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
Navigating Payment and Reimbursement for Radiology AI Solutions
Radiology AI reimbursement in the US remains complex and fragmented, complicating provider and vendor payment strategies.
•HealthExec
Experts Advocate Licensing Model for Clinical AI Regulation
Three prominent medical leaders propose a six-step licensing pathway to govern autonomous clinical AI, drawing direct parallels to physician licensing.
•Radiology Business
AMA Urges Caution on AI for Medical Diagnosis and Treatment
The American Medical Association advises against using AI and chatbots as replacements for physician-led diagnosis and treatment decisions.