Paid to Deny: Inside Medicare's AI Prior Authorization Experiment

New documents from a federal lawsuit reveal how CMS's WISeR model denied 20,000 claims in 90 days, left one patient waiting 83 days for a 72-hour decision, and paid vendors a percentage of every claim they rejected.

On September 8, 2026, the Electronic Frontier Foundation published 1,000 pages of internal CMS documents obtained through a federal lawsuit filed six months earlier. The documents reveal the inside operation of WISeR, a prior authorization AI model that launched January 1, 2026, and now governs Medicare prior authorization across six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.

The core finding is structural rather than technical. Vendors operating WISeR are paid 10 to 20 percent of what CMS calls "averted expenditures," the official term for claims they deny. The documents show what happens when that incentive structure meets real patients waiting for real care.