Lawmakers say the Centers for Medicare and Medicaid Services’ WISeR Model, mandated in six states, has produced rising delays and denials in Medicare that harm patients and add administrative burden. Rep. Suzan DelBene told HHS Secretary Robert F. Kennedy Jr. at a Capitol Hill hearing that CMS added “new layers of red tape” forcing patients through extra authorization steps as denials increased after the rollout.
The WISeR Model is a model-driven utilization management program that uses algorithmic review to flag “wasteful and inappropriate” services, highlighting the growing role of automated decision tools in clinical pathways. Lawmakers and providers warn opaque rules can disrupt care continuity, increase appeals and strain EHR workflows. The dispute amplifies calls for transparency, external audits and real-world outcome monitoring to ensure algorithmic Medicare tools protect patients and maintain clinician trust.
