Receivership Order Issued Against Meritus Health Insurers

Printable Version

Phoenix – The Maricopa County Superior Court today issued an Order for Appointment of Receiver and Injunction against two Arizona health insurance companies, Compass Cooperative Health Plan, Inc., a health care services organization doing business as Meritus Health Partners, and Compass Cooperative Mutual Health Network, Inc., a disability insurer doing business as Meritus Mutual Health Partners.  Arizona Department of Insurance (ADOI), Interim Director, Leslie Hess, filed suit against the health insurers on August 1, 2016, requesting that the Court find both companies insolvent and issue an order appointing the Director of ADOI as the receiver for both companies. 

Both companies were placed under supervision by the Director of ADOI on October 30, 2015.  As a result, the companies were ordered to stop writing new and renewal business as of December 31, 2015.  With the issuance of the Director’s supervision order, Meritus enrollees were eligible to participate in open enrollment to obtain other health insurance for plan year 2016.

Under the Department’s Supervision, both companies have been winding down their operations and paying provider claims (hospitals, doctors, etc.).  However, the companies ran out of money and were unable to continue to pay provider claims without liquidating assets.  The Director sought an Order of Receivership to be able to liquidate the companies’ assets in order to pay provider and creditor claims in accordance with Arizona law. 

“Requesting the Court issue an order placing any company into receivership is not an easy step for me to take,” said Interim Director Leslie Hess.  Our agency’s number one priority is to protect the citizens of Arizona and I believe this order is necessary to do just that.” 

Meritus was incorporated December 7, 2012, as a nonprofit corporation and was one of the original 23 consumer operated and oriented plans (CO-OPs) that were formed around the country to offer health insurance.  The two Meritus companies provided health insurance coverage for approximately 59,000 Arizona residents in Maricopa, Pima and Pinal counties.

Copies of the Complaint and the Receivership Order are available on the Department’s website under the Meritus link.

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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 this state.

GO-PRO Video Leads to Conviction of Insurance Fraud Suspect

Phoenix, AZ – Robert Atlas falsely reported to GEICO that he had crashed his 2012 Corvette Stingray while exiting the I-10 freeway, on the exit ramp at Wild horse pass in Chandler Arizona. Robert was paid $61,465.11 by GEICO for the loss of his Corvette. It was later discovered that on 10/10/2015, Robert Atlas had actually raced his Corvette Stingray in a drag race at a drag racing event at Wild Horse Pass Motorsports Park. He subsequently lost control of his corvette during the race and crashed into the concrete barrier totaling his Corvette Stingray. This crash was captured on a Go-Pro video and published on YouTube. The policy does not cover damage caused to the vehicle if it was involved in drag racing. Robert was later shown the video footage and he admitted to making the false claim to GEICO Insurance.


On 1-25-17, Robert Atlas pled guilty to Insurance Fraud as a Class 6 Undesignated offense and as required by the Plea Agreement he paid the entire amount of restitution back to GEICO Insurance prior to sentencing. He was sentenced to two years supervised probation and was assessed $1,560.00 in court costs.


The case was investigated by the Arizona Department of Insurance Fraud Unit and prosecuted by the Arizona Attorney General’s Office.


YouTube video below.


https://www.youtube.com/watch?v=j-xdgp3x4g0

Extension of Major Medical Transitional Policies through Calendar Year 2018

Phoenix - The Arizona Department of Insurance (ADOI) announced today that insurers in the individual and small group[1] major medical health insurance markets can choose to renew transitional policies for a policy year beginning on or before October 1, 2018, provided all transitional coverage ends by December 31, 2018.    Transitional policies are non-Affordable-Care-Act-compliant policies that have been continuously in effect since by or before December 31, 2013.  At least 6 health insurers have individual or small group transitional policies still in effect in Arizona.

This extension is the maximum extension permitted under the Insurance Standards Bulletin issued on February 23, 2017 by the Center for Consumer Information and Insurance Oversight (CCIIO), and gives insurers the option to continue the pre-2014 individual and small group policies covering approximately 70,000 Arizonans through the end of 2018.  Insurers that offer this extension of transitional coverage are required to send each policyholder a renewal notice that explains the offer to continue the transitional policy through the end of 2018 and includes information regarding any related price increase.  Insurers must also send a 90-day notice for the final discontinuation of the transitional plans.

The extension does not affect grandfathered policies issued prior to March 23, 2010.  These policies can remain in effect as long as they maintain grandfathered status.

For additional information on the Affordable Care Act, please visit the Arizona Department of Insurance website or call Consumer Assistance at (602) 364-2499. 

 

[1] Small Group refers to a policy issued to an employer who employs at least two but not more than fifty eligible employees

(ARS § 20-2301(A)(21)).

 

Insurance Agent Arrested for Stealing $80,000 of Premiums

Phoenix, AZ – It seems that between March 2016 and January 2017, Ms. Rosita Johns diverted over $80,000.00 in premiums paid by two companies towards their workers’ compensation and general liability insurance policies.  

On August 10, 2016, Burke Construction Group Inc. filed a complaint with the Arizona Department of Insurance Consumer Protection Division concerning the theft of $11,200 it paid to Ms. Johns for a surety bond.  Johns never issued the bond and appears to have diverted the funds for her personal use.  On October 25, 2016, the Department revoked her individual insurance license as well as the licenses of three of her business entities.  It was at that time, the Consumer Protection Division referred the case to the Department’s Fraud Division.

Further investigation by the Fraud Division uncovered another victim, which paid more than $69,470 for workers compensation, general liability, and automobile policies.  Ms. Johns did not forward the premiums to the insurance company and policies were not issued.  Again, it appears John’s diverted the funds for her personal use.

On April 5, 2017, Johns was taken into custody and booked into the Maricopa County Jail for theft and insurance fraud.  The Fraud Division’s investigation is ongoing as additional victims are being identified.

The investigation is being submitted to the Arizona Attorney General’s Office for prosecution.

Insurance Professional License Number Crosswalk (MS EXCEL)

With the Department of Insurance move off of its old regulatory system to State Based Systems ("SBS"), the license number for each Arizona-licensed insurance professional (insurance producer/agent, surplus lines broker, insurance adjuster, etc.) changed. Attached is a MICROSOFT EXCEL file that contains the name, old (legacy) license number, new license number and National Producer Number for each insurance professional licensed whose license expired/expires on or after 4/30/2016. Use the LICENSE SEARCH menu option at the top of this page to view the license record for a particular licensee or company.

Insurance Professional License Number Crosswalk (CSV)

With the Department of Insurance move off of its old regulatory system to State Based Systems ("SBS"), the license number for each Arizona-licensed insurance professional (insurance producer/agent, surplus lines broker, insurance adjuster, etc.) changed. Attached is a COMMA-SEPARATED VALUES (CSV) file that contains the name, old (legacy) license number, new license number and National Producer Number for each insurance professional licensed whose license expired/expires on or after 4/30/2016. Use the LICENSE SEARCH menu option at the top of this page to view the license record for a particular licensee or company.

Long-term Care Insurance: Notice of Publication of Final Rulemaking

On May 12, 2017, the Arizona Secretary of State published the Department's Final Exempt Rulemaking in the Arizona Administrative Register (23 A.A.R. 1120, May 12, 2017).

Suspect Arrested in $52,000 Auto Glass Scam

Phoenix, AZ – On Tuesday, June 13, 2017, the Arizona Department of Insurance (ADOI) Fraud Division arrested Mr. Marcel Deweaver on allegations of fraud schemes, theft, insurance fraud and identity theft.
Between August 2015 and June 2017, Mr. Deweaver allegedly filed over 120 fraudulent claims with multiple insurers. After obtaining vehicles through various auto dealerships, Deweaver allegedly had the vehicles covered under fraudulent insurance policies that he obtained under stolen identities, and paid premiums with fraudulent debit and credit cards; then would intentionally damage the safety glass of the vehicle and file a claim. Deweaver allegedly shopped around to different independent glass installation shops for ones that offered the highest incentives, up to $150 per claim, to fix the damages. The total loss to the insurance companies is believed to exceed $52,000 in fraudulent claims.
Deweaver was arrested Tuesday afternoon after the Arizona Department of Insurance Fraud Division developed information that Deweaver was in a 2012 Ford Explorer that he fraudulently obtained from a local dealership. The vehicle came to the attention of the ADOI Fraud Division after seven separate insurance claims had been filed within a month. After locating the vehicle in an apartment complex, ADOI agents requested assistance from the Arizona Department of Public Safety (DPS) once they realized Deweaver was in the vehicle and it exited the parking lot. In an odd turn of events, after believing that he was being followed, Deweaver pulled off onto the shoulder of the interstate seeking assistance from a DPS officer involved in a traffic stop, at which point ADOI agents took him into custody.
Marcel Deweaver was booked at the Maricopa County Jail and is being held on charges of fraud schemes, theft, insurance fraud and identity theft. The ADOI Fraud Division would like to thank National Insurance Crime Bureau for their assistance with the investigation, and the Arizona Department of Public Safety for their assistance in making the arrest.

CV2016-011872: Meritus Insurers; COMPLAINT

Verified Complaint for Appointment of Receiver and Injunction

CV2016-011872: Meritus Insurers; RECEIVERSHIP ORDER

Order for Appointment of Receiver and Injunction

Meritus Health Insurers in Receivership, Common Questions and Answers

Answers to frequently asked questions concerning Meritus Health Partners, In Receivership, and Meritus Mutual Health Partners, In Receivership.