Trump Administration Launches AI-Driven Prior Authorization Pilot in Medicare

The Trump administration will initiate a pilot program named WISeR (Wasteful and Inappropriate Service Reduction) starting January 1, 2025, which intends to implement AI-driven prior authorization for certain Medicare services in six states: Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington. This marks a significant federal expansion of prior authorization, a process commonly used in private insurance but previously limited in traditional Medicare. The program targets procedures deemed prone to fraud and waste, including skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy, although emergency and inpatient-only services will be excluded to avoid patient risk.