Fed. Trade Comm'n v. Simple Health Plans LLC

379 F. Supp. 3d 1346
CourtDistrict Court, S.D. Florida
DecidedMay 14, 2019
DocketCase No. 18-cv-62593-GAYLES
StatusPublished
Cited by6 cases

This text of 379 F. Supp. 3d 1346 (Fed. Trade Comm'n v. Simple Health Plans LLC) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fed. Trade Comm'n v. Simple Health Plans LLC, 379 F. Supp. 3d 1346 (S.D. Fla. 2019).

Opinion

DARRIN P. GAYLES, UNITED STATES DISTRICT JUDGE

*1352THIS CAUSE comes before the Court on Plaintiff Federal Trade Commission's ("FTC") Ex Parte Motion for a Temporary Restraining Order with Asset Freeze, Appointment of a Temporary Receiver, and other Equitable Relief and Order to Show Cause why a Preliminary Injunction Should Not Issue [ECF No. 3], specifically the FTC's request for preliminary injunctive relief. The Court has reviewed the Motion and the record and is otherwise fully advised.

This action revolves around consumers' decisions to purchase health insurance to cover routine and unexpected medical expenses. Through its evidence, the FTC gives a well-documented account of a classic bait and switch scheme-aided by rigged internet searches, deceptive sales scripts, and predatory practice. Though consumers believed they were purchasing comprehensive health insurance coverage, Defendants sold them practically worthless limited indemnity or discount plans. While Defendants, under the control of Defendant Steven J. Dorfman ("Dorfman"), profited from their scheme, consumers were left with inadequate health coverage and devastating medical bills. Dorfman, relying primarily on his own declaration, disputes the FTC's account and contends that consumers were not misled. Based on the record before it, the Court finds that a preliminary injunction is necessary to protect consumers, prevent future violations of the law, protect assets, and to preserve the status quo pending the resolution of this litigation.

PROCEDURAL BACKGROUND

On October 29, 2018, the FTC filed its Complaint for Permanent Injunction and Other Equitable Relief [ECF No. 1] against Defendants Simple Health Plans LLC ("Simple Health"), Health Benefits One LLC ("HBO"), Health Center Management LLC ("HCM"), Innovative Customer Care ("ICC"), Simple Insurance Leads LLC ("SIL"), Senior Benefits One LLC ("SBO") (collectively the "Corporate Defendants"), and Dorfman (together with the Corporate Defendants collectively referred to as the "Defendants") alleging that Defendants violated Section 5(a) of the FTC Act, 15 U.S.C. § 45(a), and the FTC's Telemarketing Sales Rule ("TSR"), 16 C.F.R. Part 310. In conjunction with the Complaint, the FTC filed an Emergency Ex Parte Motion for a Temporary Restraining Order [ECF No. 3]. On October 31, 2018, the Court entered a Temporary Restraining Order (the "TRO") and froze all of Defendants' assets, including Dorfman's personal assets. [ECF No. 15]. The Court also appointed Receiver Michael Goldberg (the "Receiver") to administer the affairs of the Corporate Defendants and to take necessary actions to protect consumers. [Id. ].

On April 16, 2019, the Court held an evidentiary show cause hearing on the FTC's request for preliminary injunctive relief.1 The FTC relied on approximately *135343 exhibits-encompassing over 1000 pages of documents, the Receiver's First Interim Report ("RR") [ECF No. 122], and the live testimony of two of Defendants' former customers. Dorfman relied on his own declaration, selections from the FTC's exhibits, and two of his own exhibits.

FINDINGS OF FACT

I. Brief Overview of Health Insurance Industry

To effectuate their bait and switch scheme, Defendants led consumers to believe they were receiving comprehensive health insurance when, in fact, they received limited indemnity plans or discount memberships. Comprehensive health insurance is exactly what the name implies-comprehensive. It generally covers a large portion of the expense for doctor's visits, emergency room visits, hospital stays, laboratory services, and prescription medicine. With comprehensive health insurance, after the payment of a premium, a deductible, and a co-payment, the risk of large medical bills shifts from the consumer to the insurance company. Plaintiff's Exhibit ("PX") 23, at 15. In addition, many comprehensive health insurance plans comply with the Affordable Care Act ("ACA"), 42 U.S.C. § 18001. ACA-qualified plans include coverage of pre-existing conditions and cover emergency medical care, hospitalization, prescription medication, preventative care, maternity care, and pediatric care. PX 23, at 15. During the relevant time period, individuals enrolled in ACA-qualified insurance plans were not required to pay the penalty imposed on people who could afford insurance but chose not to purchase it. Related to comprehensive health insurance is the concept of a preferred provider organization ("PPO"). In a PPO, the plan contracts "with a broad range of providers (physicians, health systems), designated as the 'preferred network.' A plan member can use any of the preferred providers, typically with favorable co-insurance, copay; and count towards a deductible." Id. at 9.

In contrast, "[i]ndemnity plans provide a defined financial benefit paid to consumers after medical expenses are incurred." Id. at 5. Under a limited indemnity plan, consumers are merely purchasing medical services at pre-negotiated discounted rates. With these plans, the risk of high medical bills falls solely on the consumer. Id. at 10. Limited indemnity plans are sometimes combined with medical discount plans. Medical discount plans are not insurance and do not guarantee coverage of medical services, "rather, they serve as a 'buyer's club' akin to a grocery store savers card ..." Id. at 6. Limited indemnity plans and medical discount plans are not ACA-compliant. Id. As a result, a consumer who only had a limited indemnity or medical discount plan was subject to the ACA penalty for failing to obtain compliant insurance.

II. The Parties

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Bluebook (online)
379 F. Supp. 3d 1346, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fed-trade-commn-v-simple-health-plans-llc-flsd-2019.