Murray and Wyden challenge Medicare’s AI reviews as doctors describe care delays

Doctors brought accounts of prolonged pain and stalled treatment to an October 9, 2026, roundtable in Vancouver, Washington. Sens. Patty Murray and Ron Wyden joined them in challenging Medicare’s AI-assisted approval pilot, which federal officials say targets waste and fraud. Murray pledged to keep fighting the program as providers described delays in getting doctor-recommended care.

A spending safeguard becomes a treatment checkpoint

The Wasteful and Inappropriate Service Reduction model, known as WISeR, uses private contractors and AI to review prior authorization requests for 17 procedures. Prior authorization means seeking approval for Medicare to pay for treatment. The pilot applies to Traditional Medicare in six states, rather than to the private Medicare Advantage plans that routinely use such reviews.

It began January 1, 2026, and is scheduled to run for six years in Arizona, New Jersey, Oklahoma, Ohio, Texas and Washington. Virtix Health handles Washington’s reviews. The procedures covered include treatments for chronic pain, incontinence, sleep apnea and wounds that are not healing.

The Centers for Medicare & Medicaid Services, or CMS, describes the technology as a way to support timely, appropriate payment while reducing wasteful spending and fraud. KUOW quoted the agency’s statement that the model helps protect taxpayers. That rationale contrasts with providers’ accounts of treatment being held up after a physician recommends it.

Examples of care subject to review

• Nerve stimulation and cervical fusion surgery are among the treatments covered by the pilot.
• Other covered procedures address incontinence, sleep apnea and wounds that are not healing.

Providers describe a growing burden

The three doctors at the roundtable said the AI tool routinely denies requests and that appeals can take months, KUOW reported. Vancouver Clinic President Keren Rosenblum described patients whose physicians had evaluated them and recommended treatment, but who remained waiting while staff worked through the administrative review process.

For older adults with chronic pain, Rosenblum said, additional weeks without treatment can disrupt sleep, limit mobility and make daily activities harder. She also described a knock-on effect: patients need appointments for additional problems, including depression, while other patients face delays because those appointment slots are taken.

Physicians support innovation and efforts to reduce waste and improve value in health care. But those goals should not come at the expense of timely access to medically necessary care.

Dr. Keren Rosenblum, president of The Vancouver Clinic, at the October 9 roundtable

EvergreenHealth CEO Ettore Palazzo likewise said his organization supports reducing fraud, waste and inappropriate use of Medicare benefits. But he described patients living with prolonged pain after January’s implementation, alongside confusion and inconsistent processes that created more work for providers. He said EvergreenHealth remained unsure whether WISeR was achieving its intended purpose.

Payment incentives sharpen the dispute

Murray’s office says each participating state uses a different for-profit CMS contractor, compensated through a share of “averted expenditures.” Murray argued that tying compensation to care not paid for creates an incentive to deny requests. Her objection concerns the business model as well as the technology used to review care.

KUOW reported that Virtix denied more claims than it approved during the first three months of 2026, citing documents obtained by the Electronic Frontier Foundation. That comparison describes the balance of approvals and denials; it does not, by itself, show whether any particular denial was medically appropriate.

The senators’ opposition predates the roundtable. Murray and Wyden introduced legislation in December 2025 to prohibit implementation of WISeR. According to Murray’s office, they also forced a July 2026 vote on a Congressional Review Act resolution to overturn the program, which Republicans blocked. Those efforts have not stopped the pilot.

At the Vancouver meeting, Murray said she was gathering evidence and patient and provider stories to make the case in Congress. She called for ending the experiment and preventing its expansion. The roundtable renewed that campaign through providers’ accounts of its effects, rather than announcing a change to Medicare’s rules.