Lawsuit Challenges Medicare AI Pilot

The federal government is piloting WISeR, a program that uses artificial intelligence to help decide whether Medicare will approve medical care. The test began in January 2026 and operates at selected clinics in Texas, New Jersey, Oklahoma, Ohio, Washington and Arizona. The Electronic Frontier Foundation (EFF) sued the Centers for Medicare and Medicaid Services (CMS) after the first few months, seeking records about how the system works and whether it was tested for accuracy, bias and AI-generated errors.

WISeR administrator Dr. Mehmet Oz said the system reviews requests for Medicare treatments and services. EFF legal projects director Kit Walsh warned that algorithmic treatment decisions could cause unwarranted or discriminatory delays and denials, and said the public lacked transparency. The lawsuit also says physicians and other providers have reported unusually high denial rates, delayed approvals, technical failures, communication gaps and administrative strain since the program launched.

The lawsuit reports that WISeR’s AI systems approved care for 62% of applicants in Texas, compared with 84% for human reviewers. It also says contracted vendors have financial incentives to deny prior approval: they are paid according to the volume of services denied and can receive nearly 20% of the resulting savings. Healthcare experts, providers and lawmakers have raised concerns about limited information on the models’ use and training data. CMS is aiming to publish a six-month performance report with metrics and comparisons to human decisions, but it has not given a release date.

The federal government is piloting WISeR, a program that uses artificial intelligence to help decide whether Medicare will approve medical care. The test began in January 2026 and operates at selected clinics in Texas, New Jersey, Oklahoma, Ohio, Washington and Arizona. The Electronic Frontier Foundation (EFF) sued the Centers for Medicare and Medicaid Services (CMS) after the first few months, seeking records about how the system works and whether it was tested for accuracy, bias and AI-generated errors.

WISeR administrator Dr. Mehmet Oz said the system reviews requests for Medicare treatments and services. EFF legal projects director Kit Walsh warned that algorithmic treatment decisions could cause unwarranted or discriminatory delays and denials, and said the public lacked transparency. The lawsuit also says physicians and other providers have reported unusually high denial rates, delayed approvals, technical failures, communication gaps and administrative strain since the program launched.

The lawsuit reports that WISeR’s AI systems approved care for 62% of applicants in Texas, compared with 84% for human reviewers. It also says contracted vendors have financial incentives to deny prior approval: they are paid according to the volume of services denied and can receive nearly 20% of the resulting savings. Healthcare experts, providers and lawmakers have raised concerns about limited information on the models’ use and training data. CMS is aiming to publish a six-month performance report with metrics and comparisons to human decisions, but it has not given a release date.