TTA’s Even Hotter July: a gloomy view on Oracle’s future, Withings gets into medical care, IKS closes TruBridge buy, Palantir/FPS contract in jeopardy, PFS’ draft telehealth provisions, more!

July 17, 2026 | by | No Comments

 

16-20 July 2026

Back into summertime doldrums with a little less news than usual. Oracle continues to depress Mr. Market with its debt load and lack of cash on hand in its ambitious transformation to an AI infrastructure landlord–but still no word about whether it can sell its EHR. But Withings makes a truly gutsy move by entering the provider fray with a CMS initiative supplementing Medicare primary care providers. IKS closes its big buy of TruBridge for $557 million in another consolidation move. NHS’ big patient database move in jeopardy if Palantir is removed. And debate on the Medicare Physician Fee Schedule and telehealth starts anew.

Please feel free to comment on the articles and pass along this Alert. Let me know if this is worth it to you! Also check out my personal page on Substack.

News roundup: Withings Medical Group service launches, MPs urge cancellation of NHS/Palantir FDP contract, IKS closes TruBridge buy for $557M, ATA comments on prelim CMS PFS for telehealth, Philips’ AI-powered…toothbrush

A gloomy view on Oracle going forward: debt, cash flow, and dependence on OpenAI

Recent Headlines, from 23andMe, to Done being Done, to Midjourney Medical scanning, to Cargo Culture

News roundup: 23andMe settles with data breach victims for $46.75M, Neuralink implants first Canadian ALS patient, Resmed selling MatrixCare EHR for $490M, Teladoc now preferred telehealth provider for NBA players

Chutes & Ladders: Done Global principals sentenced on Adderall fraud, Oracle E-Biz Suite hacked, OpenAI’s 5% offer to US government, Meta considers cloud AI, Pearl’s $110M raise

Midjourney Medical audaciously promises a revolution in whole-body scanning, powered by Butterfly Network chips. Can the reality ever match the hype?

Vinegary Must Reads This Week: Silicon Valley’s ‘Cargo Culture’; the clinical query tool explosion between OpenEvidence and general AI

Amazon’s One Medical Seniors hacked by ShinyHunters, issues “final warning” on 8.8 TB of patient data

Perspectives: The most aggressive AI adoption in healthcare is happening off the books

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A gloomy view on Oracle going forward: debt, cash flow, and dependence on OpenAI

July 16, 2026 | by | No Comments

Oracle is beginning to turn into one of those cautionary case studies. And that’s not good news for healthcare. From their faltering EHR to the hacking of their software, Oracle’s news hasn’t been cheerful. While still profitable in the quarterly reports, the debt load and its obligations in their chosen wrenching changeover from a software developer/seller to an AI infrastructure landlord have been followed by speculation. The latest speculation from June is selling their EHR business [TTA 2 June]–if they can find a buyer. The EHR is a distant second to Epic in every metric [TTA 27 May] and Oracle has an immense obligation to the Federal Government for both the Military Health System (MHS) and VA’s EHR Modernization that won’t complete projected rollout until 2031.

A recent analysis published in Seeking Alpha (may require free account, PDF here) will give one further pause.

The debt load is a crusher. There’s anywhere from $72 to $100 billion in debt on Oracle’s books, and that preceded the PIMCO financing of $16.3 billion that included equity. Their credit rating from major raters is one step above junk: BBB-negative from S&P Global Ratings and Moody’s Baa2 Negative outlook. [TTA 7 May] Oracle has already projected it needs more: an additional $40 billion in fiscal 2027 through a mix of debt and equity.

Net debt is soaring. Oracle ended FY 2026 with net debt of $97.6 billion. This represents a ~20% increase versus the $81.4 billion of FY 2025. Looking forward, this analyst is projecting that the net debt by end of FY 2027 will be in the range of ~$120 billion.

There’s another little problem called cash flow. Years of positive free cash flow, even during the pandemic recession, turned sour in their FY 26 to a negative $23.7 billion. The analysis states that Oracle is now heavily dependent on external cash–debt–to finance its AI infrastructure building. S&P also noted that capital expenditure has been geometrically increasing: $6.9 billion (2024), $21.1 billion (2025) and $55.7 billion (2026). The guidance for fiscal 2027? Between $90 and $95 billion. That is over a 70% increase. Cash flow clearly can’t pay down the debt they already have, a fact that banks factored in to cut off the lending spigot.

Its performance obligations are also crushing. $553 billion has been reported for OpenAI alone [TTA 7 May].  This article reports remaining performance obligations of $638 billion, about half of which is for OpenAI. Despite the disparity in numbers (perhaps completed obligations?), in this analyst’s view, something happens to OpenAI–for instance, a pullback in the confidence of markets to finance their aggressive expansion (and, this Editor would add, an IPO)–Oracle would be hit hard. To paraphrase an overworked analogy, if OpenAI stumbles and sprains its ankle, Oracle would break both legs.

But..but…isn’t demand supposed to be increasing, infinitely?  Increased demand is critical to continued financing. Yet there are leading indicators that demand is leveling off. Corporations are increasingly limiting internal use of AI by employees to tamp down soaring token usage costs and control budgets. These companies have also found that AI tools often do not work as well in replacing humans as they were cracked up to be. And now seemingly every software offering is ‘powered by AI’. The newness is wearing off.

The chip cycle is speeding up–not good news for AI infrastructure builders.  Nvidia is now in full production of its Vera Rubin chip, which is dramatically faster than the previous generation Blackwell chip. Our March reporting picked up that Oracle had forward commitments with Nvidia to use the older Blackwell chip for the OpenAI data centers, and OpenAI wasn’t happy about that. It’s not a simple matter of going to Nvidia and returning old chips and getting new ones–that isn’t done. Vera Rubin is also twice as expensive on a per-rack basis than Blackwell–$7.8 million versus $4 million. Add to this the long taffy pull of building (online is 12-18 months minimum), power, water, and labor costs…it adds up, as any builder will tell you.

Given the above factors, it shouldn’t be any surprise that Oracle stock is down 30% since last December and continues to decline.

Extra: The article also contains a short history of financial cycles. There are parallels drawn comparing the AI boom we are in to similar technology-driven boom and bust cycles, dating back to the building of canals in the 1700s, railways in the 1800s, and electrification in the early 1900s.  

Editor’s note: Any analysis of Oracle’s financial health is based on this article, previous articles, multiple sources, and Oracle’s disclosures. Our interest is primarily in the well-being of Oracle Health and the markets it serves. We do not engage in stock picking and none of the above should be construed as financial advice.

Chutes & Ladders: Done Global principals sentenced on Adderall fraud, Oracle E-Biz Suite hacked, OpenAI’s 5% offer to US government, Meta considers cloud AI, Pearl’s $110M raise

July 9, 2026 | by | No Comments

One big years-long chute for Done Global’s Ruthia He and David Brody. The convicted former founder/CEO and clinical president were sentenced to substantial Federal prison terms this past Tuesday. Ms. He will be facing six years in prison, followed by three years of supervised release, and a fine of $1 million. Dr. Brody was sentenced to two years imprisonment, three years of supervised release, and a fine of $1 million. In addition, there will be restitution to fraud victims.

To be announced at a later date: when sentences will start and where they will be served, based on recommendations from the Bureau of Prisons.

While Done Global is effectively ‘done’, the company also does business under the name Mindful Health.

The points of the (at least) $100 million fraud were based on the illegal telehealth prescription of Adderall and other Schedule II stimulants such as Vyvance. Medications on Schedule II have accepted medical uses but carry high potential for abuse and psychological or physical dependence and thus are controlled:

  • A scheme that used the Done Global technology platform, compensation structure, and clinical protocols to unlawfully distribute over 37 million pills of Adderall, defraud insurers of over $12 million, and obstruct the federal investigation that followed.
  • The defendant (He) spent over $40 million on social media advertisements to deceive Americans into believing they had attention deficit hyperactivity disorder (ADHD), falsely diagnosing patients with ADHD, and distributing Adderall, including to patients who the company was warned were suffering from Adderall psychosis, bipolar, depression, anxiety, and other mental health conditions that were worsened by stimulant prescriptions. 
  • These were designed to boost the Done Global valuation to above $1 billion.

From the detailed Department of Justice press release: “The defendants refused to hire or fired Done clinicians who did not participate in the conspiracy, while paying up to $60,000 per month to clinicians who signed Adderall prescriptions every 30 seconds. The defendants also used an “auto-refill” platform technology feature after an initial diagnosis to minimize follow-up appointments, where prescribers signed prescriptions for Adderall based on an automatically generated message that a patient desired a refill. Because of these policies, some patients went years without seeing clinicians, who continually authorized refills even through involuntary psychiatric holds or after the patients had died.”

Dr. Brody alone personally wrote prescriptions for 394,324 Schedule II stimulant pills prescribed to 6,559 Done members. He never evaluated them nor reviewed a single patient record. Part of the case was Done’s record of misdiagnosis, over-prescribing, and patient death.

Additional charges against Ms. He included diversion of company assets and operations abroad. As indictments neared in 2023/2024, they both deleted records, instructed employees to delete  incriminatory documents and messages from the company servers, and transferred communications to platforms such as WhatsApp and Signal using disappearing message settings to conceal sensitive information.

After completion of her sentence, it is likely that Ms. He will be deported to her home country of China. She attempted to flee to Hong Kong in February 2023 and was forced to surrender her passport. Despite this, she made a second attempt after obtaining Chinese travel documents, then was arrested and detained before trial as a flight risk. Two other factors were that she transferred $4.6 million in ad-related revenue to China and set up a shell company there. 

The Drug Enforcement Administration (DEA), HHS-Office of Inspector General, IRS Criminal Investigations, and the Centers for Medicare and Medicare Services (CMS) investigated as violations included financial diversion, record falsification, drug prescribing and Medicare/Medicaid fraud. The main DOJ units involved were the National Fraud Enforcement Division and the Health Care Fraud Unit.

The case was heard in the Federal Northern District of California by Judge Charles Breyer. Dr. Brody plans to appeal and significantly apologized for his actions. KQED and Behavioral Health Business.

Background on the indictment and conviction, TTA 24 January and prior as noted in the article. There is no additional information to date on the grand jury charges from December 2025 of the Done and Mindful companies. 

Editor’s POV: Done wasn’t the first–the far larger Cerebral was in 2022. While it is still in business, Cerebral has spent much of its time and fisc in litigation and settlements. Neither will be the last.  DOJ and Federal agencies are cracking down hard on waste, fraud, and abuse in healthcare; major targets of DOJ/HHS/DEA scrutiny are telementalhealth and substance use disorder (SUD) management, including prescribing and payments. More to come.

Another chute for Oracle, leading to the Hacking trap door. The vulnerability is within Oracle’s E-Business Suite (EBS) and affects the file transmission component of Oracle Payments payments. The flaw has been tracked as CVE-2026-46817 and carries a severity rating of 9.8 out of 10. 900 systems may be exposed, though Oracle flagged it in their May patch updates. The US National Vulnerability Database states that the vulnerability can be exploited remotely over HTTP without authentication. Oracle software seems to be a favorite target of hackers. Cybersec organizations Defused and Shadowserver, along with the US Cybersecurity and Infrastructure Security Agency (CISA) have flagged multiple software vulnerabilities across Oracle’s EBS, WebLogic Server, and PeopleSoft.  Computing UK

Is it a Chute or Ladder? Or Run For Your Life? OpenAI and Sam Altman made headlines before the July 4 celebrations with an offer of a 5% share of the company to the US Federal Government. Both OpenAI and Anthropic are imminent IPOs. The Financial Times report is based upon “early conversations” cited from two insiders. A 5% share, based on current valuations, is about $42.6 billion. It is not only a nice chunk of change in the public fisc but also a clever PR move that may help neutralize public blowback and downright hostility towards unwanted technology; sprawling, noisy, spewing, heat pooling and energy-greedy data centers; AI job displacement; companies discovering that AI is draining them dry without ROI; environmental and community groups; unions, local governments, and more. How it will mollify people who are angry about any of the previous is doubtful. Nor will it please those aligned with socialist Senator Bernie Sanders, who is demanding close to half of OpenAI’s and Anthropic’s value to be held in a sovereign wealth fund.

Whether Anthropic and the hyperscalers building like mad such as Oracle, Meta, Microsoft and others would follow Altman’s lead is debatable. The Computing UK take on this is that it is a cynical and obvious bribe, perhaps one worthy of a Marie Antoinette (who may never have said ‘let them eat cake’…but nevermind). The accountant or computing side of this Editor’s brain flags that neither OpenAI nor Anthropic are remotely profitable. Oracle as a hyperscaler has already fallen into a debt canyon from where it may not emerge. Likely, Oracle is not the only one either, if you isolate AI from hyperscalers’ other sustaining businesses.

A generous offer or a Trojan Horse? You pick….

In this Editor’s view, it satisfies no one, solves no real problems, puts power in exactly the wrong hands, and creates a major conflict of interest in the objective and responsible development of AI.

In the Ladder department, Meta is talking up selling its excess AI cloud computing capacity, thus creating a new revenue stream. If this Editor is not mistaken, it’s similar to the Amazon Web Services model. A second stream would be renting out its AI application programming interface (API) to developers. The charge will be based on usage. That assumes that Meta is envisioning a time that they will have that excess capacity to sell. Right now, there is a dearth of actual, online data centers and a shortage of capacity [TTA 14 May].  Computing UK

A $110 million split raise for Pearl Health rounds it out. The Medicare value-based care management services organization (MSO) and population health services for providers gained a $50 million Series C equity investment from Andreessen Horowitz with participation from Viking Global Investors, AlleyCorp, and Ulysses Capital, plus a $60 million debt facility led by Trinity Capital. The new funds will be used for developing their AI platform, turning clinical intelligence into measurable outcomes, growing health system and payer partnerships, expansion into Medicare Advantage, and new risk offerings. Pearl’s funding to date is $205 million since 2020. It claims that it reached profitability last year and will triple its patient base from 2024 to the end of this year. It currently serves 10,000 providers across 40 states, with more than 250,000 Medicare beneficiaries, in CMS ACO models such as the Medicare Shared Savings Program (MSSP) and ACO REACH ending this year. The shrinking list of competitors in this space include Aledade and Astrana Health (which bought one of the pioneers, Collaborative Health Systems).  Release, MedCityNews

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

June 2, 2026 | by

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. It’s to be expected. The Gartner Hype Curve is fully in gear and the momentum from Inflated Expectations to the Trough of Disillusionment will continue, until it is processed and moves on to the Slope of Enlightenment.

A Must-Read potpourri: the ‘math’ of AI data center builds, healthcare AI failures, telehealth in schools, Hippocratic AI’s problems, the loss of empathy.

May 14, 2026 | by | 1 Comment

Your Editor will be Away From The Desk more than a bit over the next two weeks that lead up to the US Memorial Day holiday. I’ve collected seven articles to read and consider over the next few days. Enjoy!

Where Are All The Data Centers?

Author: Ed Zitron.  Self-published on Where’s Your Ed At?

If you’re puzzled about the ‘math’ of data centers–what capacity is available now, what is actually online/operational, and what’s the pipeline like–you will appreciate the detail that Mr. Zitron has gone to in cataloging those and much more. It turns out that we are not in the Land of Math, but in the Land of Myth, ruled by the Great Oz.

Despite what the builders say, and Microsoft’s and Oracle’s ever-cheery press releases, operational data centers are a fraction of what’s needed now or projected. The centers take 18-24 months to build and then many more months to complete–to fit out with chips, cooling, power, and networking that links sites and the end users. The AI giants, despite all the money flowing their way, will run out of money before the operating capacity they need gets online. Every data center takes 18-24 months to build, and even with retrofitting older data centers, the capacity is not there, nor for some time to come. In other words, the cavalry is in a neighboring country, much less the next state. Nobody has yet built an operating 1 GW data center. Centers are in megawatts and that, not many MWs. 

FTA:

  • “Oracle is building 7.1GW of total capacity for OpenAI, and keeps — laughably! — saying 2027 or 2028, when at this rate, Stargate Abilene won’t be done until mid-2027, and the rest either never get finished or are done in 2030 or later.”
  • “This is setting up a horrifying situation where Oracle desperately needs OpenAI to pay it for capacity that doesn’t exist, and if it ever gets built, it’s likely to be years after OpenAI has run out of money, which is the same problem that Microsoft, Google, and Amazon have with their $748 billion of deals with Anthropic and OpenAI, though thanks to the $340 billion or more necessary to build the Stargate data centers, Oracle’s problems are far more existential.”

The article also makes the point that Oracle does not have the fallback businesses that Microsoft, Google, and Amazon have to cushion the blow of AI failure. Oracle has the bottomless pit of Oracle Health, only one part of which is the VA EHR. It has a crushing burden of a massive debt load, the most recent being financed by a large bond fund since banks wouldn’t touch it. It kicked 30,000 employees and their expertise  to the curb. Will Larry Ellison sell a yacht or an island to help finance this as a 40% owner? More in Oracle Steps Back From The Debt Brink and Oracle’s Rock and Hard Place in Abilene

This is one long, well-written, and researched analysis by Mr. Zitron, whose expertise is in PR and is a well-known Silicon Valley critic. 

Telehealth in Schools: Expanding Student Access in a Hybrid Health Care System

Author: Paul Samargedlis. Published on Telehealth.org

Healthcare shortages across the US are affecting K-12 schools and children’s health. School-based telehealth programs can reduce absenteeism, expand access to mental health care, and deliver preventive care, bringing that care to where children already are. School-based telehealth programs in states such as Texas and North Carolina have demonstrated measurable improvements in attendance and emergency department utilization. Much will have to change in coordinating efforts and obtaining funding among school systems, local providers, and governments.

Artificial Intelligence Acquisitions: Agencies Should Collect and Apply Lessons Learned to Improve Future Procurements

Author: Government Accountability Office (GAO) Report to Congressional Requesters. April 2026 (49 pages)

Federal agencies reportedly more than doubled their use of artificial intelligence (AI) from 2023 to 2024, and they used a range of approaches to acquire additional AI capabilities through fiscal year 2025. In April 2025, the Office of Management and Budget (OMB) issued guidance to help agencies acquire AI responsibly, but agencies have not by and large shared that knowledge. This paper attempts to fill this gap in part. GAO identified trade-offs, challenges and benefits. The paper identifies approaches agencies made in acquisition and makes recommendations. The recommendations most impact DOW, DHS, GSA, and the VA.

Top AI Failures in Healthcare

Author: Dmitrii Gorbunov. Published on LinkedIn.

Mr. Gorbunov sums up five costly failures (or about to be failures) where AI has been used in healthcare: physician decision overrides (UnitedHealthcare), claims denials (Cigna), fabrications of consent documents (Sharp Healthcare), and adding diagnostic codes without physician confirmation (Kaiser Permanente). The fifth one, Doctronic, was spoofed by Mindguard to issue triple the dose of Oxycontin [TTA 26 Mar]. The lack of rules, audit and audit trails that can be confirmed and trusted will cost healthcare organizations money and already are having legal consequences.

The next may require subscription to view on Substack

The Architecture of Voice: Why AI Tools Can Mimic Style But Not The Voice

Stuart Miller (Haverin Consulting)’s fourth article on AI’s effect on language and writing. An AI LLM can partly fill two parts of the Competence Framework–Skills and Knowledge–but it does not have Experience. It is incomplete in these three points of Context, and Voice represents the accumulation of Context. FTA: “The dangerous part is the assumption that accelerated Knowledge substitutes for Experience, when in fact accelerated Knowledge, and improved Skills untethered from time, is precisely the recipe for the Builder’s Mirage. The Builder’s Mirage is the illusion of competence, produced without the underlying thing being present.”

Sergei Polevikov’s Substack under AI Health Uncut will require subscription to fully view. His latest are:

Hippocratic AI Fires Its International Sales Team

It’s turning into Theranos 2.0. FTA: “Revenue is an estimated $17–20M ARR. Burn rate is $404M.” Their customers are also their investors. and “Hippocratic AI has quietly withdrawn from all of its international markets, terminated every international contract, and let go of the international sales team that built those relationships.” Contracts were sold without country language versions, adequate GPU infrastructure, and compliance.

Christina Farr: “Where is all of our empathy? Where did it go?”

Christina Farr is the former CNBC healthcare tech reporter, founder of  Second Opinion Media, and is a funder/advisor in the field. The article is derived from his and Alex Koshykov’s interview for their podcast Digital Health Inside Out (48 minutes, go to YouTube, no paywall). “A no-holds-barred conversation about what’s broken in healthcare media, what’s about to break in digital health, and why she’s not coming back to journalism.”

Until next week….

Two weekend ‘must reads’: the New Yorker’s Sam Altman/OpenAI exposé–and comments; a further deep dive into Carbon Health’s implosion

April 10, 2026 | by

Too long to summarize or opine on this week–but a must for your weekend reading. Grab the cuppa for the talk of AI World–a New Yorker dissection of Sam Altman, the CEO of OpenAI (link below). To say it is an exposé worthy, at first glance, of the Old School (ain’t no school like the Old School–Ed.) on probably the most important company of AD 2026 is to undersell it. It’s a long article and you’ll need at least one break.

OpenAI, founded as a non-profit with integrity at its core to “prioritize the safety of humanity over the company’s success, or even its survival”, recapitalized last year as a for-profit corporation with 26% of the shares owned by the OpenAI Foundation. It is now a trillion-dollar company that had no trouble raising a paltry $122 billion last week [TTA 2 April] though arguments are made that at least some of that money are IOUs or contingent. ChatGPT has become almost generic for AI, like Kleenex has become for tissues. The battles over control and direction of the company are now totally controlled by Sam Altman, whom former colleagues are not shy about pointing out his difficulty with the truth and a pattern of deceit, for instance to his board, to employees, and Microsoft. Yet everyone continues to do business with him. The FOMO Factor is very strong.

Mr. Altman makes extremely broad statements on the future of work (most traditional managerial, healthcare, and IT jobs will be taken over by AI, thus most of us will be unemployed), has easy access to President Donald Trump, as well as other world executives, and may, as the headline barks, control our future. Thus, he is a person of consequence.

My read so far of this is that within OpenAI, there is no one to counterbalance Mr. Altman’s immense ambition, his desire to dominate and win, not only with AI but also over all business and everyday life. These are character issues that also show up in aspects of his personal life, detailed in the article. If past results are predictive of the future, this flaw usually curdles into the desire to control countries and a complete disrespect for the rest of us leading our lives. 

Sam Altman May Control Our Future–Can He Be Trusted?, 

I will offer two LinkedIn comment posts on this article from an AI person I respect, the head of Curiouser.ai, Stephen Klein. Many of his posts on LinkedIn deal with what AI can and cannot do in business. He writes that he is “committed to designing technology that augments people, creates jobs, and elevates humanity. It’s time we all got back to thinking for ourselves.” 7 April, 8 April 

Our second Must Read is from Sergei Polevikov’s AI Health Uncut, a long analysis on the failure of Carbon Health and what it tells us in “this business we have chosen”. “What The Hell Went Wrong?” and its implications need answers–because it’s being repeated again and again. Today’s article (9 April) is Part 1 of 2, sets the stage about the mistakes made (insiders talk) and, with full credit, springboards off Stuart Miller’s (Haverin Consulting) original analysis made at the time of the Chapter 11 reorg. What we called the ‘Ominous Parallels’ was a Must Read here on 12 February.  TTA (as Telecare Aware, our original name) and this article are also mentioned twice (thanks!).

Those who have yet to subscribe for Mr. Polevikov’s analytic, erudite, and revealing (Emperor’s New Clothes!) POVs can read part of this article for free–but seriously, if you’re in this business, the subscription is worth your money. He also podcasts (links are on his Substack, link at lower right sidebar).

An early and scandalous publisher (before he utterly lost it), Matt Drudge, used to say that he ‘went where the stink is’. Mr. Polevikov does the same. The stink is of our broken primary care reimbursement system, the Covid steroids that pumped up the company, flailing management running through money like drugs, and good ideas for patient care buried under incompetence. 

A study in contrasts: OpenAI raises $122B, eMed’s $200M Series A. Then there’s Avo’s $10M Series A, Stedi’s $50M Series C. And Oracle expands Nashville campus!

April 2, 2026 | by

Your Editor is feeling a little whipsawed this usually quiet pre-Easter and Passover week. We opened with 30,000 Oracle employees losing their jobs. Yet even if Oracle can’t get it, there’s plenty of money out there that’s looking for an investment home. Some rounds are huge–if it’s AI or GLP-1, you can bet on BIG–but most fundings for startups and early stage companies are modest in a pre-2019 way. The money that’s out there lines up for ‘sure things’.

OpenAI had no problem raising $122 billion as it moves to conquer the AI World (and maybe the Universe) via ChatGPT. Considering their claim that they are generating $2 billion in revenue per month, just replace the millions raised in the earlier digital age with billions. There’s a laundry list of investors including institutions, individual investors via banks, plus exchange-traded funds managed by ARK Invest. The anchor investors are strategic partners Amazon, NVIDIA, and SoftBank, with continued participation from Microsoft. SoftBank co-led the round alongside a16z, D. E. Shaw Ventures, MGX, TPG, and accounts advised by T. Rowe Price Associates. The release notes leadership in consumer AI and growth in enterprise AI; as noted here, in January OpenAI debuted ChatGPT for Healthcare (enterprise) and put into test ChatGPT for Health (consumer).

At a ‘virtual VC conference’ earlier this week, one investor panelist estimated that 14% of venture capital funding in 2025 went to exactly two companies, OpenAI and Anthropic (Claude). That disproportion rings alarm bells to this Editor, who well remembers the ludicrous dot-com boom/bust, and even earlier the insane financing that went into (mostly failed) airlines during deregulation–including the airline she worked for.

Another healthcare segment that hasn’t had much problem raising funds is e-prescribing of GLP-1 drugs. Miami-based eMed raised $200 million in its Series A, bringing its valuation to over $2 billion. Fronted by NFL quarterback legend Tom Brady, recently named founding chief wellness officer who is also an investor, the round was led by earlier investor AON Consulting with the addition of a starry roster of individual investors noted in their brief release. eMed’s eRx is marketed both to individuals and employers; the fresh funding will support further development of its agentic AI platform plus a new capitated model “designed to help employers bend the healthcare cost curve”. This Editor notes the lede in most articles about eMed is Brady and the $2 billion valuation; as our Readers know, the latter is a subjective and oft-inflated estimate of market value especially at this early stage. TTA dug into eMed and some of the company’s interesting history, crossing over into Ali Parsa and Babylon Health, here.  Reuters, FierceHealthcare, Mobihealthnews

Moving back into reality, Avo, a NYC-based clinical AI information platform, raised a $10 million Series A. Avo’s calling card is bringing together EHR, revenue cycle including payer, patient data, and knowledge bases to streamline use at the point of care. Funders were led by Noro-Moseley Partners, with participation from existing investors AlleyCorp, Las Olas Venture Capital, MedMountain Ventures, Epsilon Health, and new investor Scrub Capital. Avo has a solid roster of customers that include Geisinger, Mass General Brigham, and local providers such as Englewood (NJ) Health. They also have an intriguing feature: an ambient listening copilot that references patient data and generates documentation that improves revenue cycle. Release

Stedi’s Series C is typical in this hard-raise market in both level and number of investors, with a bit of a twist. The $50 million raised brings their total to $142 million, and will be used to expand its product presence and scale infrastructure. Denver-based Stedi’s calling card is an API-first and cloud-native financial clearinghouse that in revenue cycle management sits between healthcare providers and payers (insurers) to process essential transactions like eligibility checks, claims, and electronic payments. The funding was led by by Addition, with participation from Stripe, Ribbit Capital, USV, First Round, BoxGroup, and Bloomberg Beta. There was also a group of angel investors who jumped in, including Tobi Lütke (CEO of Shopify), Guillermo Rauch (CEO of Vercel), and Karim Atiyeh (CTO of Ramp). Finsmes

Since we opened with Oracle, we’ll close with them. Five days before 30,000 employees globally were declared unnecessary, Oracle announced that they leased additional space in Nashville, specifically 116,000 square feet within The Neuhoff District at 1320 Adams Street. Oracle now has 2,000 “seats” across three Nashville locations. The release touts “teams focused on a wide variety of roles, including sales and marketing, cloud engineering, software development, and product management. The company is actively recruiting ambitious thinkers and leaders eager to shape the next generation of cloud infrastructure and AI innovation. ” Perhaps some of those hundreds of folks in KC and other locations can be rehired in Nashville (sic).

The weekend read: why SPACs came, went, and failed in digital health–the Halle Tecco analysis/memorial service; why OpenAI is going to be a bad, bad business

April 10, 2025 | by

Let us now hold the formal memorial service for the SPAC–the special purpose acquisition company, at least for digital health. Halle Tecco, whom many of us know as the founder and past CEO of Rock Health, plus angel investor, plus adjunct professor in digital health at Columbia, now has an opinion blog on Substack. As our Readers know, this Editor, who is none of the above, has been shoveling dirt on SPACs here on TTA since they became an Easy Way To Avoid the cumbersome, oh-so-tiresome preparation for a public IPO during the Digital Health Boom of 2020-22 (RIP). She has been covering their Trouble Every Day and demise ever since. Having not kept quantitative track of Cracked SPACs, only the news as they floated, declined, and failed, this Editor enjoyed Ms. Tecco’s quantitative analysis of the overall picture. She puts it into a readable business context. 

Shockingly, SPACs across all IPOs are still going on. In 2023 and 2024, total SPACs as a percent of IPOs neared 40%. Their high was reached in 2022 at 73%. The attractiveness of SPACs was obvious: an investor sets up a publicly traded company and goes through the hassle of an IPO. It raises money on public markets and from investors to acquire another company. Then it hunts for a company to acquire. The target is landed, is acquired, symbols change, and the deal is done, all in three to six months. The acquired company doesn’t have to go through the investor pitches, the due diligence, the incessant filing…less fuss and muss, but missing the rigor of a traditional IPO. For the SPACs, especially those focusing on digital health, 2020-22 became FOMO Fever–the fear of missing out.

For digital health companies, the boom became a race to the bottom. 

  • 30.4% went bankrupt, some spectacularly, others with a whimper as they’ve failed, one after the other: 23andMe, Cano Health, Babylon Health, Nuvo, Pear, others
  • 26.1% were acquired well below their SPAC entry price: Sharecare, SOC Telemed, Akili and others. The only exception: Augmedix, with a $40 million SPAC valuation, was bought for $139 million by Commure. (Commure is backed by General Catalyst and Andreessen Horowitz; Commure/Athelas itself is an interesting and complex story.)
  • 39.1% are still in business but trading below their SPAC entry price. A number flirted with the Devil of Demise and are recovering: Clover Health, Owlet (baby monitors), Butterfly (ultrasound POC), Talkspace. DocGo became a Covid play and then got into political trouble and is nearing $2/share from their late 2022 high of just below $11. And others.
  • There is exactly one success story: hims & hers (4.3%)

Enjoy this read on her blog. If you prefer a podcast, here’s Ms. Tecco on her ‘Heart of Healthcare’ with Mohamad Makhzoumi (link is to Spotify), co-CEO of New Enterprise Associates (NEA), a VC in healthcare and technology (33 minutes), discussing healthcare’s evolution, so to speak, from “the trailer park of venture investing” and the hilarious ‘healthcare hokey-pokey’. And here’s a Gimlety View of SPACs from 26 June 2024.

Another Big and Disastrous Fail in the making may be OpenAI, the creator of ChatGPT. It is converting from a non-profit to a for-profit company, losing its founder group, fundraising like crazy, and generally has ditched its Mission. “OpenAI is an AI research and deployment company. Our mission is to ensure that artificial general intelligence benefits all of humanity.”  OpenAI has raised the largest venture-backed fundraise of all time, $6.6 billion, and is now valued at $157 billion. Why overvalued? A tell is that SoftBank has invested $500 million into this megillah–this Editor recalls that SoftBank invested in Theranos and WeWork. Another tell–the NY Times and The Information estimated that Open AI lost $5 billion in 2024, it loses money on every copy of ChatGPT, and its revenue projections are near-absurd at $11.6 billion in 2025 and $100 billion by 2029. It totally ignores that every major player has an AI program, from Microsoft to Google. If you’re a fan of ChatGPT or need your eyes cleared around this type of AI, grab your cuppa and a bottle of your favorite pain reliever for Ed Zitron’s article, OpenAI Is A Bad Business. (Ed is an English tech writer, podcaster, and PR specialist)

Two Must Reads: Is AI the next hype bubble replacing crypto–and capable of great harm?

February 7, 2024 | by

crystal-ballTwo articles that consider the current state of AI to read and ponder. On one hand, far less than what it’s hyped to business–especially healthcare–and on the other, more malevolent with great potential for harm.

The first article by Gintaras Radauskas in Cybernews confirmed this Editor’s misgivings on exactly what is artificial intelligence (AI) and the unrealistic expectations around it. It seems that a lot of the thinking around AI is doubletalk–gibberish, as he put it, leading off with analyzing a recent interview of Sam Altman of Microsoft-backed OpenAI and its chatbot ChatGPT. 

“To me, AI looks like a solution to a problem that’s not a problem – or, actually, a non-solution to the very real problems that are not going away.”

  • He draws parallels to cryptocurrency, which was widely hyped in the past few years as a secure alternative currency that was off the dollar and global bank grid. Even large banks, financial institutions, and big VCs like Sequoia Capital were sucked in. And real people did lose real money–famous football quarterback Tom Brady to African and Indian students.

This Editor knew the high and nonsensical point of the bubble was when she was in her local Shoprite perhaps two years ago and after checkout, next to the NJ Lottery machine and containers of sidewalk deicer, there was a machine that would convert my very real US greenbacks to crypto. The end of the bubble was the FTX bankruptcy in November 2022, then the arrest followed by last year’s trial and conviction of FTX’s Sam Bankman-Fried. Gaining little notice was that FTX was itself hacked and drained in a SIM-card swapping scheme in late 2022 before its collapse that emptied the accounts of 50 people. Those three perpetrators were indicted earlier this month. CNBC

  • When crypto imploded, ChatGPT took its place in the TechWorld Hype Universe. Bank of America terms it a ‘defining moment–like the internet in the ’90s’. For those of us who were around then, there were bulletin boards (!), multiple platforms (AOL), something called search engines (AltaVista, Dogpile), and lots of websites that surfaced and then went under the waves. A lot of money changed hands and a lot of parties were thrown before the dot.com bust. Unlike the internet boom, AI is already dominated by the tech giants like Microsoft (OpenAI) and Google (Bard, now Gemini) so it’s actually less of a risk for the large companies eager to use it.

But then why are these large companies not on board yet? “Only 3.8% of businesses reported using AI to produce goods and services, according to November’s Business Trends and Outlook Survey. It’s safe to say we’re very, very far away from mass adoption and use of AI.”

Perhaps it’s this. AI has already been parodied as a highly sophisticated long-form autocomplete tool. Your Editor has experimented with generative AI via Microsoft’s Bing. Example: an article on a non-healthcare topic, antique auto restoration. It was largely but not entirely accurate. But it was written at about a fifth-grade level in a style that was flat and uninteresting–the dumbing-down of the value of copy to inform and persuade continues. (Companies look at writers and marketers as an expense to be eliminated, not managed. As a marketer from the start of my career, and who worked for or with some of the best-known US agencies renowned for creativity, I would not recommend that career path to anyone today.) 

  • And finally, the ultimate use of AI is to get rid of people. That is what automation does. And while it can increase accuracy, speed, and take away drudgery in tasks like healthcare billing and coding, healthcare is about people–and while it can make it appear more responsive, when the humans are gone, will only the chatbots be left, with coding that endlessly replicates itself, like the automated phone menus that leave you in the ether with your questions unanswered–except it’s your diagnosis or information that your doctor’s trying to obtain? And what happens to the professionals trained to do these tasks and who already use automation tools to do their work? What happens when AI picks up and propagates a wrong treatment or surgical technique? This is not quite the analogy of the blacksmith and horseshoes or film versus video. We are ill equipped to deal with the societal effects of training people for jobs that no longer exist and concentration of technology into a very few companies.

And if we leave these tasks to AI without human intervention and supervision, what will happen?

The second article, linked to in the first, could be titled after the 1960s movie ‘Experiment in Terror’. Imagine asking AI about you. It tells you you’ve died and gives links to your obituary. Alexander Hanff, a founder of IT companies, computer scientist, and privacy technologist did. And ChatGPT repeatedly told him he was dead, complete with fake links to his obit in the Guardian and very convincing text. Now imagine you’re applying for a job, a loan, a mortgage, or a passport. The AI tool tells the employer, the bank, and the Feds that you’re dead. Hanff was already warned by a professional colleague who conducted the same exercise and received a bio back with false information. This deep fakery, origin unknown and undiscoverable, is huge potential for harm. Conclusion:

“Based on all the evidence we have seen over the past four months with regards to ChatGPT and how it can be manipulated or even how it will lie without manipulation, it is very clear ChatGPT is, or can be manipulated into being, malevolent. As such it should be destroyed.” ®

Hanff has company with Steve Wozniak of Apple on this [TTA 5 May 2023]. Read this one all the way through. And be scared. The Register