Corporate investigations archive

Congressional Committee, Regulators Question Cigna System that Lets Its Doctors Deny Claims without Reading Patient Files

This article is published in partnership with ProPublica. A key congressional committee asked insurance giant Cigna on Tuesday to provide corporate documents so that lawmakers can examine the company’s practice of denying health care claims without ever opening a patient file. House...

May 16, 2023 Read Now >

Zynex: Company Overbilling Federal TRICARE Program for Electrodes; Practice Mirrors 2018 DOJ False Claims Act Settlement

Zynex Medical (ZYXI), a manufacturer of electrotherapy devices for pain management, is overbilling TRICARE, the military health program for active-duty soldiers and their family members, for millions of dollars in unnecessary supplies for its devices, according to a Capitol Forum...

May 11, 2023 Read Now >

TD Bank/First Horizon: CEO Met With Top Bank Examiner Days After Deal Delay Announced, Document Shows

Days after the head of Toronto-Dominion Bank (TD) declared he was “fully committed” to his company’s proposed acquisition of First Horizon Bank (FHN), he met with senior officials of one U.S. regulator that will decide whether the $13.4 billion deal goes ahead, according to an...

May 04, 2023 Read Now >

CFPB March Complaint Data: Total Monthly Complaints Hit 12 Month High as Bureau’s Policy Statement on Abusive Acts or Practices Appears to Signal Paradigm Shift, Prioritizing Fair Dealing Over Consumer Sovereignty

Total monthly complaints submitted by consumers to the CFPB rose to 112,600 in March 2023, reflecting an approximately 30% increase from February and the highest total number of complaints over the past twelve-month period, as measured by The Capitol Forum. The categories with the largest...

Apr 20, 2023 Read Now >

How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

This article was published in partnership with ProPublica. When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong. Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin...

Mar 25, 2023 Read Now >

InMode: Company Only Recently Began Submitting Required Malfunction and Injury Reports to FDA

Prior to last month, InMode (INMD), a manufacturer and vendor of aesthetic medical devices, had not been submitting mandatory reports to the Food and Drug Administration regarding injuries and malfunctions stemming from the use of its devices, according to a Capitol Forum analysis of an...

Mar 10, 2023 Read Now >

Xponential: Sales Pitch to Some Former Franchisees May Have Violated Franchise Disclosure Rules

Fitness franchisor Xponential (XPOF) in some cases appears to provide financial projections as part of its sales pitch to prospective franchisees beyond those contained in its franchise disclosure documents—a potential violation of federal franchise rules—according to interviews and...

Mar 10, 2023 Read Now >

CMS Policy: Advance Notice Appears to Target Lucrative Diagnosis Codes Previously Used by Companies Like Signify and Oak Street Health

The Centers for Medicare and Medicaid has proposed changes to the risk adjustment model that will reduce or eliminate some of the extra money the agency pays to Medicare Advantage plans to manage and treat certain chronic conditions. In focus are certain inappropriate coding...

Mar 03, 2023 Read Now >

Federal Reserve Taps Amazon for New Payments Project; Lawmakers Calls for Scrutiny

The Federal Reserve has tapped Amazon (AMZN) to provide data storage for an ambitious new payment system, according to sources familiar with the matter. The move could increase political pressure to put the tech giant under the watch of U.S. financial system regulators. The new...

Feb 24, 2023 Read Now >

FleetCor: Company and FTC Unable to Come to Agreement on Injunctive Relief Order; Judge Asks Parties to Answer Questions Ahead of Potentially Issuing Order

After initially trying to get the Federal Trade Commission and FleetCor (FLT) to reach an amicable decision on the scope of an order for permanent injunction and other relief, federal district court judge Amy Totenberg may be forced to issue an order, as the parties appear to remain far...

Feb 22, 2023 Read Now >

Xponential: Some Franchisees Say They Struggle to Make Business Model Work at Franchised Locations; Company Potentially Obfuscates Franchise Failure Rate in Disclosure Documents

Fitness franchisor Xponential (XPOF), whose brands include Club Pilates, Pure Barre and Cycle Bar, touts that it has never had a studio go out of business, even in the midst of pandemic restrictions that temporarily shut down exercise facilities and scared customers away from gyms. The...

Feb 15, 2023 Read Now >

Pediatrix: Halt of Arbitration Payment Determinations Could Delay Company’s Collection of Disputed Payments

In response to a Texas Federal District Court decision vacating certain No Surprises Act implementation rules, the Centers for Medicare and Medicaid Services last week paused the issuance of all new No Surprises Act arbitration payment determinations and recalled all determinations issued...

Feb 15, 2023 Read Now >

Natera: Kentucky AG Investigation Ongoing; Public Records Request Indicates AG Formulating Policies, Official Actions

A response to a public records request from the Kentucky Attorney General indicates that the office may be formulating policy recommendations in regard to its active criminal investigation of the genetic testing company Natera (NTRA). The Capitol Forum has previously reported that Natera...

Feb 06, 2023 Read Now >

Corcept: Use of Charitable Foundations Could Draw DOJ Scrutiny

Corcept Therapeutics Incorporated (CORT) appears to have provided patients with free Korlym or financial assistance through charitable foundations to give them access to the company’s expensive flagship drug. After those people got access to the drug, the company aggressively pushed...

Jan 24, 2023 Read Now >

Zynex: Company Improperly Billing Worker’s Compensation Funds for TENS Devices; Practices Strikingly Similar to Competitor Being Sued by 28 Liberty Mutual Insurers

A Capitol Forum investigation has uncovered extensive issues regarding the billing practices of the medical device company Zynex (ZYXI), with these issues ranging from the use of improper billing codes to shipping large quantities of unnecessary supplies to patients. These issues bear...

Dec 21, 2022 Read Now >

Procept Biorobotics: UnitedHealthcare Commercial Policy Effective December 1, 2022, Reiterates Aquablation as Unproven and Not Medically Necessary Due to Insufficient Evidence of Safety and/or Efficacy

UnitedHealthcare (UNH), the largest insurer in the country, recently released its prostate surgeries and interventions commercial medical policy effective December 1, 2022. The policy reiterates the insurer’s prior view that aquablation, which uses a high pressure saline solution to...

Dec 13, 2022 Read Now >

InMode: Company Misrepresents Licensing Requirements and Earnings Potential when Selling Devices to Doctors, According to Former Sales Representatives

InMode (INMD), a manufacturer of aesthetic medical devices, often does not tell doctors interested in purchasing their products about the additional licensing requirements needed to operate the devices, according to former company sales representatives. The omission, the former employees...

Dec 09, 2022 Read Now >

Corcept: DOJ Investigation may Involve Off-Label Marketing of Flagship Drug; Source says Potential Promotion for Off Label use Continues

Drug manufacturer Corcept (CORT) disclosed that late last year it received a records subpoena from the U.S. Attorney’s Office for the District of New Jersey, stating that the office was “seeking information relating to the sale and promotion of Korlym, Corcept’s relationships with...

Dec 09, 2022 Read Now >

Natera: Company’s Ties with China’s BGI Genomics Exposes it to Political and Regulatory Risk

Natera’s (NTRA) joint venture with a Chinese genetic testing company that has ties to the People’s Liberation Army could spell issues for the company and raise potential national security and human rights concerns, according to national security experts interviewed by The Capitol...

Dec 07, 2022 Read Now >

Healthcare Policy: DOJ Sues Cigna Over Medicare Advantage Risk Score Adjustments; Alleged Practices Similar to Those Uncovered in Reporting About Oak Street Health and Signify Health

Yesterday, the Department of Justice announced that it had filed a civil lawsuit against Cigna (CI) alleging that the insurer defrauded the Medicare Advantage program out of tens of millions of dollars. The allegations raised by the government are similar to those uncovered by The Capitol...

Oct 18, 2022 Read Now >

CFPB September Complaint Data: Credit Acceptance Sees 8% Month-Over-Month Increase in Complaints, Some Complaints Allege Potential Violations of SCRA; ENOVA Sees a Number of Complaints and Recent California Decision Could Negatively Affect Business

The information contained in this report is compiled from the CFPB’s publicly available complaint data. The agency uses complaint information to monitor risk in financial markets, assess risk at companies, and prioritize agency action. The Capitol Forum’s compilation of the data also...

Oct 13, 2022 Read Now >

FTAI Infrastructure: Drag on Freight Revenues Likely Amidst US Steel Idling Facilities

Energy and transportation company FTAI Infrastructure (FIP) will likely see lower revenues this quarter amid a cut to steel and tin production from its largest freight customer, US Steel (X), according to a Capitol Forum investigation. ...

Oct 10, 2022 Read Now >

Procept Biorobotics: UnitedHealthcare Community Plan Policies Reiterate No Coverage for Aquablation, Indicating Procedure is Unproven and Not Medically Necessary Due to Insufficient Evidence of Safety and Efficacy

Last week, UnitedHealthcare (UNH), the largest insurer in the country, published updated coverage determinations for three Community Plan Medical Policies in New Jersey, Kentucky, and Tennessee. The updated determinations did not include coverage for the prostate treatment known as...

Oct 07, 2022 Read Now >

The Beauty Health Company: Company Faces Undisclosed Competition for Consumable Serums; Company’s Allegedly Anticompetitive Practices Face Tying Allegations in Court, Nominative Fair Use Arguments from Spas

The Beauty Health Company (SKIN) produces devices and serums for facial treatments at spas and dermatology clinics, with the Hydrafacial system being its flagship brand. While the company commands a high price for the Hydrafacial system and equipment, the consumable serums, boosters, and...

Oct 05, 2022 Read Now >

For health-related articles; image of pen and stethoscope

Pediatrix: Storm Clouds Loom over Enforceability and Deterrent Effect of Company’s Physician NonCompete Agreements

Pediatrix Medical Group (MD), the leading neonatology and specialty pediatric care staffing company, relies on noncompete agreements with physicians and nurse practitioners that bar them from working at a competing practice in a geographical area after leaving the company. The...

Sep 30, 2022 Read Now >

Postal Policy: Express One Seeks Injunction Preventing Termination of Reseller Contract; Company Files Unredacted Contract

Postage Reseller Express One earlier today filed for a temporary restraining order and preliminary injunction preventing the USPS from terminating the Shipping Services Contract the parties entered into in December 2019. The termination is set to become effective after Friday September...

Sep 29, 2022 Read Now >

FleetCor: FTC’s Proposed Order Seeks to Ban Company’s Fee Practices

The FTC is seeking a court order for permanent injunction and other relief against FleetCor (FLT) and its CEO Ronald Clarke that would prohibit some of the practices the company has relied on to generate hundreds of millions in improper fee revenue from small businesses that use its fuel...

Sep 22, 2022 Read Now >

ZoomInfo: Company Sold Personal Phone Numbers of EU Citizens Without Consent After Saying It Does Not Sell Personal Data; Practice Likely Violates GDPR, According to Experts, and Undermines Company’s Lawful Basis for Operating in EU

Citizens of European countries subject to the General Data Protection Regulations are having their personal mobile phone numbers processed and sold without their consent by ZoomInfo (ZI), an aggregator of business-related contact information, according to a Capitol Forum...

Aug 19, 2022 Read Now >

Adtalem Global Education: Department of Education Initiates DeVry Recoupment Action; Company Likely on Hook for Borrower Defense Claims

The Department of Education announced that yesterday it formally notified DeVry that the institution is liable to the Department for nearly $24 million for approved borrower defense claims, according to a press release. The notice is an initial demand that relates to DeVry Direct Loan...

Aug 16, 2022 Read Now >

JPMorgan Chase Avoided Public Punishment From CFPB Under Trump After Discovery of Alleged Fake Accounts

JPMorgan Chase Bank (JPM) avoided public sanctions during the Trump administration for allegedly creating fake accounts when the Consumer Financial Protection Bureau (CFPB) opted to quietly close the matter instead, according to sources familiar with the matter, adding yet another major...

Aug 10, 2022 Read Now >

Privacy Policy: Third-Party Businesses that Engage in Data Collection for Cross-Contextual Advertising May Have to Alter Practices Under CPRA, Experts Say

The draft regulations of the California Privacy Rights Act contain various provisions that are designed to limit the sharing of consumers’ personal data with third-party companies that do not directly interact with consumers, according to privacy experts interviewed by The Capitol...

Aug 08, 2022 Read Now >

FirstCash: California Regulator Takes Action Against Four Technologies for Operating Without License; Levitin Opines that California Retail Installment Sales Agreements Resemble Direct Loans and Loans are Unconscionable

American First Finance, a point-of-sale consumer finance and rent-to-own company recently acquired by payday lender FirstCash (FCFS), operates in California without a nonbank lending license because the company has determined its retail sales installment agreements do not constitute a...

Aug 08, 2022 Read Now >

AdaptHealth: Consolidation of Acquired Businesses Left Patients with Decreased Access to Oxygen and Forced Workers to Violate Federal Safety Regulations to Make Deliveries

AdaptHealth (AHCO), a distributor of durable medical equipment, has a strong appetite for purchasing local and regional competitors, acquiring over 90 medical suppliers over the last four years. These acquisitions and the resulting efforts by the company to cut costs, however, can often...

Jul 15, 2022 Read Now >

Privacy Policy: California Starts Formal Rulemaking Process to Implement CPRA; Regulations as Proposed Enhance Consumer Protections and Do Not Exempt Business Information

On Friday, the California Privacy Protection Agency initiated the formal rulemaking process to adopt proposed regulations implementing the Consumer Privacy Rights Act of 2020 (CPRA), which amend and expand upon the California Consumer Privacy Act. The proposed regulations strengthen...

Jul 11, 2022 Read Now >

Perdoceo Education Corporation: Insider Selling Red Flags at Perdoceo; Advocates Call ED ‘Asleep at the Wheel’ on For-Profit Education

Elise Baskel took over as President of Perdoceo’s (PRDO) Colorado Technical University (CTU) in January 2022. In short order, Baskel implemented a trading plan known as 10b5-1 to regularly sell off her vested shares in Perdoceo, ultimately selling off 100% of her vested shares over a...

Jun 17, 2022 Read Now >

FirstCash: Financing Practices of American First Finance Subsidiary Could Draw Scrutiny from Democratic Majority FTC, Expanded Ongoing State AG Investigation

The financing practices of American First Finance (AFF), a subsidiary of pawn shop operator FirstCash, Inc. (FCFS), could draw the scrutiny of the Federal Trade Commission and state attorneys general, according to an investigation by The Capitol Forum. AFF specializes in point-of-sale...

Jun 01, 2022 Read Now >

MultiPlan’s ‘Maybe You’re In-Network’ PPO Product May Violate No Surprises Act, Experts Say

MultiPlan’s (MPLN) products for health plans fall under two umbrellas—a preferred provider organization (PPO) network product and products related to payment editing, negotiating, and repricing of healthcare claims. The Capitol Forum has previously reported about the company’s...

Apr 28, 2022 Read Now >

Upstart: Seemingly Important Upstart Accounting Change Made Public via KBRA Pre-sale Securitization Report; Expert Says Accounting Change Likely to Be Mentioned in Upcoming 10-Q

Upstart amended loan modification program in April. According to a new KBRA pre-sale report on Upstart’s (UPST) structured pass through trust series 2022-2a, “In April 2022, Upstart amended its CRB and FinWise loan modification policies. Under the new policy, borrowers that have...

Apr 27, 2022 Read Now >

Carvana: Auction Participants Moving Away from ADESA After Announcement of Acquisition

Earlier this year, online used car dealer Carvana (CVNA) announced that it was acquiring the auction business of KAR Global (KAR) for $2.2 billion. The press release accompanying the announcement noted that the acquisition would greatly expand Carvana’s existing auto reconditioning...

Apr 14, 2022 Read Now >

Provider Shows How Multiplan Incentivizes Him to Raise His Billing Rate; Multiplan Says It “Does Not Encourage Providers to Overcharge”

Multiplan (MPLN) says that it provides “independent, fair, and reasonable” pricing for out-of-network healthcare services. Previous Capitol Forum reporting showed that Multiplan’s pricing is not independent, as it can be manipulated by insurers. According to Capitol...

Apr 08, 2022 Read Now >

Natera: Company Reviewed MGML Non-Profit Status Twice; Review Raises Questions of Rigor, Potentially Exposing Company to Securities Litigation Risk

Last month, investment research firm Hindenburg Research published a report on the genetic testing company Natera (NTRA) that accused the company of deceptive practices regarding its insurance billings. At the center of the report was the allegation that the company had used a company...

Apr 06, 2022 Read Now >

In Blow to Multiplan, UnitedHealth Group Has Begun Transitioning Clients to Naviguard, UnitedHealth’s In-house Product

UnitedHealth Group (UNH) is now offering its large employer customers options to transition away from paying high fees for Multiplan’s (MPLN) out-of-network claim pricing services, according to a Capitol Forum investigation. One option for employers is to switch to Naviguard,...

Mar 23, 2022 Read Now >

ZoomInfo: Advocates for Victims of Domestic Violence Raise Concerns Over ZoomInfo’s Community Edition; FTC Nominee Has Championed Policies That Protect Victims of Abuse

Advocates for victims of domestic violence tell The Capitol Forum that they are concerned about the possibility that some victims of domestic violence may unknowingly be exposing sensitive contact information to ZoomInfo’s (ZI) database via the company’s Community Edition service....

Mar 11, 2022 Read Now >

Multiplan: Company’s Information Sharing, Meetings Practices Could Raise Antitrust Concerns, Experts Say

Multiplan (MPLN), a company that helps health insurers underpay healthcare provider bills, may have an antitrust issue on its hands, according to experts who reviewed Multiplan practices that came to light during testimony in a recent litigation between a health insurer and emergency...

Mar 07, 2022 Read Now >

Oak Street Health: DOJ Investigation Likely Focuses on Program That May Be Problematic Under Federal Antikickback Laws

Last November, Oak Street Health (OSH), an operator of primary care clinics for Medicare beneficiaries, disclosed to investors that it had received a civil investigative demand from the Department of Justice. While the company has not shared many details about the scope of the...

Feb 22, 2022 Read Now >

NLRB Atlanta Opera Briefs Include Antitrust Arguments and Novel Proposals, Setting Stage for Gig Economy to Face All-of-Government Approach on Misclassification Concerns

Public interest, government, and industry groups recently submitted more than 30 amicus briefs to the NLRB in a case called Atlanta Opera that could redefine the distinction between employees and independent contractors, and in turn have significant implications for prominent gig economy,...

Feb 17, 2022 Read Now >

ZoomInfo: Privacy Experts Raise Concerns About Community Edition Data Collection; Practices Could Run Afoul of GDPR, FTC Guidelines

Privacy advocates and experts interviewed by The Capitol Forum are raising concerns about the data collection practices of ZoomInfo (ZI), an aggregator of business contact data that includes profiles for over 10 million businesses and 125 million business professionals. At issue is...

Feb 10, 2022 Read Now >

InnovAge: Company Received Civil Investigative Demand from DOJ; Kentucky No Longer Intends to Enter into Agreement with Company

InnovAge (INNV), the country’s largest provider of senior healthcare services under the government’s Program for All Inclusive Care for the Elderly, disclosed in its most recent quarterly filing that it received a civil investigative demand from the Department of Justice under the...

Feb 09, 2022 Read Now >

Oak Street Health: Internal Company Documents, Former Medical Staff Detail Efforts to Increase Patient Risk Scores; Company Diagnosis Rates of Chronic Conditions Much Higher Than National Averages

Oak Street Health (OSH), an operator of primary care clinics for Medicare beneficiaries, appears to encourage physicians to diagnose chronic conditions in their patients even when the diagnosis may not be appropriate, according to internal company documents reviewed by The Capitol Forum...

Feb 04, 2022 Read Now >

For-Profit Colleges Under CFPB Scrutiny for Lending Practices; Experts Expect Data Sharing with Education Department

The Consumer Financial Protection Bureau is becoming a new threat to for-profit colleges as the regulator signaled last week that it will examine institutional practices around lending money to students and collecting on those loans. For-profit institutions that engage in...

Feb 01, 2022 Read Now >

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