News 1/16/26

Top News

Kaiser Permanente affiliates will pay $556 million to settle False Claims Act allegations that they inflated Medicare Advantage risk scores.

Federal investigators say that Kaiser electronically searched patient histories for diagnoses that had not been reported to CMS for risk adjustment, then pushed clinicians months later to add those conditions to patient charts as medical record addenda.

Reader Comments

From Data Diver: “Re: Kaiser coding settlement. MA risk adjustment has become the national sport, where everyone claims innocence while quietly hiring more coders and consultants. A half-billion dollar settlement suggests that the line between legitimate documentation improvement and outright upcoding is not a faint one. If this is what gets caught, I can only imagine what stays below the waterline.”

HIStalk Announcements and Requests

Ms. S of Burlington, NC provides an update about HIStalk reader donations that fully funded, with matching money applied from third parties as well as my Anonymous Vendor Executive, her Donors Choose teacher grant request for headphones.

Sponsored Events and Resources

None scheduled soon. Contact Lorre to have your resource listed.

Acquisitions, Funding, Business, and Stock

Vista AI, which offers automated MRI scanning software, raises a $29.5 million Series B round, with several health systems joining other investors.

Sales

• Advanced Health chooses 1upHealth’s data interoperability platform.

People

The Stowers Institute for Medical Research names Dan Devers, JD (Cerner) as general counsel.

Steve LeBlond, MBA (Sutter Health) joins Prisma Health as CIO/CDO.

RLDatix hires Richard Jarvis, MSChE (OptumUK) as CTO.

Komodo Health names Amit Sangani (Meta) as CTO.

AMIA names Philip Payne, PhD (WashU Medicine, BJC Healthcare, and Washington University School of Medicine in St. Louis) as president and board chair.

Announcements and Implementations

Epic posts social media videos of Emmie, its MyChart AI assistant for patients that includes a chatbot for inquiries.

Google Research updates its open MedGemma model with improved medical imaging support and a speech to text model that is fine tuned for medical dictation.

Hospitals list their top RCM priorities as improving patient experience, boosting revenue, and cutting costs, according to a new FinThrive survey. Executives cite prior authorization, denials, and clinical documentation and coding as their main AI targets, and nearly 60% expect to consolidate RCM vendors within three years.

A Black Book survey finds that for behavioral health, post-acute care, public health, and community-based organizations, the “last mile” of health data interoperability still relies on manual work and fragmented systems because of cost, immature APIs, and slow vendor onboarding.

US healthcare spending rose 7.2% to $5.3 trillion in 2024, with $1.6 trillion spent on hospital services. CMS says that healthcare spending accounted for 18% of US gross domestic product.

Government and Politics

The White House unveils “The Great Healthcare Plan,” which would send federal funds directly to citizens to purchase their own health insurance, while asking insurers to lower premiums. The proposal also seeks to require drug makers to match US prices to those charged overseas and to shift more prescription drugs to over the counter status. The administration will ask Congress to approve the plan, which does not restore federal ACA premium subsidies or address the significant cost driver of provider pricing.

Researchers question a bill that would require Medicare to cover every FDA-designated “breakthrough” device, warning that it would sidestep CMS’s evidence-based review, expose patients to unsafe or unproven products, and hamstring CMS from reversing coverage if unfavorable evidence arises.

Privacy and Security

A Fortified Health Security report finds that total reported healthcare breaches doubled in 2025, as did the number of email-based breaches.

Sponsor Updates

• Medicomp Systems releases a new episode of its “Tell Me Where IT Hurts” podcast featuring Acting Administrator of DOGE and CMS Strategic Advisor Amy Gleason.
• Health Data Movers releases a new episode of its “Quick HITs” podcast titled “Turning Healthcare Data Strategy into Execution with Mohammed Abdelaziz.”
• Five9 expands its partnership with Google Cloud and announces a new joint Enterprise CX AI solution.
• Healthmonix rebrands its MIPS Cost Analytics product to Healthmonix Cost and its MIPS Analytics product to Healthmonix Analytics.
• The “Walk-Ins Welcome” podcast features Inbox Health Enterprise Sales Lead Guy Bergman and SVP of Sales Edward Sherlock.
• The University of Southern California presents its Distinguished Alumni Award to Infinx co-founder Sandeep Tandon.

Blog Posts

• Navigating healthcare data through QHIN connectivity: A smarter approach to patient information (Altera Digital Health)
• Hospital CIOs Share Their EHR Help Desk Improvement Wish Lists (Med Tech Solutions)
• Major Challenges Facing the Healthcare Industry Today (Bizmatics)
• Share Your Story at the 2026 Connect Social Care Summit (Findhelp)
• Patient Access Automation: A Strategic Imperative (Impact Advisors)
• 2026 Horizon Report: The New Reality of Healthcare Cybersecurity (Fortified Health Security)
• The High Cost of Delayed Details in Surgical Departments (LiveData)
• The latest in interoperability: Everything you need to know (Meditech)
• VBC under pressure: Five insights from the front lines (Navina)

Contacts

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