CMS WISeR Model
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The Wasteful and Inappropriate Service Reduction (WISeR) Model is an active U.S. Centers for Medicare & Medicaid Services (CMS) pilot that uses artificial intelligence and machine learning, alongside clinical review, to assess selected services under Original Medicare. It began in January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington; CMS plans to run it through December 2031.[1]
How the model works
For selected services, providers and suppliers can request prior authorization or proceed to a medical review before payment. CMS lists skin and tissue substitutes, electrical nerve-stimulator implantation and knee arthroscopy among the services in scope. CMS says appropriately licensed clinicians decide all recommendations for nonpayment and that the model does not change Medicare coverage or payment policy. Participating companies receive a performance-adjusted share of expenditures that CMS determines were averted by their reviews.[1]
Oversight and concerns
On May 12, 2026, the U.S. Government Accountability Office concluded that CMS's WISeR implementation notice is a rule subject to the Congressional Review Act's submission requirements. The decision addresses the notice's legal classification; it does not itself end the model.[2]
On September 8, the Electronic Frontier Foundation (EFF) published records obtained from CMS through a freedom-of-information lawsuit. EFF reported provider complaints about long waits, denials and technical failures; it also raised concerns about the financial incentive created by payments tied to averted expenditures.[3] Ars Technica's September 25 review of the released records reported vendor responses alongside providers' complaints and described a CMS corrective-action plan for one participant.[4]
At a September 16 House Ways and Means Committee markup, Representative Suzan DelBene proposed requiring CMS to release audits and corrective-action plans for model participants. Her office reported that the amendment failed 18–19.[5]
See federal authorities and healthcare AI law.
References
- ↑ 1.0 1.1 Centers for Medicare & Medicaid Services, “WISeR (Wasteful and Inappropriate Service Reduction) Model,” reviewed September 27, 2026.
- ↑ U.S. Government Accountability Office, B-337994, “Applicability of the Congressional Review Act to Notice Implementing the Wasteful and Inappropriate Services Reduction (WISeR) Model,” May 12, 2026.
- ↑ Electronic Frontier Foundation, “New Records Reveal Problems with Medicare’s AI Prior Authorization Experiment,” September 8, 2026.
- ↑ Beth Mole, Ars Technica, “Trump admin using AI to deny medical care for seniors in disastrous experiment,” September 25, 2026.
- ↑ Office of Representative Suzan DelBene, “Ways & Means Republicans Continue Covering Up Harms of Trump’s Medicare AI Experiment,” September 16, 2026.