Medicare's WISeR AI denied 53% of Washington requests in Q1

Records from the first three months of Medicare's new AI-driven prior authorization pilot show one contractor denied 53 percent of the requests it decided in Washington state, according to reporting by Ars Technica. The program, called WISeR (for Wasteful and Inappropriate Service Reduction), launched on January 1, 2026 and layers prior authorization onto Traditional Medicare for the first time.

The vendor, Virtix, made over 6,000 prior authorization decisions through the end of March and denied more than half of them, prompting CMS to require a corrective action plan. In Arizona, a different contractor decided 14,300 requests over the same period and denied fewer than 20 percent. Virtix has since said its affirmation rate is trending "more positively toward a rate closer to 70%."

The six-state pilot, covering Arizona, New Jersey, Oklahoma, Ohio, Texas and Washington, is scheduled to run six years. Contractors are paid a share of "averted expenditures," tying their fees to the volume of care they block, and decisions CMS promised within 72 hours have in many cases stretched into weeks or months. One provider called the program "a disgrace to the human race," and internal feedback describes patients crying in pain while they wait.

Congressional Democrats have moved to kill it. Senators including Ron Wyden, Elizabeth Warren, Patty Murray, Kirsten Gillibrand and Ruben Gallego have introduced legislation and a Congressional Review Act resolution of disapproval after the Government Accountability Office ruled the WISeR model is subject to the CRA, opening a 60-day window in which the Senate can force a floor vote.