Pilot program aims to cut waste in Medicare with AI, but critics fear it could delay care

Beginning next year, the federal government will begin using artificial intelligence to determine whether Medicare patients in Washington need prior authorization to receive certain treatments.

The new requirement is part of a pilot program from the Centers for Medicare and Medicaid Services that aims to cut costs and prevent unneeded procedures. The WISeR Model program will evaluate these prior authorization requests through private third-party companies.

Six states were chosen by CMS to participate in the pilot program: Washington, New Jersey, Ohio, Oklahoma, Texas and Arizona. The new requirements start at the beginning of next year and will run through 2031.

“CMS is committed to crushing fraud, waste, and abuse, and the WISeR Model will help root out waste in Original Medicare,” CMS