Newly released internal documents — obtained by the Electronic Frontier Foundation via a FOIA lawsuit — paint a troubling picture of Medicare's AI-based prior authorization pilot, the Wasteful and Inappropriate Service Reduction (WISeR) model. Launched in January 2026 across six states, the program was designed to curb fraud and waste in services like nerve stimulators and steroid injections. But records show at least one vendor, Innovaccer (assigned to Ohio), warned CMS weeks before launch that its system lacked full functionality and hadn't undergone sufficient end-to-end testing — yet the program launched anyway.

The fallout was significant. Authorization decisions routinely exceeded the promised 72-hour turnaround, with one request going unanswered for 83 days. Vendors Virtix Health and Zyter issued over 20,000 non-affirmations combined in the program's first three months, with Virtix denying more requests than it approved. Physicians reported patients waiting at the bedside for pain procedures, and some providers went months without payment. A "gold card" system — allowing high-performing physicians to bypass prior auth — has since improved things for some, but smaller practices remain burdened.

By the Numbers:

• 83 days: longest recorded wait for a prior authorization response
• 20,000+: combined non-affirmations by Virtix and Zyter in the first 3 months
• ~30% of January requests from two vendors were 6–21 days old
• 69% of insured adults view prior authorization as a burden (KFF poll)

Why it matters: WISeR is scheduled to run through 2031, and its results could shape whether AI-driven prior authorization expands across Medicare. With CMS eyeing potential additions like MRI scans, oncology care, and cardiac catheterization, physicians warn that applying an unproven, glitch-prone system to time-sensitive care could put lives at risk.