10-11-2026 4:42pm

The feds are using AI to deny care to WA seniors, Sen. Murray says

Chris Clasen Editor

Published October 9, 2026 at 4:45 PM PDT

U.S. Sen. Ron Wyden, left, and U.S. Sen. Patty Murray attend a roundtable in Vancouver, Wash., with local health care leaders on Oct. 9, 2026. The Senators met with local health care leaders to discuss concerns about the Wasteful and Inappropriate Service Reduction (WISeR) model, a Trump administration pilot program that's using artificial intelligence to evaluate some Medicare claims in Washington and five other states.

Doctors and Democratic lawmakers convened a roundtable Friday to critique a new federal pilot program involving health care for Medicare patients. They said the program, which is in place in six states, including Washington, is using artificial intelligence to delay and deny care for Medicare patients seeking certain procedures.

U.S. Sen. Patty Murray, a Washington Democrat, is trying to end the pilot program, which was implemented Jan. 1 and is slated to run for six years. The model employs private companies to review what’s called “prior authorization” requests — or approval to pay for — 17 different procedures. The companies are using AI to review those requests.

The administration says the purpose of the pilot program is to reduce wasteful spending and fraud.

“The Wasteful and Inappropriate Service Reduction Model helps protect American taxpayers by leveraging enhanced technologies … to ensure timely and appropriate Medicare payment for select items and services,” said a press release from the Centers for Medicare and Medicaid Services.

The companies that review the Medicare claims — in Washington’s case Virtix Health — are paid based on how many claims they deny.

“ This is run by a for-profit contractor, and they are paid a percentage [of the] care they deny,” Sen. Murray said at the roundtable. “That's outrageous. When your business model relies on denials, denials are what seniors are going to get.”

In the first three months of 2026, Virtix Health denied more claims than it approved, according to documents obtained by the Electronic Frontier Foundation.

The treatments reviewed by the AI tool include nerve stimulation, cervical fusion surgery, and other treatments meant to address chronic pain or incontinence. Some of the other procedures included in the new AI review process treat sleep apnea or wounds that are not healing.

“These procedures are all absolutely essential for seniors in order to keep their mobility,” Sen. Ron Wyden, an Oregon Democrat, said at Friday’s event.

The three doctors at the roundtable said the AI tool routinely denies prior authorization for the 17 procedures included in these reviews. And, they said, appealing the decisions can take months.

“These are patients who had their physicians evaluate them and recommend a treatment, but they were left waiting while we had to navigate this complicated administrative review process,” said Dr. Keren Rosenblum, who practices in Vancouver, Washington.

“For older adults living with chronic pain, these delays really matter,” she said. “Every additional week without treatment can mean disrupted sleep, limited mobility, difficulty performing daily activities, and diminished independence.”

From left, Leon McCook, a physician with PeaceHealth, and Keren Rosenblum, president of The Vancouver Clinic, attend a roundtable to discuss the impacts of a new federal pilot program that uses artificial intelligence to evaluate some Medicare claims. Local health care leaders met with U.S. Sen. Ron Wyden and U.S. Sen. Patty Murray on Oct. 9, 2026, in Vancouver, Washington, to discuss concerns about the program, which was implemented Jan. 1 in six states, including Washington.

“These are not simply scheduling inconveniences,” she said. “They have real consequences for quality of life.”

Chronic pain can reduce patients’ mobility and increase their stress and depression, Rosenblum said, so their overall health can worsen as they await treatment.

“It’s clogging the system because these patients are needing care for these additional problems [such as depression],” she said, “and then other patients are getting delayed because these appointments are getting taken.”

Senator Murray introduced a bill in December to try to prevent the use of AI by private companies reviewing Medicare claims in the six states included in the pilot. That bill was voted down, but she said she plans to keep trying.