Rep. Craig Introduces Bill to Block Use of AI in Medicare Coverage Decisions, Prevent Unfair Claims Denials for Seniors

EAGAN, MN – Today, U.S. Representatives Angie Craig and Suzan DelBene (WA-01) introduced a bill to prevent the expansion of prior authorization in Traditional Medicare and protect seniors from being denied care based on artificial intelligence (AI)-generated coverage decisions. 

The Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act would prohibit the Center for Medicare and Medicaid Innovation (CMMI) from implementing the Wasteful and Inappropriate Service Reduction (WISeR) model. This model, which is set to begin in six states in 2026, works by hiring private companies to use AI to automate prior authorizations. 

Concerningly, model participants are compensated based on a share of “averted expenditures," rewarding participants based on the volume or cost of care they deny. That means the more these private companies deny Medicare claims, the more dollars they rake in.  

“It’s already too hard for seniors to access health care in this country,” said Rep. Craig. “While insurance companies continue to deny claims at an alarming rate, the last thing we need is to give private contractors even more incentives to deny care. The WISeR model is a disaster for our seniors, and that’s why I’m introducing this bill with my colleagues to stop companies from profiting off sick seniors and outsourcing coverage decisions to AI.” 

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