COMPANIES MADE MILLIONS TO PERPETRATE FRAUD
NORMAN J CLEMENT, RPH, DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., DAVID STEIN, MD IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
Attn: 60 minutes investigation Dept.
HELP US 60 MINUTES
A letter to CBS’s 60 Minutes from youarewithinthenorms.com alleges widespread fraud in U.S. government medical data analytics.
The letter claims that a technology company named Qlarant uses defective data to falsely accuse doctors and pharmacists of healthcare fraud, leading to wrongful convictions and asset forfeitures and alleges this disproportionately affects minority healthcare providers.
It further asserts that Qlarant’s algorithms lack scientific validity and are manipulated to ensure convictions, raising concerns about due process and patient care, ultimately urging an investigation into the use of unregulated clinical decision software like NarxCare and Qlarant’s data analysis methods. Some medical professionals and patients have been adversely impacted.
Listen to Qlarant “AI Gate Scandal” Allegations: Healthcare Fraud Detection Review Below
DANGER!!! UNDERMINING HEALTHCARE TREATMENTS AND PROTOCOLS THROUGH DATA ANALYTIC ABUSES DANGER!!!
Qlarant, a Maryland-based technology company, gets paid millions of dollars by state/federal agencies and private insurance companies such as Blue Cross Blue Shield Association for providing defective data analytics to accuse many innocent doctors and pharmacists criminally. Qlarant NBI medics use data analytics and “red flags” as criminal forensic tools to identify healthcare fraud and controlled substance medication violations.
According to Dan Martin JD, a partner in Jones Walker’s Litigation Practice Group, article, “Federal agencies using generative AI(Artificial Intelligence), computer data analytics to search for Health Care Fraud,” Medical Economics Sept.12, 2023: “Data analytics is a good tool to suggest the need for further investigation, but it should not be used to determine misconduct conclusively.
The Department of Justice and Health and Human Services boast a yield of $4 or greater return on investment for every $1 spent on Health Care Fraud (HCF) detection and enforcement. They point specifically to their reliance on data analytics as a key driver of this return.”
VAGINAL PELVIC RECONSTRUCTIVE SURGEON WALKED AWAY FROM MEDICINE; “I WONT BE A DOC IN THE BOX, PUSHING ALGORITHMS”
COMPANIES PUSHING ALGORITHMS TO CUT OFF PATIENTS’ CARE
” Qlarant Health Integrity (NBI Medic) advertises that they use specialized data analysis, which helps law enforcement locate buried targets and “speed conviction,”
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US PROSECUTORS HAVE ATTACKED
Unfortunately, the government’s rush to use its new tools in such a sweeping manner has resulted in many innocent physicians, clinics, and pharmacists being accused of wrongdoing. Most(>90%) of the accused and criminally indicted doctors and pharmacists are blacks, colored Asians, Hispanics, and Jews.
Many innocent providers have spent millions on legal defense after being targeted through Qlarant’s erroneous conclusions drawn from defective data analytics.
WARNING!!! A PATHWAY BACKWARD: UNREGULATED CLINICAL DECISION SOFTWARE
According to Michele J. Buonora MD, MS, MHS, Sydney A. Axson,PhD.,MPH., Shawn M. Cohen, MD and William Becker, MD;
***
“…Amidst the US overdose epidemic, policymakers, law enforcement agencies, and healthcare institutions have contributed to a decrease in opioid prescribing, assuming reduced mortality would result-an assumption we now understand was oversimplified. At this intersection between public health and public safety domains as they relate to opioid prescribing, unregulated and proprietary clinical decision support tools have emerged without rigorous external validation or public data sharing.
In the following piece, we discuss challenges facing clinicians practicing medicine amidst unregulated clinical decision support tools, using the case of Bamboo Health’s NarxCare-a prescription drug monitoring program-based analytics platform marketed as a clinical decision support tool that is already positioned to impact over 1 billion patient encounters annually.
We argue that sufficient evidence does not yet exist to support NarxCare’s wide implementation and that clinical decision-support tools like NarxCare have flourished in recent years due to a lack of federal regulatory oversight and shielding…”
***
However, Qlarant, on their website, states that it “has the knowledge, skills and abilities derived from many years of fraud investigations using data analytics” to aid DEA, US Dept. of Health and Human Services, the Office of Inspector General (OIG), Centers of Medicare and Medicaid and private Insurance Companies like Blue Cross Blue Shield with the medical records they have acquired from doctor’s offices and pharmacy records from pharmacies as evidence of violations of Health Care Fraud (HCF) and the Controlled Substance Act.
“…Qlarant, by maximizing false data to the DEA, is maximizing their pockets…”
On its website, Qlarant advertises that it is an expert in detecting fraud, waste, and abuse (FWA). In partnership with HHS/OIG, FBI, DEA, and private insurance companies such as BCBS, they can sift through medical records and provide the information necessary to maximize the DEA, HHS/ OIG, FBI law enforcement efforts to maximize criminalization of medical providers and pharmacists.
In actuality, Qlarant, by maximizing false data to the DEA, is maximizing their pockets. Qlarant gets a percentage of the restitution that is claimed from the providers.
Qlarant Health Integrity (NBI Medic) advertises that they use specialized data analysis, which helps law enforcement locate buried targets and “speed conviction,”
b) Data mine for trends and targets for “ coordinating for conviction” and for the “strength of convictions”,
c) perform “ pre-seizure identification of the most likely drug-seeking patients.”
d) engage in pre-indictment targeting and categorization of a physician’s property records, physician ownership/asset, and physician financial filings for purposes of maximizing criminal asset forfeiture and restitution for USDOJ, HHS, and private insurers like Blue Cross Blue Shield ( of course, the more money the doctor has, the more Qlarant can maximize its profits)
e) have customized program options where Qlarant can create a program around specific needs in each respective region, giving the US Attorney’s Office “great latitude to build upon specific issues known in their area based upon experiences and knowledge of the potential bad actors.” Attached is the Qlarant website advertising.
*https://youarewithinthenorms.com/2023/04/30/vendor-data-fraud-bamboozled-by-bamboo-study-shows-dea-has-operated-as-a-criminal-enterprise-resulting-in-thousand-of-deaths-and-false-imprisonment-of-doctors/
@bobsheerin.apdf @SnarkilyAndrew60 @Shirl @Ashley Clark ❤️ @AM to PM Pain [Steve] #chronicpainpatients #spooniesoftiktok #pain #apdf2020
♬ original sound – Bob Sheerin
QLARANT HAS NO SCIENTIFIC ORIGINS IN THEIR ANALYSIS
Qlarant advertises that their analytic experts and analytic tools are used to measure aberrant behavior and indicate the likelihood of diversion. 1) They will review Prescription Drug Monitoring data (PDMP). But the PDMP has errors. ( I can provide proof of 100s examples of PDMP errors that Pharmacists document upon request).
2) Patients who are prescribed more than 100 morphine equivalents per day ( there is no scientific origin of 90 MME maximum daily dose, nor any scientific evidence of it except it is an arbitrary number). Qlarant’s failure to discuss the disease and Disease state pathology demonstrates Qlarant as completely fraudulent. The pharmacology and unique properties of each opioid and patient individuality must be considered when a therapeutic opioid conversion is contemplated. Conversion should not simply rely on a mathematical formula embedded within the questionable CDC guidelines. In fact, the CDC issued a statement stating that the 90 MME maximum daily dose is a recommendation and is not to be used by law enforcement to attack physicians who prescribe more than that as it is based on a patient’s individual needs.
3) identifying patients ( through geo) traveling long distances to obtain narcotics. (I can provide proof upon request of patients that Qlarant has fraudulently added to their data for criminal asset forfeiture). Through these types of fraudulent analyses, Qlarant has investigated hundreds of Health Care Fraud providers and referred those investigations to law enforcement for criminal investigation.
Frequently Asked Questions about the Alleged AI Gate Scandal in US Healthcare
1. What is the central claim being made regarding AI and data analytics in US healthcare, according to the source?
The central claim is that government and private entities are using fraudulent or defective AI and data analytics tools, particularly those provided by companies like Qlarant, to wrongly accuse doctors and pharmacists of healthcare fraud and controlled substance medication violations. This is allegedly leading to thousands of needless deaths, suffering, and the unjust prosecution of healthcare providers.
2. Who is Qlarant, and what role do they play in this alleged scandal?
Qlarant is a Maryland-based technology company that provides data analytics services to state/federal agencies and private insurance companies. The source alleges that Qlarant’s data analytics are defective and are used to identify healthcare fraud and controlled substance medication violations, resulting in the unjust targeting and prosecution of doctors and pharmacists for alleged wrongdoing. They allegedly manipulate data to maximize profits through criminal asset forfeiture.
3. What specific concerns are raised about the data analytics and algorithms used by companies like Qlarant?
The primary concerns are that the algorithms used by Qlarant lack scientific origins, have large internal errors, significant bias, and lead to incorrect conclusions. Furthermore, the source claims that these algorithms are not independently peer-reviewed, lack validity and reliability testing, and can be manipulated to build a case against targeted healthcare providers. They also don’t account for individual patient needs or disease pathology when flagging prescriptions.
4. How are Prescription Drug Monitoring Programs (PDMPs) and morphine milligram equivalents (MMEs) involved in this controversy?
The source claims that PDMP data, which is often used by companies like Qlarant, contains errors and that using arbitrary MME thresholds (like 90 MME) to identify potential fraud is not scientifically valid. They argue that focusing solely on MME thresholds without considering individual patient needs and disease states can lead to misinterpretation and unjust targeting of physicians.
5. What is NarxCare, and why is it mentioned as a concern?
NarxCare is a prescription drug monitoring program-based analytics platform marketed as a clinical decision support tool. The source highlights concerns raised by medical professionals that tools like NarxCare have been implemented without sufficient evidence to support their widespread use and lack federal regulatory oversight. These tools impact a large number of patient encounters annually, raising concerns about their impact on clinical decision-making.
6. Is there any suggestion of bias in how these data analytics tools are being applied?
Yes, the source alleges that a disproportionate number of doctors and pharmacists accused and criminally indicted based on these data analytics are blacks, colored Asians, Hispanics, and Jews. This raises concerns about potential racial and ethnic bias in the application of these tools and enforcement actions.
7. What legal and financial repercussions do healthcare providers face as a result of being targeted by these data analytics?
Healthcare providers targeted by these data analytics tools can face substantial penalties, including incarceration, significant fines, loss of licenses, and criminal restitution penalties. They often incur significant legal defense costs, even when they are ultimately found not guilty, as shown in the example of Dr. Lesly Pompy.
8. What is being requested of CBS’s “60 Minutes” or other investigative journalists?
The source is pleading with CBS’s “60 Minutes” and other investigative journalists to investigate these allegations and expose the alleged fraud and data manipulation by companies like Qlarant. The goal is to raise awareness about the potential harm to innocent healthcare providers and their patients and to push for greater oversight and regulation of AI and data analytics tools in healthcare.
QLARANT MANIPULATION OF DATA
Qlarant publicizes that it can refer cases to the USDOJ for criminal indictment and then assist USDOJ Prosecutors in the trial to ensure the conviction of the person whom they originally referred to the USDOJ.
Qlarant advertises that it can identify waste, fraud, abuse, and improper prescribing for referral to law enforcement and then ensure high conviction rates on those referrals. Qlarant ensures that the USDOJ can successfully obtain a conviction with recovery through criminal asset forfeiture or restitution.
Qlarant has not published a detailed analysis of the available mathematical and statistical methods used to ensure no large internal errors, significant bias, incorrect conclusions, etc., in its criminal forensic tools or data analytics algorithms. Qlarant has not published its algorithms’ and data analytics’ validity and reliability.
Qlarant has failed to answer general questions on the population, samples, and other questions concerning the descriptive and inferential statistics utilized. Qlarant has not published its criminal forensic tools regarding regression, correlation analysis, and predictive analytics.
Qlarant’s manipulation of data by its algorithm allows US Prosecutors to prosecute with a successful conviction, “Tell me the man, and I will show you the crime.” Once a US Prosecutor identifies a so-called lousy actor and provides information to Qlarant, It can manipulate the evidence to create a proof of the crime to help the US Prosecutor persecute the doctor and achieve a conviction.
In “Tell Me the Man, and I Will Show You the Crime,” Qlarant will help a US prosecutor build an indictment against a healthcare provider that the US Prosecutor wants to target. Qlarant provides personally identifiable information (PII) or protected health information(PHI)data to the Government that is essential to charge a doctor or pharmacist. Qlarant provides materially false and fabricated data to the Government to ensure convictions.
Qlarant NBI Medic’s mathematical equations, computer algorithms, and/or statistical methods have large internal errors, significant bias, incorrect conclusions, etc.
The computer algorithms, data analytic targeting packages of Qlarant NBI Medic, and the validity and reliability testing of Qlarant NBI Medic criminal forensic precrime criminal tools are questionable and not scientifically valid or peer-reviewed.
There are no published scientific explanations or validity reports describing how Qlarants computer algorithms endeavor to determine a physician’s quality of patient care or testify regarding the contents of a physician’s mind without seeing or speaking with the physician.
Qlarant website publicizes and emphasizes its ability to speed criminal convictions with a conveyor belt algorithm, coordinate for conviction with the US Attorney’s Office, and strengthen convictions through data manipulation.
https://www.facebook.com/story.php?story_fbid=339323762087169&id=1094599019&mibextid=qC1gEa
THE DEA’s PDMP DOSING DISCRIMINATION AND BIAS TARGETS HEALTHCARE PROVIDERS/PATIENTS BASED ON SKIN COLOR AND NATION OF ORIGIN
60 MINUTES: SAVE MY SONS AND DAUGHTER, ALL PHYSICIANS, FROM GOING TO FEDERAL PRISON!!!!!!
Qlarant NBI medic, through the utilization of novel criminal forensic tools, has prosecuted, incarcerated, searched, and seized the financial assets of thousands of doctors and pharmacists.
Based on Qlarant’s fabricated algorithms and data analytics, doctors/ pharmacists can face substantial penalties, including incarceration, as well as substantial fines and criminal restitution penalties.
Qlarants manipulation of data has resulted in many innocent physicians and pharmacists being accused of wrongdoing, losing their licenses, convicted, and incarcerated.
Qlarants manipulated data algorithms have resulted in many innocent providers spending millions on legal defense after being targeted through erroneous data mining and analytics. (Qlarant’s data analytics targeted Dr Pompey Leslie, who was recently found not guilty on all counts by a jury trial. He lost his medical license and ability to make a living. He lost five years of his life and all his money fighting for justice).
Qlarant NBI Medic has admitted that they manipulate data, are motivated and incentivized to manipulate data to fraudulently seek pecuniary gains via asset forfeitures of innocent health care providers- Dr Shiva Akula and many more doctors have been targeted by Qlarant’s faulty algorithms and indicted or incarcerated based on Qlarant’s manipulated data mining.
Qlarant’s chief technology officer, William Mapp, has said, “Qlarant’s algorithms are considered proprietary and intellectual property and have not been independently peer-reviewed.
“It sucks when we get it wrong.”
Yes, it sucks when an innocent person is indicted or incarcerated due to Qlarant’s manipulated data mining.
The federal government has long used digital analytics and data mining to search for instances of Health Care Fraud, even though we all agree that tackling fraud, waste, and abuse is important.
But the concern arises when Qlarant is falsely and with manipulated data accusing innocent physicians and pharmacists of pecuniary gains via asset forfeitures of health care providers.
THIS LETTER IS FROM ONE BRAVE MOTHER
One brave mother of indicted physician, and my youngest son and daughter, who are physicians under attack.
Please investigate and get this story out. Too many innocent lives and families are being destroyed by Qlarant’s manipulated data algorithm.
HELP US 60 MINUTES THE TARGETING CRISIS IS A HOAX
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FOR NOW, YOU ARE WITHIN
THE NORMS
References:
1. Interview on Youtube.com of Dr. Anand Part 2 by Dr. Linda Cheek, President of Doctors of Courage
Briefing Document: “AI Gate Scandal” Allegations Regarding Qlarant and Healthcare Fraud Detection
Date: June 4, 2024 Subject: Review of “LETTER TO CBS 60 MINUTES: AI GATE SCANDAL…” Source: youarewithinthenorms.com, November 20, 2023
Executive Summary:
This briefing document summarizes the key allegations made in a published letter concerning the technology company Qlarant and its use of data analytics in detecting healthcare fraud. The letter alleges that Qlarant’s data analytics are “fraudulent,” “defective,” and lead to the wrongful accusation, indictment, and conviction of innocent doctors and pharmacists, disproportionately affecting minorities.
It claims Qlarant manipulates data to ensure convictions and profits from asset forfeitures, and calls for a “60 Minutes” investigation. The letter also raises concerns about unregulated clinical decision support tools like Bamboo Health’s NarxCare.
Main Themes and Key Ideas:
- Allegations of Fraudulent Data Analytics: The central theme is that Qlarant, a technology company working with government agencies and private insurers, utilizes “defective data analytics” and “red flags” as criminal forensic tools, leading to the false accusation of healthcare fraud and controlled substance medication violations.
- “Qlarant, a Maryland-based technology company, gets paid millions of dollars by state/federal agencies and private insurance companies such as Blue Cross Blue Shield Association for providing defective data analytics to accuse many innocent doctors and pharmacists criminally.”
- “Qlarant NBI medics use data analytics and “red flags” as criminal forensic tools to identify healthcare fraud and controlled substance medication violations.”
- Incentivization of False Convictions & Financial Gain: The letter alleges that Qlarant is incentivized to manipulate data to maximize its profits through criminal asset forfeiture and restitution from healthcare providers.
- “Qlarant, by maximizing false data to the DEA, is maximizing their pockets. Qlarant gets a percentage of the restitution that is claimed from the providers.”
- “Qlarant NBI Medic has admitted that they manipulate data, are motivated and incentivized to manipulate data to fraudulently seek pecuniary gains via asset forfeitures of innocent health care providers…”
- Disproportionate Impact on Minority Healthcare Providers: A significant concern raised is the alleged racial bias in the application of these data analytics, with the claim that a disproportionate number of accused and indicted doctors and pharmacists are minorities.
- “Most(>90%) of the accused and criminally indicted doctors and pharmacists are blacks, colored Asians, Hispanics, and Jews.”
- Lack of Transparency and Scientific Validation: The letter criticizes Qlarant for lacking transparency in its methodologies and failing to provide scientific validation for its data analytic algorithms.
- “Qlarant has not published a detailed analysis of the available mathematical and statistical methods used to ensure no large internal errors, significant bias, incorrect conclusions, etc., in its criminal forensic tools or data analytics algorithms.”
- “Qlarant’s chief technology officer, William Mapp, has said, “Qlarant’s algorithms are considered proprietary and intellectual property and have not been independently peer-reviewed.”
- Impact on Patient Care and Access: The document suggests that the use of these tools is leading to the curtailment of patient care, particularly for pain management, and causing doctors to leave medicine due to fear of prosecution.
- “COMPANIES PUSHING ALGORITHMS TO CUT OFF PATIENTS’ CARE”
- “VAGINAL PELVIC RECONSTRUCTIVE SURGEON WALKED AWAY FROM MEDICINE; “I WONT BE A DOC IN THE BOX, PUSHING ALGORITHMS””
- Concerns Regarding Unregulated Clinical Decision Support Tools: The document extends its critique to other unregulated clinical decision support tools, such as Bamboo Health’s NarxCare, questioning their validation and potential impact on patient encounters.
- “In the following piece, we discuss challenges facing clinicians practicing medicine amidst unregulated clinical decision support tools, using the case of Bamboo Health’s NarxCare-a prescription drug monitoring program-based analytics platform marketed as a clinical decision support tool that is already positioned to impact over 1 billion patient encounters annually.“
- Call for Investigation: The document concludes with a direct appeal to “60 Minutes” to investigate these allegations and expose the alleged injustices.
- “HELP US 60 MINUTES”
- “Please investigate and get this story out. Too many innocent lives and families are being destroyed by Qlarant’s manipulated data algorithm.”
Important Quotes:
- “Data analytics is a good tool to suggest the need for further investigation, but it should not be used to determine misconduct conclusively.” (Quoting Dan Martin JD)
- “Qlarant Health Integrity (NBI Medic) advertises that they use specialized data analysis, which helps law enforcement locate buried targets and “speed conviction,”“
- “Qlarant’s manipulation of data by its algorithm allows US Prosecutors to prosecute with a successful conviction, ‘Tell me the man, and I will show you the crime.'”
Points to Consider:
- The letter presents serious allegations that require independent verification.
- The source is an advocacy website, potentially indicating a biased perspective.
- The document references multiple individuals and organizations, suggesting a broader network of concerned parties.
- The use of strong language and emotionally charged statements (“DANGER!!!”, “FRAUDULENT”, “DOJ DEA HYENA”) should be noted.
- The specific examples of alleged manipulation and wrongful convictions (Dr. Pompey Leslie, Dr. Shiva Akula) warrant further investigation.
Recommendations:
- Treat the information in this document as allegations until verified by independent sources.
- Conduct further research into Qlarant, its data analytics methodologies, and its relationships with government agencies and private insurers.
- Investigate the specific cases mentioned in the document to determine the validity of the claims of wrongful conviction.
- Seek comment from Qlarant, the DEA, the DOJ, and other relevant organizations.
- Consider the potential implications of unregulated clinical decision support tools on patient care and due process.
Timeline of Events
- Prior to September 12, 2023: Qlarant develops and markets data analytics tools for healthcare fraud detection. They partner with government agencies (DEA, HHS/OIG, FBI) and private insurers (Blue Cross Blue Shield). They begin using PDMP Data for analytics.
- September 12, 2023: Dan Martin JD publishes an article in Medical Economics discussing the use of AI/Data Analytics to find instances of Healthcare Fraud.
- Prior to November 20, 2023: Doctors and pharmacists are targeted by Qlarant’s data analytics, leading to investigations, indictments, loss of licenses, legal battles, and incarceration for some. Many of those targeted are black, colored Asians, Hispanics, and Jews.
- November 20, 2023: The “LETTER TO CBS 60 MINUTES: AI GATE SCANDAL…” is published on youarewithinthenorms.com, outlining concerns about Qlarant’s data analytics and its impact on healthcare professionals and patients.
- November 22, 2023: Renee Blare comments on the post, recounting how United Healthcare cut her and her husband off from their Medicare plans.
- Unspecified Date: Dr. Lesly Pompy is acquitted after a 5-year legal battle, although he lost his medical license and finances.
- Unspecified Date: Dr. Shiva Akula and other doctors are targeted by Qlarant’s algorithms and indicted or incarcerated based on Qlarant’s manipulated data mining.
- May 9, 2024: Renee Blare comments on the post, requesting law enforcement have a subpoena before gaining access to PDMP data.
- May 19, 2024: Renee Blare posts that United Healthcare let them back on their Medicare plans.
Cast of Characters
- Norman J. Clement, RPH, DDS: Author of the letter and the “You’re Within The Norms” website. A pharmacist and dentist, he seems to be a central figure in advocating for healthcare professionals targeted by data analytics.
- Malachi F. Mackandal, PharmD: Listed in the preamble of people involved in the case.
- Belinda Brown-Parker: Listed in the preamble of people involved in the case.
- Joseph Solvo Esq.: Listed in the preamble, likely a lawyer.
- Walter R. Clement BS., MS, MBA: Listed in the preamble of people involved in the case.
- Harvey Jenkins MD, PH.D.: Listed in the preamble of people involved in the case.
- David Stein, MD: Listed in the preamble of people involved in the case.
- C.T. Vivian: Listed in the preamble of people involved in the case.
- Jelani Zimbabwe Clement, BS., MBA.: Listed in the preamble of people involved in the case.
- Patrice Lumumba: Listed in the preamble of people involved in the case.
- Erlin Clement Sr.: Listed in the preamble of people involved in the case.
- Evelyn J. Clement: Listed in the preamble of people involved in the case.
- Walter F. Wrenn III., MD.: Listed in the preamble of people involved in the case.
- Julie Killingsworth: Listed in the preamble of people involved in the case.
- Renee Blare, RPH: Comments on the post regarding her experience with United Healthcare. A pharmacist.
- Terence Sasaki, MD: Listed in the preamble of people involved in the case.
- Lesly Pompy, MD: A doctor who was targeted by Qlarant’s data analytics, lost his medical license and finances, but was eventually acquitted.
- Christopher Russo, MD: Listed in the preamble of people involved in the case.
- Nancy Seefeldt: Listed in the preamble of people involved in the case.
- Willie Guinyard BS.: Listed in the preamble of people involved in the case.
- Joseph Webster MD., MBA: Listed in the preamble of people involved in the case.
- Beverly C. Prince MD., FACS.: Listed in the preamble of people involved in the case.
- Neil Arnand, MD.: Listed in the preamble of people involved in the case.
- Richard Kaul, MD.: Listed in the preamble of people involved in the case.
- Leroy Baylor: Listed in the preamble of people involved in the case.
- Jay K. Joshi MD., MBA: Listed in the preamble of people involved in the case.
- Adrienne Edmundson: Listed in the preamble of people involved in the case.
- Ester Hyatt PH.D.: Listed in the preamble of people involved in the case.
- Walter L. Smith BS.: Listed in the preamble of people involved in the case.
- Brahm Fisher Esq.: Listed in the preamble of people involved in the case.
- Michele Alexander MD.: Listed in the preamble of people involved in the case.
- Cudjoe Wilding BS: Listed in the preamble of people involved in the case.
- Martin Njoku, BS., RPH.: Listed in the preamble of people involved in the case.
- Debra Lynn Shepherd: Listed in the preamble of people involved in the case.
- Beres E. Muschett: Listed in the preamble of people involved in the case.
- Dan Martin, JD: A partner in Jones Walker’s Litigation Practice Group. He wrote an article in Medical Economics about AI and healthcare fraud.
- Michele J. Buonora MD, MS, MHS: Author of a study about NarxCare.
- Sydney A. Axson,PhD.,MPH.: Author of a study about NarxCare.
- Shawn M. Cohen, MD: Author of a study about NarxCare.
- William Becker, MD: Author of a study about NarxCare.
- Tim Rats, MD: Quoted about Qlarant maximizing false data to the DEA to maximize profits.
- Rajendra Bothra, MD: Mentioned as an example of those targeted.
- Shiva Akula, MD: Mentioned as an example of those targeted.
- William Mapp: Chief Technology Officer of Qlarant.
- Linda Cheek, MD: President of Doctors of Courage, interviewed Dr. Anand.
- Claudia Merandi: Founder of Don’t Punish Pain Rally Organization.
- Juandolyn Stokes: Radio Host – WAOK Radio Station.
- Qlarant: A Maryland-based technology company that provides data analytics services for healthcare fraud detection. They are the central target of the complaints in the document.
- US Department of Justice (DOJ): Uses Qlarant’s data for prosecuting healthcare fraud.
- Drug Enforcement Administration (DEA): Uses Qlarant’s data for prosecuting healthcare fraud.
- Health and Human Services Office of Inspector General (HHS/OIG): Uses Qlarant’s data for prosecuting healthcare fraud.
- Centers for Medicare and Medicaid Services (CMS): Receives data analytics services from Qlarant.
- Blue Cross Blue Shield Association (BCBS): A private insurer that uses Qlarant’s data analytics.
- Unnamed “Brave Mother”: Mother of an indicted physician, speaking out against Qlarant’s practices.
Important Considerations:
- Bias: The document is clearly biased against Qlarant and the use of data analytics in healthcare fraud detection. It presents a one-sided perspective.
- Scope: The document focuses on the negative consequences of data analytics, particularly for healthcare professionals. It does not provide a balanced view of the potential benefits of these technologies.
Study Guide: AI Gate Scandal and Healthcare Fraud
Review Topics
- Qlarant’s Role: Understand the function of Qlarant NBI Medic and its use of data analytics in healthcare fraud detection.
- Data Analytics and AI: Analyze how data analytics and algorithms, including AI, are used and potentially misused in healthcare.
- Healthcare Fraud Detection: Explore the processes and tools used by agencies like the DOJ, HHS, and DEA in detecting healthcare fraud.
- Impact on Healthcare Providers: Investigate the effects of fraud accusations and investigations on physicians, pharmacists, and patient care.
- Regulatory Oversight: Examine the role of regulatory oversight and the consequences of unregulated clinical decision support tools.
- Ethical Considerations: Evaluate the ethical considerations of using data analytics in healthcare, particularly regarding bias, accuracy, and patient well-being.
- Legal and Justice Issues: Consider the legal implications of false accusations and the potential for racial and socioeconomic bias in healthcare fraud enforcement.
- Prescription Drug Monitoring Programs (PDMPs): Discuss the use of PDMPs and their potential for errors and misuse.
- The Overdose Epidemic and Opioid Prescribing: Understand the complex relationship between opioid prescribing, overdose mortality, and the role of clinical decision support tools.
- Asset Forfeiture: Explain the role of asset forfeiture in these cases.
- Role of Media: Understand the role of media outlets like “60 Minutes” to expose unethical or criminal practices.
Quiz
Answer the following questions in 2-3 sentences each.
- What is Qlarant NBI Medic’s primary function, and what services does it offer to government agencies and private insurance companies?
- According to Dan Martin JD, what is the appropriate use of data analytics in healthcare fraud investigations?
- What are some of the potential consequences for healthcare providers who are targeted through Qlarant’s data analytics, as mentioned in the article?
- What is NarxCare, and what concerns are raised about its implementation?
- According to the article, what are some of the specific criticisms of Qlarant’s data analysis methods and algorithms?
- How does Qlarant allegedly contribute to maximizing criminal asset forfeiture, according to the article?
- What is the significance of the statement “Tell me the man, and I will show you the crime” in the context of Qlarant’s operations?
- What concerns are raised about the use of Prescription Drug Monitoring Program data?
- What is the 90 MME maximum daily dose, and what concerns are mentioned in the article?
- What are the article’s authors hoping to accomplish by reaching out to “60 Minutes?”
Quiz – Answer Key
- Qlarant NBI Medic provides data analytics to government agencies and private insurers to identify healthcare fraud and controlled substance violations. They use “red flags” to accuse doctors and pharmacists criminally.
- Data analytics should be used as a tool to suggest the need for further investigation, but should not be used to conclusively determine misconduct.
- Healthcare providers targeted by Qlarant may face criminal indictment, spend millions on legal defense, lose their licenses, and potentially face incarceration and substantial fines.
- NarxCare is a prescription drug monitoring program-based analytics platform marketed as a clinical decision support tool. Concerns are raised about its lack of rigorous external validation and federal regulatory oversight.
- Criticisms include large internal errors in mathematical equations and statistical methods, significant bias, a lack of published scientific explanations, and the absence of validity and reliability testing.
- Qlarant is accused of manipulating data and maximizing false data to the DEA, which contributes to maximizing the potential for criminal asset forfeiture from targeted providers.
- The statement refers to Qlarant’s alleged ability to manipulate evidence to create proof of a crime once a prosecutor has identified a target, ensuring a conviction.
- There are concerns about errors in the PDMP data and that law enforcement use that data to target healthcare providers and patients based on bias.
- It is a maximum daily dose of morphine equivalents, and there are concerns that it is arbitrary and law enforcement is attacking physicians who prescribe more than that.
- The article’s authors are seeking an investigation into Qlarant’s practices and exposure of the alleged harm caused by manipulated data algorithms in healthcare fraud detection.
Essay Questions
- Discuss the ethical implications of using unregulated AI and data analytics tools in healthcare fraud detection. What safeguards should be in place to protect healthcare providers and patients from wrongful accusations?
- Analyze the potential for bias in data-driven healthcare fraud detection. How might factors such as race, socioeconomic status, and geographic location influence the targeting of healthcare providers?
- Evaluate the role of regulatory oversight in ensuring the responsible use of clinical decision support tools like NarxCare. What specific regulations should be implemented to prevent the misuse of these tools?
- Explore the impact of healthcare fraud investigations on the healthcare system as a whole. How do these investigations affect patient access to care, physician morale, and the overall cost of healthcare?
- Considering the article’s allegations, what steps can healthcare providers take to protect themselves from wrongful accusations of fraud based on data analytics?
Glossary of Key Terms
- Qlarant NBI Medic: A technology company that provides data analytics services to government agencies and private insurance companies for healthcare fraud detection.
- Data Analytics: The process of examining large datasets to uncover hidden patterns, correlations, and other insights, often used in healthcare fraud detection.
- AI (Artificial Intelligence): The theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.
- Healthcare Fraud (HCF): Intentional deception or misrepresentation made by healthcare providers or beneficiaries for the purpose of receiving unauthorized benefits or payments.
- Red Flags: Indicators or patterns in data that suggest potential fraudulent activity in healthcare billing, prescribing, or patient care.
- Clinical Decision Support Tools: Software applications designed to provide healthcare professionals with evidence-based guidance and information to improve clinical decision-making.
- NarxCare: A prescription drug monitoring program-based analytics platform marketed as a clinical decision support tool to help identify potential opioid misuse.
- PDMP (Prescription Drug Monitoring Program): A state-level electronic database that tracks the prescribing and dispensing of controlled substances to patients.
- MME (Morphine Milligram Equivalent): A standardized unit of measurement used to compare the potency of different opioid medications.
- Asset Forfeiture: The process by which law enforcement agencies seize assets believed to be associated with criminal activity, including healthcare fraud.
- PII (Personally Identifiable Information): Any information that can be used to identify an individual, such as name, address, or Social Security number.
- PHI (Protected Health Information): Any health information that is individually identifiable and protected under the Health Insurance Portability and Accountability Act (HIPAA).
- DEA (Drug Enforcement Administration): A United States federal law enforcement agency under the United States Department of Justice tasked with combating drug smuggling and use within the United States.
- DOJ (Department of Justice): A federal executive department of the U.S. government responsible for the enforcement of the law and administration of justice in the United States.
- HHS (Department of Health and Human Services): A cabinet-level executive branch department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services.
2. Norman Clement Pharm D Author– You are within the norms.com
3. Claudia Merandi – Founder of Don’t Punish Pain Rally Organization
4. Dr Lesly Pompy was indicted based on Qlarant’s faulty data algorithms. Acquitted after 5 years.
5. Belinda Parker Brown – Louisiana United International
6. On Point with Juandolyn Stokes – Radio Host – WAOK Radio Station. “ Criminalization of Black and Brown Doctors March 18, 2023 and Feb 16, 2023
