Federal AI Prior Authorization Program Delays Critical Care for Medicare Patients, Senate Report Finds

AI Prior Authorization Program Under Fire for Delaying Senior Care

Washington state hospitals are reporting significant delays for Medicare patients awaiting procedures now subject to prior authorization under a new federal program. In some cases, patients are waiting two to four times longer than before, according to a new report from U.S. Sen. Maria Cantwell (D-Wash.).

The report is among the first to document alleged patient harm resulting from the Centers for Medicare and Medicaid Services’ (CMS) Wasteful and Inappropriate Service Reduction, or WISeR, Model. Launched on January 1, the program uses artificial intelligence to automate prior authorization decisions for certain medical services.

Senator Cantwell Criticizes CMS Over AI ‘Denial Device’

During a Senate Finance Committee hearing on Wednesday, Cantwell raised concerns directly with Health and Human Services Secretary Robert F. Kennedy Jr. She argued that CMS is deploying AI as a “denial device,” forcing patients to wait weeks for approvals that previously required no prior authorization.

"CMS is using AI as a ‘denial device,’ and patients are waiting weeks to get approval for services that previously didn’t require approval."

Democrats Urge CMS to Scrap WISeR Program

Cantwell is one of several Democratic lawmakers advocating for the immediate termination of the WISeR program. Critics argue that the AI-driven system is exacerbating delays in critical care, particularly for seniors who rely on timely medical interventions.

The controversy underscores broader concerns about the use of AI in healthcare decision-making, with lawmakers and healthcare providers questioning whether automated systems are prioritizing cost-cutting over patient well-being.

Next Steps and Full Coverage

For a deeper dive into the WISeR program and its impact on patient care, continue to STAT+ for the full report.