April 19, 2024

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FTC scores $195M judgment against Simple Health over allegedly bogus insurance

2 min read

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The Federal Trade Commission has obtained a $195 million judgment against Simple Health Plans and its CEO, Steven J. Dorfman, over charges they duped consumers into signing up for “sham” healthcare plans that did not deliver the promised coverage or benefits.

This effectively left consumers uninsured and exposed to limitless medical expenses, the FTC said.

In granting the FTC’s motion for summary judgment, the Federal District Court in the Southern District of Florida also banned Simple Health, five related entities and Dorfman from telemarketing and from marketing, promoting, selling or offering any healthcare products.

“Simple Health preyed on consumers by selling them bogus healthcare insurance that cost them thousands of dollars for ‘benefits’ that in fact left consumers unprotected,” said Samuel Levine, director of the FTC’s Bureau of Consumer Protection.

WHAT’S THE IMPACT?

In a complaint filed in 2018, the FTC said that Florida-based Simple Health misled people into thinking they were buying comprehensive health insurance that would cover preexisting medical conditions, prescription drugs, primary and specialty care treatment, inpatient and emergency hospital care, surgical procedures, and medical and laboratory testing.

Instead, the complaint claimed that most consumers who enrolled reported paying as much as $500 per month for what was actually a medical discount program or extremely limited benefit program – one that did not deliver the promised benefits and often left consumers with thousands of dollars in uncovered medical bills.

The court found that Dorfman and Simple Health, along with Health Benefits One, Health Center Management, Innovative Customer Care, Simple Insurance Leads and Senior Benefits One violated the FTC Act and the agency’s Telemarketing Sales Rule.

The court ordered that all of their assets, which have been frozen since November 2018, be liquidated and all the proceeds be turned over to the FTC, which is expected to use the money to provide refunds to consumers.

In addition to the banned conduct, the order also prohibits any misrepresentations in the sale of any good or service. The defendants also are prohibited from collecting any money for any healthcare product they previously sold and are required to destroy any personal information they collected about their customers.

THE LARGER TREND

Candida Girourard, Simple Health’s chief compliance officer, agreed in February 2021 to settle the FTC’s charges. As part of that settlement, Girouard is banned from marketing, promoting or selling any healthcare-related products, from making misrepresentations in connection with the sale of any good or service, and from violating the FTC’s Telemarketing Sales Rule.

Jeff Lagasse is editor of Healthcare Finance News.
Email: [email protected]
Healthcare Finance News is a HIMSS Media publication.

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