Older Americans on traditional Medicare have seen treatment delayed and, in many cases, refused since the Trump administration began using an artificial intelligence-assisted system to review whether certain procedures will be covered, newly released internal documents show.

The Wasteful and Inappropriate Service Reduction, or WISeR, model began on 1 January 2026 in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. It introduces technology-assisted prior authorisation for selected services, a process that Original Medicare has historically used more selectively, including for certain durable medical equipment and other services.

The Centers for Medicare & Medicaid Services (CMS) says the pilot cuts 'wasteful, low-value services' by pairing AI tools with human clinicians. It covers around a dozen procedures, including epidural steroid injections, nerve stimulators, cervical spinal fusions and skin substitutes for wounds.

Delays and Denials Under the WISeR Medicare Model

Hundreds of pages released to the Electronic Frontier Foundation (EFF), a US digital rights group, in ongoing litigation describe technical breakdowns, long waits and refusals of procedures that were previously approved. One provider told federal officials the programme was 'a disgrace to the human race'.

Decisions are supposed to be returned within 72 hours. One case logged in the documents was still pending after 83 days. Another provider said a surgery was pushed back 'almost two months due to zero communication'.

A provider working with the contractor Innovaccer in Ohio described three patients with spinal compression fractures left 'in deep pain' while hospitals waited for approval for kyphoplasty, a minimally invasive procedure. 'There is no way to get a hold of a human to talk to,' the provider wrote.

The documents also show problems among the contractors. Innovaccer warned the government before launch that its systems were not ready and, when the rollout went ahead, temporarily set its platform to approve every request to avoid a backlog.

Zyter spent months confusing Part A hospital claims with Part B outpatient services. Its chief executive told the technology site Ars Technica the firm is now 'fully functional across Medicare Part A and Part B claims'.

A weekly report from March showed a third contractor, Virtix, had approved 2,863 requests and denied 3,233, a rejection rate of 53 per cent. CMS placed Virtix on a corrective action plan in June for missing the 72‑hour deadline. The company told Ars Technica it had cut its average turnaround to about 1.18 days and that the plan was lifted on 14 August.

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Payment Incentives and Growing Political Scrutiny

At a Senate confirmation hearing, the Democratic senator Patty Murray asked Chris Klomp, Donald Trump's nominee for deputy health secretary, whether WISeR contractors 'make more money if they deny care'. Mr Klomp, who already oversees Medicare within CMS, replied: 'My understanding is no.'

CMS planning documents obtained by the EFF indicate otherwise. They show contractors can receive 25 per cent of estimated Medicare spending avoided following an eligible denial. A memo from the agency's Office of the Actuary, quoted by Ms Murray, warned that 'model participants will have an incentive to deny as many claims as possible'.

An 'Aggregate Quality Score' can reduce that payment by 5 or 10 per cent, depending on the score. Even a score below 60 per cent still earns 90 per cent of the payout.

The Democratic congresswoman Suzan DelBene tried to force the release of further WISeR documents through a committee vote but was blocked by Republicans. 'The more that Americans learn about WISeR, the more outraged they get,' she said, accusing officials of using AI to 'jeopardise' care and push Medicare towards privatisation.

Healthcare providers in Washington state have also raised concerns with Ms Murray about delays under the programme. At the time of Ars Technica's reporting, neither CMS nor the Department of Health and Human Services had publicly commented on the wider performance issues.

Federal documents also list potential future additions, including cancer treatments, air ambulance transport, MRI scans, pacemakers and genetic tests.

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