HITshow Daily: January 16, 2026 (Friday)
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Today on HITshow:
Three clear blocks: accountability now, policy signals next, and an operator playbook. Federal prosecutors announce a $556M settlement with Kaiser Permanente affiliates tied to Medicare Advantage risk-adjustment allegations, new Senate scrutiny widens pressure on MA coding practices, and MedPAC discusses MA status including dual-eligible special needs plans. Plus: White House rolls out new healthcare cost framework emphasizing price transparency, and Providence lays out a multi-year turnaround path with ~$2B in strategic improvement goals.
HOST: RHONDA BROOKS
📍 AI & Machine Learning — Jade Romero
Federal prosecutors announced a $556M settlement involving Kaiser Permanente affiliates tied to Medicare Advantage risk-adjustment allegations. The government says certain Kaiser affiliates submitted diagnosis information that increased MA payments in ways that didn’t align with rules, using documentation workflows and incentives that encouraged adding diagnoses after the fact. Risk adjustment is enterprise compliance—if incentives or operational pressure push clinicians toward questionable documentation patterns, that becomes board-level risk.
📍 Finance & Capital — Logan Stokes
A new Senate report is putting Medicare Advantage risk-adjustment tactics under broader scrutiny, framing MA coding practices as a major cost and oversight issue. The report focuses on how risk scores are influenced by chart reviews, in-home assessments, and diagnosis capture strategies that can raise payments without changing care delivered. Health systems negotiating MA contracts should expect more scrutiny, more documentation requirements, and potentially more conservative payer behavior around coding intensity.
📍 Healthcare Policy & Advocacy — Anika Shah
MedPAC met this week with Medicare Advantage on the agenda, including a status report and focus on dual-eligible special needs plans (D-SNPs). The discussion touches how MA compares to traditional Medicare on cost and access, how risk adjustment and coding intensity affect spending, and how plan design and quality incentives influence care delivery. Watch for more pressure around coding intensity, continued debate over whether MA is overpaid, and policy moves affecting how plans manage high-need populations.
📍 Healthcare Policy & Advocacy — Rhonda Brooks
The White House rolled out a new healthcare cost framework emphasizing stronger price transparency expectations for healthcare entities in federal programs and clearer disclosure from insurers on denials and premium allocation. While not enacted law, it signals political messaging direction: more public pricing pressure, more reporting expectations, and more scrutiny of variation.
📍 Finance & Capital — Teresa Vaughn (Operator Playbook)
Providence is laying out a multi-year turnaround path with about $2B in strategic improvement goals across three buckets: (1) tighten the basics through cost discipline and reducing avoidable variation, (2) reshape the portfolio via partnerships, selective divestitures, and hard looks at build-versus-buy decisions, and (3) modernize the platform with tech and workflow improvements that reduce friction. Key lessons: sequence matters (stabilize before transforming), turnarounds are operational behaviors not just financial cuts, and change fatigue is the biggest mistake—protect care teams, simplify workflows, and communicate clearly.
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