EFF Sues CMS Over AI in Medicare Prior Authorization Requests

The Electronic Frontier Foundation (EFF) has initiated legal action against the Centers for Medicare and Medicaid Services (CMS) concerning the Wasteful and Inappropriate Service Reduction (WISeR) Model, introduced on January 1, 2026. This model leverages artificial intelligence (AI) for processing prior authorization requests within traditional Medicare. The lawsuit, filed in a California federal court, follows an unanswered Freedom of Information Act request by EFF, seeking details on the WISeR Model's AI algorithms and data sources.

Operating across six states, the WISeR Model enlists private technology firms to conduct AI-based reviews, raising concerns about algorithmic bias and privacy threats. These worries are compounded by the risk of inappropriate care denials. Citing a Washington Post analysis, EFF highlighted a disparity in prior authorization approval rates, with initial requests in Texas approved at 62%—later increasing to 84% after manual oversight—compared to the national Medicare Advantage rate of 92%. EFF argues these figures indicate an urgent need for enhanced transparency and oversight as AI-driven processes increasingly influence Medicare administration.

For further inquiries regarding the WISeR Model or EFF's legal suit, stakeholders are encouraged to contact coding@aasm.org.