FOIA records reveal delays and testing gaps in Medicare's AI prior auth pilot

Internal communications reveal that vendor Innovaccer warned CMS weeks before launch that its system lacked full functionality and had not undergone sufficient end-to-end testing. Despite these warnings, CMS proceeded with the rollout. In the first three months, vendors Virtix Health and Zyter issued over 20,000 non-affirmations, with Virtix denying more requests than it affirmed. While some providers have since received "gold card" status to bypass the process, the records highlight a lack of transparency regarding AI training data, bias testing, and appeal outcomes.

The pilot is scheduled to run through 2031, but the findings raise concerns about potential expansion to urgent care services like MRI scans and oncology. Critics argue that the current system's instability poses risks to patient safety, particularly if applied to time-sensitive medical procedures without first resolving the existing delays and technical gaps.