I really don't know - I was never in that section of the business. Speculating...maybe they have their framework or some other VB6 piece certified for HIPPA compliance and don't want to change?

That industry is very old fashioned though - another good example is that every blue cross franchise uses the same software to process medicare/medicaid claims, and that software is powered by COBOL. At first it's shocking and you wonder how on earth things stay on the rails...but after a while you get used to it, a strange status quo.