CMS Reprimands WISeR Contractor

Multiple reports indicate that the Centers for Medicare and Medicaid Services (CMS) reprimanded an unnamed contractor for the Wasteful and Inappropriate Service Reduction (WISeR) Model in Washington state for significant delays in claims processing.

This reprimand follows media coverage of significant operational problems in Washington and other states, the House Appropriations Committee's action to strip funding for the program in FY 2027, a Government Accountability Office report concluding that CMS should have submitted the WISeR model to Congress for review before implementing it, and ongoing lawsuits filed against CMS regarding the program.

WISeR tests the use of artificial intelligence and other technologies to implement prior authorization in Traditional Medicare, where such technologies have typically not been used. CMS has said the model's intent is to reduce fraud and unnecessary services. WISeR has sparked controversy since its announcement last summer.

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For more information and questions, please contact:

Sheila Madhani

Madhani Healthcare Consulting

Email: smadhani@madhani-health.com

Tel: (202) 679-2977