U.S. Sen. Kirsten Gillibrand is renewing her push to end a Medicare pilot that uses artificial intelligence in coverage reviews, citing reports of declining services and warning that financial incentives could put patients’ access to care at risk.
The New York Democrat, ranking member of the Senate Aging Committee, criticized the Trump administration’s Wasteful and Inappropriate Service Reduction model, known as WISeR, in an Oct. 30 statement.
“AI has no place making the final call on Americans’ medical care,” Gillibrand said.
The pilot operates in six states, excluding New York. The Centers for Medicare & Medicaid Services says licensed clinicians determine all recommendations for nonpayment, with technology supporting the review process.
Gillibrand questions incentives for participating companies
In her announcement, Gillibrand said reports of substantial declines in Medicare services raise concerns about whether patients are receiving care recommended by their doctors.
Her statement did not quantify those declines or provide a breakdown by state or service.
Gillibrand also criticized the program’s payment structure, arguing that compensating participating technology companies for spending avoided through their reviews creates an incentive to deny care.
CMS describes the payments as a percentage of expenditures associated with averted wasteful or inappropriate care, adjusted using performance measures that include provider experience.
The disagreement centers on whether the system can distinguish unnecessary services from needed treatment without creating additional barriers for patients.
Gillibrand’s office said she introduced a resolution in May to end the pilot and that Senate Republicans blocked the measure in July. Her latest statement calls for ending the program following the reported service reductions.
How the Medicare pilot works
According to CMS’s program description, WISeR runs from Jan. 1, 2026, through Dec. 31, 2031, in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
It applies to selected Original Medicare services, including certain skin and tissue substitutes, electrical nerve stimulator implants and knee arthroscopy procedures. Medicare Advantage is excluded.
Providers can seek prior authorization — a coverage review before a service — or have claims reviewed after treatment but before payment.
CMS says the model targets services vulnerable to fraud, waste or inappropriate use without changing Medicare coverage rules. It excludes emergency services, inpatient-only services and services that would pose substantial risks if delayed.
The agency says appropriately licensed clinicians make nonpayment recommendations using evidence-based review procedures.
That requirement differs from Gillibrand’s characterization of algorithms making the final decision. Her broader objection concerns the use of AI in the process and whether the payment incentives encourage restrictions on care despite clinical oversight.
For New York patients, the announcement does not establish a new statewide approval requirement. Gillibrand’s effort concerns an existing six-state federal test and whether it should continue.
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