By admin 
PHOENIX (AZFamily) — Newly released documents show problems with a Medicare pilot program that launched this year in select states, including Arizona.
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Arizona is one of six states nationwide in a pilot program for the Wasteful and Inappropriate Service Reduction (WISeR) model through the Centers for Medicare & Medicaid Services.
Earlier this year, the Electronic Frontier Foundation sued the government for records related to the program after complaints from providers and patients began to pile up.
“It’s really important for the public to get more information about how these private companies are operating AI systems that influence Medicare beneficiaries’ access to care,” said Lena Cohen, a Staff Technologist at the Electronic Frontier Foundation.
Earlier this month, EFF released around 1,000 pages of records obtained through litigation related to the WISeR model from the lead-up to its launch through its first few months in operation.
“That includes long wait times, rampant technical issues, a financial incentive to deny care, and even reports of harm to patients,” said Cohen about the findings.
CMS says the goal of the WISeR model is to reduce costs and administrative burdens on providers and suppliers while ensuring people with Medicare get the best care based on their specific needs.
For select procedures that CMS says have a history of fraud, waste, and abuse, doctors in states where the pilot program is happening must submit paperwork to an outside organization to get authorization for a limited number of procedures. The model uses technology, such as artificial intelligence, to determine whether a request is appropriate.
Those procedures range from implantation of electrical nerve stimulators to knee arthroscopy for knee osteoarthritis.
“We had upset patients, upset staff, and a whole lot of question marks on the part of the providers, too,” explained Dr. Matthew Crooks.
Dr. Crooks is the Director of Interventional Pain Management at OrthoArizona and often uses the WISeR model in his duties as a board-certified interventional pain physician.
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He said that when he first heard of the WISeR model in the summer of 2025, it was an appealing idea, but that optimism quickly faded after the program was implemented.
“Basically like a learning process that we had to go through of how to navigate these companies,” he explained.
1.55 million Arizonans were covered under Medicare as of June, according to CMS.
Dr. Crooks says the program has improved over the year, as has many doctors’ familiarity with it.
“It has gotten considerably better,” he said.
For Arizona, CMS picked Zyter to handle the WISeR program. The company said their focus is to make prior authorization faster, more consistent, and easier for providers while preserving the clinical safeguards essential to patient care.
As a CMS-selected participant in the WISeR model, Zyter provides the technology platform and operational support for prior authorization workflows, including organizing clinical information, accelerating clinical review, and reducing administrative burden while maintaining appropriate clinical oversight. Clinical determinations are made by licensed clinicians through the model’s established review process, and any adverse determinations are reviewed by board-certified, independent clinicians, in alignment with CMS requirements.
Our focus is to make prior authorization faster, more consistent, and easier for providers while preserving the clinical safeguards essential to patient care. More than 92% of provider requests are processed electronically, and the median response time across authorization requests is under six minutes.
Dr. Crooks says, in his opinion, more changes should be made to the program, including more closely following Medicare’s guidelines and improving processes for how the AI reads notes and phrases submitted by physicians.
“If we can use AI to help us identify those quality practitioners and the right circumstances where these procedures are offered and to eliminate the wasteful settings where these procedures are performed that potentially may harm patients,” Crooks says. “That’s a noble goal to have.”
The pilot program is scheduled to run in the six states through the end of 2031.
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