Maine says companies sold fraudulent health insurance

Posted July 02, 2012, at 6:14 p.m.
Last modified July 03, 2012, at 9:04 a.m.

The Bureau of Insurance on Monday said four companies must stop doing business in Maine and pay penalties of $260,000 resulting from a “fraudulent health insurance scheme.”

After consumer complaints of unpaid medical bills, the bureau investigated United States Contractors Trust, Real Benefits Association, Metropolitan Business Alliance LLC (also known as National Association of Business Leadership, NABL), and Access Health Now.

The companies apparently are well known across the country and have been the target of a number of similar actions by state regulators and law enforcement groups.

In Maine, according to the bureau’s cease and desist order, the companies have left consumers with “crushing medical expenses” when they had been paying for what they thought was health insurance.

In the bureau’s order, the state relates the experiences of a 63-year-old substitute teacher from Garland who had seen TV ads for the insurance offerings and called the associated toll-free number.

“She began paying monthly premiums of $242 in April of 2009, and she received an insurance card issued by Real Benefits Association. In July of 2010, she had surgery, incurring medical bills totaling $12,644.55,” according to the order. “When she called the number on her card, she was told there had been a change in her health plan. She was mailed a new insurance card issued by USCT, which listed April 1, 2009, as the effective date of her USCT coverage. However, when she called the number on her new card, she was told her claim payment would be delayed due to a backlog.

“After paying the respondents thousands of dollars for this coverage, [the woman] remains responsible for substantial medical bills that she cannot afford to pay.”

None of the companies are licensed in Maine, and after a June 20 hearing, they were found to have violated state law and ordered to stop doing business here.

“Unlicensed insurance activities must be reported and stopped,” said Insurance Superintendent Eric Cioppa in a release. “Maine policyholders paid their premiums, but received little to no benefit in return. Anyone seeking to purchase insurance can always contact the Bureau to make sure the company is licensed in Maine.”

The release didn’t have any further information about the companies.

But according to a March complaint by the Colorado attorney general’s office, the programs Real Benefits Association, National Association of Business Leadership and United States Contractors Trust all were marketed by Consolidated Medical Services LLC, a business founded in Highlands Ranch, Colo., by Joseph Benedetto.

Both Benedetto and Consolidated Medical Services were named in the Colorado AG’s filing, which accused the defendants of deceptive trade practices, charging they “misled thousands of people” to invest money in their Internet-based “affiliate marketing program,” according to the complaint.

“Defendants recruited individuals to assist with the marketing of medical benefits programs that defendants claim are a valid substitute for traditional health insurance. Defendants enticed these individuals — whom defendants called their “affiliates” — to pay defendants hundreds and often thousands of dollars for marketing products and services, all the while knowing that the Affiliates had almost no chance of making money,” the claim states. “Defendants also made false and misleading statements about the coverage provided by the medical benefits programs they marketed.”

The claim also noted that the Real Benefits Association, National Association of Business Leadership, and United States Contractors Trust “regularly failed to pay consumers’ claims, and they have been the subject of cease and desist orders from insurance regulators in at least 10 states, including one cease and desist order from Kansas that specifically named defendant Benedetto.”

Maine consumers and health care providers who have not received payment for medical bills from these companies are encouraged to notify the Bureau of Insurance by phone at 624-8475 and ask for Kelly Rogers. They also may contact the bureau by email at insurance.pfr@maine.gov (include USCT/NABL in the subject line); or by mail: USCT/NABL Consumer Assistance, Maine Bureau of Insurance, 34 State House Station, Augusta 04333-0034.

CORRECTION:

An earlier version of this story contained a time element error. The Bureau of Insurance said four companies must stop doing business in Maine and pay penalties of $260,000 resulting from a “fraudulent health insurance scheme” on Monday, not Tuesday.

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