Place Legal Limits on Automated Decision-Making in Government Programs

Investigate and place stronger legal limits on the use of automated decision-making in Medicare and other government benefit programs. The WISeR model, Medicare's AI-driven prior authorization program, has already caused delays, denials, and documented patient harm. New records obtained through EFF's lawsuit show that CMS rushed the rollout, then quietly sent corrective action requests to four of the six WISeR vendors in the program's first three months, citing missed deadlines, inaccurate denials, and inadequate provider communication. The problems go deeper than a rocky launch. WISeR's payment structure gives vendors, in the government's own words, "an incentive to deny as many claims as possible." Key safeguard information has been redacted from public records. And the "human in the loop" protection CMS touts is undermined by research showing that AI recommendations lead reviewers to rubber-stamp automated judgments. One health insurer's clinical reviewers spent an average of 1.2 seconds per case. Outsourcing consequential decisions about seniors' medical care to private AI companies, without transparency, proper testing, or legal accountability, is not acceptable. Congress must act to set clear legal limits on automated decision-making in Medicare before more patients are harmed.