrics on how the CMS evaluates vendor success and the criteria for removing participants from the program. According to Rep. Suzan DelBene (D-Wash.), the firm Virtix, which handles claims in Washington, has already been ordered to submit a corrective action plan for failing to meet the pilot's 72-hour review requirement. While Virtix has denied receiving such an order, a CMS spokesperson affirmed the agency audits participants to ensure accountability against established performance metrics.

This push for data follows previous congressional efforts to challenge the WISeR model. Earlier this month, a House committee unanimously voted to include an amendment in the 2027 HHS spending legislation that would block funding for the pilot. Democrats in both the House and Senate have introduced resolutions this spring aimed at rolling back the program entirely, citing concerns that it was implemented without proper vetting or sufficient patient safeguards.