From the article:

In January, the Trump administration rolled out a pilot program that uses artificial intelligence to authorize or deny certain types of care for patients with Medicare—a federal healthcare program for seniors that previously hasn’t required doctors to get any such pre-approval, called prior authorization.

Not long after, media outlets began relaying the disastrous outcomes: technical difficulties, long delays in decisions and care, puzzling denials, frustrated doctors, and patients suffering in pain. Those reports were largely confirmed earlier this month when the Electronic Frontier Foundation released a tranche of federal documents about the program, called WISeR, that the group obtained amid litigation. The documents included feedback from healthcare providers, including one who called the program “a disgrace to the human race” and reported seeing patients crying in pain as they waited for care.

Amid the worrying reports, lawmakers have been trying to get answers and shut the program down. Meanwhile, the Government Accountability Office determined in May that Trump officials did not follow proper procedure in setting up the program, calling its legality into question. Still, it appears to be moving ahead unabated, with plans to expand in the years to come.

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WISeR, which stands for Wasteful and Inappropriate Service Reduction, aims to use AI and machine learning to ensure “appropriate Medicare payment” for select services while benefiting taxpayers “by decreasing fraud, waste and abuse.” It was rolled out in January in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—and intends to run until the end of 2031.

So far, the program requires prior authorization for around a dozen medical services, including nerve stimulation, epidural steroid injections for pain, cervical fusions (permanently connecting bones in the neck), skin substitutes for wounds, and treatments for incontinence and impotence.

According to the documents released by the EFF, the program’s implementation was rushed, and the technology wasn’t ready. One vendor, Innovaccer, was so unprepared that it asked the government to delay the rollout, and when it didn’t, the vendor set up its program to automatically approve all requests temporarily.

“[A]uto-affirming is the only path available that avoids creating a backlog of unprocessed prior authorizations and claims while we finalize, validate, and deploy the full rules-based solution,” Innovaccer wrote, according to a letter it sent to government officials.

But others carried on. One vendor, Zyter, had data discrepancies for months because it apparently didn’t understand the difference between Medicare Part A, which covers inpatient/hospital care, and Part B, which covers outpatient services. Zyter’s CEO, Sundar Subramanian, told Ars Technica in a written statement that the company is now “fully functional across Medicare Part A and Part B claims.” The company is working closely with federal partners and the healthcare providers to “enhance the experience,” Subramanian said.

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In addition to a questionable number of denials, decisions from the various contracted companies often took too long. WISeR is intended to provide authorization decisions within 72 hours, but many have taken weeks, some even months. The documents from EFF reveal at least one request was still pending after 83 days. In a survey, one healthcare provider said it “had a surgery pushed back almost two months due to zero communication.”