Tom Fiel runs a sports and family medicine clinic in Arizona. He moved his billing to a $7 billion Silicon Valley startup called Commure, and then he went ten pay periods in a row without a paycheck. "It's horrible, horrible service," he told STAT. "I don't have a positive thing to say about it."

Now a second data point. A physical therapy group near Cincinnati calls the same company's AI scribe "revolutionary" and describes its billing rollout as "super smooth." Both statements are true. The distance between them is the entire story.

Casey Ross and Brittany Trang spent months inside Commure for STAT, reviewing contracts, internal Slack messages, and legal filings, and talking to more than three dozen people. The piece is less an argument about whether the AI works and more a quiet investigation of a harder question. If you were a clinic owner, how would you ever find out? Commure sells fast, and it pays some of its most enthusiastic customers to promote it. When the vendor is quietly funding the reference call, the one number a buyer trusts stops meaning anything.

Commure is not one company. It is a stack of them, bought over several years and bolted together. It set out in 2020 to build "a new operating system for health care," and its executives liked to cast it as a kind of Robin Hood, using AI to pry money loose from insurers and hand it back to doctors. "I would love a world where the market cap of a UnitedHealth is a fifth, but every doctor is a millionaire," CEO Tanay Tandon said in an interview with Y Combinator.

The money followed the pitch. Commure has raised more than $850 million from Sequoia, Morgan Stanley, 8VC, and General Catalyst, and hit a $7 billion valuation in a $70 million round this past May. Its biggest deal was a 2023 merger with Athelas, the blood-testing company Tandon founded at 18 with his high school science fair rival. Athelas pivoted to AI medical billing, Commure absorbed it, and the combined product line now runs under an AI-native EHR called Air. The company says its tools reach more than 500 health care organizations, including 130 of the nation's largest health systems.

Inside, one value became scripture. Four former employees described the same three words hammered through every meeting. Speed above all else.

The most potent form of marketing, Tandon told Y Combinator, is a provider telling other providers about their revenue gains. "The most potent word of mouth in the world." It is also, STAT found, a form of promotion the company was willing to pay for.

Josh Adams, chief operating officer of Modern Physical Therapy in Arizona, did not just buy Athelas. His contract put him on the hook to refer $750,000 in new business within a year. Miss the threshold, and his clinic could be charged a $66,000 "referral obligation fee." The company says the provision was never enacted and that no business or money ever changed hands under it.

The affiliate program was more explicit. According to a contract template, anyone making a "warm introduction" that closed a deal collected 2 percent of the fees Athelas earned from that customer. The document did the math for you. A new client paying $600,000 a year would net the referrer $12,000, in quarterly installments. The page describing the program was pulled from the company's website shortly before STAT published.

The blurriest case is Matthew Kearns. He works for a physical therapy chain in western New York, yet he has a Commure email address, sits in an internal Slack channel, and starred in a company marketing video shot at an industry conference, delivering a testimonial with the Athelas logo flashing behind him. On the company site he is quoted saying the software "fuels this ultimate magic that turns dreams into reality." He is, as STAT puts it, otherwise indistinguishable from the sales staff swirling around him on the exhibit floor.

Two former federal prosecutors reviewed the contract language and said it could be legally problematic under the anti-kickback statute.

This ground is well trodden, and expensively so. In 2021, athenahealth paid $18.25 million to settle allegations it paid illegal kickbacks, part of it through a lead-generation program to identify new customers. In 2023, NextGen Healthcare paid $31 million to settle a case that included a nearly identical arrangement, a credit worth 2 percent of an ensuing sale. Same rate. Same idea.

Lauren Lively, the former assistant U.S. attorney who led the NextGen case, has heard every version of the defense. "Companies are always saying, 'Everyone does this. It's such a small amount of money. Who cares?'" she told STAT. "The 'who cares' is that it's corrupting the normal process of companies vetting products." That sentence is the thesis of the whole investigation, delivered by someone who prosecuted it.

Here the reviews go fully bimodal, which is the interesting part.

On the failure side, the numbers are not rounding errors. Karissa Nichols runs billing for Gottsche Rehabilitation in rural Wyoming. Medicare payments stalled weeks after onboarding, the clinic fell roughly $500,000 behind on collections, and Athelas staff were asking her questions that seemed strange for a billing specialist. "They were coming back to us and saying, 'Well, what should a claim form look like?'" Sun Life Health, a federally qualified health center in Arizona, watched every dental claim from August to November 2025 get denied, a $1 million hole on its own, and the system never learned to handle sliding-fee patients. Fiel, the Arizona physician, went without pay for ten cycles.

On the success side, the praise is just as concrete. Oxford Physical Therapy near Cincinnati credits the billing software with a real jump in collections. Janaki Jain, who runs billing at Arizona Urology, says revenue collected from insurers rose 40 percent over the practice's old system. But note what it cost her. It took nearly a year of integration, and she met regularly with the company's staff to write the billing logic herself. Her verdict is the quietest and most useful line in the article. "The AI only works and is only as smart as what you teach it."

That is the pattern hiding under the noise. The tools reward customers who pour months of human labor into teaching them, and they punish clinics that get them dropped in fast. Speed above all else is the company motto and also, apparently, the failure mode.