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An investigative report reveals how Medicare's WISeR pilot program is bringing private-insurance-style prior authorization into traditional Medicare — and, by tracing a single water-and-electricity bill from Chennai, India, uncovers Virtix/CorroHealth, a company using AI to deny patients' treatment claims, along with the private equity capital behind it. The report argues that AI is currently being used in healthcare primarily for paperwork and billing games rather than for improving patient care.
The Trump administration's AI program WISeR is causing significant delays and denials in Medicare care for seniors, leading to controversy, legal challenges, and concerns about AI's role in healthcare decisions.
AI is being piloted by the Trump administration for insurance prior authorization decisions, but physicians worry it may increase wrongful denials of necessary treatments.
An investigation reveals that EviCore, a company owned by Cigna, uses an AI algorithm to increase denials of medical prior authorization requests, often resulting in delayed or denied care for patients. The company profits by reducing health spending, sometimes with a 3-to-1 return on investment for insurers.