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The Trump administration’s AI-driven Medicare prior authorization pilot program, called WISeR, is drawing intense scrutiny after federal documents obtained through litigation by the Electronic Frontier Foundation revealed a financial structure that pays contractors a share of costs averted through claim denials, alongside widespread reports of delayed care, technical failures, and patient suffering. WISeR, which stands for Wasteful and Inappropriate Service Reduction, launched in January across six states, New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington, and is intended to run through the end of 2031, using AI and machine learning to determine “appropriate Medicare payment” for roughly a dozen medical services including nerve stimulation, epidural steroid injections, cervical fusions, skin substitutes for wounds, and treatments for incontinence and impotence. The program marks a significant departure for traditional Medicare, which previously hadn’t required doctors to obtain prior authorization for these kinds of services. The Government Accountability Office determined in May that Trump officials failed to follow proper procedure in establishing the program, calling its legality into question, though it has continued operating with plans for further expansion. Last week, Rep. Suzan DelBene’s effort to force the release of additional WISeR documents was voted down by Republicans on committee, prompting her to say, “it’s clear why the administration is doing everything they can to conceal these documents. The more that Americans learn about WISeR, the more outraged they get at the Trump administration for jeopardizing their care and trying to privatize Medicare.”

The EFF’s document release exposed serious technical dysfunction across multiple vendors. Innovaccer was so unprepared for the January rollout that it asked the government to delay it, and when officials refused, the company temporarily configured its system to automatically approve all requests, writing in a letter that “auto-affirming is the only path available that avoids creating a backlog of unprocessed prior authorizations and claims while we finalize, validate, and deploy the full rules-based solution.” Another vendor, Zyter, reportedly struggled for months with data discrepancies because it didn’t understand the distinction between Medicare Part A, which covers inpatient care, and Part B, which covers outpatient services; the company’s CEO told Ars Technica it is now “fully functional across Medicare Part A and Part B claims.” A third vendor, Virtix, was found denying more requests than it approved, rejecting 3,233 of 6,096 reviewed pre-authorization requests, or 53%, according to a March 30 weekly report. WISeR is supposed to deliver authorization decisions within 72 hours, but many decisions have taken weeks or even months, with EFF documents showing at least one request still pending after 83 days; one provider reported having “a surgery pushed back almost two months due to zero communication.” Virtix was placed on a Corrective Action Plan by the Centers for Medicare & Medicaid Services in June for noncompliance with the 72-hour window, though the company told Ars Technica it has since reduced turnaround times to 1.18 days for prior authorization and 1.17 days for prepayment review, with the plan ending August 14th.

The human toll described in provider feedback has been stark. One Ohio healthcare provider working with Innovaccer wrote in a survey response, “I have had to watch 3 patients cry at bedside for not hearing back on their prior auth for kyphoplasty/vertebral augmentation procedure. These patients are in deep pain… there is no way to get a hold of a human to talk to… what a disgrace to the human race in America. This is third world.” Another Ohio provider described the experience as “extremely disappointing,” writing that “a 3-4 day delay for necessary pain procedures is already difficult for vulnerable patients, but when providers cannot obtain answers for weeks, the situation becomes unacceptable… Patients deserve better. Providers deserve answers. And systems designed to improve care should never result in preventable suffering.” Innovaccer told Stat News its technology is now “fully live” and that it has “worked closely with all of our partners to refine and improve the program since its launch.” Perhaps most consequentially, at a Senate hearing last week, Sen. Patty Murray directly asked Chris Klomp, Trump’s nominee for Deputy Secretary of HHS and current CMS deputy administrator, “do the contractors in the model, who are the private companies conducting the prior authorization assessments, make more money if they deny care? Just ‘yes’ or ‘no.’” Klomp replied, “my understanding is no,” an answer directly contradicted by CMS’s own planning documents, which describe a “novel payment approach where the model participants are compensated based on a share of averted expenditures,” paying companies 25% of the regional benchmark cost for every denied request. Murray also cited a CMS Office of the Actuary memo stating bluntly that “model participants will have an incentive to deny as many claims as possible,” noting that “in the first three months of this year, the Washington state contractor denied more requests than they approved.”

Klomp defended the program by pointing to financial penalties for inappropriate denials and an upcoming vendor “report card” system, but the CMS documents reveal these penalties are minimal. Companies scoring between 100% and 85% on their “Aggregate Quality Score” still receive the full 25% of averted costs from denials; those scoring between 84% and 60% see only a 5% reduction, receiving 95% of that 25%; and even companies scoring below 60%, a failing grade by conventional standards, still receive 90%. Companies only forfeit payment if a denial is appealed and overturned, but appeal rates remain low, only 11.5% of Medicare Advantage denials are appealed, even though 80% of appeals succeed in overturning the denial. Murray remained unconvinced by Klomp’s assurances, noting she had already heard from Washington state seniors who suffered for weeks in pain while doctors “battled with these contractors for approval,” and said hospitals in her state report the situation hasn’t improved since January. “I already know CMS is planning to expand this to oncology,” Murray said. “I am going to do everything I can to stop this. It is really hurting patients.” According to the CMS documents, the administration plans to expand WISeR’s prior authorization requirements beyond current categories to cancer treatments, air ambulance transport, advanced imaging like MRIs, cardiac catheterization, pacemakers, implantable cardioverter defibrillators, and genetic and molecular lab tests.

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>On July 4, 2025, a protest outside of the Prairieland Immigration and Customs Enforcement (ICE) detention facility near Dallas, Texas, escalated as some protestors broke off and committed acts of vandalism. The protest had started hours earlier as a noise demonstration where activists set off fireworks and used other noise makers to alert detainees in the facility that they supported them.

>But when law enforcement arrived to respond to the vandals, a police officer was shot nonfatally in the neck area. Authorities later charged protester Champagne Song for the shooting.

>Meagan Morris, who says she was a half-mile away playing Pokémon in her car when she heard the gunshots, was soon after stopped by police and taken into custody.

>Three months later, the Trump administration accused her and eight other defendants—three of whom, including Morris, are trans—of being “Antifa terrorists” and “Antifa Cell operatives.”

>Morris and her codefendants were eventually sentenced in part for providing material support for terrorists in what the Department of Justice called “the first sentencing of defendants affiliated with Antifa,” a name which refers to a decentralized movement based on militant opposition to fascism.

>The sentencing comes after Trump signed an executive order declaring antifa, short for anti-fascism, as a terrorist organization, despite no such unified organization existing. And in May, the administration’s counterterrorism strategy listed “radically pro-transgender” groups as a national security threat.

>Morris was sentenced to 50 years in prison, which has caused legal experts concern. They noted that her sentence is unusually harsh, more than double the longest sentence for a Jan. 6 rioter, and that it could set a precedent for strict crackdowns on freedom of speech and assembly.

>After speaking to Morris’ codefendant and girlfriend, Autumn Hill, we wanted to hear from Morris. In this episode of “UNCLOSETED with Spencer Macnaughton,” she’s calling in from Johnson County Jail in Texas, where she is currently serving her sentence.

Michigan Secretary of State Jocelyn Benson said Sunday that she will ensure her state’s voters “know the truth about our elections” heading into the November midterms, following a federal judge’s renewed block on the Trump administration’s attempt to restrict mail-in voting. “We will use every tool in our toolbox,” Benson said on “Face the Nation with Margaret Brennan.” “We’ll follow the law. We’ll protect the right to vote. And that’s why, frankly, state officials who know how to do that, to stand up to the president, are so important right now.” Benson is the Democratic nominee for Michigan governor, facing Republican Rep. John James in November.

U.S. District Judge Indira Talwani extended a previous ruling Friday barring the U.S. Postal Service from enforcing new mail-in ballot requirements that critics feared would prevent voters, particularly those in marginalized groups, from participating. The requirements stem from executive orders President Trump issued in March and would have required USPS to follow strict federal guidelines governing the design, transmission, and tracking of mail-in ballots. The Trump administration filed a last-ditch appeal to the Supreme Court on Sunday, marking the third time it has asked the high court to intervene in this dispute. The Supreme Court has allowed the plan to move forward previously but has not ruled on whether it is legal. While Trump has claimed the changes would bolster election security, state leaders and voting rights groups around the country have argued the rules would unconstitutionally manipulate who can and cannot participate in the election process.

Trump has previously tried to undermine confidence in Michigan’s elections and its mail-in voting procedures specifically, though his accusations have largely gone unproven. Michigan lawmakers did find that a small number of non-citizens voted in the 2024 general election; of 22 cases reviewed, Michigan Attorney General Dana Nessel charged six people with election law violations. Benson said her office has taken steps to keep Michigan’s voter rolls accurate and emphasized that cases of non-citizens voting are rare in the state. “I’m really proud that our elections have been ranked among the most secure and accessible in the nation,” Benson said. “The fact that we have identified a handful of individuals who are ineligible to vote and we were able to hold them accountable, that shows that the system is working,” she continued. “And I’m proud of the work that our 1,500 local officials do every day to continue to ensure that every eligible vote and only eligible votes are counted in every election.”