Medicare AI Denies Care

WashingtonOne Medicare AI vendor denied 53% of requests.

Traditional Medicare required no prior authorization for these services before the WISeR pilot began in January.

Centers for Medicare and Medicaid Services documents show vendors earn 25% of the benchmark cost of each denied request.

Virtix, the vendor, says federal coverage rules, not its own, decide each denial.

WISeR is set to run through 2031 despite federal auditors questioning its legality.

How each outlet framed it

Ars Technica leans critical: exposes perverse incentive: AI vendors profit from denials, illustrated by provider testimony of patients 'crying in pain' awaiting care