The **Electronic Frontier Foundation (EFF)** has escalated its concerns over the use of artificial intelligence in healthcare decision-making by filing a Freedom of Information Act (FOIA) lawsuit against the **Centers for Medicare & Medicaid Services (CMS)**. The suit aims to uncover details about the **WISeR** (Wasteful and Inappropriate Service Reduction) program, a multi-state initiative employing AI to assess requests for medical care under Medicare. ### Concerns Over Algorithmic Bias and Transparency "Tasking an algorithm with making determinations about treatment can create unwarranted—and even discriminatory—delays or denials of necessary medical care," stated Kit Walsh, EFF’s Director of AI and Access-to-Knowledge Legal Projects. The EFF emphasizes the critical need for transparency, citing concerns about potential algorithmic bias, privacy violations, and wrongful denials of care. ### WISeR Program Details and Criticisms The **WISeR** program, announced by **CMS** Administrator Dr. Mehmet Oz last year, utilizes AI to evaluate prior authorization requests from Medicare beneficiaries. Prior authorization, previously uncommon in original Medicare, requires healthcare providers to obtain advance approval from a patient’s health insurer before delivering certain treatments or services for coverage. However, details regarding the AI algorithms used in **WISeR**, including their training data and safeguards against systemic flaws, remain scarce. Healthcare experts, providers, and lawmakers have voiced concerns that **WISeR** could harm patients if implemented without adequate safeguards. Despite these criticisms, **WISeR** was launched in six states in January, potentially impacting up to 6.4 million Medicare beneficiaries. ### Incentives and Reported Issues The **WISeR** program incentivizes contracted companies to deny prior approvals, compensating vendors based on the volume of healthcare services they deny, with potential earnings of up to 20 percent of the associated savings. Reports have emerged of delays in care approval, communication gaps, and administrative strain shortly after **WISeR**'s launch. ### EFF's FOIA Request and Lawsuit Earlier this year, the **EFF** submitted a FOIA request to **CMS**, seeking agreements with software vendors participating in **WISeR**, records related to accuracy, bias, or hallucination testing of vendor technology, and records related to audits, monitoring, or evaluation of **WISeR** and participating vendors. To date, **CMS** has not provided these records, prompting the **EFF** to file the lawsuit demanding their immediate processing and release. "The public has a right to know more about the algorithms driving decisions around their healthcare," said Tori Noble, Staff Attorney at EFF. "Without greater transparency, patients, providers, and policymakers will continue to be left in the dark.” *EFF thanks Stanford Law School's Juelsgaard Intellectual Property & Innovation Clinic for their help in preparing this lawsuit.* **For the complaint:** [https://www.eff.org/document/complaint-eff-v-cms-medicare-wiser-foia](https://www.eff.org/document/complaint-eff-v-cms-medicare-wiser-foia)