Medicare's AI prior authorization pilot rushed and problematic, documents show

New documents obtained by STAT News indicate that a Medicare pilot program deploying artificial intelligence for prior authorization decisions was launched on a rushed timeline and encountered significant problems during rollout, according to the outlet’s September 15 report.

The documents show that the pilot, part of Medicare’s effort to test AI-assisted review of prior authorization requests, moved forward despite unresolved issues. STAT News reports that the compressed launch schedule contributed to complications once the program was in operation, and that some beneficiaries experienced delays in receiving care as a result.

The report does not specify the full scope of the delays or the number of patients affected, but frames the pilot’s difficulties as stemming directly from the pace at which it was implemented. STAT News’ account draws on internal materials that had not previously been made public, offering documentation of the gap between the program’s design and its execution.

The pilot represents one of the federal government’s early tests of AI in a healthcare administrative function with direct consequences for patient access to treatment. According to the reporting, the problems identified in the documents raise questions about the adequacy of preparation and oversight before the system was put into use affecting Medicare beneficiaries.

STAT News’ report is based on documents reviewed by the outlet and is presented as an investigative account of the pilot’s rollout.