The Trump administration’s WISeR pilot uses artificial intelligence and private contractors to approve or deny prior authorisation for some Medicare services, marking a new requirement for treatments that previously did not generally need pre-approval. Reports and newly released documents describe technical failures, lengthy delays, questionable denials and distress among patients and doctors, while critics argue the system could encourage vendors to reject claims and accelerate Medicare privatisation.

Launched in January across six states, the programme covers about a dozen services, including pain treatments, cervical fusions, wound care and treatments for incontinence and impotence, and is scheduled to continue until 2031. The rollout was reportedly rushed: one vendor temporarily auto-approved requests because its system was not ready, another confused Medicare’s hospital and outpatient categories, and Virtix denied 3,233 of 6,096 requests it reviewed in one weekly report. The Government Accountability Office has questioned whether the programme was established lawfully, but efforts by lawmakers to obtain more information or halt it have so far failed.