Medicare's AI gatekeeper left patients in pain for months

A federal pilot called WISeR has put AI in the middle of Medicare's prior-authorization decisions in six states — Ohio, New Jersey, Arizona, Washington, Oklahoma and Texas. For the first time, seniors there must get permission before receiving services like nerve stimulators and skin substitutes, with private vendors' AI helping decide what gets approved or denied.

Records from a Freedom of Information Act lawsuit by the Electronic Frontier Foundation show the program launched in January 2026 even though Ohio's vendor, Innovaccer, warned CMS a month earlier that its software wasn't ready. Two vendors alone denied 5,944 claims in the first three months; providers describe month-long waits, including one who wrote: ‘I have had to watch 3 patients cry at bedside for not hearing back on their prior auth.’

CMS says the problems are resolved and a licensed clinician reviews every denial; Innovaccer says the program is now ‘fully live.’ But the pilot runs until 2031 — and CMS planning documents float adding air ambulances, MRIs, pacemakers and cancer care to the AI gatekeeper's list.