Harrisburg, PA – On the heels of Governor Josh Shapiro’s recent launch of a new consumer protection tool to help Pennsylvanians report scams, the Pennsylvania Insurance Department (PID) today announced that its hard work in investigating misconduct has resulted in the indictment of multiple businessmen and two entities in a nationwide telemarketing fraud scheme related to the misrepresentation of insurance plans.
“PID’s goal is to ensure Pennsylvanians are protected from predatory business practices that cause financial harm and loss. It’s at the heart of everything we do. In this case, even though PID exercised its regulatory authority to the fullest extent, we did not stop there,” said Pennsylvania Insurance Commissioner Michael Humphreys. “The work performed by our dedicated team of investigators assisted the federal and state partners in their attempts to put an end to this fraudulent activity."
PID’s investigation of Seguro Medico began in 2015, when the business was known as National Brokers of America. Seguro Medico and its owner have used many names, including Quick Health, Q Health, Benefits Now, Express Benefits, and YourBenefits4U.
PID’s investigations culminated in multiple consent orders (agreements between PID and an insurance company or agent that resolve an investigation or enforcement action without going to court). The entities were not honest in how they sold insurance to policyholders. They claimed to compare their plan to other health insurance plans available, but no comparison actually occurred. This misrepresentation tricked people into purchasing plans that did not meet their medical needs. Additionally, the entities practiced unlicensed activity, submitting over 5,000 insurance applications without a license. These consent orders ended the licensure of Seguro Medico and owner Arthur Walsh in Pennsylvania. Even when these entities challenged PID in both the Commonwealth Court and the Pennsylvania Supreme Court, PID kept fighting to ensure that they could not do business in Pennsylvania.
While Seguro Medico has offices based in Pennsylvania, it has been unable to sell plans in Pennsylvania since 2022. Despite this, PID still received complaints from out-of-state residents regarding these entities, resulting in significant losses. Seguro Medico tricked consumers into buying health plans that were not what they claimed to be, which caused financial harm to many individuals across the country. PID remained diligent and proactive in making multiple referrals, both before and after ending Seguro Medico’s licensure in Pennsylvania, to our federal and state partners so that all consumers could ultimately be protected against Seguro Medico and its related entities. PID’s referrals led to further investigation from FBI and IRS Criminal Investigation.
“When we hear from consumers that an insurance company or agent might be doing something wrong, we can start an investigation and make sure they are treating Pennsylvanians fairly and following the law,” said Director of the Bureau of Licensing and Enforcement Mike Fissel. “If you or your family have a concern or issue with your insurance company or agent, reach out to PID. We are here to help.”
Pennsylvanians are encouraged to call 1-866-PACOMPLAINT, visit pa.gov/consumer, or email consumer@pa.gov to report financial, insurance, and consumer concerns. Whether it’s a denied health insurance claim, a suspicious financial transaction, or a problem with a student loan servicer, help is now just a call or click away.
PID reminds Pennsylvanians to stay vigilant against insurance scams. Insurance fraud can take many forms, including staged accidents, inflated claims, fake policies, and deceptive agents. Pennsylvanians can avoid fraudulent insurance sales scams by:
- Being cautious of unexpected calls: If you didn’t call them first, the salesperson probably found your information on a mailing list.
- Not buying insurance over the phone: The risk of fraud is greater if you buy insurance over the phone or online. Hang up on callers if something doesn’t sound or feel right.
- Watching for scam artists: Be wary of people who say they are from Medicare, Social Security or any government agency, including PID. Medicare and PID do not make sales calls. Also, health plans and annuities are never offered at a discount or sale price.
- Keeping all documents and take notes: Request that policy and coverage information be emailed to you from the salesperson and review it prior to agreeing or giving any of your banking details. Keep any paperwork you get from an insurance company. Write down the names of people you talk to and details of conversations you have.
- Checking licenses: Ensure that the companies and individuals you are dealing with to purchase insurance are licensed by PID. You can confirm licensed companies and individuals online at pa.gov/insurance.
- Never being rushed: Be wary of offers for a “last-chance deal.” If someone calls, emails, or mails you an offer, decline it. Next, look it up online to see if it’s true and the company is real.