Medicare AI program faces scrutiny over care denials and privacy concerns

Newly released records obtained by the Electronic Frontier Foundation (EFF) reveal significant issues with Medicare’s Wasteful and Inappropriate Service Reduction (WISeR) model. The AI-driven program, designed to evaluate prior authorization requests for medical services, has been linked to operational chaos, delays, and denials of care.

The documents include requests for corrective action plans sent by the Centers for Medicare & Medicaid Services (CMS) to several vendors. The EFF argues that the rollout was rushed and highlights a lack of transparency regarding whether clinician oversight is sufficient to prevent inappropriate AI-driven denials.

Separately, in Canada, the Northwest Territories Office of the Information and Privacy Commissioner (OIPC) reported instances of unauthorized medical record “snooping” by employees. The 2025-26 report noted that staff accessed sensitive information for reasons such as curiosity, including one instance where a temporary employee viewed 372 client records.