Business ProfileforSimple Health Plans LLC

UPDATE As of February 9, 2024

FTC Obtains $195 Million Judgment, Permanent Ban on Telemarketing and Selling Healthcare Products Against Simple Health Over Charges It Sold Sham Health Insurance

FTC charged that Simple Health claimed to offer health care insurance with comprehensive coverage and instead effectively left most consumers uninsured

The Federal Trade Commission has obtained a $195 million judgment against Simple Health Plans LLC and its CEO Steven J. Dorfman over charges they duped consumers into signing up for sham health care plans that did not deliver the coverage or benefits they promised and effectively left consumers uninsured and exposed to limitless medical expenses.

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.

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. In reality, 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 that did not deliver the promised benefits and often left consumers with thousands of dollars in uncovered medical bills, or worse yet, unable to get necessary healthcare.

The court found that Dorfman and Simple Health, along with Health Benefits One LLC, Health Center Management LLC, Innovative Customer Care LLC, Simple Insurance Leads LLC, and Senior Benefits One LLC 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.

Simple Health’s Chief Compliance Officer Candida Girouard 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. 

LINK: https://www.ftc.gov/news-events/news/press-releases/2024/02/ftc-obtains-195-million-judgment-permanent-ban-telemarketing-selling-healthcare-products-against?utm_source=govdelivery

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The following describes a pending government action that has been formally brought by a government agency but has not yet been resolved. We are providing a summary of the governments allegations, which have not yet been proven.

UPDATE as of February 4, 2021

One of the defendants behind an alleged sham health insurance scheme has been permanently banned from the health care business as part of a settlement with the Federal Trade Commission.

The FTC’s proposed settlement with Candida Girouard stems from an ongoing lawsuit against the Florida-based Simple Health enterprise.  The FTC alleges that the Simple Health defendants collected more than $195 million by enrolling American consumers in worthless association and discount memberships with limited benefits, leaving tens of thousands of consumers uninsured, some stuck with thousands of dollars in unpaid medical bills.

In its complaint against Simple Health, the FTC alleged that Chief Compliance Officer Girouard was an integral part of the scheme, which lured consumers through a network of deceptive websites and misled them to think they were buying comprehensive health insurance that would cover preexisting medical conditions, prescription drugs, and a host of standard care, treatments, and tests. In fact, the FTC alleges, people who enrolled in the plans later learned that the Simple Health plans were not comprehensive health insurance and did not provide the promised coverage and benefits. Consumers instead were enrolled in membership plans that provided extremely limited benefits and left them responsible for the vast majority of their medical expenses. Under the proposed settlement, Girouard is banned from advertising, marketing, promoting, offering for sale, or selling any healthcare-related products. She also is banned from making misrepresentations in connection with the sale of any good or service, and is prohibited from violating the FTC’s Telemarketing Sales Rule. The settlement includes a monetary judgment of $195.5 million, which is suspended due to her inability to pay. Girouard also must fully cooperate with the FTC and with investigations related to the case.

The FTC continues to litigate against the other defendants in the case, including Simple Health Plans LLC, five related companies, and the companies’ owner and CEO, Steven J. Dorfman.

LINK: https://www.ftc.gov/news-events/news/press-releases/2021/02/one-defendants-behind-alleged-sham-health-insurance-scheme-agrees-settle-ftc-charges

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UPDATE as of November 2, 2018

According to the FTC's complaint, the defendants behind Simple Health lured consumers through a network of deceptive lead generation websites that claimed to provide information about comprehensive health insurance. On the sites, the defendants falsely held themselves out as experts on and providers of government-sponsored health insurance policies, such as those offered under Medicare and the Affordable Care Act. In many cases, the sites also misleadingly featured the logos of the AARP or well-known insurance carriers, such as Blue Cross Blue Shield plans, when in fact the defendants were not affiliated with such entities.

For example, one of the websites, www.trumpcarequotes.com, deceptively claimed to offer "Health Insurance for Smart People" from "the Nation's Leading Carriers" at "Low Affordable Premiums" with "Prescription Drug Coverage." Another Simple Health website, www.simplemedicareplans.com, promoted "Medicare Health Plans for Your Needs and Budget."

According to the FTC's complaint, consumers who submitted their contact information to one of the defendants' websites or called one of the toll-free phone numbers on the sites ended up on the phone with telemarketers working for the defendants. The telemarketers often falsely identified themselves as insurance agents licensed in the consumer's state.

The defendants' telemarketers led consumers to believe that for a one-time enrollment fee, ranging from approximately $60 to $175, and a monthly payment, ranging from approximately $40 to $500, Simple Health could provide them with a "PPO" health insurance plan that was comprehensive and widely accepted by doctors in the consumers' geographical areas, the FTC alleged. In many cases, they promised that the plans would have no copays or deductibles.

Those who enrolled subsequently learned that the plans they had purchased from Simple Health are not comprehensive health insurance and do not provide the promised coverage and benefits. A typical plan provides no coverage for preexisting medical conditions or prescription medications, pays only $50 toward physician visits--capped at three visits per year--and covers a maximum of $100 per day for hospitalization. The maximum benefit a consumer could realize from the plan is $3200 per person, per year, and only if that person were hospitalized for 30 days.

The FTC alleged that as a result, tens of thousands of consumers who thought they had purchased comprehensive health insurance found themselves uninsured, some saddled with substantial medical expenses that they assumed would be covered by the purported health insurance they had obtained from Simple Health.

On top of that, because the defendants' limited benefit plans and discount memberships do not qualify as health insurance under the Affordable Care Act, some people who enrolled were subject to a fee imposed on those who can afford health insurance, but choose not to buy it, the FTC alleged.
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On October 31, 2018, FTC Matter/File Number:
1723148, a federal judge temporarily shut down a Florida-based operation that allegedly collected more than $100 million by preying on Americans in search of health insurance, selling these consumers worthless plans that left tens of thousands of people uninsured.

The Federal Trade Commission (FTC) seeks to permanently stop the defendants' practices and return money to consumers.

In a complaint filed in federal court against Simple Health Plans LLC, the company's owner, Steven J. Dorfman, and five other entities, the FTC alleged that the defendants misled people to think 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.

According to the FTC's complaint, the defendants behind Simple Health lured consumers through a network of deceptive lead generation websites that claimed to provide information about comprehensive health insurance.

The defendants are charged with violating the FTC Act and the agency's Telemarketing Sales Rule.

The defendants named in the complaint are Steven J. Dorfman, Simple Health Plans LLC, Health Benefits One LLC, Health Center Management LLC, Innovative Customer Care LLC, Simple Insurance Leads LLC, and Senior Benefits One LLC.

For further assistance:

Headquarters
Federal Trade Commission
600 Pennsylvania Avenue, NW
Washington, DC 20580
Telephone: (202) 326-2222
www.ftc.gov

Link: https://www.ftc.gov/news-events/press-releases/2018/11/ftc-halts-purveyors-sham-health-insurance-plans?utm_source=govdelivery