Your guide to USA TODAY's investigation of Utah COVID-19 testing startup Nomi Health

EDITOR'S NOTE: This page is a guide to USA TODAY's monthslong investigation of Utah-based Nomi Health, the no-bid contracts it received, and questions that officials raised over its testing accuracy and campaign contributions.

In early 2020, nearly no one outside of Silicon Slopes, a well-connected, influential business group in Salt Lake City, had ever heard of Nomi Health. Yet as the COVID-19 pandemic endangered the lives of Americans and threatened to crater the economy, the startup soon became a household name in Utah and several other Republican-controlled states as it oversaw massive testing programs.

USA TODAY has since March been investigating the company.

What is Nomi Health?

In 2019, Utah entrepreneur Mark Newman founded Nomi Health, which he said got its name from "No Middleman Healthcare." He previously created an on-demand video interviewing service, and Nomi was part of four politically well-connected Utah firms that came together as the COVID-19 pandemic worsened in March 2020. Nomi essentially would act as a general contractor for the enterprise, setting up testing sites, hiring nurses and staff, and purchasing testing equipment.

Who are Nomi's collaborators?

Nomi would use COVID-19 tests supplied by Co-Diagnostics, a molecular testing company that had "no major customers" in 2019, according to the company's annual report. Rounding out the Utah team were two software firms – Domo and Qualtrics – that provided electronic dashboards and test surveys.

Who is Co-Diagnostics?

In the years leading up to 2020, Co-Diagnostics was a tiny Utah startup focused on molecular testing. Since becoming publicly traded in 2017, Co-Diagnostics had been losing money, and in its 2019 annual report, the company said it needed to overcome the disadvantages of being a startup with “no history of success and no respect of the medical and testing professionals.” When COVID-19 hit, it created a PCR test and began selling it in Europe and the United States. Nomi was one of its buyers. Co-Diagnostics faces a lawsuit alleging it made false, misleading statements to inflate its stock price to benefit directors.

Who are Domo and Qualtrics?

Domo and Qualtrics are Utah software companies that provided electronic dashboards and test surveys for Nomi. Their chief executives were on the board of Silicon Slopes, a nonprofit that promoted Utah-based tech firms and used its political connections to persuade Utah to hire Nomi. Executives at Domo and Qualtrics saw their compensation rise after joining with Nomi.

How much did Nomi make?

In a month – March 31 to May 1, 2020 – Nomi had signed no-bid contracts in four states, and would later win additional state contracts through the traditional competitive procurement process. By the time Florida came on board a year later, taxpayers in those states would pay Nomi a collective $219 million, the records show.

How many states were they in?

Nomi started in Utah and expanded to Iowa, Nebraska, Tennessee and Florida. Here's a breakdown of how much they were paid: Utah ($78.5 million), Iowa ($26 million), Nebraska ($62 million), Tennessee ($5.9 million) and Florida ($46.5 million). The company currently is doing testing in Hawaii but has no government contracts.

How accurate were the tests?

Tennessee's Health Department reported that Nomi Health's testing results were "inconsistent," and it spent nearly $6 million to pull out of its contract with the company about 45 days after signing on. Nomi officials said the money was paid for services provided. USA TODAY found that the Tennessee Public Health Laboratory had concluded the state had "no confidence" that the testing would "provide reliable and reproductive results." Further, the state "reasonably determined" that the actions of Nomi and its subcontractors "have caused, or reasonably could cause, life, health, or safety to be jeopardized." Nomi officials did not say whether they disclosed the report to the other states despite multiple attempts from USA TODAY to get them to answer the question. Nomi said its tests performed the way they are supposed to.

Were there other issues?

Shortly after Tennessee's health department agreed to a $26.5 million no-bid contract with Nomi, the company sent personal protective equipment to the state. One health official had hoped to receive thousands of gown sleeves, masks and disinfectant for front-line medical workers. Instead, Nomi sent thousands of pink bovine insemination gloves, wipes labeled "for veterinary use" that didn't kill the COVID-19 virus, and low-quality face masks, the official said. Tennessee ended its contract early and paid Nomi nearly $6 million. The state also said Nomi failed to provide suitable lab machinery and personal protective equipment "free from material defect." Newman, Nomi's chief executive, didn't dispute that Tennessee received bovine gloves, saying they were a supplement to other, appropriate supplies.

Who received campaign money?

After Republican governors gave lucrative, no-bid COVID-19 deals to Nomi, the company and a subcontractor, Domo, gave more than $1 million to GOP campaigns, with six-figure contributions going to the Republican Governors Association and five-figure contributions going to state GOP campaigns. Some of the largest contributions went to Florida Gov. Ron DeSantis, a Republican, whose administration gave Nomi contracts that totaled $46.5 million from February to June 2021. As Nomi Health has expanded in Hawaii, the company, its chief executive and others associated with the Utah business have donated the maximum amount, or near the legal limit, to Democratic campaigns in the politically blue state.

Is Nomi still operating?

The company secured $110 million from venture capital firms Rose Park Advisors of Boston and Arbor Ventures of Singapore late last year. Nomi this year has gone on a buying spree, snapping up three other health care companies in its effort to eliminate third-party health insurance and make it less expensive for patients and providers.

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This article originally appeared on USA TODAY: Nomi Health: What to know about USA TODAY COVID testing investigation