EFF records show Medicare warned AI prior-authorization vendors over delays

The Electronic Frontier Foundation published more than 800 pages of records on Oct. 27 about WISeR, a Medicare program that uses AI to evaluate prior authorization requests for certain medical services, obtained through a lawsuit EFF filed in March. The records show the Centers for Medicare & Medicaid Services sent requests for information or for corrective action plans to at least four of the program’s six vendors in its first three months, citing problems that included, in a March letter to vendor Virtix, decision turnaround times beyond guidelines and “denials that appear inaccurate or inconsistent with applicable criteria,” EFF reports. EFF says the public still lacks the information to judge whether clinician review provides meaningful oversight of the AI systems, and it is asking Congress to set legal limits on automated decision-making in Medicare.