Facebook Helps Nab Phoenix Women for Insurance Fraud

PHOENIX – A Phoenix woman, who was paid $26,500 by Travelers Insurance Company after she claimed she lost her wedding rings while swimming in the Pacific Ocean, pled guilty to two counts of insurance fraud.  The fraud was uncovered, in part, by a Facebook photo showing her still wearing the distinctive rings after they were supposedly lost.

 

Maria Apodaca Simmons made a claim on her Travelers Insurance policy for the rings on June 4, 2013, saying she lost them while swimming in the ocean a few days after her wedding in May.  

 

In October 2013, Simmons also filed a $14,000 claim for her husband’s wedding band, claiming it was lost when he was swimming while on vacation.  A State Farm employee thought something was amiss when interviewing her about her husband’s ring. The employee noticed that she was wearing what appeared to be the wedding rings that she told Travelers were lost while swimming.  Simmons provided State Farm with the same appraisal which included photos of the rings that she used for the Travelers policy.

 

Arizona Department of Insurance investigators were called in and later discovered a Facebook page with a photo showing her wearing the same rings after the date of the Travelers claim.  Arizona Department of Insurance investigators executed a search warrant on Simmon’s residence in Phoenix this past January and recovered her rings.  Simmons first said the rings she was wearing were duplicates, but the jeweler who made the custom rings told investigators that he had only made one set.  Simmons eventually implicated herself in the fraud in statements she made relative to the Travelers claim and admitted that the claim made on her husband’s wedding band was also fraudulent.

 

A complaint was filed on August 25, 2014 charging Maria Apodaca Simmons with two counts of insurance fraud. Simmons pled guilty to both counts on September 23, 2014.  As part of a plea agreement with the State, Simmons will be placed on probation, agreed to pay restitution $26,953.60 to Travelers Insurance, and $1,005.11 to the Arizona Department of Insurance for investigative costs.  Simmons will be sentenced on October 29, 2014 at 8:30 a.m. by Maricopa County Superior Court Judge Sam Myers.

 

About the Arizona Department of Insurance

The Arizona Department of Insurance, an agency of the State of Arizona, is responsible for the education and protection of insurance consumers and for oversight of the insurance industry in the state.

Health Insurance Telemarketers Annoy; Pose Fraud Risks

Phoenix, AZ—The Arizona Department of Insurance (ADOI) wants to make citizens aware of scams involving aggressive telemarketers attempting to sell health insurance plans and, in some cases, attempting to gain personal and financial information possibly for criminal purposes.

The ADOI has received complaints from people who received multiple phone calls, robocalls, and text messages claiming to be from the National Health Enrollment Center, the Healthcare Enrollment Center and from Healthcare.gov. Some people report that they were contacted multiple times a day, sometimes from different phone numbers, despite requests to be placed on the companies' do-not-call lists. Additionally, some people report having been asked to provide health insurance enrollment information, including such information as address, date of birth, social security number, and personal health information that, in the wrong hands, could be used in identity theft or other fraud schemes.

Arizona citizens who have received persistent phone calls or text messages from these or other callers attempting to sell them health insurance are encouraged to file a complaint with:

Federal Trade Commission (FTC)

Arizona Department of Insurance Consumer Protection Division

  • Visit https://insurance.az.gov/consumers
  • Or call the ADOI’s Consumer Protection Hotline at 602-364-2499, or 1-800-325-2548 if calling within Arizona but outside Maricopa County.

We can all take steps to avoid becoming victims of fraud.

  • Never provide someone who calls you with your bank account number, your social security number, your credit card number, or your personal health information. If you are asked to provide this information, hang up.
  • Research the insurance agent and insurance company you are considering using by finding their license information through the ADOI’s License Search webpage (https://insurance.az.gov/license-search), and use contact information in the license record to contact them. Be skeptical and do research.
  • For information about insurance available from Health Insurance Marketplace, visit the Healthcare.gov website or call Healthcare.gov directly at 1-800-318-2596. The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

Regulatory Bulletin 2019-01

Use of Credits and Premium Rebates in the Health Insurance Market 


FY 2020 INSURER ANNUAL ASSESSMENT INVOICES ARE AVAILABLE

Click here to view invoices for annual assessments to insurance companies and service companies. Payments are due August 9, 2019

Follow the instructions on the first page of the document to locate the invoice that applies to your company.  

Please consider using the OPTins "Assessment" account to pay your assessment invoice.  

Arizona Sample Notice of Continuation Coverage (Mini-COBRA)

Pursuant to ARS § 20-2330, a health benefits plan issued or renewed after December 31, 2018, must allow an enrollee and any qualified dependent to continue coverage after a qualifying event.  The law requires a small employer (with an average of at least 1 but fewer than 20 employees) to notify an enrollee in writing of the right of the enrollee and any qualified dependents to continue coverage under the employer's health benefits plan upon an enrollee's qualifying event.  Pursuant to Subsection C of the law, the Department has prepared a sample notice of coverage continuation form and is making the sample available on its website.  A small employer that uses, properly completes, and timely issues the Department's form is presumed to satisfy notification requirements.  On January 23, 2019, the Department uploaded a new version of the form.