In 2026, the Centers for Medicare & Medicaid Services (CMS) will introduce the Wasteful and Inappropriate Service Reduction (WISeR) Model, a new initiative designed to combat fraud, waste, and abuse in the fee-for-service (FFS) Medicare program. The WISeR Model will use technology to make medical review processes easier. It will use advanced artificial intelligence and machine learning to look at claims for specific services in six states. CMS will collaborate with third-party vendors to review, with payment incentives tied to proven reductions in spending on medically unnecessary care.
Read on to explore the WISeR Model’s structure, scope, and impact on healthcare providers, suppliers, and Medicare integrity. This +Insight highlights CMS’s goals, payment methods, safeguards for necessary care, and the growing role of real-time oversight technologies.
