Arizona Attorney General (AG) Kris Mayes recently announced a consent judgment with SimonMed Imaging MSO, LLC (SimonMed), alleging that the medical imaging service provider violated the Arizona Consumer Fraud Act through billing practices the AG claimed were unfair and misleading. SimonMed provides management services, including billing, collections, information technology, and other business administrative services, to SMI Imaging, LLC (SMI), a wholly owned subsidiary of SimonMed Imaging LLC. According to its website, SimonMed Imaging LLC is the largest outpatient physician radiology group in the U.S., and its subsidiary SMI is the provider entity in connection with outpatient imaging clinics in Arizona. SimonMed expressly denies any liability or wrongdoing, and the consent judgment is not to be construed as an admission of wrongdoing or a violation of the law.
Pursuant to the consent judgment, when determining the amount a consumer owed for services, SimonMed used a third-party tool to provide a good-faith estimate of the amount the consumer would owe. Typically, SimonMed required consumers to pay the good-faith estimate at the time of service. However, the ultimate amount owed was not determined until the claim was submitted to the consumer’s insurance company and adjudicated. This process can take between six and eight weeks.
If the amount charged for the good-faith estimate exceeded the adjudicated amount, SimonMed issued a refund to the consumer. Mayes alleged that, between 2022 and 2024, SimonMed failed to issue refunds to consumers within a reasonable time. While employees allegedly told consumers that refunds would be processed within seven to 10 days of an inquiry, some consumers waited more than a year to receive refunds.
Further, the AG alleged SimonMed offered a “tokenization” service in which a consumer would leave their credit card on file, only to be charged after adjudication. Despite the availability of this service, SimonMed employees represented that payment must be made prior to the service. In practice, the AG claims that tokenization was offered only if the patient became irate or threatened to leave.
The consent judgment requires SimonMed MSO to pay $50,000 in civil penalties, $20,000 in restitution, and $20,000 in costs and fees. Consumers who believe they were affected by SimonMed’s billing practices may file a complaint with the AG’s office prior to April 30, 2026, to be considered for distribution of the restitution payment.
The consent judgment also contains injunctive provisions. Specifically, for a period of five years, SimonMed must:
- Keep statistics to compare good-faith estimates given on the date of service with the final adjudicated amount and provide reports to the state on a quarterly basis, providing information on:
- The number of claims fully adjudicated,
- The number of claims for which the final adjudicated amount was less than the estimate,
- The number of claims for which a customer paid more than the good-faith estimate,
- The average amount of underpayment, and
- The average amount of overpayment;
- Offer the option to tokenize a credit card to any customer who disagrees with the good-faith estimate;
- Clearly and conspicuously display a sign in each Arizona SimonMed location describing the credit-card-on-file policy;
- Monitor the average days between when a claim is adjudicated and refunded to ensure it is less than 60 days;
- Refund all customers who overpaid;
- Include the “Important Notice About Direct Payment For Your Health Care Services” notice required by A.R.S. § 36-437(I) in writing prior to accepting direct payment; and
- Respond in writing to all consumer complaints sent by the state to SimonMed within 15 days.
Why It Matters
This consent judgment underscores that state AGs are not only focused on headline-grabbing pricing issues, but also are closely scrutinizing routine revenue cycle practices. Even when a third-party tool is used in good faith, delays in issuing refunds or inconsistent explanations to patients about payment options may be characterized as “unfair” or “misleading.”
The case also emphasizes the need to ensure front-end patient communications address all available payment options, rather than reserving certain practices for patients who complain or push back. Regulators are likely to scrutinize whether “optional” payment mechanisms are clearly disclosed, consistently offered, and accurately described in both written and verbal communications.
Finally, the consent judgment shows the kind of granular, ongoing oversight remedies AGs are willing to impose. While SimonMed did not admit to any wrongdoing, the injunctive terms effectively serve as a compliance roadmap for other providers. Health care entities that collect up-front estimates or hold patient credit cards on file should proactively review their policies, scripts, notices, and refund processes — especially in Arizona and other states with active consumer protection enforcement — to reduce the risk of similar investigations.
