The Electronic Frontier Foundation (EFF), a nonprofit focused on digital privacy and civil liberties, has filed a lawsuit against CMS seeking greater transparency into the Wasteful and Inappropriate Service Reduction (WISeR) Model.
Filed in federal court in California, the suit follows an unanswered Freedom of Information Act (FOIA) request for records related to WISeR, which launched Jan. 1, 2026, in six states. Under the model, CMS uses artificial intelligence (AI) to review prior authorization requests for a limited set of services in traditional Medicare, with private technology vendors contracted to conduct the reviews.
EFF’s lawsuit raises concerns about the lack of public information on WISeR’s AI algorithms, including their training data and whether safeguards address bias, privacy risks, and inappropriate denials of care. EFF claims the model has already delayed care for Medicare beneficiaries and increased provider administrative burden. The complaint cites a Washington Post analysis: In Texas, only 62% of WISeR requests were initially approved, rising to 84% after human review, compared to a 92% national Medicare Advantage approval rate. EFF argues these findings highlight the need for transparency and oversight as CMS expands AI-driven prior authorization in traditional Medicare.
Members may send questions about the WISeR model and this lawsuit to coding@aasm.org.
