A Medicare pilot program that uses artificial intelligence to help review prior authorization requests has led to “lengthy treatment delays” and concerns about inadequate testing, according to newly released government records.
The Wasteful and Inappropriate Service Reduction (WISeR) model launched in January and operates in six states, covering 13 medical services. Providers must obtain authorization through technology platforms operated by private contractors that use AI tools to help evaluate requests, reported Newsweek on Monday.
Delays In Treatment
Records released through a Freedom of Information Act lawsuit brought by the Electronic Frontier Foundation show widespread delays, technical failures, inappropriate denials and reports of patient harm. CMS says participating vendors should generally respond within 72 hours, but one authorization request went unanswered for 83 days.
“The problem isn’t just the algorithm. Medicare inserted AI into prior authorization before parts of the technology and the surrounding process were fully tested and working together,” Michael Ryan, finance expert and founder of MichaelRyanMoney.com, told Newsweek. “The result is a faster way to create a bottleneck. When a request that is supposed to take 72 hours can sit unanswered for weeks, that is no longer administrative efficiency. For the beneficiary, it is delayed treatment.”
Questions Over Testing
“The systems were not thoroughly tested prior to launch, which is now causing lengthy delays beyond the 72-hour prior authorization turnaround,” Kevin Thompson, CEO of 9i Capital Group and host of the 9innings podcast, told Newsweek. “If you show me the incentive, I’ll show you the outcome, and that is what you are seeing here: increased denials and longer prior authorization timelines.”
EFF said the records raise questions about testing for accuracy, bias and hallucinations, as well as audits and monitoring of participating vendors.
CMS said it is “firmly committed to ensuring timeliness, accuracy, and transparency” under WISeR and will take corrective actions as appropriate.
The issue comes as Medicare prior authorization faces broader pressure, including concerns about denied requests later being overturned and the potential for increased authorization workloads to create bottlenecks for doctors and patients.
Disclaimer: This content was produced with the help of AI tools and was reviewed and published by Benzinga editors.
Image via Shutterstock
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