The Puppet Startup

For years, the story was about partnership and innovation. A visionary Chief Medical Information Officer (CMIO) of a tech giant, Reid Conant, reached out with an exciting opportunity: join his cutting-edge AI startup, Clinical AI Solutions, Inc. (CAIS), and help revolutionize healthcare.

The pitch was compelling. The promise was equity. The future was bright.

It was also a complete and total fraud.

CAIS was not a startup. It was a captive puppet entity, a shell company created and controlled by Nuance Communications (now part of Microsoft) for one purpose: to systematically lure, capture, and misappropriate the intellectual property of innovators, leaving them with worthless paper while Nuance harvested billions in value.

This is the story of how a corporate “conflict of interest” wasn’t an oversight—it was the entire business plan.

To understand the fraud, you must first understand the players. At the center was Reid Conant, who didn’t just wear two hats, he wore at least four, each creating a devastating conflict with the others:

1. Hat #1: The Supplier. Conant was the Chief Medical Information Officer (CMIO) of Nuance Communications, a publicly traded leader in clinical speech recognition.
2. Hat #2: The “Competitor”. He was simultaneously the Founder and CEO of Clinical AI Solutions, Inc. (CAIS), a company purportedly offering “AI-based” clinical optimization services.
3. Hat #3: The Customer. In addition, he served as CMIO for Tri-City Emergency Medical Group, a potential client for both Nuance and CAIS.
4. Hat #4: The Shadow. Behind the scenes, he controlled CAI Technologies, LLC, a parallel private entity.

This wasn’t a complex web of alliances. This was one man sitting on all sides of the table, controlling the supplier, the partner, and the customer in any given deal. The most egregious violation? The CAIS Employee Handbook explicitly forbade employees from “representing a supplier”—a rule Conant aggressively enforced on his staff while personally violating it every single day by negotiating deals between CAIS and his other employer, Nuance.

This “quadruple conflict” is the foundation. It wasn’t a bug in the system; it was the system.

The core lie was that CAIS was an independent, high-growth startup. The truth was exposed in a single, unguarded email.

On July 16, 2019, Nuance General Manager Michael Clark was discussing organizational structure. In black and white, he wrote the following about the CEO of the supposed independent startup:

“He [Reid Conant] technically reports to me…”

Let that sink in. The CEO of a venture-backed AI startup does not “report to” a mid-level executive at a potential partner. Employees report to bosses. Subordinates report to managers. This email is a direct admission that CAIS was not a partner—it was a clandestine, off-books division of Nuance.

Conant’s own behavior proves this daily. He used his reid.conant@nuance.com email to execute CAIS’s initial consulting agreements. When questioned, his response was telling: he told the innovator to instead use his CAIS email, noting, “Important we keep it separate. I am sure you understand.” The separation was a legalistic fig leaf, a conscious theater meant to hide the fundamental fusion of the two entities.

The recruitment was a masterpiece of fraudulent inducement. The target was promised “amazing work in the exciting and confluent area of medicine and AI-based technologies” and valuable equity in a legitimate company.

The reality, exposed just weeks after signing on, was a brutal bait-and-switch.

Instead of pioneering AI, employees were directed to review the “Nuance/CAIS Services Agreement” to prepare for “subcontracting for Nuance on Services projects.” The focus was on “SOWs,” “Milestones,” and “Payment criteria” for an upcoming meeting with a Nuance team lead.

The “partnership” was a sham, legally enshrined in a “Professional Services Terms and Conditions Addendum.” This contract didn’t describe a partnership of equals. It defined CAIS as a “Subcontractor,” gave Nuance the “Right to Reject” any deliverable, and set up a payment system where Nuance collected all client money and paid CAIS a percentage. CAIS was a pass-through vehicle, a legally distinct shell that functioned as a cheap, controllable labor force for Nuance.

Why would Nuance need its own CMIO to create an external subcontractor to do… Nuance’s own work? Because this shell had a special purpose: it could interact with and extract value from third parties in ways Nuance’s own HR department could not.

Once the innovator was inside, the harvest began. His proprietary “Health Check” and “Managed Services” methodology, a complete system for driving clinical adoption, was systematically transferred to Nuance leadership over 48 hours. Conant praised the work in an email and stated, “I will use this (judiciously) in meetings Tues at Nuance.” He did exactly that, presenting the stolen blueprint to Nuance’s top brass the following Tuesday.

The program was a massive success, deployed at over 40 of Nuance’s most at-risk clients, saving them tens of millions in revenue renewal. Internal project grids show it generated 60-65% profit margins. Client testimonials called it “the best project we have ever done for physicians.” A Nuance Senior Vice President wrote to the commingled team, “Great job team!” confirming there was only one team: Nuance’s.

Then, at the peak of this profitability and demand, with new high-margin contracts on the table, Conant announced CAIS was “closing,” citing “challenges.” He instructed his team to stop pursuing new business and announced he was “taking a full-time job with Nuance.”

A profitable, high-demand company, generating 65% margins, does not voluntarily shut down. This economically irrational act has only one logical explanation: CAIS had served its purpose. The IP had been fully extracted. The Microsoft acquisition of Nuance (for $19.7 billion, based on its AI capabilities) was underway. The puppet entity was no longer needed.

The proof? On the same day, the innovator finally confronted Conant in writing about the fraud, and Nuance publicly launched “Dragon Medical One Essentials,” a no-cost, carbon-copy version of his proprietary “Health Check” program. The theft was now complete and commercialized.

The final, chilling piece of evidence that this was a deliberate playbook, not a one-time mistake, emerged recently.

Following the dissolution of CAIS, Reid Conant has established a new entity, Extrapolate Advisory, LLC.

Its registered principal address? 3525 Del Mar Heights Rd., Suite #275, San Diego, CA 92130.

This is the exact same suite as the now-defunct CAIS.

The shell game continues. The playbook is being reused. The only thing that changes is the name on the fraudulent facade.

The Lesson: In the age of AI hype, the most dangerous algorithm isn’t in the code—it’s in the corporate structure designed to separate innovators from their life’s work. CAIS wasn’t a startup. It was a trap. And its story is a warning to every builder, creator, and visionary: before you join a “revolutionary partnership,” look behind the curtain. You might just find your corporate partner pulling the strings of your would-be competitor.