WISeR pilot: the AI that ruled on approvals was rushed and full of errors

The Medicare pilot program called WISeR, short for Wasteful and Inappropriate Service Reduction, started in January 2026. It requires providers to get prior authorization before they perform certain procedures or order certain products, including skin substitutes and epidural injections for pain. The experiment covers New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. It is set to run until 2031.

The Electronic Frontier Foundation obtained more than a thousand pages of documents and data through a public records lawsuit. They show a rushed rollout full of errors. One of the technology vendors for WISeR warned the Centers for Medicare and Medicaid Services that expecting a finished product by the set implementation deadline was unrealistic. The result, as described in a STAT report from September 15, 2026, was delays in delivering services.

What it means for a patient

Prior authorization programs are nothing new in the American system. What is new is how much of the decision-making is automated, and how fast the rollout happened. When an algorithm issues approvals or denials for pain treatments or for products used on hard-to-heal wounds, every delay turns directly into patient waiting time, not into administrative costs.

The documents also show an information asymmetry. The agency knew about the vendor's warnings and still did not move the deadline. In practice, public oversight of such a program rests on court-ordered disclosures, because applications and correspondence with contractors are not published on an ongoing basis.

The scale of the disclosure matters on its own. This is not a single document but more than a thousand pages of correspondence, notes and materials that the agency released only under court pressure. The picture that emerges is consistent: a political deadline coupled with technology that was not ready. In a program whose horizon reaches 2031, fixes after launch are not the exception but the rule. What stays open is who monitors, during that time, how many approvals and denials the algorithm issues, and on what basis.

In the background, another dispute is playing out over how Medicare pays for care technologies. The agency is expanding the ACCESS model, in which it pays companies for managing chronic diseases, while at the same time proposing to limit remote patient monitoring, which we cover in separate articles. The common thread is one: more and more decisions about services are made in code, and fewer and fewer of them are first tested on paper.