1. United States
2. Fla.
3. Letter

I am writing to express my strong opposition to the implementation of artificial intelligence in Medicare's prior authorization process through the Wasteful and Inappropriate Service Reduction (WISeR) Model. This program, set to begin in January, poses significant risks to patient care and the integrity of our healthcare system. The use of AI in making prior authorization decisions for critical procedures such as skin and tissue substitutes, electrical nerve-stimulator implants, and knee arthroscopy for osteoarthritis is deeply concerning. While CMS claims that final determinations will be made by human employees, the involvement of AI in this process introduces a dangerous element of automation to healthcare decisions that require nuanced human judgment. Of particular concern is the incentive structure for companies conducting the review process. These entities stand to benefit financially from denying coverage, as they receive payments for lowering costs. This misalignment of incentives could lead to increased denial rates, potentially delaying or preventing necessary medical interventions for Medicare beneficiaries. The six-year pilot program, currently limited to Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, sets a troubling precedent. If expanded, it could affect millions of Medicare recipients nationwide, many of whom rely on timely approvals for essential medical procedures. While the stated goal of reducing fraud and waste is laudable, the potential consequences of this AI-driven approach far outweigh any perceived benefits. Experts have warned that AI implementation may lead to higher denial rates and critical mistakes, particularly in cases where immediate care is crucial. I urge you to take immediate action to halt the implementation of the WISeR Model. Instead, focus on improving the existing prior authorization process through increased staffing, better training, and enhanced oversight of review companies. Our seniors deserve a healthcare system that prioritizes their well-being over cost-cutting measures that may compromise care quality. The expected increase in Medicare Part B premiums makes this issue even more pressing. Beneficiaries should not face the double burden of higher costs and reduced access to care due to AI-driven denials. Please act now to protect Medicare beneficiaries from the potential harms of AI in healthcare decision-making. Our most vulnerable citizens are counting on your leadership to ensure they receive the care they need without unnecessary technological barriers.