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Medicare's Wasteful and Inappropriate Service Reduction (WISeR) program, launched on January 1, 2026, in six states, has a stated goal of curbing low-value care and reducing fraud. Three months in, the pilot has generated mounting complaints from physicians, medical societies, and at least one federal lawsuit, as reported by Medscape Medical News.
WISeR represents a significant departure from traditional Medicare, which has historically permitted physicians to deliver most covered services without preapproval. The program requires prior authorization for a defined set of procedures, including epidural steroid injections, vertebral augmentation, nerve stimulators, and certain wound care services, in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Each state has been assigned a single private vendor to review authorization requests, and those vendors may use artificial intelligence to automate portions of the review process. The pilot is set to run through 2031.
Physicians in multiple states have described a system marked by delayed determinations, unexplained denials, and a disconnect between authorization vendors and Medicare Administrative Contractors. Interventional pain specialists in Arizona reported that despite obtaining valid authorization numbers, claims were still being denied. Initial denial rates reached 30-40% in some practices, even when procedures met existing Medicare coverage criteria. Practices in Washington reported wait times exceeding the program's stated three-day turnaround, with denied claims coded as unprocessable and therefore ineligible for appeal.
The Electronic Frontier Foundation filed a federal lawsuit against CMS in late March, seeking records related to vendor compensation structures, AI algorithms, system testing protocols, and data privacy safeguards. According to Healthcare Dive, EFF raised concerns that vendor compensation may be tied in part to savings generated from denied claims, creating a potential financial incentive to restrict care. In Texas, only 62 percent of initial WISeR requests were approved, rising to 84 percent after human review, compared to a 92 percent national approval rate in Medicare Advantage.
Medical societies in Arizona and Washington have formally raised concerns with CMS, citing portal access problems, peer-to-peer scheduling delays, and what one state association described as a systemic administrative disconnect rather than a physician compliance issue. The Society of Interventional Radiology reported that member feedback has been overwhelmingly negative, pointing to vague criteria, burdensome documentation, and minimal technical support.
