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
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