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Lawmakers and experts warn against AI‑driven prior‑authorization programs, cite CMS 'WISER' pilot
Summary
Witnesses and members raised concerns that using AI to automate prior‑authorization reviews could delay or deny medically necessary care, questioned incentive structures that pay vendors from savings tied to denials, and urged human‑in‑the‑loop standards and independent validation.
Members of the House Energy and Commerce hearing focused extensive questioning on the use of AI in prior authorization and on a CMS pilot program discussed in testimony.
Michelle Mello, professor of law and health policy at Stanford, told the committee that prior authorization is already “fraught” and that adding AI could make outcomes better or worse, but that the effect is unknown without independent study. “We don't know because there are no publicly available information that would enable somebody like me…
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