On January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) launched an unprecedented audit tool called the Wasteful and Inappropriate Service Reduction (WISeR) Model. The WISeR model aims ...

CMS is launching a six-year pilot of the WISeR Model, starting January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, which will use AI and human review to expand prior ...

Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. On June 27, 2025, the Centers for Medicare and Medicaid ...

Earlier this year the Centers for Medicare and Medicaid Services introduced the “Wasteful and Inappropriate Service Reduction” model, a series of prior authorization requirements designed to ensure ...

Berwick is a former administrator of the Centers for Medicare and Medicaid Services. He is a senior fellow for health policy and Ducas is the VP of health policy at the Center for American Progress.

Medicare's six-year WISeR programme uses AI and machine learning to assist reviews of selected services in six states, with licensed clinicians responsible for non-payment recommendations.

Medicare is testing the use of AI to conduct prior authorizations to target wasteful medical spending ...

In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on ...

Medicare AI prior authorization program WISeR secretly penalized four of six AI vendors within its first three months while CMS publicly defended the program against opposition. New FOIA records ...

Ohio and five others states saw myriad issues in the first months of the Wasteful and Inappropriate Services Reduction model, ...

The University of Kentucky alleges CVS Health diverted more than $41 million in 340B drug savings from four hospitals between 2020 and 2025. Judge Strikes Medicaid Test Forcing Chronically Ill ...

For now, the most reasonable stance is watchful waiting: acknowledging the real problems WISeR seeks to address, recognizing the equally real risks it introduces, and insisting on transparency and ...