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AI Will Soon Have a Say in Approving or Denying Medicare Treatments
The pilot aims to reduce wasteful Medicare spending by using AI to approve or deny care, covering six states and running through 2031, officials said.
- On Jan. 1, the Trump administration will launch the WISeR pilot testing AI for Medicare prior authorization in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington through 2031.
- Taking a page from private insurers, federal officials say prior authorization can curb fraud, waste and patient harm, aiming to use AI to find savings by denying wasteful Medicare services next year.
- The WISeR pilot will review prior-authorization requests for skin and tissue substitutes, electrical nerve-stimulator implants and knee arthroscopy, with CMS ensuring review by a `qualified human clinician` and prohibiting pay tied to denial rates.
- Many physicians worry AI could deny doctor-recommended care, and House members recently supported Rep. Lois Frankel's measure to block pilot funding; an American Medical Association survey found 61% see rising denials.
- Experts warn that algorithms often deny high-cost care and shared-savings arrangements reward vendors for delivering less, while some say the plan relies on subjective measures and contractors assessing their own results.
15 Articles
15 Articles
Trump launches AI program to deny Medicare services
Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.The pilot program, designed to weed out wastef...
News Medical
Philly VoiceAI will soon have a say in approving or denying Medicare treatments
Taking a page from the private insurance industry's playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.
kffhealthnews.org
AI Will Soon Have a Say in Approving or Denying Medicare Treatments
Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients. The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on t…
Private health insurers use AI to approve or deny care. Soon Medicare will, too
Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients. The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on t…
Oswego County TodayGillibrand Slams Trump Administration Ploy To Undermine Seniors’ Access To Treatment Under Traditional Medicare
WASHINGTON, D.C. - Today, U.S. Senator Kirsten Gillibrand, the top-ranking Democrat on the Senate Aging Committee, is calling on the Trump administration to halt an experiment that would allow private insurance companies and artificial intelligence (AI)tools to delay and deny care to seniors enrolled in Traditional Medicare across six states. Senator Gillibrand, along with Senate…
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