Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.
The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions. It will affect Medicare patients, and the doctors and hospitals who care for them, in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, starting Jan. 1 and running through 2031.
The move has raised eyebrows among politicians and policy experts. The traditional version of Medicare, which covers adults 65 and older and some people with disabilities, has mostly eschewed prior authorization. Still, it is widely used by private insurers, especially in the Medicare Advantage market.
And the timing was surprising: The pilot was announced in late June, just days after the Trump administration unveiled a voluntary effort by private health insurers to revamp and reduce their own use of prior authorization, which causes care to be “significantly delayed,” said Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services.
“It erodes public trust in the health care system,” Oz told the media. “It’s something that we can’t tolerate in this administration.”
But some critics, like Vinay Rathi, an Ohio State University doctor and policy researcher, have accused the Trump administration of sending mixed messages.
On one hand, the federal government wants to borrow cost-cutting measures used by private insurance, he said. “On the other, it slaps them on the wrist.”
Administration officials are “talking out of both sides of their mouth,” said Rep. Suzan DelBene, a Washington Democrat. “It’s hugely concerning.”
Patients, doctors, and other lawmakers have also been critical of what they see as delay-or-deny tactics, which can slow down or block access to care, causing irreparable harm and even death.
“Insurance companies have put it in their mantra that they will take patients’ money and then do their damnedest to deny giving it to the people who deliver care,” said Rep. Greg Murphy, a North Carolina Republican and a urologist. “That goes on in every insurance company boardroom.”
Insurers have long argued that prior authorization reduces fraud and wasteful spending, as well as prevents potential harm. Public displeasure with insurance denials dominated the news in December, when the shooting death of UnitedHealthcare’s CEO led many to anoint his alleged killer as a folk hero.
And the public broadly dislikes the practice: Nearly three-quarters of respondents thought prior authorization was a “major” problem in a July poll published by KFF, a health information nonprofit that includes KFF Health News.
Indeed, Oz said during his June press conference that “violence in the streets” prompted the Trump administration to take on the issue of prior authorization reform in the private insurance industry.
Still, the administration is expanding the use of prior authorization in Medicare. CMS spokesperson Alexx Pons said both initiatives “serve the same goal of protecting patients and Medicare dollars.”
Unanswered Questions
The pilot program, WISeR — short for “Wasteful and Inappropriate Service Reduction” — will test the use of an AI algorithm in making prior authorization decisions for some Medicare services, including skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy.
The federal government says such procedures are particularly vulnerable to “fraud, waste, and abuse” and could be held in check by prior authorization.
Other procedures may be added to the list. But services that are inpatient-only, emergency, or “would pose a substantial risk to patients if significantly delayed” would not be subject to the AI model’s assessment, according to the federal announcement.
While the use of AI in health insurance isn’t new, Medicare has been slow to adopt the private-sector tools. Medicare has historically used prior authorization in a limited way, with contractors who aren’t incentivized to deny services. But experts who have studied the plan believe the federal pilot could change that.
Pons told KFF Health News that no Medicare request will be denied before being reviewed by a “qualified human clinician,” and that vendors “are prohibited from compensation arrangements tied to denial rates.” While the government says vendors will be rewarded for savings, Pons said multiple safeguards will “remove any incentive to deny medically appropriate care.”
“Shared savings arrangements mean that vendors financially benefit when less care is delivered,” a structure that can create a powerful incentive for companies to deny medically necessary care, said Jennifer Brackeen, senior director of government affairs for the Washington State Hospital Association.
And doctors and policy experts say that’s only one concern.
Rathi said the plan “is not fully fleshed out” and relies on “messy and subjective” measures. The model, he said, ultimately depends on contractors to assess their own results, a choice that makes the results potentially suspect.
“I’m not sure they know, even, how they’re going to figure out whether this is helping or hurting patients,” he said.
Pons said the use of AI in the Medicare pilot will be “subject to strict oversight to ensure transparency, accountability, and alignment with Medicare rules and patient protection.”
“CMS remains committed to ensuring that automated tools support, not replace, clinically sound decision-making,” he said.
Experts agree that AI is theoretically capable of expediting what has been a cumbersome process marked by delays and denials that can harm patients’ health. Health insurers have argued that AI eliminates human error and bias and will save the health care system money. These companies have also insisted that humans, not computers, are ultimately reviewing coverage decisions.
But some scholars are doubtful that’s routinely happening.
“I think that there’s also probably a little bit of ambiguity over what constitutes ‘meaningful human review,’” said Amy Killelea, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University.
A 2023 report published by ProPublica found that, over a two-month period, doctors at Cigna who reviewed requests for payment spent an average of only 1.2 seconds on each case.
Cigna spokesperson Justine Sessions told KFF Health News that the company does not use AI to deny care or claims. The ProPublica investigation referenced a “simple software-driven process that helped accelerate payments to clinicians for common, relatively low-cost tests and treatments, and it is not powered by AI,” Sessions said. “It was not used for prior authorizations.”
And yet class-action lawsuits filed against major health insurers have alleged that flawed AI models undermine doctor recommendations and fail to take patients’ unique needs into account, forcing some people to shoulder the financial burden of their care.
Meanwhile, a survey of physicians published by the American Medical Association in February found that 61% think AI is “increasing prior authorization denials, exacerbating avoidable patient harms and escalating unnecessary waste now and into the future.”
Chris Bond, a spokesperson for the insurers’ trade group AHIP, told KFF Health News that the organization is “zeroed in” on implementing the commitments made to the government. Those include reducing the scope of prior authorization and making sure that communications with patients about denials and appeals are easy to understand.
‘This Is a Pilot’
The Medicare pilot program underscores ongoing concerns about prior authorization and raises new ones.
While private health insurers have been opaque about how they use AI and the extent to which they use prior authorization, policy researchers believe these algorithms are often programmed to automatically deny high-cost care.
“The more expensive it is, the more likely it is to be denied,” said Jennifer Oliva, a professor at the Maurer School of Law at Indiana University-Bloomington, whose work focuses on AI regulation and health coverage.
Oliva explained in a recent paper for the Indiana Law Journal that when a patient is expected to die within a few years, health insurers are “motivated to rely on the algorithm.” As time passes and the patient or their provider is forced to appeal a denial, the chance of the patient dying during that process increases. The longer an appeal, the less likely the health insurer is to pay the claim, Oliva said.
“The No. 1 thing to do is make it very, very difficult for people to get high-cost services,” she said.
As the use of AI by health insurers is poised to grow, insurance company algorithms amount to a “regulatory blind spot” and demand more scrutiny, said Carmel Shachar, a faculty director at Harvard Law School’s Center for Health Law and Policy Innovation.
The WISeR pilot is “an interesting step” toward using AI to ensure that Medicare dollars are purchasing high-quality health care, she said. But the lack of details makes it difficult to determine whether it will work.
Politicians are grappling with some of the same questions.
“How is this being tested in the first place? How are you going to make sure that it is working and not denying care or producing higher rates of care denial?” asked DelBene, who signed an August letter to Oz with other Democrats demanding answers about the AI program. But Democrats aren’t the only ones worried.
Murphy, who co-chairs the House GOP Doctors Caucus, acknowledged that many physicians are concerned the WISeR pilot could overreach into their practice of medicine if the AI algorithm denies doctor-recommended care.
Meanwhile, House members of both parties recently supported a measure proposed by Rep. Lois Frankel, a Florida Democrat, to block funding for the pilot in the fiscal 2026 budget of the Department of Health and Human Services.
AI in health care is here to stay, Murphy said, but it remains to be seen whether the WISeR pilot will save Medicare money or contribute to the problems already posed by prior authorization.
“This is a pilot, and I’m open to see what’s going to happen with this,” Murphy said, “but I will always, always err on the side that doctors know what’s best for their patients.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Hours after Charlie Kirk’s assassination, Suzanne Swierc shared two thoughts on her private Facebook page — that the killing of the right-wing activist was wrong, and that his death reflected “the violence, fear and hatred he sowed.”
The post upended her life.
Indiana Republican Attorney General Todd Rokita soon obtained a screenshot of the post by Swierc, an administrator at Ball State University, and added it to an official website naming and shaming educators for their comments about Kirk.
Libs of Tik Tok, a social media account dedicated to mocking liberals, shared her comments with its 4.4 million followers on X. A week after the post, the university fired her.
“The day that my private post was made public without my consent was one of the worst days of my life,” Swierc told reporters this past week. She said she received calls, texts and other harassing messages, including one suggesting she should be killed, that left her terrified.
A wave of firings and investigations has swept through academia and government in the wake of Kirk’s death, as state agencies, colleges and local school districts take action against employees over comments perceived as offensive or inappropriate. Dozens of workers in higher education alone have lost their jobs.
A Texas State University student was expelled after he publicly reenacted Kirk’s assassination; Texas Gov. Greg Abbott and other Republicans had called for the student’s expulsion. Clemson University in South Carolina fired one worker and removed two professors from teaching. The University of Mississippi fired an employee. An Idaho Department of Labor employee was terminated.
The purge is driven in part by Republican elected officials who are encouraging Americans to report co-workers, their children’s teachers and others who make comments seen as crossing the line. They have been egged on by the Trump administration, with Vice President JD Vance urging listeners of Kirk’s podcast to call the employer of anyone “celebrating” his killing.
President Donald Trump has threatened to expand the crackdown beyond Kirk, warning falsely in the Oval Office last week that negative press coverage of him is “really illegal,” despite constitutional protections for freedom of the press.
Trump headlines Arizona memorial service for Charlie Kirk at packed stadium
At Kirk’s memorial service, Trump said, “I hate my opponent.” His choice to lead the Federal Communications Commission threatened ABC over comments about the reaction to Kirk’s death made by the late-night comedian Jimmy Kimmel and the network pulled his show for several days.
Mark Johnson, a First Amendment attorney based in Kansas City, Missouri, who has been practicing law for 45 years, said he had never seen a moment like the current one.
“Not even close,” Johnson said. “What’s been happening in the last month is astonishing.”
In Indiana, Rokita is using his office’s “Eyes on Education” webpage to publicize examples of educators who have made controversial remarks about Kirk. The page, billed as a transparency tool, housed a hodgepodge of submitted complaints about teachers and schools in the past. Now, it also includes 28 Kirk-related submissions as of Thursday afternoon.
Wisconsin Republican U.S. Rep. Derrick Van Orden threatened to strip an entire town of federal funding after a high school math teacher noted on her personal Facebook page that Kirk had in the past said some gun deaths are worth it to have the Second Amendment. The teacher has been suspended.
Oklahoma State Superintendent Ryan Walters, who is leaving his job next month to head up a conservative teachers organization, has launched investigations of school employees in response to tips submitted to Awareity, an online platform that allows parents and others to report concerns. Last week the Oklahoma State Department of Education said it had received 224 reports of “defamatory comments.”
Florida Republican U.S. Rep. Randy Fine has urged people with information about anyone celebrating Kirk’s death who works in government in Florida to contact his office. And South Carolina Republican U.S. Rep. Nancy Mace wants federal funding cut off for any school that fails to fire or discipline staff who “glorify or justify” political violence.
“It’s at a scale never before seen and I think it’s completely unhinged,” Todd Wolfson, president of the American Association of University Professors, said of the rush to fire higher education faculty.
Free speech consequences?
Kirk, who founded the campus conservative activism organization Turning Point USA and was close to Trump, was a hero to many Republicans. They saw a charismatic family man and a Christian unafraid to take his hard-right vision onto liberal college campuses.
But many Democrats and liberals experienced Kirk as a provocateur with a record of incendiary remarks about people of color, immigrants and Islam. While many of Kirk’s opponents have condemned the assassination, some have also emphasized their disagreement with his views or suggested his death arose out of what they saw as his hateful rhetoric.
“I have faculty who are getting fired, who have tenure and are getting fired, for saying things like ‘I condemn political violence but the words that Charlie Kirk used, he sort of reaped what he sowed,’” Wolfson said. “All things told, I may not agree with that statement, but that’s a perfectly reasonable thing for somebody to say. Certainly not something to be fired for.”
MSUN professor on leave as influencers targeted Montanans in wake of Charlie Kirk’s death
Some Republicans have long denounced what they view as past Democratic censorship, including Biden administration efforts to pressure social media companies to censor content during the COVID-19 pandemic. They have also criticized firings and pushed back on perceived political correctness run amok during the height of the #MeToo and Black Lives Matter movements, moments of ascendant progressive influence.
But as the current round of terminations plays out, some conservatives argue public employees who speak out about Kirk are facing the consequences of their actions. Oklahoma state Rep. Gabe Woolley, a Republican, said individuals in a taxpayer-funded role who work with children should be held to a high level of accountability.
“I think the most important factor to consider … is that these people chose to enter the public square on public social media accounts and to mock and celebrate the death of an American patriot who was a Christian martyr who was killed for his faith doing what God called him to do,” Woolley said.
Woolley added that “if you choose to make something public, you should not be shocked or surprised by any type of public pushback.”
Swierc described a relatively restricted Facebook account. It was private and couldn’t be found by searching for her name; only individuals with mutual Facebook friends could request to add her as a friend. She did not list her employer on her profile.
Swierc’s post on Kirk could only be seen by her Facebook friends. At some point, someone — Swierc doesn’t know who — made a screenshot of the post. It was then circulated publicly and ended up on Indiana’s “Eyes on Education” page.
On Sept. 17, Ball State University President Geoffrey Mearns fired Swierc, who had been director of health promotion and advocacy within the Division of Student Affairs. In a letter informing Swierc of her termination, Mearns wrote that many current students had written to the university to express concern and that her post had caused unprecedented disruption.
Swierc filed a federal lawsuit against Mearns on Monday, alleging he violated her First Amendment rights. Swierc, who is represented by the American Civil Liberties Union of Indiana, wants a court to order Mearns to expunge her termination from her Ball State University personnel file, along with unspecified damages.
“I do not regret the post I made, and I would not take back what I said,” Swierc said during a virtual news conference organized by the ACLU of Indiana. “I believe that I, along with every person in this country, have First Amendment rights to be able to speak on a number of things.”
Ball State University declined to answer Stateline’s questions, citing the lawsuit. In an unsigned public statement on the day of Swierc’s firing, the university said the post was “inconsistent with the distinctive nature and trust” of Swierc’s leadership position and had caused significant disruption to the university.
Swierc’s lawsuit is one of a growing number of legal challenges to firings and employee discipline over comments about Kirk. On Wednesday, a federal judge ordered the University of South Dakota to reinstate an art professor who had placed on administrative leave after calling Kirk a “Nazi” but later deleted the post and apologized.
Aggressive state attorney general
Swierc didn’t name Rokita, the attorney general, as a defendant in her lawsuit, but the official has loomed over the situation.
Two days after Kirk’s assassination, Rokita urged his followers on X to submit to him any evidence of educators or school administrators celebrating or rationalizing the killing. He wrote that they must be held accountable and “have no place teaching our students.”
But Rokita has also said the Indiana Attorney General’s Office isn’t investigating individuals submitted to his “Eyes on Education” page — suggesting the effort is mainly intended to generate public pressure against employers. Each example on the page lists contact information for the school’s leadership and in some instances information about the next local school board meeting.
“For a government official, especially of that caliber, to be creating a database and doing this has an incredibly chilling effect on speech,” said Ashkhen Kazaryan, a senior legal fellow at The Future of Free Speech, a nonpartisan think tank located at Vanderbilt University that promotes the values of free speech and free expression.
Rokita didn’t agree to an interview. “Our goal is to provide transparency, equipping parents with the information they need to make informed decisions about their children’s education,” Rokita said in a news release.
On Monday, Rokita sent a six-page letter to school superintendents and public university administrators, providing guidance on the legal authority to fire and discipline teachers for speech related to Kirk. The letter suggested that speech occurring on social media is a factor that weighs in favor of the authority to fire an employee because it carries the risk of being amplified and disrupting school operations.
Rokita also analyzed comments about Kirk by a U.S. history teacher in Indiana who had said the assassinated activist can “suck it” and referred to comments made by Kirk in 2023 that some gun deaths every year are the cost of Second Amendment rights. The district’s employer had chosen not to terminate the teacher, but Rokita laid out a legal justification for firing the employee.
He concluded the letter by writing that many schools would be within their legal authority to fire teachers “who have similarly contributed to the divisive and, for many, painful eruption of controversial discourse on social media and elsewhere concerning Charlie Kirk.”
Joseph Mastrosimone, an employment law professor at Washburn University, said private employers have broad discretion to fire workers over speech. But the government is different, he said, with the First Amendment providing at least some level of protection to employees.
Decades of court cases have established the core principle that if a public employee is speaking in their capacity as a citizen on a matter of public concern, then the government can only take action if the speech causes significant disruption to the delivery of the public service and that disruption outweighs the employee’s interest in the speech, he said.
Mastrosimone said if a teacher’s message made in his or her own time is causing community outrage and pandemonium, “that’s probably going to count as some disruption.”
“And there might be sufficient disruption to outweigh whatever interest the employee has in the speech,” Mastrosimone said. But the closer the teacher’s message is to core political speech — such as voicing support for a candidate for office — the more the scales tip in favor of the employee being able to speak without fear of discipline.
“It is certainly a matter of public concern, what’s going on here with the Charlie Kirk assassination. The interests are probably pretty high, I would think,” Mastrosimone said.
Push to honor Kirk
As some Republican officials have called for action against public employees who have made comments about Kirk, they have often drawn a line at what they see as celebrating or glorifying his assassination. Walters, the outgoing Oklahoma state superintendent, has gone further and is investigating districts for “refusing to honor his memory.”
The Oklahoma State Department of Education last week said in addition to reports on individual teachers, it was investigating 30 reports of schools that didn’t observe a moment of silence. Three reports alleged schools weren’t flying their flags at half-staff.
On Tuesday, Walters announced an official push to start a Turning Point USA chapter in every Oklahoma high school. Later that day, he announced he would resign as superintendent to become CEO of the Teacher Freedom Alliance, a new group that casts itself as a conservative alternative to teachers’ unions.
Walters’ Turning Point effort comes after Oklahoma state Sen. Shane Jett, a Republican, filed three pieces of legislation to honor Kirk, including one that would establish “Charlie Kirk Free Speech Day” and another requiring public colleges and universities to develop a “Charlie Kirk Memorial Plaza” on their campuses.
Walters and Jett didn’t respond to interview requests.
“Charlie Kirk inspired a generation to love America, to speak boldly, and to never shy away from debate. Our kids must get involved and active,” Walters said in a news release on Tuesday. “We will fight back against the liberal propaganda, pushed by the radical left, and the teachers unions. Our fight starts now.”
Stateline reporter Jonathan Shorman can be reached at jshorman@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Michigan Advance, and is supported by grants and a coalition of donors as a 501c(3) public charity.
For months, the complaints have rolled in from parts of the country hit by natural disasters: The Federal Emergency Management Agency was moving far too slowly in sending aid to communities ravaged by floods and hurricanes, including in central Texas and North Carolina. Many officials were blaming Kristi Noem, the homeland security secretary, whose agency oversees FEMA.
“I can’t get phone calls back,” Ted Budd, the Republican senator from North Carolina, told a newspaper this month, describing his attempts to reach Noem’s office. “I can’t get them to initiate the money. It’s just a quagmire.” The delays were caused in part by a new policy announced by DHS that requires Noem’s personal sign-off on expenses over $100,000, several news outlets reported.
But records obtained by ProPublica show how one locality found a way to get FEMA aid more quickly: It asked one of Noem’s political donors for help.
The records show that Noem quickly expedited more than $11 million of federal money to rebuild a historic pier in Naples, Florida, after she was contacted by a major financial supporter last month. The pier is a tourist attraction in the wealthy Gulf Coast enclave and was badly damaged by Hurricane Ian in 2022.
Frustrated city officials had been laboring for months, without success, to get disaster assistance. But just two weeks after the donor stepped in, they were celebrating their sudden change of fortune. “We are now at warp speed with FEMA,” one city official wrote in an email. A FEMA representative wrote: “Per leadership instruction, pushing project immediately.”
Along with fast-tracking the money, Noem flew to Naples on a government plane to tour the pier herself. She then stayed for the weekend and got dinner with the donor, local cardiologist Sinan Gursoy, at the French restaurant Bleu Provence, according to records and an interview with the Naples mayor. This account is based on text messages and emails ProPublica obtained through public records requests.
Noem’s actions in Naples suggest the injection of political favoritism into an agency tasked with saving lives and rebuilding communities wiped out by disaster. It also heightens concerns about the discretion Noem has given herself by personally handling all six-figure expenses at the agency, consolidating her power over who wins and loses in the pursuit of federal relief dollars, experts said.
Jeffrey Schlegelmilch, director of the National Center for Disaster Preparedness at Columbia University, said that politics has long been a factor in federal disaster relief — one study found that swing states are more likely to get federal help, for example. But “I’ve not heard of anything this egregious — a donor calling up and saying I need help and getting it,” he said, “while others may be getting denied assistance or otherwise waiting in line for help that may or may not come.”
In a statement, DHS spokesperson Tricia McLaughlin said, “This has nothing to do with politics: Secretary Noem also visited Ruidoso, NM” — where floods killed three people in July — “at the request of a Democrat governor and has been integral in supporting and speeding up their recovery efforts.”
“Your criticizing the Secretary’s visit to the Pier is bizarre as she works to fix this issue for more than 1 million visitors that used to visit the pier,” McLaughlin added. She did not answer questions about the donor’s role in expediting the funding or Noem’s relationship with him. Reached by phone, Gursoy said “get lost” and hung up. He did not respond to detailed follow up questions.
Noem has been criticized for creating a bottleneck at FEMA. When the floods hit Texas this summer — ultimately killing over 100 people — it took days to deploy critical search-and-rescue teams because Noem hadn’t signed off on them, according to CNN. Budd, the Republican senator, said this month: “Pretty much everything Helene-related is over $100,000. So they’re stacking up on her desk waiting for her signature.”
Noem has denied there were delays in the Texas flood response and has defended her expense policy, saying it has saved billions of dollars. “Every day I get up and I think, the American people are paying for this, should they?” she recently said. “And are these dollars doing what the law says they should be doing? I’m going to make sure that they go there.”
Once a sleepy fishing town, Naples is now home to CEOs and billionaires (a property listed for $295 million recently made headlines as the most expensive home in the U.S.). The city is known as an important stop for Republican politicians raising money, and Noem has held multiple fundraisers in the area. State credit card records suggest she visited Naples at least 10 times during her last four years as South Dakota governor.
Noem’s top adviser, Corey Lewandowski, also appears to own a home in Naples near the city’s pier, according to property tax records. Lewandowski is an unpaid staffer at DHS serving as Noem’s de facto chief of staff. (Media reports have alleged the two are romantically involved, which they have both denied.) Lewandowski told ProPublica that he was not involved in the pier decision and that he was not in Naples during Noem’s visit.
For the first seven months of the Trump administration, the pier reconstruction was in bureaucratic purgatory. The city had long been struggling to secure the regulatory approvals it needed to start building, and emails suggest Trump’s wave of federal layoffs had made the process even slower. “These agencies are undergoing significant reorganizations and staff reductions,” a city official told a frustrated constituent in early August. That “sometimes means starting over with new reviewers — something we’ve faced more than once.”
McLaughlin said “both past FEMA and the City bear responsibility” for the delays. She listed “several failures” since the process started in 2023, including “FEMA staff changing up” and indecision by the city government.
By this summer, Naples officials were getting desperate. In June, one tried to enlist Sen. Rick Scott, R-Fla., to press FEMA to move ahead. “We were told yesterday that Secretary Noem would have to ‘personally’ approve the Pier project before FEMA funding would be obligated,” the city official wrote to the senator’s staff. The Naples mayor, Teresa Heitmann, also personally wrote to FEMA. Heitmann said she was “perplexed” by the delays and begged the agency for guidance.
Heitmann had long been paying expensive Washington consultants to help her city navigate the process. But she was “feeling increasingly helpless,” she later said, until she had the idea that would finally put her project on the fast track. On July 18, the mayor emailed a Google search to herself: “Who is the head of Homeland security?” She was going to go straight to Noem.
Heitmann determined that her best bet for getting Noem’s attention was Gursoy. A Naples cardiologist, Gursoy has no obvious experience working with the federal government; much of his online footprint centers on his enthusiasm for pinball. But Gursoy gave Noem at least $25,000 to support her campaign for governor in 2022. That was enough to put him near the top of Noem’s disclosed donor list. (In South Dakota, campaign contributions remain relatively small.)
On planning documents for the 2024 Republican National Convention obtained by ProPublica, the Florida doctor is listed as an attendee affiliated with the delegation from South Dakota, a state he has no apparent connection to besides his support for Noem. Heitmann told ProPublica that Gursoy introduced her to Noem at a political event at a private home in Naples while Noem was governor.
“Hello it’s Teresa,” the mayor texted Gursoy in early August. “I really need your help.” She explained the tangle of bureaucracy she’d been contending with. “FEMA is holding us up,” Heitmann wrote. “Kristi Noem could put some fire under the FEMA employees slacking.”
Gursoy responded: “Okay. I will get on it.”
The next week, on Aug. 11, the doctor gave Heitmann an update. “Kristi was off for a few days for the first time in a long time, so I left her alone,” he said. “I just txted her now.” Within 24 hours, he had exciting news. He told the mayor to expect a call from Noem’s “FEMA fixer” shortly.
The identity of the “fixer” is not clear, but by Aug. 27, Naples officials were seeing a “flurry of activity” from Noem’s agency. That day, a FEMA staffer told the city that “FEMA is intending to expedite the funding” for the pier. “Secretary Noem took immediate action when I reached out to ask for help,” the mayor soon posted on Facebook.
Two days later, Noem flew to Naples. Her schedule listed a 30-minute walk-through at the pier with the mayor, followed by a nail salon appointment and dinner at Bleu Provence, which serves wagyu short ribs and seared foie gras. Noem then stayed through the weekend at the four-star Naples Bay Resort & Marina. Heitmann told ProPublica she wasn’t at the French dinner but Gursoy was. “I didn’t ask her to come, but she showed up,” the mayor told the local news. “I was very impressed.”
Before she left town, Noem posted about the Naples pier on Instagram. She was finally getting the project back on track, she said. “Americans deserve better than years of red tape and failed disaster responses,” Noem wrote. “Under @POTUS Trump, this incompetency ends.”
DHS did not answer questions about whether the government paid for Noem’s weekend in Naples.
Do you have any information we should know about Kristi Noem, Corey Lewandowski or DHS? Josh Kaplan can be reached by email at joshua.kaplan@propublica.org and by Signal or WhatsApp at 734-834-9383. Justin Elliott can be reached by email at justin@propublica.org and by Signal or WhatsApp at 774-826-6240.