He said his understanding was no. Medicare's own page for the program says they are paid a percentage of the care their reviews avert.
“Asked at a September 16 Senate hearing whether the private contractors in WISeR, Medicare's AI-assisted prior authorization pilot, make more money if they deny care, CMS deputy administrator Chris Klomp answered 'My understanding is no' and said inappropriate denials carry significant financial penalties.”
Chris Klomp, CMS deputy administrator and nominee for HHS deputy secretary (Senate HELP hearing), 16 September 2026
Recorded 26 September 2026. Our ruling means: not supported by its own sources.
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?
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
My understanding is when they deny care, and if they do so inappropriately, there are significant financial penalties and that CMMI is carefully watching their performance and has the ability to terminate.
The Wasteful and Inappropriate Service Reduction (WISeR) Model helps protect American taxpayers by leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services.
All recommendations for non-payment are determined by appropriately licensed clinicians who will apply standardized, transparent and evidence-based procedures to their review.
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.
the WISeR program uses long-established [National Coverage Determinations] and [Local Coverage Determinations] set by CMS, not by Virtix Health, to evaluate the medical appropriateness of each requested procedure.
at a Senate Committee on Health, Education, Labor, and Pensions (HELP) hearing to consider Trump’s latest slate of nominees for the Department of Health and Human Services (HHS)
Chris Klomp, deputy administrator of the Centers for Medicare and Medicaid and US President Donald Trump's nominee to be deputy secretary of Health and Human Services (HHS)
WISeR will run for six performance years from January 1, 2026 to December 31, 2031 in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
Those reports were largely confirmed earlier this month when the Electronic Frontier Foundation released a tranche of federal documents about the program, called WISeR, that the group obtained amid litigation.
In a statement to Ars Technica, Virtix confirmed it was on a CAP but said it has since “reduced its average turnaround time for prior authorization to 1.18 days
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