Ohio begins Medicare pilot using AI to screen procedure approvals

Ohio’s participation in the WISeR Model pilot is not about frontier models, but it is a concrete example of how AI is being wired directly into life‑and‑death administrative decisions at scale. The systems in question are pattern‑matching tools trained on claims and clinical data to flag procedures as potentially inappropriate; humans supposedly remain the final decision‑makers. In practice, though, what gets flagged tends to shape what gets denied, and the story captures real worry from doctors that opaque risk scores will add friction and deter marginal but necessary care.

For the broader AI race, this is a preview of what large‑scale agentic deployment will look like in regulated sectors: algorithms doing triage on millions of individual decisions, with human reviewers acting as overworked backstops. That dynamic will show up in credit, hiring, policing and, eventually, access to advanced AI services themselves. How well the Medicare pilot manages appeals, bias and explainability will influence whether similar schemes become politically acceptable or trigger a backlash that slows adoption of AI decision‑support tools more generally.