Over 6 million Americans on Medicare will now need to get prior authorization from AI for these 17 procedures
Market WatchBy Jessica HallDec. 30, 2025Traditional Medicare in six states will soon feel more like privatized Medicare Advantage, using prior authorizations to determine what care can be covered for older adults.Starting in January, about 6.4 million Americans enrolled in traditional Medicare in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington state will be part of a pilot program using artificial intelligence for prior authorizations. The program — known as the Wasteful and Inappropriate Service Reduction (WISeR) model — will require additional approvals for 17 different medical procedures.
Medicare’s new AI experiment sparks alarm among doctors, lawmakers
StatelineBy: Anna Claire VollersDecember 4, 2025A Medicare pilot program will allow private companies to use artificial intelligence to review older Americans’ requests for certain medical care — and will reward the companies when they deny it.In January, the federal Centers for Medicare & Medicaid Services will launch the Wasteful and Inappropriate Services Reduction (WISeR) Model to test AI-powered prior authorizations on certain health services for Medicare patients in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. The program is scheduled to last through 2031.The program effectively inserts one of private insurance’s most unpopular features — prior authorization — into traditional Medicare, the federal health insurance program for people 65 and older and those with certain disabilities. Prior authorization is the process by which patients and doctors must ask health insurers to approve medical procedures or drugs before proceeding.
So now we have to fight a machine!
But that is not all...
AP NewsBy HALLIE GOLDENDecember 31, 2025President Donald Trump’s administration announced on Tuesday that it’s freezing child care funds to Minnesota and demanding an audit of some day care centers after a series of fraud schemes involving government programs in recent years.Deputy Secretary of Health and Human Services Jim O’Neill said on the social platform X that the move is in response to “blatant fraud that appears to be rampant in Minnesota and across the country.”
The McCourt School of Public Policy at Georgetown University reported that the fraud rate for states are... Minnesota’s improper payment rate was about 2.2 % in recent reporting periods and by comparison, improper rates in other states vary widely — e.g. Alabama ~0.2 %, California ~8.1 %, Connecticut ~18.8 %, South Carolina ~20.5 %!
So the question is why Minnesota?
Minnesota Gov. Tim Walz (D) slammed the Trump administration for pausing child care payments to his state amid increased federal scrutiny of alleged fraud within its social services programs.“This is Trump’s long game,” Walz wrote Tuesday in a post on the social platform X. “We’ve spent years cracking down on fraudsters. It’s a serious issue — but this has been his plan all along.“He’s politicizing the issue to defund programs that help Minnesotans,” he added.The Department of Health and Human Services (HHS) froze child care payments to the North Star State earlier Tuesday.Deputy HHS Secretary Jim O’Neill wrote online that he has demanded an audit from Walz on the day care centers highlighted in a video published Friday by YouTuber Nick Shirley. O’Neill said all payments from the department’s Administration for Children and Families to states across the country will require prior justification and a receipt or photo evidence.
And it is not like Minnesota wasn't doing anything about the fraud,
He added on X that his administration has “spent years cracking down on fraud — referring cases to law enforcement, shutting down and auditing high-risk programs.”
So why is Trump's adminstration going after Minnesota?
So why do you think the Trump adminstration is going after Minnesota?
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