Records obtained by EFF show CMS challenged four of six vendors in Medicare's AI prior-authorisation pilot

The Electronic Frontier Foundation (EFF) has released more than 800 further pages of records from the Centers for Medicare & Medicaid Services (CMS) about WISeR, the federal pilot in which private technology vendors use AI to review prior-authorisation requests in traditional Medicare. EFF obtained the documents after it sued CMS in March under the Freedom of Information Act.

According to EFF, CMS sent requests for information or demands for corrective action plans to four of the six vendors in the programme's first months. Virtix received a request dated 17 March 2026 that cited decision times above the agreed limits. Zyter, which runs on Palantir software, received one dated 27 February. Innovaccer received a formal notice of non-compliance dated 20 February and two corrective-plan requests. EFF names only three of the four vendors.

One CMS document says the payment structure gives vendors "an incentive to deny as many claims as possible", because they are paid partly from savings. EFF says one vendor denied more requests than it approved in the early months, but gives no count. Vendor descriptions of the safeguards meant to keep automation clinically appropriate appear to be redacted. CMS's published rules say a non-affirmation must be made by a licensed clinician, not by technology alone. The records also show that 66 companies applied to take part.

WISeR started on 1 January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, and covers services such as skin substitutes, spinal interventions, electrical nerve stimulators and knee arthroscopy, TechTimes reports. A Senate vote to repeal it failed 46-50 in July. EFF now asks CMS to disclose the vendors' safeguards and data sources and asks Congress to set legal limits on automated decisions in Medicare.