Medicare’s AI push snarls patients and doctors in errors and delays

Medicare's AI Initiative Sparks Challenges for Patients and Healthcare Providers

Medicare s AI push snarls patients - In recent months, a new Medicare program has introduced unexpected hurdles for patients and doctors alike, leading to delays and errors in care. Bill Curry, a 65-year-old cattle farmer in rural Oklahoma, has felt the impact firsthand. For years, he made quarterly trips to Oklahoma City for spinal epidurals to manage his back pain. But this year, the journey became more frequent—adding 10 hours of travel time after a single procedure required unexpected preapproval.

The program, known as WISeR (Wasteful and Inappropriate Service Reduction Model), uses artificial intelligence to streamline prior authorization. This process mandates insurance approval for specific treatments, tests, and prescriptions. While the Trump administration argues that services like epidurals are susceptible to misuse, the rapid implementation has caused confusion among healthcare professionals. Oklahoma became one of six states testing the initiative in January, joining Arizona, New Jersey, Ohio, Texas, and Washington.

Rollout Speed Raises Concerns

Doctors and administrators have criticized the quick pace of WISeR's launch. The program was announced in June 2025 and deployed in mid-January, a timeline deemed "quicker than normal" by Todd Baker, former CEO of the Ohio State Medical Association. "Providers just sort of had to figure it out," noted Jeb Shepard of the Washington State Medical Association. Government contractors echoed similar sentiments, with Jeremy Friese, CEO of Humata Health (Oklahoma's vendor), stating, "We've had an aggressive rollout from the time of being notified to going live."

Despite the urgency, some professionals say the system is still evolving. Tech teams in other states reported adding features to their platforms as late as spring 2025. Abe Sutton, director of the Center for Medicare and Medicaid Innovation, emphasized that the reforms aim to "ensure prior authorization is efficient, fast, and streamlined," though he did not comment on the timeline.

Challenges in the Field

Patients like Curry have faced disruptions. Initially, he was required to visit the clinic twice in a single month, with a third appointment "just to fill out a piece of paper" about his condition. "It's been a hassle," Curry said. Similar frustrations have emerged across pilot states, where healthcare workers describe the program as "horrendous" and note that Medicare beneficiaries now encounter the same bureaucratic delays as private insurance holders.

WISeR targets 13 services flagged for potential misuse, including skin substitutes and kyphoplasty. A report by the Medicare Payment Advisory Commission highlighted the latter as overused. However, Sutton acknowledged that "the percentage of providers committing waste, fraud, and abuse is small." The program's focus is on curbing unnecessary care, not denying essential treatments.

Even as federal officials refine the process for Medicare, the Trump administration seeks to reduce prior authorization requirements for private insurers. According to a KFF poll from January, 69% of insured adults oppose the practice, calling it burdensome. For many, the goal remains clear: ensuring patients receive the care they need, not the care that may be overprescribed.