New records obtained by EFF expose additional issues with Medicare’s AI-driven prior authorization program and show why we need stronger legal limits around government use of
automated decision-making
.
EFF
sued
the government back in March for information about the
Wasteful and Inappropriate Service Reduction (WISeR) model
, a new Medicare program that uses AI to evaluate prior authorization requests for certain medical services. We
previously released records
showing that WISeR has resulted in delays and denials of care, operational chaos, and reports of patient harm. Today, we’re publishing over 800 new pages of records, including:
Requests for information (RFIs) or requests for corrective action plans (CAPs) sent from the Centers for Medicare & Medicaid Services (CMS) to four of the six WISeR vendors, along with the vendors’ responses.
Applications of 66 companies to the WISeR model, including those of the 6 selected companies.
Task orders and contracts for the evaluation, implementation, and monitoring of the WISeR model.
Documents obtained through EFF’s lawsuit are available
here
.
These newly released documents show that the WISeR rollout was rushed and rocky from the start, highlighting the dangers that arise when governments
treat AI like a silver bullet
for complex problems. The documents also highlight the need for more transparency about safeguards against inappropriate, AI-driven denials. The public still lacks the information needed to assess whether clinician review is providing meaningful oversight of AI systems and whether appropriate data is being used to evaluate prior authorization requests.
EFF has
long argued
that AI has no place in consequential government decisions about peoples’ rights or access to benefits, such as
immigration enforcement
and
policing
decisions. That’s because using automated decision-making in these contexts risks decisions that violate people’s rights or deprive them of benefits they’re
