EFF has sued CMS to compel disclosure about the WISeR pilot deploying AI for Medicare prior authorization.
Key Details
- 1EFF filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) after receiving no response to a FOIA request about the WISeR pilot program.
- 2WISeR uses AI/ML to automate prior authorization in traditional Medicare across six states: NJ, OH, OK, TX, AZ, and WA, starting January 1, 2026.
- 3EFF seeks details on the algorithms, methodologies, safeguards, training data, and vendor agreements related to the AI system.
- 4Concerns have been raised by advocacy groups and some lawmakers about risks such as algorithmic bias, privacy violations, and wrongful denials of care.
- 5CMS has not released any information yet, prompting a legal challenge to enforce transparency.
Why It Matters
This case highlights growing concerns about the use of AI for clinical decision-making in reimbursement, which can directly impact radiology workflows and patient care. Increased scrutiny may influence future regulation and deployment of AI in imaging and broader healthcare settings.
Source
HealthExec
Related News
•Radiology Business
Pennsylvania Bill Mandates AI Use Disclosure in Healthcare Facilities
Pennsylvania House passes a bill requiring healthcare facilities, including imaging centers, to disclose their use of AI in clinical care.
•Radiology Business
Radiology Societies Urge Patient Safety in FDA Generative AI Regulation
RSNA and ACR call for patient safety and ongoing monitoring as the FDA considers regulations for generative AI in radiology.
•AuntMinnie
HPI Rebuts AI's Supposed Impact on Radiology Workforce Shortage
Harvey L. Neiman HPI challenges recent claims that AI has lessened the radiology workforce burden, citing evidence of rising workloads and imaging volumes.