Roughly 1,000 pages of documents produced by the Centers for Medicare & Medicaid Services relative to the opening months of its controversial AI prior authorization program outline sweeping issues such as delayed approvals, miscommunication and provider frustration.
Electronic Frontier Foundation (EFF), a digital and privacy rights nonprofit, recently shared the documents it obtained regarding the Wasteful and Inappropriate Service Reduction (WISeR) Model through a Freedom of Information lawsuit, filed back in March.
The trove includes participation agreements between the agency and six tech vendors, internal guidelines outlining the program and how vendors were selected for participation, status report correspondences from Medicare Administrative Contractors (MACs) and providers’ responses to feedback regarding one of the tech vendors, Innovaccer.
The records run into April 2026, with EFF noting in a breakdown blog post that CMS is continuing to produce records that it intends to publish.
“The public deserves to know how AI is driving decisions that affect patients’ access to care,” EFF wrote.
CMS first rolled out the Innovation Center model in June, launched on Jan. 1, and plans to conclude the test run at the end of 2031. The program uses AI to expand the scope of prior authorization in traditional Medicare for certain services seen as “vulnerable” to waste, fraud and abuse, part of the Trump administration's push to curb improper spending. The pilot is active in Arizona, Ohio, Oklahoma, New Jersey, Texas and Washington.
The records outline thousands of prior authorization requests in which turnaround exceeded the pilot’s three-day goal. That includes several hundred that were still unanswered as of the end of March, one of which was 83 days old.
Other program updates outlined issues in which miscommunications between tech vendors and Medicare administrative contractors (MAC) led to breakdowns in required processes, or miscategorization of some providers’ approval requests. The logs also include reports of system downtime that delayed responses to approval requests, and multiple complaints from providers about delays or a lack of communication from one vendor, Innovaccer, that is processing requests in Ohio.
“We have patients calling our offices crying in pain because their procedures are being delayed while awaiting approvals or guidance tied to this model,” one reads. “A 3-4 day delay for necessary pain procedures is already difficult for vulnerable patients, but when providers cannot obtain answers for weeks, the situation becomes unacceptable.”
"I have had to watch 3 patients cry at bedside for not hearing back on their prior auth for Kyphoplasty/vertebral augmentation procedures," reads another submitted feedback form, which was written in all caps. "These patients are in deep pain."
Innovaccer, for its part, told CMS ahead of the Jan. 1 start that it would need more time to fully implement its systems, with several letters in the documents outlining its gradual (though ongoing as of early April) progress in developing multiple features and clearing request backlogs. Other vendors also appear to have experienced technical issues before and after the program’s launch.
EEF’s breakdown of the documents underscores that CMS’ payment methodology for WISeR vendors incentivizes more denials through limited payment reductions based on a vendor’s aggregate quality scores. The group also pointed to plans outlined in CMS’ documents to include additional medical services beyond the program’s initial 13, such as air ambulance transport, MRI scans and some high-cost Part B medications.
“Records released thus far echo concerns that providers have raised since WISeR launched, including long delays, financial incentives to deny care, and technical problems,” EEF wrote. “But important questions remain about the AI systems private companies are using to inform decisions about whether to provide people with Medicare benefits.”
The WISeR model has faced pushback from providers, like the American Hospital Association and American Medical Association, and lawmakers, primarily Democrats, over concerns of improperly delayed care. An early report from a group of Washington state hospitals outlined substantial increases in the average time for an urgent or standard authorization during the program’s first month.
Legislators in the Senate attempted to advance a bill to roll back the WISeR model, though that was rejected in July on a party-line 46-50 vote. That vote came just a week after the U.S. Government Accountability Office (GAO) determined that the model is subject to the Congressional Review Act, meaning it should have been submitted to Congress prior to its implementation.