Centers for Medicare and Medicaid AI failures

Medicare's AI prior-authorization pilot drew a federal reprimand after delays and disputed denials

Medicare's WISeR pilot, launched January 1, 2026 in six states, uses AI to screen certain doctor-ordered procedures for prior authorization, with contractors paid a share of the spending their denials avert. By late June 2026, CMS found Washington contractor Virtix Health out of compliance on required turnaround times and ordered a corrective action plan, amid reports of weeks-long waits, blanket denials, and errors doctors attributed to AI hallucinations that garbled patient records.

Confidence

Medium (multi-source)