The Centers for Medicare and Medicaid Services has selected the six technology companies that will administer artificial intelligence-powered prior authorization programs for Medicare, STAT has learned.Â
The pilot, called the Wasteful and Inappropriate Services Reduction (WISeR) model, is a CMS effort to reduce waste and abuse within the taxpayer funded health insurance program that spent more than a trillion dollars in 2024. The new prior authorization program will launch in January and run until 2031 in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.Â
CMS’ decision to test the use of AI technology for prior authorizations comes at a time when large private insurers — including UnitedHealthcare and Humana — are facing class action lawsuits and congressional scrutiny over their use of AI for making decisions about care for Medicare Advantage beneficiaries. There is also congressional pushback against the WISeR program; on Friday, a congressional representative from Washington, one of the states where the program will be implemented, is planning to introduce a bill to prevent the Department of Health and Human Services from implementing WISeR.
STAT+ Exclusive Story
Already have an account? Log in
This article is exclusive to STAT+ subscribers
Unlock this article — plus in-depth analysis, newsletters, premium events, and news alerts.
Already have an account? Log in
Individual plans
Group plans
To read the rest of this story subscribe to STAT+.