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EFF Deeplinks · September 9, 2026

New Records Reveal Problems with Medicare’s AI Prior Authorization Experiment

Health AdministrationPublic PolicyLaw
THE AI ANGLE
Evaluating Medicare prior authorization requests to determine coverage for medical treatments

Records obtained by the Electronic Frontier Foundation through a FOIA lawsuit reveal that Medicare's experimental WISeR program, which uses private AI vendors to evaluate prior authorization requests, has caused extensive delays, operational failures, and patient harm. The documents disclose that the Centers for Medicare & Medicaid Services rushed the launch despite warnings of unready software and implemented a payment model that financially rewards vendors for denying care. For faculty in health administration, public policy, and law, this case illustrates the acute regulatory, ethical, and operational risks of delegating public benefit adjudications to algorithmic systems.

THE TEACHING ANGLE
Students can analyze the policy and administrative tensions of contracting private AI vendors to curb healthcare expenditures when contract incentives actively reward care denials and low quality scores carry minimal penalties.

Read the original at eff.org   Generate teaching or study materials

Instructors get discussion guides, assignments, and mini-cases. Students and readers get a plain summary, class prep, and an exercise. All built from the full article. Three are free with an account.

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