{"version":1,"type":"story","url":"https://digestai.news/story/medicare-ai-pilot-reveals-delays-testing-gaps","json":"https://digestai.news/story/medicare-ai-pilot-reveals-delays-testing-gaps.json","markdown":"https://digestai.news/story/medicare-ai-pilot-reveals-delays-testing-gaps.md","slug":"medicare-ai-pilot-reveals-delays-testing-gaps","headline":"FOIA records reveal delays and testing gaps in Medicare's AI prior auth pilot","summary":"Newly released Freedom of Information Act records expose significant operational failures in the Centers for Medicare & Medicaid Services (CMS) Wasteful and Inappropriate Service Reduction (WISeR) pilot. The roughly 1,000-page document set, obtained by the Electronic Frontier Foundation, details how the AI-assisted prior authorization program, launched in six states this January, suffered from severe backlogs and technical deficiencies. One request went unanswered for 83 days, far exceeding the promised 72-hour turnaround, while clinicians reported postponing or canceling procedures due to pending approvals.\n\nInternal 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.\n\nThe 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.","keyPoints":["FOIA records show Medicare's WISeR AI pilot had severe delays, with one prior authorization request unanswered for 83 days.","Vendor Innovaccer warned CMS its system was untested and lacked full functionality weeks before the January launch.","Vendors issued over 20,000 non-affirmations in the first three months, with Virtix denying more requests than it affirmed."],"whyItMatters":"The findings highlight critical risks in deploying AI for high-stakes healthcare decisions, revealing gaps in testing, transparency, and patient safety that could undermine public trust in automated prior authorization systems.","category":{"slug":"policy","name":"Policy & Regulation","url":"https://digestai.news/category/policy"},"entities":{"companies":["Electronic Frontier Foundation","Innovaccer","Virtix Health","Zyter"],"models":[],"people":["Lena Cohen","Matthew Crooks"]},"firstPublishedAt":"2026-09-13T17:00:00Z","updatedAt":"2026-09-13T17:00:00Z","sourceCount":1,"hasPrimarySource":false,"sources":[{"outlet":"medscape.com","title":"New Records Reveal Backlogs, Testing Gaps in Medicare's AI Prior Authorization Pilot","url":"https://medscape.com/viewarticle/new-records-reveal-backlogs-testing-gaps-medicares-ai-prior-2026a1000xzz","publishedAt":"2026-09-13T17:00:00Z","type":"press","primary":false,"lead":true}],"sourceNotes":null,"discussions":[],"thread":null,"cite":{"text":"Digest AI, \"FOIA records reveal delays and testing gaps in Medicare's AI prior auth pilot\", 13 September 2026, https://digestai.news/story/medicare-ai-pilot-reveals-delays-testing-gaps","publisher":"Digest AI","title":"FOIA records reveal delays and testing gaps in Medicare's AI prior auth pilot","datePublished":"2026-09-13T17:00:00Z","url":"https://digestai.news/story/medicare-ai-pilot-reveals-delays-testing-gaps"},"generatedBy":"Written by Digest AI's editorial model from the linked sources; the sources are the record.","license":"Headlines, digests and key points are written by Digest AI and may be quoted with a link to the story page. Linked articles belong to their publishers. Terms: https://digestai.news/terms#reuse"}