On January 1st, 6 states (NJ, OH, OK, TX, AZ, WA) will begin rejecting Medicare claims for 17 specific treatments as part of WISeR model to reduce "waste, fraud and abuse", using AI. Targeted are treatments for back and knee injuries, Parkinson's Disease, sleep apnea, incontinence, impotence
Posted by JoeGibbon@reddit | PrepperIntel | View on Reddit | 131 comments
Individual-Engine401@reddit
Why these? If Kennedy saying these illnesses don’t exist? My mother will dalways d without her CPap machine
Worshipme988@reddit
They have some kind of hand in the money made by not covering these. Period. This admin has executed nothing that didnt immediately deliver money to their pockets.
California will begin producing and selling insulin for extremely cheap. We are gonna need more of this.
JoeGibbon@reddit (OP)
I notice that some of the treatments are often associated with diabetes and people who are overweight, like the skin grafts for people with chronic lesions from poor circulation, sleep apnea.
While RFK Jr and CMS haven't provided any rationale for targeting these treatments specifically -- other than a vague assertion that they are prone to "overuse" -- you can't help but notice that connection to RFK's hate-boner toward diabetes and overweight people. It's like they think diabetes and poor circulation is a choice, and if they take away the medical treatment you'll choose not to have diabetes or something.
Fuck if I know, none of this makes any sense.
kl2342@reddit
Lotta words to state the obvious - it's eugenics
Huckleberry_83@reddit
Like the post above, it's specifically targeting hypoglossal nerve stimulators (InSpire is the current brand name). It should not affect CPAPs.
DisplacedNY@reddit
Incontinence is a weird thing not to treat.
Tiger0520@reddit
Interesting thank you so much for responding
Tiger0520@reddit
Do the states have any say in this? I’m asking, but it’s really surprising to me that Washington is on the list.
JoeGibbon@reddit (OP)
Yes, I believe it was voluntary to participate in the pilot program. But once a state is signed up, all medical providers in the state are forced to participate.
JoeGibbon@reddit (OP)
I work for a company that has picked up one of these contracts to implement the AI review process.
CMS (Centers for Medicare & Medicaid Services), as an extension of policy decisions made by DOGE, RFK Jr and "Dr. Oz", are implementing a claim review model they call WISeR. The stated purpose of this review process is to reduce waste, fraud and abuse in the Medicare system by either automatically rejecting or manually reviewing any of 17 treatments that have been flagged as likely to be wasteful. The 6 states mentioned are part of a mandatory pilot program that begins January 1st, 2026. All Medicare claims submitted in these states during the trial period will either be rejected or subject to a manual review, where no such review process currently exists.
The 17 targeted treatments include:
JoeGibbon@reddit (OP)
If you or someone you know are currently on Medicare or Medicaid and are receiving any of those treatments, be prepared for your claims to be rejected or to go through some ridiculous red tape.
To add insult to injury (literally), contractors will receive a percentage of any money "saved" by rejecting claims in this way, incentivizing these companies to reject claims to benefit their bottom line.
It is again worth noting, no such review process exists currently. If a doctor prescribes these treatments today, the government has no say in whether the treatment is actually necessary. It should not be left to Elon Musk, RFK Jr, Dr. Oz or ChatGPT to decide whether pain treatment for your catastrophic back injury, sleep apnea or lesions from poor circulation are actually needed, after your doctor has already ordered the treatment.
This is part of an overall strategy to privatize government services and enrich corporations while tax payers and the people who need these treatments are fucked.
Blood-blood-blood@reddit
This is fucking foul
JoeGibbon@reddit (OP)
Yeah it's pretty fucked.
ForgettableSquash@reddit
Jesus h. Those things work great too. These people are horrible.
JoeGibbon@reddit (OP)
I've had a few of the procedures on this list myself. The results were life changing. They made the difference between waking up in extreme pain every morning and having no pain at all, without opioids or any other kind of pain killing drugs. I cannot imagine the ignorance and cruelty it takes to deny that to someone just because they don't have private insurance.
It already takes going through a lot of red tape just to get onto Medicare, now they're trying to turn Medicare into a profit machine just like the privatized healthcare sector. And they don't care who it hurts.
KatCorona@reddit
Ding ding ding! This is the point right here. Get rid of treatments that work and you stay reliant on pills and other treatments that don’t work so you have to keep going in and using the system more. Then once everything is privatized and these for-profit companies take over, the profit margin will continue to grow exponentially at our expense.
Side note- I’m sincerely happy that those treatments worked for you and you are not having to live in pain and reliant on opiates! 🙌🏼
ForthrightGhost@reddit
It’s time to do direct action and put pressure on these state’s governments. They have to know that WE are in charge, not them.
theoneyewberry@reddit
I wish they didn't care. The cruelty is the point.
ForgettableSquash@reddit
Feature, not a bug
modernsparkle@reddit
Especially after gutting Medicaid. And like you said, these are treatments that help people. People with intractable pain. And instead there is profit on the pausing of these payouts.
Appreciate you sharing, I just can’t believe it
PerceiveEternal@reddit
And the perpetrator of one of the biggest mediocrity frauds in history is current a U.S. Senator for Florida. Interesting how the system isn’t designed to flag people like him.
SmilingAmericaAmazon@reddit
I think you meant Medicare and auto incorrect intervened
PerceiveEternal@reddit
Hah! that I did. ty
Ywasitsohard2signup@reddit
This actually made me sick to read. I really appreciate the attention you're bringing to this.
zumba_fitness_@reddit
You'd think that after getting a CEO killed over their shitty practices that they'd try to make it better, not worse
TwistedScarletRose@reddit
Isn't this the exact type of shit that motivated Luigi in the first place? Why are we inciting even more violence?
_MrBalls_@reddit
Yes, exactly
WhyAreYallFascists@reddit
Allegedly. I don’t think it was him.
Ruthless-words@reddit
My thoughts exactly. I have ankylosing spondylitis which causes severe spinal arthritis, nerve, muscle and back pain — decompression and steroid injections are like the top treatment for me (I’m 33) - but most doctors are conservative with this treatment and wait until it’s really bad or you’re older to do anything. I’m working on PT and medications right now (I do get buvicane nerve injections for pain relief)
They talk allll the time about opioid addiction and frankly they seem to be doing everything in their power to make people turn to drugs (and violence) instead of actually treating the root causes of pain.
Or, you know, they could lower the costs of medications and office treatments so this shit isn’t flagged for abuse because of its cost.
JoeGibbon@reddit (OP)
Good point.
Traditional-Leg-1574@reddit
This is the crux, they deny you healthcare, they make money. It’s not healthcare, it’s a business. I remember not too long ago a certain large health insurance company was getting bad press for using ai to deny claims. Now it’s ok?
ErictheAgnostic@reddit
Sooo...why are you a part of this?
JoeGibbon@reddit (OP)
I'm not. I was informed of the project and was asked to join it on Friday, I researched it over the weekend and I declined to participate in it first thing on Monday morning. Then I made this post.
g4bkun@reddit
Doctor here.
Notice how almost none of these treatments are life saving per se, they are aimed at improving life quality.
It is almost as if that directive is aimed towards making people's lives worse.
Any_Perception6527@reddit
I’m not defending the act but just looking at it another way… it’s not deciding whether or not quality of life is medically necessary - it’s deciding if the American taxpayer should pay for others’ quality of life vs. life saving services.
ThrowawayRage1218@reddit
As someone in chronic pain, who loves people with chronic pain and chronic illnesses, I would gladly increase the amount of taxes I pay if it meant everyone gets the medication and treatment they need regardless of whether it's life saving, in exchange for less of it going to the military industrial complex, private schools, insurance companies, and politicians' salaries.
Any_Perception6527@reddit
And that’s a great point. The fact is though, the taxpayer well is only so deep, even if we “tax the rich” (and I am not rich, by far!). The money has to come from somewhere, and we have to look at all spending - take a little from here to give it over there.
ThrowawayRage1218@reddit
So, we start with taxing the rich. Actually taxing them. Maybe even make being a billionaire a nonstarter: you get to $1B, then every penny over that is taxed at 100% because 1) there is no ethical way to be a billionaire and 2) nobody needs that much money for anything. Ever.
Then we have meaningful capital gains and inheritance taxes. I say this as someone who, though I grew up poor, my dad remarried a rich woman after I was already out of the house so I stand to be very comfortable in retirement. Would gladly have that taxed if it means feeding and housing people.
Then we pull government funding from ALL for-profit private enterprises that are not dedicated to research. Airlines, banks, all of it. Nobody gets a bailout; if you fail you fail. Do better.
Then we tax churches over a certain income amount, take down those megachurches to a more reasonable level. Or, we give them a choice: pay taxes, or give up your right to taxpayer-funded services. Can't have it both ways. Ditto the private schools which in the US are primarily religious.
Then we start defunding the military at least a little. As a veteran, who worked in finance, do you know how much money is wasted every year because if you don't spend your entire budget you don't get as much the following year? We had units buying flat screen TVs for their break room just to make sure they had wiggle room in their budget the following year in case they needed it. Millions of dollars is wasted every year producing tanks and planes the actual units don't even want. There's a field out in the desert full of rotting military equipment that's never been used.
Then we take away the president's in-perpetuity salary. Secret service, sure I get that. The threat to their lives remain after they leave office. But they can go out and get a job.
Then we tie Congressional salaries to the minimum wage. Not that they make minimum wage, but they cannot make more than x% of minimum wage. See how fast that minimum wage raises to deal with the cost of living.
Because you know what everyone deserves? Quality healthcare and education, clean water, safe food, clothing in good repair, safe homes in good repair, electricity, and anything else you need to function in today's society such as a phone, internet, and a car. These are not luxuries; you literally cannot participate in society without them, which makes them utilities. These are human rights. And "we have to take life-changing healthcare from poor people" isn't the first or even 50th step we take to provide those things. The Nordics manage to provide for their people and are happy, healthy, and safe; why can't the so-called wealthiest/strongest/most powerful country in the world do the same thing?
Our system is broken. Letting politicians and private companies off the hook isn't the way to fix it. Taxing poor people at a disproportionate rate and taking away their treatments isn't the way to fix it. We all, every single one of us, deserve a life of safety and dignity, free of as much physical pain as possible. No exceptions.
JoeGibbon@reddit (OP)
This is exactly the brand of actual waste and abuse that I saw when I was subcontracting on gov projects about a decade ago. Not just the DoD, either. Most departments that aren't nickle-and-dimed have a budget surplus that they waste at the end of the fiscal year, so they don't lose the budget. They go into a mad frenzy spending on shit they don't need, to keep extra millions of dollars of budget money they don't need.
I was put on so many software projects that whatever department hired us didn't even want, they just had an extra $million to spend and they had to do it quick. I'd show up on site for the project kickoff meeting, we'd talk about what needed to be done to actually set up and use our product and they'd be like, "ah, nevermind we'll maybe do it next year." And we'd never hear from them again.
There's a lot of talk about how the DoD hasn't passed a budget audit in years. It's mostly excused away as, "well we have really expensive black projects that we can't disclose," and people begrudgingly accept that answer and move on. But I have a feeling a lot of this wasteful spending is driving that secrecy as well. "Sorry, we can't tell you what we spent that $5 million on, it definitely wasn't for software licenses we'll never use..."
ThrowawayRage1218@reddit
A million times this. Like, I don't necessarily agree with the "use it or lose it" approach; some years you need more funding than others. But wasting millions on frivolous shit isn't the answer either. What is the answer? Don't know. But not this.
If I'd stayed in I would've tried to work my way into black budget up at DFAS just to blow the whistle. But as you may be able to tell, I wasn't exactly military material. I went for college money and only for college money; 4 and out.
zoinkability@reddit
You are on Medicaid and have a stroke.
Under your logic the only treatment that should be offered is what keeps the person alive, not what restores them to health/function. None of the rehab, none of the care beyond “you are not dead.” Medicaid would have no obligation to provide care beyond keeping you alive, even if the minimal “keeping you alive” treatment left you a vegetable.
Multiply that by all the other things and you don’t have health insurance at all, you have “keeping bodies alive insurance.”
CapitalJellyTripled@reddit
Medicaid was not designed to only provide life saving services. You’re thinking of EMTALA, which is already a law. The irony is that allowing people to be uninsured and uncovered raises the prices for everyone wherever you’re on private insurance or Medicaid/Medicare. The corporate insurance lobby gets fucking filthy rich, while you think it’s about taxpayers lol. You need to ask yourself “but who benefits and why” about 5 extra times per issue. You’re stopping WAY too prematurely for your own good.
zoinkability@reddit
You are on Medicaid and have a stroke.
Under your logic the only treatment that should be offered is what keeps the person alive, not what restores them to health/function. None of the rehab, none of the care beyond “you are not dead.” Medicaid would have no obligation to provide care beyond keeping you alive, even if the minimal “keeping you alive” treatment left you a vegetable.
Multiply that by all the other things and you don’t have health insurance at all, you have “keeping bodies alive insurance.”
geddysbass2112@reddit
I they will wonder why people are snapping. Engineered by design.
KitsuneMilk@reddit
When you factor in the QALY system, it becomes even more insidious.
When you can be denied interventions because your "quality of life" won't improve and it will "only prolong the suffering," what else can this be but a way to create cause to deny future life-saving treatments (without having to explicitly ban them) with the argument that "their QOL was terrible anyway."
g4bkun@reddit
Interesting point, you're entirely right.
I shudder, thinking about the implications this will have for patients with chronic illnesses
KitsuneMilk@reddit
If I had to guess, I'd expect a broader rollout of elective euthanasia.
When Oregon passed it, I had friends who lived there (who are no longer friends for obvious reasons) asking if I wanted to come-- as if killing yourself is some kind of tourist activity. The broader public sees "elective" and thinks it means "free of any pressure and fully willfully desired" when financial, social, and familial pressures are a constant push in that direction.
But hey, when they make living so miserable that people "elect" the alternative, they can say it was totally, definitely, 100% a choice and wash their hands clean of the entire thing.
g4bkun@reddit
That's... unsettling, I've been pro euthanasia for most of my career, but in the back of my mind, I've always thought about the darker side of it.
KitsuneMilk@reddit
Given my experiences as someone who has been pressured by friends, family, and medical professionals at various points in my life to "just consider it", I am in the camp of I understand why it can be useful, but it feels (to me) too dangerous to have in our healthcare system as it exists today, especially now.
Not Dead Yet collects stories and experiences from chronically ill and disabled people if you ever want to explore that darker side.
JoeGibbon@reddit (OP)
Yea exactly. This is just the start of it, too, I'm afraid. It starts with 17 little treatments and if nobody stops them they'll keep expanding it.
I've had a few of the treatments on this chopping block, after a spinal injury that left me with 3 herniated discs. Nerve ablation, steroid injections and spinal fusion. The first two were life changing, giving me time without pain -- with no opioids or other addictive pain meds -- before the permanent fix (spinal fusion). Before those treatments I was in pain all day and waking up every morning wondering why I should keep living. Without those procedures I'd probably be dead today, not because the injury was life threatening, but because the pain was unbearable.
I was fortunate enough to have private insurance at the time and was able to get these treatments without any hassle. I can't imagine the cruelty it takes to deny someone this life changing therapy, just because they don't have private insurance.
g4bkun@reddit
I'm glad that everything seems to have gone well for you.
People need to realize, that modern medicine is just not about keeping people alive, but also improving quality of life, be it either through the use of medications or surgery.
Regretfully , said interventions are the easiest for insurers to deny or to delay until they can no longer be done because the patient would no longer benefit from it, or they are dead.
rando1219@reddit
I’m confused why they even need AI. Don’t these procedures have a medical billing code they would just reject?
JoeGibbon@reddit (OP)
I'm glad you asked!
The process for producing those ICD10 or CPT codes goes a little something like this:
This is why AI is involved. There are companies that are already using AI to read chart data and convert it to billing codes. It's a fairly easy pivot for these companies to use that same tech to look for a handful of ICD10/CPT codes to divert to this WISeR thing.
Adulations@reddit
These all seem reasonable wtf
Kinetic_Vagabond@reddit
Wow. We use Bio grafts for chronic wounds a lot in wound care, and they work! That's dumb.
BroccoliOscar@reddit
“Suffer because I want to give a bigger share of your tax dollars to drug and medtech companies” is one hell of a policy.
Aggressive-Ideal-911@reddit
How are any of these treatments wasteful or fraudulent ?
JoeGibbon@reddit (OP)
RFK Jr's brain worm said so
yogzi@reddit
Sabotage your workplace
CaptKJaneway@reddit
I can at least get behind the removing funding for treatment of impotence. Less old men raping little girls that way
Bobert77@reddit
CMS’s RFA makes clear it will contract with “technology partners” (companies that apply AI/ML and prior-auth workflows) and that model participants would be paid a share of averted expenditures (a novel payment approach described in the RFA). That is a built-in financial incentive for vendors that operate the prior-auth platform.
_ghostperson@reddit
AI: "lol, humans don't need knees to live"
Ornery-Atmosphere930@reddit
Know who gets a lot of back and knee injuries? Blue collar workers and people in caring professions (healthcare, education, childcare, elderly care, etc). So, poor people and (disproportionately in caring professions) women. Looks pretty on brand for Project 2025. Force people to work and sacrifice their bodies for their survival, refuse to pay a living wage and force reliance on state programs like Medicare, then cut the programs they rely on to keep their bodies functional enough to continue working for next to nothing.
nobodyof@reddit
Nah i know, i know, but hear me out. The billionaires with get more billions, right? And isnt that, at the end of the day, what really matters?
/s
IncomingAxofKindness@reddit
Gotta make sure UNH gets back to all time highs now that they've bought the dip.
JoeGibbon@reddit (OP)
One of the first things I thought of when I saw that knee treatment was my dad, who's an enthusiastic Trump supporter. He's on Medicare, he's had that procedure done a few times because he worked construction his whole life and destroyed his knees.
He doesn't live in any of the 6 states where this is happening, but I'm sure he won't care that people just like him will be denied the same treatments he's getting, because RFK Jr's brain worm said this treatment is "overused".
cadeycaterpillar@reddit
Don’t worry, this is the pilot program. It’ll be coming to his state real soon.
Huckleberry_83@reddit
"And CMS is considering implementing a "gold card" program to exempt certain providers from prior authorizations if 90% of their requests get approved in a provisional period." Why does everything have to be gold?
rando1219@reddit
The Oval Office isn’t covered in expired Disney Fast passes
AnotherBaldWhiteDude@reddit
So not necessarily a "death panel" currently, but coming soon, AI death panels. What a fun lil future we've made for ourselves.
Piss_in_my_cunt@reddit
😭😭😭 “hey we’re going to PILOT a program to make Medicare dollars more accountable and go further for life-saving and medically necessary treatments.”
Everyone on a prepper sub: utter panic and hysteria
JoeGibbon@reddit (OP)
Yes, this is a pilot program in 6 states. All Medicare claims in those states will be reviewed and anyone getting these 17 affected treatments will have their claims denied. The contractors running the AI systems get a kickback for every denied claim.
Healthcare providers will now have to deal with extra administrative procedures where there were none previously. The program incentivizes healthcare providers to stop providing these services to Medicare patients, and if they do deem it necessary they have to go through a system of automated rejections and appeals just to get paid.
You know what happens after a successful pilot? A full rollout. You know what happens after this program and its 17 little treatments is deemed the greatest boon to American healthcare since penicillin? More treatments get added and more claims denied.
Hope you or anyone you know isn't on Medicare. I don't think there are any emojis to express what they'll be going through in the coming years.
Piss_in_my_cunt@reddit
Honey first of all I can read, thanks. Second, I work in provider logistics, I’m closer to this issue than you might think, and you’re a moron if you think this is some Nazi shit. The system is abused, full stop. Private insurance companies are a large benefactor of said abuse. So are some private practices. Pilots like these pave the road to each and every Medicare dollar providing better health for our seniors and providing less parasitic profit for system abusers.
Tldr, get over yourself and calm down.
JoeGibbon@reddit (OP)
I've worked with Medicare enrollment and claims processing for the last 6 years or so. Worked as a technical consultant to prime contractors for about 5 years before that. I'm aware there is rampant waste, fraud and abuse inherent in the system. Unfortunately, most of that waste and abuse is in the DoD. Simply forcing them to account for money spent would eliminate as much waste, fraud and abuse as any such waste in Medicare 10 times over.
I'd rather eliminate unnecessary projects that cost millions and go nowhere in the DoD & DoJ, vs punishing poor and old people on Medicare who need treatments for traumatic back injuries, Parkinson's Disease and sleep apnea. Let's start with the bigger part of the discretionary budget, first.
Ilovemytowm@reddit
Thank you for this post and all the information I learned I'm in one of the affected states. What a goddamn nightmare all of this is I want to cry seriously want to fucking cry I can't take it anymore.
Ilovemytowm@reddit
Maggat said what?
zyiadem@reddit
Despite being a prepper you seem to lack any awareness of how interconnected everything is, seems like you need to spend a bit more time thinking.
Ilovemytowm@reddit
You fucking moronic maggat clown take your troll bot bullshit somewhere else.
goldbeater@reddit
General strike coming up
TinyEmergencyCake@reddit
Have you joined a union yet?
goldbeater@reddit
Yes,but I’m Canadian.
TinyEmergencyCake@reddit
Then why are you commenting to strike on a post regarding the usa
goldbeater@reddit
Don’t you think we have a dog in this fight ? It’s hard to watch your country fall into the hands of authoritarians. My country has been attacked economically and our sovereignty threatened. Your demented leader is being manipulated by the likes of Bannon and Miller and other Project 2025 goons. When Canadians hear the words “manifest destiny “ we start to get nervous. When Trump talks about the “imaginary line” that we call a border,we start to get nervous. When Trump starts to talk about needing our water,we start…you get the idea. Imagine if Mark Carney went on national tv and said the US should be one of our provinces. Not just once as a flippant joke,but many times and then going after you auto industry,mining industry and more ,in a play to bring you to heel. You would all be losing your collective shit ! So don’t be surprised when Canadians call for you to do something more to end the madness we see from this regime every day. You Americans like to laugh and put down the French,but they make you look like slaves to authority. They would never have let anything like this happen. The government works for them. Can you say the same ? What have you all been stockpiling all those guns for ? Isn’t it your dream of fighting your government someday ,or are you just going to roll over while the military takes over blue states ? Your civil war has already started,the first deaths at the hands of Trumps secret police have been committed. People have been disappearing.When they come for your guns because they fear you might fight back,what will happen ? Will it be too late ? So I call for a general strike instead of armed rebellion. I’m against war and Fascism and so I’m easily branded as Antifa and your government has declared people like me to be terrorists,perhaps you as well. I hope my American neighbours can solve these issues peacefully.
TinyEmergencyCake@reddit
An ad hoc strike without support from unions will struggle to be successful. The major unions already have a strike scheduled for mayday 2028. It's that far away because the time is needed to develop strong solidarity between unions, encourage workers, and bolster strike funds.
Most people cannot just ... not go to work here in the usa. We don't have healthcare like you do. For most people their healthcare is tied to their job. So getting fired --no matter how illegal that would be-- means complete loss of access to healthcare.
That's only one reason. There's many others. Most workers cannot afford a single day off.
Yes, we're going to general strike. No, we can't do it without union support. Encourage people to join unions, instead of encouraging them to "general strike!"
It's incredibly unhelpful.
goldbeater@reddit
2028 will be far too late
TinyEmergencyCake@reddit
It won't.
JoeGibbon@reddit (OP)
It might.
TinyEmergencyCake@reddit
This is anti voter rhetoric
goldbeater@reddit
I don’t see that. I see pro democracy rhetoric. Dominion Voting Machines recently bought by a republican should cause all the alarm bells to go off,but your mainstream media has also been bought by republicans,so not much happens. I support paper ballots and an end to gerrymandering.(there,some pro voter rhetoric for you ).
JoeGibbon@reddit (OP)
Wut
brought2light@reddit
We can strike without being in a union. We can all strike.
blackgandalff@reddit
I agree. However I do find it corny as fuck when Canadians pretend like they’re right here with us.
brought2light@reddit
That's exactly the answer. And I'm American.
The_Dead_Kennys@reddit
God, this is so fucking evil.
ky420@reddit
They are really gonna ruin people's lives with ai.
Railamaar@reddit
I fucking loathe these bastards who think they know everything . And I want to sure them all into oblivion fur literally practicing medicine without a license. Oh, wait, isn't that what the orange twats "doctor" actually is doing?
And I have no illusions that if THEY needed any of these treatments that they would have zero iotas of any delay or issues receiving them.
I get spinal injections every 90 days because my spine is jacked. Already have my spinal stimulator, 2 fusions and still hurt. Been disabled since 2019 and finally got approved in 2022. Hubby is retiring in 2 years and Medicare will be much more used.
And, I can't even get any fucking pain meds cause, you know, they are addicting. But heroin is fiiiiine
Fuck them ALL
I never thought I would actually hate it here.
Doctor_Nerdy@reddit
Are you fxng kidding me?! There is so much wrong with this I don’t even know where to start.
JoeGibbon@reddit (OP)
Yeah it's balls.
Fedexed@reddit
I have sleep apnea, and there were times I would wake up gasping for air. My CPAP might have saved my life
LilahPayne@reddit
They aren’t taking away machines. In regard to sleep apnea they are talking about hypoglossal nerve stimulators which would be something like Inspire. Phrenic nerve stimulator is also on the list and that’s another implantable device that can help central sleep apnea
danjouswoodenhand@reddit
It doesn’t look like CPAP is on the list - I’m guessing it’s one of the nerve stimulation treatments? Sucks either way.
ClassicAct@reddit
CPAP is treatment for sleep apnea which is listed.
Winter_Proposal_6647@reddit
I know mine did. It was detected(thru a heart monitor) that my heart was actually stopping from me not breathing. The devices are expensive but it saved my life.
h2power237@reddit
Something had got to give. There is a ton of fraud and abuse in Medicare. Trust me I run these programs and see it all of the time. It’s similar controls to what’s in Medicare Advantage.
This is what happens when you are running a huge deficit. I would love to take an axe to the defense as well. There is even more fraud and waste there.
Isaiah_The_Bun@reddit
this is gonna be epic. glad im just watchung from the north
Cultural-Company282@reddit
When old, white retirees can't get their Medicare dick pills, they might regret their Trump vote.
Femveratu@reddit
Cervical fusion? Must be for a pain only diagnosis as opposed to some sort of spinal Instability.
AppalachanKommie@reddit
That’s sad, send another 50 billion to israel.
JoeGibbon@reddit (OP)
And 20 billion to Venezuela.
Current-Tale8250@reddit
Look at Frankel#5 … amendment that will stop this. Might get passed.
JoeGibbon@reddit (OP)
Thank God. I hope this actually makes it into the budget bill, assuming Congress will ever fucking vote on anything again.
https://appropriations.house.gov/news/press-releases/committee-approves-fy26-labor-health-and-human-services-education-and-related
Vercoduex@reddit
Someone needs to shadow realm rfk for real.
Present-Opinion1561@reddit
It sounds like the participate companies will earn more money the more denials their AI hands out.
"Model participants will receive a percentage of the savings associated with averted wasteful, inappropriate care as a result of their reviews. That percentage will be adjusted based on the participant’s performance on measures related to the process, including provider experience.”
https://www.cms.gov/priorities/innovation/innovation-models/wiser
located under Participant Information dropdown.
JoeGibbon@reddit (OP)
Yes, this part in particular stuck out to me. It's bad enough the government -- "Doctor" Oz and RFK Jr specifically -- is making top down determinations about what treatments are unnecessary without providing any research or reasoning for their decisions. But to incentivize these companies to deny everything, while punishing medical providers with red tape headaches when they do order these treatments is unconscionable.
Margotkitty@reddit
I find it so interesting how so many Americans are completely uninformed about the history of who Trump has pardoned. They fall for his “end waste fraud and abuse” schtick.
Trump commuted the sentence of Philip Esformes, the man convicted of the largest-ever Medicare fraud scheme in American history. He stole 1.3 BILLION from American taxpayers.
Tell me why anyone who wants to end waste, fraud and abuse would let someone off the hook for just exactly those things?
Now they are coming for actual treatments for pain and quality of life/comorbidities for American taxpayers. And they’re incentivizing it for the people who are going to be deciding if you get it or not - if they decide you “don’t qualify” then THEY get paid. What do you think is going to happen?
Insanity. Most Americans I talk to have never heard of Philip Esformes and aren’t aware of his fraud case, or his pardon. Even Trump supporters have a hard time coming up with a reason why letting him off for such a massive crime was a good idea. They can, at least initially, recognize that this guy essentially stole money from their own pockets too.
Biggest fraudster granted clemency by Trump. sentence commuted.
Trump let’s multiple health care fraudsters walk Trump rewards fraud
cadeycaterpillar@reddit
I mean he also gave one to the Silk Road guy while simultaneously screeching about closing the border on Canadian fentanyl. They know their voters are uninformed and will never hear about these things on Fox so they don’t care.
mslinky@reddit
Without critical thinking skills people only hear what they want to hear.
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Accio_Diet_Coke@reddit
I think they are going to get a wave of chaos when older men find out about “diagnosing and treating impotence”.
this_is_no_exit@reddit
What a monstrous thing to do
EastTyne1191@reddit
This is a great reminder that aside from the shutdown and economic misery we've been thrown into, our basic societal infrastructures are being undermined. The repercussions of these policies will take years (decades for some) to undo.
Elon-Tesla-@reddit
Deny
Defend
Dispose
This is MAGA
mrtailormade99@reddit
But there’s money to bail out Argentina
satsugene@reddit
Diagnosis and Treatment of Impotence
How much did Hims or Bluechee pay to get ED treatments off the list of what people could go though their usual insurance/channels to pay for.
JoeGibbon@reddit (OP)
Yeah, that one has Alex Jones herbal boner pill energy.
slysnow99@reddit
The Bluechew commercials are so fucking distrubing
dodekahedron@reddit
Vagus nerve stimulation really works for my condition im about to retire on disability with, and qualify for mediwhatever
So...
I mean this kinda blows. I am assuming there are steps to like get a secondary look and approve?
JoeGibbon@reddit (OP)
The process workflow is ridiculously complicated, but it basically boils down to:
So the short answer to your question is yes, there is a manual review process involved under certain circumstances, but the people who review it work for the government as part of this WISeR thing. I hate to be cynical, but I imagine they have people like Big Ballz and Baron Trump making those decisions.
And then ultimately you can appeal anything that has been rejected, but I'm not sure under what criteria they'll decide they were wrong about these treatments being "overused", since they haven't provided any evidence or reasoning whatsoever that shows why they decided that in the first place. I mean, what are they going to compare your appeal to, since they're just making shit up as they go?
Fuck man, it makes me sick just thinking about all this.
slysnow99@reddit
Holy shit
classicgirl65@reddit
This is pure evil.
LackNo6962@reddit
Yay, AI Publicans