The Trump administration is testing an AI-based program in six states to reduce medical spending, sparking debate over potential care delays and wrongful coverage denials.

The U.S. government has launched a pilot program called the Wasteful and Inappropriate Service Reduction Model (WISeR) to evaluate medical claims using artificial intelligence. The project, which runs through December 2031, aims to reduce unnecessary spending in original Medicare by identifying potentially overused services. While proponents suggest AI could expedite claims, critics and physicians express concern that the technology may increase wrongful denials and create new administrative burdens for providers.

Concerns Over AI in Healthcare

A 2025 American Medical Association survey found that 61 percent of physicians worry AI will exacerbate the denial of necessary treatments. Critics, including health policy analysts and researchers, argue that AI should be used to facilitate care rather than deny it. There is also scrutiny regarding the financial incentives for vendors in the WISeR model, who earn a share of 'averted expenditures,' raising concerns that profit motives could lead to increased claim rejections.

Regulatory Landscape and Industry Response

While expanding AI use in original Medicare, the administration is simultaneously pressuring private insurers to streamline their own prior authorization processes. CMS Administrator Mehmet Oz has warned insurers that the government may impose regulations if they do not reduce the burden on patients. Industry data suggests that prior authorization requests declined by 11 percent between June 2025 and April 2026, though it remains unclear if denial rates have similarly decreased.