By Eric Lullove, DPM, Blue Amp Media Medical Contributing Editor
Let me be direct with you. When I started pulling on this thread—what I expected to find was a bureaucratic procurement story about government contractors. What I found instead was something considerably more unsettling: a layered, interlocking surveillance architecture operating inside the US healthcare system that most clinicians, administrators, and even healthcare attorneys have never seen mapped in its entirety.
This piece is the first half of my attempt to do that mapping.
What follows examines how Palantir Technologies—a company born from Central Intelligence Agency (CIA) seed funding and best known for helping Immigration and Customs Enforcement (ICE) track undocumented immigrants—has embedded itself at virtually every level of the federal health infrastructure: from hospital operating rooms to the Department of Health and Human Services (HHS), from the Centers for Medicare and Medicaid Services (CMS) to the immigration enforcement apparatus.
In Part 2, I will map the other side of this architecture: the Medicare audit contractor ecosystem—the Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), Targeted Probe and Educate (TPE), and Wasteful and Inappropriate Service Reduction (WISeR) programs that govern your billing compliance—and show how these two systems are converging into something none of us voted for.
Photo by Brett Sayles / Pexels (free license). Server racks in a data center—the physical layer of the surveillance infrastructure described in this article.
How Deep Does It Go?
The question I set out to answer was deceptively simple: how extensively has Palantir Technologies penetrated US healthcare data systems? The answer, documented through federal procurement records and investigative reporting, is: comprehensively.
Start at the hospital level. Palantir has signed Artificial Intelligence Platform (AIP) contracts with Cleveland Clinic, Tampa General Hospital, HCA Healthcare, and Option Care Health, deploying its AIP software for patient flow optimization, staffing, and supply chain management.[1] Healthcare now accounts for 15 percent of Palantir’s commercial revenue—a line of business that generated $702 million in 2024.[2] The company has been transparent about its strategy: create operational dependency. Multiyear contracts at institutions like Tampa General have progressed to AI-driven revenue cycle management, meaning hospitals are not simply purchasing software. They are restructuring their financial operations around Palantir’s infrastructure.
But the hospital-level presence is the visible layer. The federal layer is where this becomes structurally significant.
In 2022, HHS signed a five-year, $90 million blanket purchase agreement with Palantir—the SHARE contract (Solutioning with Holistic Analytics Restructured for the Enterprise)—making Palantir’s Foundry platform available to every HHS agency through a single procurement vehicle.[3] The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and CMS can all access Foundry without separate competitive bidding. That is not a contract. That is infrastructure.
The downstream agency penetration is documented. NIH uses Foundry. CDC used it during the pandemic for data analytics. FDA has deployed it. And in June 2024, the Advanced Research Projects Agency for Health (ARPA-H) awarded Palantir a separate $19 million, two-year contract to serve as its core data infrastructure—to “rapidly collect, synthesize, analyze, and make decisions from a range of data sources.”[4]
At CMS specifically, federal spending records show Palantir received awards for a “national provider directory—proof of concept,” positioning it as a potential backbone for a unified federal database of every healthcare provider in the United States. That project, formally the National Directory of Healthcare Providers and Services, has been in development for years. Palantir is now among the finalists for its architecture.[5]
Palantir’s core value proposition to the government is connecting databases that were never meant to be connected.
The Cross-Program Data Fusion Problem
The most alarming documented concern in this space is not what Palantir does within any single agency. It is what happens at the seams between agencies.
The Electronic Frontier Foundation (EFF) has documented that ICE used Palantir’s ELITE tool to access Medicaid enrollment records from HHS.[6] Read that again carefully: the immigration enforcement apparatus used a healthcare data platform to identify and locate individuals enrolled in the Medicaid program. A healthcare safety-net database, collected for the explicit purpose of administering medical benefits to low-income patients, was operationalized as a deportation tool.
This is not an allegation. It is documented. Palantir has denied building this functionality explicitly, but the EFF’s findings and subsequent investigative reporting from The Intercept and leaked ICE procurement documents tell a consistent story:[7] Palantir’s software is architected to eliminate the walls between databases that were built to be separate. Medicaid data merging with immigration records. Tax returns merging with law enforcement databases. Passport data merging with cell phone location records.
Photo by Brett Sayles / Pexels (free license). The technical infrastructure that enables cross-database queries across agencies.
Each individual dataset was collected legitimately, for a specific statutory purpose, with specific legal restrictions on its use. Palantir’s Foundry eliminates those restrictions operationally by making cross-database queries trivially executable. The legal walls remain. The technical walls do not.
In New York City, the Health and Hospitals Corporation paid Palantir nearly $4 million between 2023 and 2026 to improve billing efficiency for Medicaid and other public benefits—including automated scanning of patient clinical notes to “increase charges captured from missed opportunities.”[8] When this arrangement was publicly disclosed by The Intercept in February 2026, the hospital system’s CEO defended it by citing an “absolute firewall” between patient data and Palantir’s government customers. The contract was not renewed after community outcry.[9]
I want to dwell on what that NYC contract actually was: a clinical AI system reading physician notes and flagging underbilled services, operating inside a public hospital system that also has contractual relationships with a company whose software ICE uses to find people. Whether those data streams were actually connected is almost secondary. The architecture that would permit such a connection was in place.
That is the appropriate unit of analysis when evaluating surveillance infrastructure: not what data is flowing right now, but what data could flow given the systems that have been deployed.
This is the infrastructure layer. In Part 2, I will map the audit contractor ecosystem that sits on top of it—the UPIC, RAC, and WISeR programs, their private equity ownership chains, and the contingency-fee incentive structures that shape how your claims are reviewed. These are not separate stories. They are the same story. And the system is scaling.