AI Prior Authorization Program Under Congressional Scrutiny as Washington Hospitals Report Care Delays for Medicare Seniors

A federal artificial intelligence program designed to reduce wasteful Medicare spending is facing mounting criticism from Washington state hospitals and at least one Democratic senator, with reports of significantly extended wait times for senior patients seeking procedures that now require prior authorization under the new model.

The Centers for Medicare and Medicaid Services launched its Wasteful and Inappropriate Service Reduction, or WISeR, Model on January 1. According to a report from U.S. Sen. Maria Cantwell (D-Wash.), hospitals in her state are documenting Medicare patients waiting two to four times longer for certain procedures subject to the program's authorization requirements. Cantwell raised her concerns directly with Health and Human Services Secretary Robert F. Kennedy Jr. during a Senate Finance Committee hearing, characterizing the AI system as functioning as a "denial device" that is leaving patients waiting weeks for approvals on services that previously did not require them.

The report represents among the first documented allegations of patient harm stemming from the WISeR Model, which represents a significant federal test of AI-driven healthcare decision-making. Cantwell is joined by several other Democratic members of Congress who have been urging CMS to terminate the program entirely. The bipartisan tension around the initiative highlights growing concern over the intersection of algorithmic tools and healthcare access for vulnerable populations. If the reported delays are confirmed more broadly, the WISeR Model could face increased legal and regulatory pressure as advocates argue that cost-reduction goals are coming at the expense of timely patient care.