AI Denials have created a Substantial Drop In Patient Services Under Pilot Program
Today, U.S. Senator Kirsten Gillibrand (D-NY), ranking member of the U.S. Senate Aging Committee, issued the following statement after reports of large drops in Medicare services in the six states under the Trump administration’s WISeR pilot program, which uses artificial intelligence (AI) to deny seniors’ medical claims:
“AI has no place making the final call on Americans’ medical care. The sudden drop in Medicare services due to Trump’s AI pre-approval experiment is dangerous and unacceptable. Healthcare decisions belong between a doctor and a patient – not an algorithm.”
In May, Senator Gillibrand introduced a resolution to end the Trump administration’s experiment with the WISeR (Wasteful and Inappropriate Service Reduction) Model that allows AI to conduct prior authorization and allows third-party AI companies to profit from denying seniors’ medical claims in Traditional Medicare. Senate Republicans voted to block her legislation in July.
The WISeR model has introduced prior authorization requirements into Traditional Medicare for a set of newly impacted health care services, letting AI decide what care patients receive even after their doctors recommend a particular procedure or medical device. The third-party AI companies involved in the program are also compensated for “averted expenditures,” rewarding those companies based on the volume or cost of care they deny to seniors on Medicare. A recent report showed that the WISeR model has been catastrophic for seniors in the six states where it has been deployed so far.