Chutes & Ladders: MA sues UHG on Medicaid fraud, Teladoc joins Walmart’s Better Care Services, raises for Signos and H1

It’s another chute for UnitedHealth Group, which hardly needs another. On Friday 29 May, the Massachusetts attorney general sued UnitedHealthcare Community Plans of Massachusetts for misrepresenting and manipulating the health records of members in the MassHealth Senior Care Options (SCO) plans. The objective was to gain higher payments from the Commonwealth of Massachusetts. The fraudulent amount in question is about $100 million. The lawsuit was filed in Suffolk Superior Court.

UnitedHealthcare is the largest provider of SCO plans in Massachusetts. SCO is a state Medicaid program that covers members 65 or older who live in designated areas of the state. Based on a mandatory in-home clinical assessment to determine their health status, covered members are assigned a level of care based on health conditions, with Level 1 being the least serious, Level 2 having behavioral health or substance use disorders, and Level 3 having the most serious health conditions. The levels have correspondingly escalating levels of payment to the plan.

The Commonwealth is stating that members were classified by UnitedHealthcare to Level 2 despite no other diagnosis or treatment. Other patients were assigned to Level 3 through improper assessments. Moreover, United allegedly knew that beginning in 2018 and continuing into 2019, members were improperly assigned to Level 3. United never disclosed the error nor repaid the higher payments resulting from the assignment. 

From the Office of the Attorney General release, “The AGO alleges that these were intentional failures, the result of a ‘growth at all costs’ strategy employed by United that incentivized and encouraged its field nurses to code MassHealth members as sicker or less able than they were.” UnitedHealthcare responded that the fraud allegations and the lawsuit are “meritless” and that “[The complaint] doesn’t accurately describe our Senior Care Options program, which helps seniors with complex care meet their individual health needs.”  MedCityNews, Healthcare Dive  

A nice ladder for Teladoc is the addition of their telehealth services to Walmart’s digital health offerings. Walmart’s Better Care Services will add Teladoc’s telehealth services in virtual urgent care for common conditions, dermatology, and nutrition for their customers. Payment can be either cash pay at $89/visit or through insurance. Prescriptions, if needed, can be sent to a pharmacy, including Walmart’s, which has same-day delivery  in as fast as an hour available in many locations. Walmart added Teladoc’s BetterHelp mental health services in January. Teladoc release, MedCityNews, Healthcare Dive

And funding ladders continue, indicating some freeing up of investment cash for companies that have gone through a few (or more than a few) rounds.

Glucose monitoring system Signos raised a $20 million round. The investment is from GV (Google Ventures), Dexcom, and Blue Cross Blue Shield of Alabama. Funding to date including this round is $57 million.  Signos is also a partner with Dexcom through their direct-to-consumer continuous glucose monitoring website, Stelo.com. Signos’ app for tracking glucose for weight management is FDA-cleared and includes insights into how behavior, lifestyle, sleep, and stress affect weight. It can also detect low and high glucose levels. Membership is $127/month including two sensors a month on the six-month plan. Mobihealthnews, Yahoo Finance

Healthcare provider data and directory company H1 raised $40 million, led by CVS Health Ventures. Across ten lettered and unlettered rounds, funding to date is $233.9 million. It has developed an AI-powered platform for identifying and engaging the right doctor across life sciences, payers, providers, and patients.  The H1 Doctor Graph platform is a structured representation of physician identity, expertise, relationships, and behavioral signals that identifies and engages the right doctors for critical workflows across pharma, health plan, health system, and technology companies. CVS Health and H1 have collaborated on several projects, including an AI model that improved the accuracy of their health care provider directory. Release, Mobihealthnews

Breaking: Anthropic files confidential S-1 with SEC for IPO, less than one week after $65B raise. But is this Peak AI?

It’s raining mega-IPOs. One week after Oura’s filing a confidential S-1 with the Securities and Exchange Commission for its IPO, massively bigger Anthropic, the developer of Claude AI, has done the same. As with Oura, neither share price nor number of shares has been disclosed in this preliminary filing. Anthropic release

The S-1 filing comes on top of their 28 May announcement of a $65 billion Series H funding led by Altimeter Capital, Dragoneer, Greenoaks, and Sequoia Capital. The valuation of $965 billion makes Anthropic the most valuable AI company on Planet Earth and perhaps the entire Solar System, surpassing OpenAI by about $113 billion. Anthropic’s valuation in February was $380 billion with their Series G raise, so the Series H valuation multiplied that by a stunning 2.5 times+ in three months. The new funds will be used for AI research, expanding its computing power for Claude, and scaling its products and partnerships.  CNBC, Mobihealthnews, Anthropic release

Anthropic’s over-the-top valuation was boosted by its projected annual revenue run of $50 billion, tipping into profitability this quarter, beating its own growth metrics regularly, and introducing new Claude products such as Claude Opus 4.8 and Claude Mythos Preview with advanced cybersecurity available to a limited group of companies. Anthropic in January rolled out Claude for Healthcare for providers and consumers. Claude pulled in front in corporate sales, ahead of OpenAI, as of April, and last month inked a new partnership with Bristol Myers Squibb to implement Claude throughout the company.

But are we at Peak AI? Axios, never one to shy away from Cold Buckets of Water when it makes for a good lede, has been trumpeting for the past week that companies are suddenly shying away from their “discovery” of soaring AI costs. Suddenly, ballooning IT costs, uncertain productivity gains, and a strange combination of employee overuse and sudden skepticism are causes for concern. An AI consultant told Axios that employees blew through half a billion dollars in a single month because they didn’t put usage limits on Claude licenses. Then the CEO of an AI software company, CloudBees, admitted that companies are using workforce cuts to offset their soaring AI costs. This has to be one of the worst-kept secrets in corporate America. Even a casual peruser of LinkedIn would have known this a year ago.

Corporate adoption in Axios‘ view is running into four expensive headwinds such as:

  • Using AI to automate disliked tasks rather than prioritizing revenue-generating tasks–which is understandable without guidance and pressure on time.
  • Using AI for trivial tasks such as checking the weather (well, no one said they couldn’t)
  • Leadership is clueless on what AI tools work and are throwing licenses at the employee wall to see what sticks.
  • Reluctance to give AI models proprietary information, which makes the AI tool less effective. (Not feeding AI models proprietary information to prevent it from becoming public in LLM models is, one would believe, an understandable concern.)

Even OpenAI’s Sam Altman commented when Anthropic’s Series H was announced that corporate costs are the most valid concern to date.

Unless there is a massive enterprise pullback in AI spend, though, look to Anthropic floating that IPO no later than the fall, even if corporate AI spend pulls back.

Selling Oracle Health’s EHR–what are the potential buyers, their odds, and price?

The speculation is now “official”, since it is by a London investment banking firm, but it confirms this Editor’s earlier view: Oracle, to become an “AI Infrastructure Landlord” (in their apt term), has to sell off what was Cerner and the EHR operation. 

That train is now approaching, though realistically, no one knows when it is due and at what station.

The need: Oracle must reduce the extent of its “liquidity and capital expenditure crisis” in order to stay in the AI Game. Layoffs of 30,000 staff, or 18% of their global employees, is not enough. A fresh financing of $16 billion from the PIMCO bond fund and others cannot relieve the financial stress created by a previous estimated $72 to $100 billion in previous debt load and payments, so significant that banks refused to lend to still-profitable Oracle. And the AI transformation itself is high risk. Oracle owes OpenAI alone $553 billion in remaining performance obligations, and it has obligations to Meta as well. Add to this the long “taffy pull”–the years-long process of building, chip expenditure, then making a data center operational and generating cash. [TTA 14 May, 7 May, and prior; also Ed Zitron’s article for a much longer take.] Take all of them together, and they are polite words for “rock and a hard place” or a Very Dark Corner.

The London investment banking firm Nelson Advisors has taken a deep yet remarkably easy-to-digest analysis on a potential sale. Highlights are below. The paper is one long web page, not a deck of 50 pages. It is well worth your reading time.

Background: Cerner was bought four years ago in the go-go days of June 2022 for $28 billion. Cerner had an aging EHR and a deteriorating market share. Recently it’s plummeted to a 27% market share versus Epic’s 48% in large health systems. Oracle’s interest was not only in health, but also the health data Cerner contained. The plans were to update the software based EHR to a cloud-native data platform as the linchpin of Healthcare Transformation (Ed. note), except that integration proved to be slow and far more expensive than estimated.

Oracle also inherited from Cerner two huge and impossible to escape Federal obligations: the Military Health System EHR and the Veterans Health Administration EHR Modernization, two separate but mandatorily interoperable systems. MHS was the first implemented and is now  completed, but remains an obligation. The VA EHRM, as TTA has chronicled, started rolling out in 2020 and by 2023 was halted after five implementations Due to Disaster. It resumed in April 2026. The VA and Congressional process for funding now has tight guardrails in place on continuance.  

Who will buy the Oracle/Cerner EHR operation is the question. For how much isn’t as clear. Selling Oracle Cerner “represents the most significant “lump sum” of liquidity available. In the Nelson analogy, Oracle took the Cerner cow, milked it of data to feed its data into its LLMs, and no longer wants knackered ol’ Bessie even rejuvenated by the cloud. (In this Editor’s view, Oracle knows it is fighting a losing battle against Epic, which does privately pretty much what it wants and plans to stay that way.)

The obvious group of potential buyers are ‘hyperscalers’ who view health data as the Next Frontier. They already have feet in this healthcare pond. They also meet approved FedRAMP High security requirements for the VA and MHS contracts. Equally, they all have drawbacks.

Microsoft seems the most logical. It already has a huge footprint and expertise within health systems, courtesy of ambient scribe Nuance/DAX Copilot and cloud computing platform Azure.

  • Conflict #1: Epic is a major Azure customer. Would Microsoft be willing to lose this business in a high-stakes move?
  • Conflict #2: FTC would likely challenge the acquisition based on this huge existing footprint.

Amazon is also engaged in healthcare, but not with health systems. It has Amazon Health Services comprising Pharmacy, One Medical, and DTC telehealth services. (Editor’s note: not mentioned by Nelson is that Amazon Health has a new leader, Dr. Roy Schoenberg, with experience in Federal contracts via Amwell for the Defense Health Agency and MHS. This broke late last week.)

  • Conflict: Amazon Web Services is an established vendor in other areas of health systems, and acquiring an EHR could be seen as too much under one roof.
  • Problem: no experience with EHRs (same as Oracle) nor highly regulated health systems. The scale of the MHS/VA implementation and academic hospitals would be a steep learning curve with little existing precedent or credibility in Amazon-World.

Google certainly has the size and resources, and could position the EHR to rival both Microsoft and Epic. 

  • Conflict #1: Cultural. Google moves fast and healthcare slowly.
  • Conflict #2: Lacks the enterprise sales and support needed to service health systems. It doesn’t have a service culture.
  • Editor’s note: Google has tried and failed to be a healthcare giant at least twice. It doesn’t seem to fit.

Nelson also looked at two outliers, UnitedHealth Group/Optum and the hospital groups HCA or CommonSpirit Health. Both would be vertical integrators. Hospital groups do not have the margin nor borrowing power to make the move. UHG and their Optum operation face cash crunches and ongoing Federal scrutiny. (Had this been a few years ago under a different management, this would have been on strategy for UHG.)

Another outlier from the international space is SAP. Their aim would be global expansion into the Middle East and Europe with another asset their enterprise resource planning (ERP) expertise. Their problem? Lack of experience in the highly regulated US environment. In the Nelson view, the US Government could be the make/break for any deal.

The final destination for this ‘hard to sell’ asset? Private equity. And more than one involved. Nelson looked at five PE players in the healthcare space: Thoma Bravo, Francisco Partners, Bain Capital, Blackstone, and New Mountain Capital. (All are familiar PEs to Readers.) Even with their considerable individual assets, it would likely take a consortium to buy Oracle Health in a $20 to $25 billion deal. Nelson rates this as the most likely scenario as long as a consortium could be formed and it can be seen as a turnaround. The drawbacks are a governance structure and the real lack of an exit strategy. (PEs always need exit strategies to keep the funders happy. They are not in it to buy and keep.) The lower price could be made palatable to Oracle if they retained the Oracle Cloud Infrastructure (OCI) network and the Oracle Autonomous Database revenue streams.

The other partner in this consortium scenario? The Federal Government. It’s a high priority to secure the EHR for both the MHS and VA. Congress is already concerned.

Place your bets!  Hat tip to a Reader who wishes to remain anonymous.