CMS launched Medicare WISeR AI pilot despite vendor warning

A WISeR vendor told the Centers for Medicare and Medicaid Services that 'it was unrealistic to expect a working product by the time the federal agency wanted to launch the program.' CMS launched anyway, in January 2026.

That warning sits in roughly 1,000 pages of records the Electronic Frontier Foundation pried loose through a FOIA lawsuit and that STAT reported on this week. The Wasteful and Inappropriate Service Reduction model, or WISeR, went live across New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington and is scheduled to run through 2031. Contractors run AI review on prior-authorization requests for procedures that include skin substitutes and epidural injections for pain management.

The first months' numbers are blunt. Two vendors denied more than 20,000 requests in three months, per EFF's read of the records. One request went unanswered for 83 days against CMS's own 72-hour response standard. Virtix denied more requests than it approved in its opening three months and was made to file a Corrective Action Plan. Innovaccer, the Ohio vendor, launched with incomplete functionality.

Provider feedback in the records is not sanded down: 'We have patients calling our offices crying in pain because their procedures are being delayed while awaiting approvals.'

The incentive structure is what makes the delays legible. Vendors keep as much as 20 percent of the associated savings on the services they block. Payment penalties for a poor quality score take back only 5 to 10 percent. Administrator Mehmet Oz has framed WISeR as a cleanup of wasteful spending; the records read as a launch calibrated for denial throughput first, testing second. Two of the health-policy analysts we track were passing the STAT piece around within hours of publication.