SimonMed Imaging must reform billing practices, pay fine after settling state AG’s lawsuit

SimonMed Imaging must reform its billing practices and pay a penalty after recently settling a lawsuit filed by one state’s attorney general. 

Arizona AG Kris Mayes (D) in court had accused the Scottsdale, Arizona-based radiology practice of issuing delayed refunds after allegedly using questionable upfront billing practices. SimonMed purportedly forced patients to pay “good faith estimates” of what they might owe after insurance was applied, promising to give back the difference if it was incorrect. 

However, this resulted in “misleading and unfair practices,” with some never getting their money back. Mayes and colleagues took SimonMed to court and won the case, according to an announcement shared Tuesday. 

“When a medical provider demands an upfront payment, the provider must refund any overpayments within a reasonable time period,” Mayes said in a statement Jan. 20. “Arizonans shouldn’t have to choose between being denied necessary medical services or paying amounts out of pocket that are ultimately covered by insurance.”

SimonMed, which operates about 60 centers across Arizona, issued a brief statement Friday in response to the settlement. 

“We value our cooperative relationship with the state of Arizona and are pleased that we were able to reach a mutually agreeable resolution of the state’s investigation," CEO John Simon, MD, told Radiology Business. 

According to the AG, the radiology group would frequently fail to issue refunds for overpayments within a reasonable time, particularly between 2022 and 2024. Some consumers reported not receiving their money back for over a year following service, according to the complaint. Other times, SimonMed employees would allegedly misrepresent refund times to customers. Additionally, despite the practice facing delays after a third-party billing vendor suffered a cyberattack, it continued requiring same-day payments. This despite SimonMed knowing consumers would face significant delays for refunds, Mayes charged. 

Under terms of the consent judgement, the practice is now required to issue refunds within an average of 60 days of adjudication after a patient’s claim is processed by insurance. For those that are not resolved in a timely manner, SimonMed must contact consumers to provide an update on the refund. Patients who disagree with the good faith estimate also must be given the option to leave a credit card on file, to be charged after insurance processes the claim. Plus, SimonMed is required to pay $50,000 in civil penalties, $20,000 in restitution and another $20,000 to cover costs and fees. 

Founded in 2003, SimonMed is one of the largest outpatient imaging providers and radiology practices in the U.S. It operates approximately 170 sites across 10 states and employs about 200 subspecialized radiologists.  The group inked a $600 million partnership with New York private equity firm American Securities in 2021 and has grown steadily since. 

Editor's note: This story has been updated to include a statement from SimonMed.