Nearly 1,000 pages of internal CMS documents — obtained by the Electronic Frontier Foundation (EFF) through a FOIA lawsuit — paint a troubling picture of Medicare's AI-driven prior authorization pilot, the Wasteful and Inappropriate Service Reduction (WISeR) model. Launched on January 1 in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington), the program uses AI to require pre-approval for 13 services deemed vulnerable to fraud and waste. But the records show that tech vendors weren't ready at launch, systems went down, and miscommunications between contractors led to widespread breakdowns.

Providers have borne the brunt of the chaos. Feedback submitted to CMS includes accounts of patients waiting weeks for approvals for procedures like kyphoplasty and epidural injections. One vendor, Innovaccer (assigned to Ohio), warned CMS before launch that its system lacked full functionality — and documents suggest some features remained unfinished as late as April. EFF also flagged that the program's payment model financially rewards vendors for more denials, raising serious conflict-of-interest concerns.

By the Numbers:

• One prior authorization request went unanswered for 83 days
• Two vendors (Virtix and Zyter) issued 20,000+ non-affirmations in the program's first 3 months
• Virtix denied more requests than it affirmed during that period
• ~30% of January requests to Virtix and Zyter were 6–21 days old
• A Senate vote to roll back WISeR failed 46–50 in July

Why it matters: WISeR is scheduled to run through 2031, and its results could shape whether AI-driven prior authorization expands across all of Medicare. With CMS eyeing additions like MRI scans, air ambulance, and cardiac catheterization, getting this right before it scales is critical for both patient safety and healthcare system integrity.