DelBene Moves to Force Trump Administration to Release Files on AI Medicare Experiment

Today, Congresswoman Suzan DelBene (WA-01) announced that she is filing a Freedom of Information Act (FOIA) request to force the Trump administration to release unseen information on the Wasteful and Inappropriate Service Reduction (WISeR) program, which pays private companies to use AI to review Medicare claims.

Since the program began in January in Washington and five other states, patients have been left in severe pain and unable to access care prescribed by their doctors. In June, DelBene announced that the Centers for Medicare & Medicaid Services (CMS) ordered the company administering WISeR in Washington to submit a corrective action plan for delays in reviewing claims following an audit. Neither the audit nor the corrective action plan has been released to Congress or the public. DelBene previously requested information on the model's performance from the administration and then moved to require CMS to release these documents through an amendment during a House Ways & Means Committee markup. The majority of Ways & Means Republicans rejected the amendment by an 18-19 vote.

DelBene announced her latest move to force the release of these documents and hold the administration accountable in an op-ed in the Everett Herald.

"Washington seniors have borne the brunt of this experimental program's malfunctions," DelBene wrote. "From January to March, over half of the claims submitted in Washington were denied and far exceeded the 72-hour decision deadline. This triggered an internal CMS audit and corrective action plan. This shouldn't come as a surprise because the program pays these private companies for every claim they deny, which incentivizes them to reject more care."

"The audit and corrective action plan have never been released, which would further help inform lawmakers, health care providers, and patients about how WISeR is failing to function," DelBene continued. "This stonewalling must end. That's why I am filing a new FOIA request for these specific documents in addition to the audits and corrective action plans of any other private company participating in WISeR."

This effort follows a bombshell report from the Electronic Frontier Foundation (EEF) on the failures of WISeR that detailed widespread delays and denials, rushed implementation, and incentives for private companies reviewing claims to deny care. EFF obtained access to the documents uncovered in the report through a FOIA request and lawsuit. The report also revealed that the administration plans to expand WISeR to cancer treatments and other types of care despite clear, documented evidence of the program's flaws.

DelBene introduced legislation last November to repeal WISeR and has led multiple other legislative efforts to stop the program.

Read DelBene's op-ed here. The text of the FOIA request can be found here.