House panel blocks Medicare AI prior authorization pilot
Appropriations Committee amendment would defund WISeR model that uses artificial intelligence to review and deny traditional Medicare claims.
House committee moves to halt AI-powered Medicare authorization program
The House Appropriations Committee voted unanimously on June 16 to block federal funding for a controversial Medicare pilot program that uses artificial intelligence to review and deny claims before services are provided.
The amendment to the 2027 appropriations bill prevents the Department of Health and Human Services from spending money on any payment model that implements prior authorization in traditional Medicare fee-for-service. That includes the Wasteful and Inappropriate Service Reduction (WISeR) Model, which CMS launched in early 2026 across six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
The amendment language states that "none of the funds made available in this act or any other act" can be used to implement WISeR or similar models. The appropriations bill will undergo further congressional review before final passage later this year.
Why it matters
The WISeR model represents a significant expansion of administrative barriers into traditional Medicare, which has historically operated with fewer restrictions than Medicare Advantage plans. The program's payment structure — which rewards vendors for authorization denials — has raised concerns that cost containment could take priority over patient access. If the appropriations amendment survives final passage, it would mark a rare congressional intervention to block a CMS innovation model before full implementation.
Medical societies united in opposition
Major cardiology organizations have strongly opposed the WISeR pilot since its unveiling in June 2025. The American Society of Echocardiography said the model "risks replicating the same harmful delays and administrative burdens that plague Medicare Advantage" and supports congressional efforts to halt implementation until proper safeguards are established.
The Society for Cardiovascular Angiography and Interventions and the American Society of Nuclear Cardiology echoed those concerns. ASNC specifically flagged the payment structure that compensates vendors for denials, warning that advanced diagnostic imaging could be targeted in future years.
The American Hospital Association and American Medical Association have also pushed back against prior authorization expansion, citing barriers to patient care and increased administrative burden on physicians.
Program details and rollout
The Trump administration introduced WISeR as part of a broader effort to eliminate fraud, waste, and abuse in Medicare spending. Under the model, CMS contracts with third-party vendors to use AI systems for reviewing authorization requests.
Initially, the program targeted skin and tissue substitutes along with electrical nerve stimulator implants. Claims for these services undergo medical review to verify that delivered services meet Medicare coverage, coding, and payment criteria before payment is issued.
Medical societies have resisted AI-based prior authorization models — whether deployed by private insurers or CMS — for several years, arguing that automated systems lack the clinical nuance required for complex medical decisions.
These details were first reported by Cardiovascular Business.
This is an original analysis by the Omega editorial team. Source reporting: AI Watch.
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