Centers For Medicare And Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services that administers Medicare, Medicaid, and related health programs covering over 160 million Americans. CMS has become increasingly active in regulating AI use in healthcare delivery and claims processing, establishing standards for algorithmic transparency and bias testing that impact how hospitals and insurers deploy machine learning systems. For enterprise AI governance, CMS policies directly shape compliance requirements around explainability, fairness audits, and documentation standards in healthcare AI applications.

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EnforcementUS2026-09-25

Federal AI Prior Authorization Program Fails 53% of Requests, GAO Finds Procedural Breach

The Trump administration's WISeR pilot, launched in January 2026 across six states, uses AI to automate Medicare prior authorization decisions. One participating vendor denied more than 53 percent of requests, and several vendors missed a mandated 72-hour decision window. The Government Accountability Office determined in May 2026 that the Centers for Medicare and Medicaid Services did not follow proper procedure in establishing the program.

AI in healthcare prior authorization Centers for Medicare and Medicaid Services algorithmic harm human oversight government AI deployment GAO AI incident