Medicare’s AI Initiative Causes Patient and Doctor Confusion with Errors and Delays – KFF Health News
June 25, 2026
KFF Health News: Medicare’s AI Push Snarls Patients and Doctors in Errors and Delays
Bill Curry, 65, raises cattle on the same land in rural Oklahoma once owned by his father and generations before him. Each quarter, for several years, he has made the 2½-hour drive to Oklahoma City for an epidural in his spine to treat his back pain. However, this year, due to a new Medicare program, Curry has found himself making that trip more frequently.
In February, during one of his visits, he was unexpectedly informed that he needed preapproval for the procedure. After another trip a month later for the injection, he had spent a total of 10 hours on the road. His clinic then requested a third visit, which he described as “just to fill out a piece of paper to tell them how you feel again.” Frustrated, he decided not to go.
In January, Oklahoma became one of six states to initiate a pilot program testing preapprovals in traditional Medicare, the federal health insurance program for individuals aged 65 and older or those with disabilities. Previously, Medicare had avoided the practice of prior authorization, which requires patients or their medical teams to seek insurance approval before undergoing certain procedures, tests, and prescriptions.
Epidurals, like those Curry receives, are among 13 medical services now subject to this new program. The Trump administration claims these services are prone to fraud or misuse. The initiative, powered by artificial intelligence and named the Wasteful and Inappropriate Service Reduction Model (WISeR), aims to save the federal government money while protecting patients from potentially unnecessary or unsafe care.
However, early feedback from Oklahoma and the other pilot states—Arizona, New Jersey, Ohio, Texas, and Washington—indicates that WISeR’s implementation has been anything but smooth. Patients, doctors, and healthcare professionals have reported confusion, errors, long wait times, and increased stress. Many describe the rollout as “horrendous,” noting that Medicare beneficiaries in these states are now facing the same bureaucratic hurdles as those with private insurance.
A significant concern is the speed of the rollout. WISeR was announced in June 2025 and launched just six months later. Todd Baker, former CEO of the Ohio State Medical Association, remarked that the timeline was “quicker than normal” for the federal government, leaving doctors scrambling to adapt. Jeb Shepard, director of policy at the Washington State Medical Association, echoed this sentiment, stating that physicians had to “just sort of figure it out.”
Government contractors have acknowledged the rapid pace of implementation. Jeremy Friese, CEO of Humata Health, the vendor for Oklahoma, noted, “We’ve had an aggressive rollout from the time of being notified to going live.” Tech executives from other states reported that they were still adding features to their systems as late as spring.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, which oversees the program, did not comment on the rollout schedule but emphasized that the goal is to make prior authorization efficient and streamlined. “The model aims to reduce inappropriate care without delaying appropriate care,” he stated.
Despite these assurances, many consumers and clinicians are frustrated with prior authorization. A KFF poll conducted in January revealed that 69% of insured adults view prior authorization as a burden. Through WISeR, doctors and their staff must log into online portals to submit medical records justifying procedures. Friese claims that 88% of applications with supporting clinical data receive an “immediate yes.” However, in practice, the process has proven cumbersome.
The University of Washington’s medical system reported nearly 100 patients waiting for epidural injections due to delays linked to WISeR. Curry, the Oklahoma cattle farmer, is considering traveling to Kansas for future treatments to bypass the approval process. Dorota Gribbin, a physician in New Jersey, noted that by the time authorization was granted for one of her patients, the individual had already sought more expensive care at a hospital.
Jennifer Valle, a precertification and insurance supervisor at Clinical Radiology of Oklahoma, expressed frustration over the “nitpicking” from reviewers regarding kyphoplasties. She noted that information her practice submitted often gets overlooked, leading to unnecessary requests for imaging already in the file. James Webb, a musculoskeletal radiologist in Tulsa, reported delays of six to eight weeks for claims that should be processed within 15 days.
Jerry Sobel, a pain management doctor in Phoenix, described the situation as “horrendous,” stating that he had not received payment from Medicare for nine epidurals as of May. Sundar Subramanian, CEO of Zyter, which has the contract for Arizona, mentioned that they are continuously monitoring operations to address questions and improve the provider experience.
Concerns about AI-driven errors are also prevalent. Doctors suspect that artificial intelligence may be contributing to denials based on inaccurate interpretations of patient data. For instance, one Arizona doctor recalled a denial stating that a patient wasn’t eligible for procedures in the thoracic region when the patient actually needed an injection in the neck. Webb documented instances where applications were denied despite clear evidence to the contrary.
Friese claimed he had not heard of any AI hallucinations affecting the process. However, the increased number of rejections has led to a rise in appeals, which adds to government costs. Sutton acknowledged that Medicare has accounted for potential changes in the volume of appeals due to the WISeR program.
While 84% of commercial insurers already utilize AI tools, they maintain that AI is not used to deny prior authorization requests. The introduction of AI in Medicare raises concerns about increased friction and frustration for beneficiaries. Miranda Yaver, a health policy researcher at the University of Pittsburgh, noted that prior authorization often shifts costs and burdens onto patients and doctors rather than saving them.
Some physicians involved in Medicare’s prior authorization pilot fear that if successful, it could expand to cover all procedures deemed fraud-prone. Mary Clarke, a family practice physician in Stillwater, Oklahoma, warned, “If they can show that they can save money, then that’s going to be extrapolated and rolled out to other procedures and multiple other things in other states.”
Sutton stated that there are currently no changes being considered for the list of services under the WISeR program, but CMS continues to evaluate whether any adjustments are warranted.
By Darius Tahir
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
June 25, 2026
KFF Health News: Medicare’s AI Push Snarls Patients and Doctors in Errors and Delays
Bill Curry, 65, raises cattle on the same land in rural Oklahoma once owned by his father and generations before him. Each quarter, for several years, he has made the 2½-hour drive to Oklahoma City for an epidural in his spine to treat his back pain. However, this year, due to a new Medicare program, Curry has found himself making that trip more frequently.
In February, during one of his visits, he was unexpectedly informed that he needed preapproval for the procedure. After another trip a month later for the injection, he had spent a total of 10 hours on the road. His clinic then requested a third visit, which he described as “just to fill out a piece of paper to tell them how you feel again.” Frustrated, he decided not to go.
In January, Oklahoma became one of six states to initiate a pilot program testing preapprovals in traditional Medicare, the federal health insurance program for individuals aged 65 and older or those with disabilities. Previously, Medicare had avoided the practice of prior authorization, which requires patients or their medical teams to seek insurance approval before undergoing certain procedures, tests, and prescriptions.
Epidurals, like those Curry receives, are among 13 medical services now subject to this new program. The Trump administration claims these services are prone to fraud or misuse. The initiative, powered by artificial intelligence and named the Wasteful and Inappropriate Service Reduction Model (WISeR), aims to save the federal government money while protecting patients from potentially unnecessary or unsafe care.
However, early feedback from Oklahoma and the other pilot states—Arizona, New Jersey, Ohio, Texas, and Washington—indicates that WISeR’s implementation has been anything but smooth. Patients, doctors, and healthcare professionals have reported confusion, errors, long wait times, and increased stress. Many describe the rollout as “horrendous,” noting that Medicare beneficiaries in these states are now facing the same bureaucratic hurdles as those with private insurance.
A significant concern is the speed of the rollout. WISeR was announced in June 2025 and launched just six months later. Todd Baker, former CEO of the Ohio State Medical Association, remarked that the timeline was “quicker than normal” for the federal government, leaving doctors scrambling to adapt. Jeb Shepard, director of policy at the Washington State Medical Association, echoed this sentiment, stating that physicians had to “just sort of figure it out.”
Government contractors have acknowledged the rapid pace of implementation. Jeremy Friese, CEO of Humata Health, the vendor for Oklahoma, noted, “We’ve had an aggressive rollout from the time of being notified to going live.” Tech executives from other states reported that they were still adding features to their systems as late as spring.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, which oversees the program, did not comment on the rollout schedule but emphasized that the goal is to make prior authorization efficient and streamlined. “The model aims to reduce inappropriate care without delaying appropriate care,” he stated.
Despite these assurances, many consumers and clinicians are frustrated with prior authorization. A KFF poll conducted in January revealed that 69% of insured adults view prior authorization as a burden. Through WISeR, doctors and their staff must log into online portals to submit medical records justifying procedures. Friese claims that 88% of applications with supporting clinical data receive an “immediate yes.” However, in practice, the process has proven cumbersome.
The University of Washington’s medical system reported nearly 100 patients waiting for epidural injections due to delays linked to WISeR. Curry, the Oklahoma cattle farmer, is considering traveling to Kansas for future treatments to bypass the approval process. Dorota Gribbin, a physician in New Jersey, noted that by the time authorization was granted for one of her patients, the individual had already sought more expensive care at a hospital.
Jennifer Valle, a precertification and insurance supervisor at Clinical Radiology of Oklahoma, expressed frustration over the “nitpicking” from reviewers regarding kyphoplasties. She noted that information her practice submitted often gets overlooked, leading to unnecessary requests for imaging already in the file. James Webb, a musculoskeletal radiologist in Tulsa, reported delays of six to eight weeks for claims that should be processed within 15 days.
Jerry Sobel, a pain management doctor in Phoenix, described the situation as “horrendous,” stating that he had not received payment from Medicare for nine epidurals as of May. Sundar Subramanian, CEO of Zyter, which has the contract for Arizona, mentioned that they are continuously monitoring operations to address questions and improve the provider experience.
Concerns about AI-driven errors are also prevalent. Doctors suspect that artificial intelligence may be contributing to denials based on inaccurate interpretations of patient data. For instance, one Arizona doctor recalled a denial stating that a patient wasn’t eligible for procedures in the thoracic region when the patient actually needed an injection in the neck. Webb documented instances where applications were denied despite clear evidence to the contrary.
Friese claimed he had not heard of any AI hallucinations affecting the process. However, the increased number of rejections has led to a rise in appeals, which adds to government costs. Sutton acknowledged that Medicare has accounted for potential changes in the volume of appeals due to the WISeR program.
While 84% of commercial insurers already utilize AI tools, they maintain that AI is not used to deny prior authorization requests. The introduction of AI in Medicare raises concerns about increased friction and frustration for beneficiaries. Miranda Yaver, a health policy researcher at the University of Pittsburgh, noted that prior authorization often shifts costs and burdens onto patients and doctors rather than saving them.
Some physicians involved in Medicare’s prior authorization pilot fear that if successful, it could expand to cover all procedures deemed fraud-prone. Mary Clarke, a family practice physician in Stillwater, Oklahoma, warned, “If they can show that they can save money, then that’s going to be extrapolated and rolled out to other procedures and multiple other things in other states.”
Sutton stated that there are currently no changes being considered for the list of services under the WISeR program, but CMS continues to evaluate whether any adjustments are warranted.
By Darius Tahir
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
