Let's see how this works. Your doctor says you need a pacemaker. Medicare demands prior authorization, and then denies the claim. Meanwhile, you still need a pacemaker. This is the Delay, Deny, Defend, Death business model.

Prior Authorization has been shown to lead to worse health outcomes, is a waste of money, and is designed to increase private company profits. In the case of the Medicare pilot, money is being skimmed from healthcare providers and going to private companies that are denying healthcare.

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Trump admin using AI to deny medical care for seniors in disastrous experiment
Vendors rolling out AI have an “incentive to deny as many claims as possible.”
Beth Mole – Sep 25, 2026

"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... 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. ...

CMS documents written as a guide for WISeR participants explain further that for every denied request, CMS will determine what the regional benchmark cost for that care would have been and then pay the company 25 percent. Murray further quoted the CMS Office of the Actuary, which explained bluntly in a memo that “model participants will have an incentive to deny as many claims as possible.” “And what do you know,” Murray said. “In the first three months of this year, the Washington state contractor denied more requests than they approved.” ...

According to the CMS documents, the Trump administration plans to expand WISeR’s prior authorization system from cancer treatments to air ambulance transport, advanced imaging (such as MRIs), cardiac catheterization, pacemakers, Implantable Cardioverter Defibrillators (ICDs), and genetic and molecular lab tests."

arstechnica.com - Trump admin using AI to deny medical care for seniors in disastrous experiment