October 10, 2017
Salem — The Oregon Department of Consumer and Business Services (DCBS), Division of Financial Regulation has fined David Sanders, Albert DiPiero, and Zoom Management Inc. (“ZMI”) $285,000 in civil penalties.
The civil penalties are part of a settlement agreement and consent order reached by DCBS, Zoom Health Plan, and ZMI. The settlement agreement also obtains funds that will be used to pay Zoom Health Plan’s member claims and liabilities.
“The size of these fines show that DCBS will not tolerate repeated violations of the insurance code,” said Jean Straight, acting director of DCBS.
The settlement agreement achieves the following:
- Establishes that Zoom Health Plan and ZMI violated the insurance code by filing financial statements that included a $3 million surplus note, for which it had never received the funds.
- Fines ZMI $150,000 for several violation of the Insurance Code.
- Fines Sanders $100,000 and DiPiero $35,000 for filing late CPA reviewed statements.
- Requires ZMI to pay Zoom Health Plan $2.1 million in cash that will be used to pay member claims and company liabilities.
- Allows members to keep their current coverage through the end of the year.
- Resolves the pending lawsuit against ZMI and regulatory issues without further investigation or litigation.
“The settlement allows Zoom Health Plan to meet its financial obligations to policyholders, without spending additional dollars and resources on costly investigations and lawsuits,” Straight said.
DCBS is the court-appointed receiver for Zoom Health Plan and is paying the claims and liabilities from its insurance business. The settlement agreement will become effective after it is approved by the court that oversees the receivership. DCBS will continue to act as receiver of Zoom Health Plan until all its claims and liabilities are discharged.
On April 25, 2017, the state filed a lawsuit in Marion County Circuit Court to recover $3 million in cash for the insurance company Zoom Health Plan. ZMI, an affiliated company, was supposed to pay the money in late 2016 in exchange for a surplus note, but never did. In its annual financial statement submitted to DCBS, Zoom Health Plan reported capital and surplus of $2,873,168 as of Dec. 31, 2016. But without the cash from the $3 million surplus note, its actual capital and surplus was negative $126,832 at the end of 2016, making it insolvent.
Sanders and DiPiero maintain that they thought that including the loan in Zoom Health Plan financial statements was appropriate. As part of the settlement agreement, DCBS agreed to not investigate whether or not the misstatement on the filing was intentional.
The settlement agreement cancels the $3 million surplus note, but requires ZMI to pay Zoom Health Plan $2,178,538 in cash. The receiver will use this, together with the company’s existing resources, to pay remaining Zoom Health Plan member claims and liabilities.
Zoom Health Plan currently serves approximately 338 members, and has offered plans in Oregon since 2015. Zoom+ Care, another affiliated company, operates clinics in Oregon and Washington. ZMI acted as a business manager for the health plan and continues to do so for the clinics.
All current Zoom Health Plan individual policies will be canceled effective Dec. 31, 2017. Group policies will expire at different times, depending on their renewal dates. No policies will remain beyond Dec. 31, 2017.
Consumers with questions can call the DCBS Division of Financial Regulation at 888-877-4894 (toll-free) or email firstname.lastname@example.org.
The Division of Financial Regulation is part of the Department of Consumer and Business Services, Oregon’s largest business regulatory and consumer protection agency. Visit dcbs.oregon.gov and dfr.oregon.gov .