Medicare's Wasteful and Inappropriate Service Reduction (WISeR) Model launched January 1, 2026, in six states, immediately drawing fire from physicians, patient advocates and members of Congress.

In this episode, Rep. Greg Landsman (D-Ohio), a co-sponsor of the Ban AI Denials in Medicare Act, explains why he believes the pilot needs to be stopped. He argues the model is less about reducing waste and more about using artificial intelligence (AI) to deny claims faster, at the expense of seniors — he points out that the entire program operates as a black box, with no transparency about how it works, why the six states were selected or how the financial incentives are structured.

Music Credits:
Rooftops by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:28 | Sponsor message Copic medical liability insurance.

0:28 – 1:02 | Cold open Landsman previews the episode's central argument: human beings denying claims is already a problem — handing that job to a computer system that isn't learning, just denying faster, makes it worse.

1:02 – 1:59 | Introduction Austin Littrell introduces the episode and previews the conversation with Landsman.

1:59 – 3:29 | What the WISeR model actually does Landsman describes the model as the administration contracting with big tech to deny claims for seniors, starting with procedures they expect to be noncontroversial — specifically to normalize AI-driven claim denials.

3:29 – 5:05 | The Ban AI Denials in Medicare Act Landsman explains the bill would stop the pilot entirely, not just the prior authorization component. He argues it should attract bipartisan support — the target should be fraud, waste and abuse, not senior care.

5:05 – 6:06 | What physicians and patients are actually experiencing Landsman says the most common story he hears is a claim that got denied, then reversed on appeal because it was always medically necessary. His argument: that's where AI should be deployed — reducing wrongful denials, not speeding them up.

6:06 – 7:13 | The transparency problem Landsman says no provider he has spoken with understands how the model is being implemented or why these six states were selected. The financial incentives reward more denials, but the formula is unknown and the code is invisible — a black box with no accountability.

7:13 – 7:56 | Has any Medicare payment model ever been stopped by Congress retroactively? Landsman says he's not aware of one — and adds that the chaotic rollout of the WISeR model has compounded the underlying policy concerns.

7:56 – 8:44 | What prior authorization reform should actually look like Landsman calls for full transparency and a measurable reduction in wrongfully denied claims as the baseline expectation for any entity receiving public money.

8:44 – 9:36 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

9:36 – 11:35 | The fate of ACA premium tax credits Landsman says 22 million Americans rely on the ACA, and 32,000 of his own constituents needed the extension to pass. He calls on the Senate to act, warning that failure to extend the credits will cause real harm — and that people will die. He frames it as a political loser for Republicans who try to block it.

11:35 – 12:42 | Common ground 2025: key provisions Landsman highlights the ACA subsidy extension and PBM reform as the plan's most important pieces, arguing that pharmacy benefit managers are charging enormous markups and those savings need to reach patients.

12:42 – 13:22 | Medicare physician fee schedule Landsman acknowledges he wasn't focused on that specific piece of the plan, but says the broader point is clear: physicians aren't getting paid what they need to be paid, and it's causing serious problems across the health care system.

13:22 – 14:24 | A message to primary care physicians Landsman closes with a direct message to physicians: he's a huge supporter, he recognizes they're being asked to do more under greater pressure for less pay, and he wants them to know they have allies in Congress.

14:24 – 15:30 | Outro Payerchin closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

S1 Ep141: Meet the congressman trying to stop AI from denying Medicare claims, with Rep. Greg Landsman of Ohio

Off the Chart: A Business of Medicine Podcast

S1 Ep141: Meet the congressman trying to stop AI from denying Medicare claims, with Rep. Greg Landsman of Ohio