Digital rights advocacy organization the Electronic Frontier Foundation has filed a Freedom of Information Act lawsuit against CMS seeking information on how the AI algorithms work in its traditional Medicare prior authorization pilot.
CMS’ Wasteful and Inappropriate Service Reduction model launched Jan. 1 in Arizona, Ohio, Oklahoma, Texas, Washington and New Jersey. The pilot will run through Dec. 31, 2031, and test whether enhanced technologies, such as artificial intelligence and machine learning, can streamline prior authorization and medical review for certain items and services that are vulnerable to fraud, waste, abuse or inappropriate use.
EFF said in a March 25 news release that there is little information about how the AI algorithms used in the program work, including what training data they rely on. The nonprofit organization also said it is unclear whether CMS has safeguards in place to prevent systemic flaws, including algorithmic bias, privacy violations and wrongful denials of care.
“Tasking an algorithm with making determinations about treatment can create unwarranted — and even discriminatory — delays or denials of necessary medical care,” Kit Walsh, EFF’s director of AI and access-to-knowledge legal projects, said in the release. “Given these serious risks, the public requires transparency that it hasn’t gotten. We’re suing to get badly needed answers about how Medicare’s AI experiment works.”
EFF said it submitted a FOIA request to CMS earlier in 2026 asking for records related to the program, including information agreements with participating software vendors. CMS has yet to release any records to the nonprofit. EFF’s lawsuit seeks their immediate processing and release.
CMS said it does not comment on pending litigation.
Read the full complaint here.
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