US Medicare is testing AI to review care: What happens when algorithm decides coverage?

The US government has started a major experiment with artificial intelligence in Medicare, using technology to identify medical services that may be unnecessary, wasteful or unsupported by evidence before Medicare pays for them.

The programme, called the Wasteful and Inappropriate Service Reduction Model (WISeR), was launched by the Centers for Medicare & Medicaid Services (CMS) on January 1, 2026. The six-year model covers Original Medicare beneficiaries in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.

CMS says WISeR combines artificial intelligence and machine learning with human clinical review to reduce unnecessary care, lower Medicare spending and speed up the review process.