Samwise Healthcare IT Newsletter
Tuesday, July 14, 2026
HHS watchdog ramps up Medicare Advantage and Medicaid fraud enforcement
The HHS Office of Inspector General is ramping up enforcement actions against Medicare Advantage and Medicaid fraud, reporting $5.6 billion in monetary impact over just six months — and excluding more than 1,200 individuals and entities from federal health programs. Highlights include a 15-year prison sentence for the CEO of Power Mobility Doctor Rx, convicted of orchestrating a $1 billion Medicare fraud scheme, and ongoing scrutiny of ABA autism therapy clinics for billing irregularities. Two major settlements — Kaiser Permanente for $556 million and Aetna for $117.7 million — reflect the OIG’s growing focus on Medicare Advantage overpayments, documentation fraud, and risk-adjustment gaming.
Sources: Healthcare Dive Share ↗ ✉︎ Email 💬 Text
Three insurers sue CMS over Medicare Advantage star rating recalculations
Two more health insurers have sued CMS over its recalculation of Medicare Advantage star ratings, alleging the methodology was applied inconsistently and without proper rulemaking. SCAN Health Plan claims the rerating cost it $125 million in bonus payments; Alignment Healthcare puts its losses at $50 million. Both join Elevance Health, which filed a similar $115 million suit earlier this year. All three allege CMS violated the Administrative Procedure Act by failing to uniformly apply the Clover Health methodology it used in certain appeals. As one insurer filing put it: “The system is undeniably broken.” The litigation total now exceeds $290 million.
Sources: Healthcare Dive Share ↗ ✉︎ Email 💬 Text
Hospital mergers more than double in Q2 as health systems pursue scale
Hospital mergers and acquisitions surged in the second quarter of 2026, with Kaufman Hall counting 18 transactions — more than double the 8 recorded in Q2 2025 — and total transacted revenue jumping from $1.4 billion to $7.7 billion year-over-year. Three deals qualified as mega-mergers. Kaufman Hall analysts frame the wave as strategic: health systems are pursuing “proactive positioning over reactive consolidation,” building scale before regulatory and reimbursement pressures force their hand. The surge has direct implications for health IT teams, as consolidations typically trigger EHR migrations, data governance overhauls, and network security integrations. Operating margins remained pressured, dipping 4% in May versus the prior year.
Sources: Healthcare Dive Share ↗ ✉︎ Email 💬 Text
Delaware deploys $6.4M in federal funds to automate prior authorization via HIE
Delaware is deploying $6.42 million in Rural Health Transformation Program funds to expand real-time prior authorization and insurance verification through the Delaware Health Information Network. The initiative uses the Smart Health Network platform to give payers and providers instant access to eligibility data at the point of care — attacking a workflow bottleneck the AMA estimates consumes 13 hours per physician practice per week. State Health Secretary Christen Linke Young said: “Technology should make healthcare easier to navigate, not more complicated.” Delaware received more than $157 million in total first-year RHTP funding from CMS, positioning the state as an early mover in federally backed health data exchange modernization.
Sources: Healthcare IT News Share ↗ ✉︎ Email 💬 Text
Telehealth’s post-COVID evolution: from standalone tool to integrated care infrastructure
Five years after COVID accelerated virtual care adoption, healthcare leaders are confronting a deeper strategic shift: telemedicine is no longer a standalone tool — it is becoming the connective tissue of digital health strategy. VirtuAlly chief nursing officer Angel Bozard says virtual care has “crossed an important threshold,” merging with AI, remote monitoring, and workforce planning into a single integrated model. Virtual nursing now returns roughly 120 minutes of documentation time per bedside nurse each shift, and tele-sitting programs are reducing patient falls. The takeaway for CIOs: telehealth can no longer be siloed — it must be designed, funded, and governed as core infrastructure alongside the EHR.
Sources: Healthcare IT News Share ↗ ✉︎ Email 💬 Text
Endeavor Health CIO: AI adoption fails without secure, unified foundations first
Deb Anderson, chief information officer at Endeavor Health, is warning peers racing to deploy AI: without secure, well-integrated foundations, new technology adds burden rather than value. Anderson’s digital transformation blueprint centers on EHR consolidation to a single enterprise platform, robust cybersecurity, and rigorous data governance — the unglamorous work that makes intelligent tools actually perform. “When technology is designed and implemented well, it fades into the background,” she says. The broader lesson for CIOs: health systems treating IT infrastructure as disconnected from organizational strategy are heading toward expensive misalignment. Technology, Anderson argues, is now the operating platform for every clinical and strategic objective the health system pursues.
Sources: Healthcare IT News Share ↗ ✉︎ Email 💬 Text
Physician AI skepticism drops 16 points in two years, athenahealth survey finds
New survey data from the athenaInstitute captures a measurable shift in physician sentiment: the share of doctors who say AI only adds complexity to an already overburdened system dropped 16 points in just two years. Chad Dodd, vice president of product management at athenahealth, attributes the turning tide to AI tools that fit existing clinical workflows rather than disrupting them. Physicians report spending roughly the same time in the EHR as before — but using that time more productively, with less cognitive burden. More than 75% of physicians now express hope that AI will improve both administrative strain and patient care outcomes. (Sponsored content by athenahealth.)
Sources: Healthcare IT News Share ↗ ✉︎ Email 💬 Text
UC San Diego study: teleoperated humanoid robots complete laparoscopic surgery on pigs
Researchers at UC San Diego have published the first study demonstrating teleoperated humanoid robots performing laparoscopic surgery on live animals, with results appearing in Nature. Using a Unitree G1 humanoid — a commercially available, economical general-purpose robot — surgeons completed gallbladder removals on pigs via remote control, including one procedure performed by two robots working in tandem. The motivation is economic: purpose-built surgical robots are expensive and space-demanding, while humanoid robots can operate within existing surgical infrastructure. Researchers note significant gaps versus established platforms, including latency, limited arm span, and reduced precision — but argue the study clarifies how close humanoids are to supporting real surgical workflows.
Sources: MobiHealthNews Share ↗ ✉︎ Email 💬 Text
Curated by JD · samwise.agency
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