Federal Test of AI-Powered Prior Authorization Delaying Care for Seniors, Congressional Report Finds

A report to Congress details significant care delays for seniors under a CMS demonstration project testing AI for prior authorization. The program, known as WISER, is active in Washington state and uses an automated system for Medicare Advantage prior auth. Hospitals reported the AI frequently denies or 'pends' clinically appropriate care, forcing providers into lengthy manual appeals. The report, cited by Senator Patty Murray, concludes the pilot has 'failed to reduce burden' and instead created new barriers. This adds evidence to the debate around AI in utilization management, highlighting risks for practices that depend on automated payer systems.