House committee votes unanimously to block AI-enabled Medicare prior authorizations
A committee in the U.S. House of Representatives voted on Tuesday to end a prior authorization pilot that is using artificial intelligence in six states to decide the fate of claims submitted to traditional Medicare—a hurdle usually only imposed by privatized Part C plans associated with the program.
Dubbed “WISeR,” the Wasteful and Inappropriate Service Reduction initiative went into effect in January 2026 in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. The Centers for Medicare & Medicaid Services (CMS), under the direction of Administrator Mehmet Oz, MD, claims the AI is being used to deny claims associated with fraud, but it is not clear what the parameters are in reality because, according to the EFF lawsuit, the agency has not been forthcoming about the algorithms and methodology used to approve or deny patient care coverage.
A lawsuit to force the agency’s hand on transparency was filed in March by the Electronic Frontier Foundation (EFF), a digital rights watchdog concerned that WISeR may result in “algorithmic bias, privacy violations, and wrongful denials of care.”
Notably, it is private, for-profit vendors supplying the AI models used as part of the pilot.
Committee moves to halt WISeR
Members of the House Appropriations Committee have their own concerns about the motivations behind the AI pilot. In a unanimous vote, lawmakers added an amendment to the 2027 U.S. Department of Health and Human Services budget that would block any funds from being used to further expand the AI pilot.
Further, the amendment would forbid HHS and CMS from putting any prior authorization process in place for traditional Medicare.
The two parties in the House Appropriations Committee came together for this one. Notably, the chair of the subcommittee that oversees HHS, Rep. Robert Aderholt (R-AL), voted to approve the amendment, calling it a “bipartisan” effort in the official wording for its inclusion as part of a larger government spending bill.
Before being implemented, the amendment will need to remain intact as the bill passes through the broader House and the U.S. Senate. It’s unclear how likely the measure is to survive Congress, let alone make it to President Donald Trump’s desk for approval.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.