Medicare's WISeR Plan Zaps Wasteful Doctor Orders
Published Date: 7/1/2025
Notice
Summary
Starting soon, Medicare will require doctors to get approval before providing certain services to cut down on waste and fraud. This new 6-year program helps make sure patients get the right care without unnecessary costs. If you use Medicare, expect smoother checks that save money and protect your health.
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Medicare requires prior approval
If you have Medicare fee-for-service, doctors will need to get approval before providing certain services. This prior authorization requirement is part of a program to reduce waste, fraud, and low-value care and will apply during the 6-year model.
Six-year model to cut fraud and waste
Medicare is launching a 6-year model focused on reducing fraud, waste (including low-value care), and abuse in fee-for-service Medicare. The model runs for six years and is intended to lower unnecessary costs and protect patient care.
Technology-enabled prior authorization
Medicare will use technology-enabled prior authorization for the select services in the model so approvals and checks are handled with digital processes. The notice says these technology-enabled checks are intended to be smoother and help cut unnecessary costs and fraud.
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Key Dates
Department and Agencies
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