EFF FOIA lawsuit over Medicare WISeR AI prior-authorization program
Summary
On March 25, 2026, the Electronic Frontier Foundation filed a Freedom of Information Act lawsuit against the Centers for Medicare & Medicaid Services seeking records on WISeR, an AI prior-authorization program affecting roughly 6.4 million Medicare beneficiaries across six states. EFF alleges that vendors receive compensation scaling with denial volumes and contends this creates a risk of discriminatory delay or denial of care. CMS has not publicly named the AI vendors or disclosed the program's testing and audit records.
What happened
- CMS launched WISeR in January 2026 as a multi-state program that uses algorithms to evaluate prior-authorization requests for Medicare-covered services.
- CMS Administrator Mehmet Oz announced the program in 2025.
- Within weeks of the January 2026 launch, healthcare providers in the participating states reported delays in care approval, communication gaps, and administrative strain.
- On March 25, 2026, EFF filed a FOIA lawsuit against CMS with the assistance of Stanford Law School's Intellectual Property clinic.
- The complaint seeks agreements with software vendors, testing records covering accuracy, bias, and hallucinations, and audit and monitoring data for WISeR and participating vendors.
Timeline
- 2025 - CMS announces the WISeR program.
- 2026-01 - WISeR goes live in six states covering roughly 6.4 million beneficiaries.
- 2026-01 to 2026-03 - Providers report delays and administrative strain tied to the program.
- 2026-03-25 - EFF files FOIA lawsuit against CMS.
What remains unclear
- CMS has not publicly named the AI vendors operating WISeR's algorithmic components.
- The specific compensation structure for vendors has not been disclosed by CMS; EFF reports incentives of up to 20 percent of identified savings.
- No accuracy, bias, or hallucination testing records for WISeR's algorithms are publicly available.
- The rate at which WISeR recommends denial or delay of prior-authorization requests has not been published.
- CMS had not responded publicly to the FOIA lawsuit at the time of filing.
Broader context
AI systems that influence access to regulated healthcare sit at a particularly difficult point on the transparency spectrum: their outputs can affect millions of patients, the underlying vendor contracts are typically shielded as procurement confidential, and the training and evaluation data are rarely part of the public record. The WISeR lawsuit is an early test of whether standard public-records mechanisms can surface enough detail about a government-deployed AI program to make meaningful review possible.
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