In re Health Insurance
Health Insurance Innovations, Inc. (now Benefytt Technologies, Inc.) and its former CEO Gavin D. Southwell committed securities fraud by falsely assuring investors of high compliance and customer satisfaction from 2017 to 2020 while concealing tens of thousands of consumer complaints and deceptive practices by distributor Simple Health Plans LLC, leading to an $11 million fine for HII, $750,000 penalty and $320,000 disgorgement for Southwell, and his $3.2 million insider stock sale.
From March 2017 to March 2020, Health Insurance Innovations, Inc. (HII) and its CEO Gavin D. Southwell made false and misleading statements to investors, claiming near-perfect compliance and 99.99% customer satisfaction while hiding that distributors—especially Simple Health Plans LLC—were engaging in widespread fraud, including misrepresenting coverage and charging unauthorized fees. Despite internal knowledge of over 24,000 consumer complaints and regulatory warnings, including the FTC’s October 2018 shutdown of Simple Health, HII and Southwell continued to misrepresent the scale of misconduct and the company’s remediation efforts. As a result, the SEC imposed an $11 million civil penalty on HII and ordered Southwell to pay $750,000 in penalties, $320,000 in disgorgement, and $41,511 in interest, while also barring him from seeking penalty offsets in investor actions.
From March 2017 to March 2020, Health Insurance Innovations, Inc. (HII), now Benefytt Technologies, Inc., and its CEO Gavin D. Southwell engaged in a pattern of securities fraud by making materially false and misleading statements to investors about the company’s compliance with consumer protection standards. Despite knowing that distributors—particularly Simple Health Plans LLC, which generated 21% of premiums and 25% of revenue in 2018—were systematically misrepresenting limited health plans as comprehensive coverage, Southwell falsely assured investors of 99.99% customer satisfaction and claimed HII had stringent oversight and had terminated non-compliant distributors. In reality, HII tracked over 24,000 consumer complaints about unauthorized charges, failure to cancel plans, and deceptive sales tactics, and had re-hired a distributor it publicly claimed to have fired for compliance failures. The FTC shut down Simple Health in October 2018 for fraud, yet HII and Southwell failed to fully disclose the extent of the misconduct, allowing HII’s stock price to remain artificially inflated. In February 2019, Southwell sold $3.2 million in HII stock, realizing $320,000 in profits, while continuing to mislead analysts and the public. After Congress announced an investigation into HII’s marketing practices in March 2019, the stock price plummeted, exposing the deception. The SEC ultimately imposed an $11 million civil penalty on HII and ordered Southwell to pay $750,000 in penalties, $320,000 in disgorgement, $41,511 in prejudgment interest, and barred him from seeking penalty offsets in future investor actions.
Extracted insights
- $118.00M $118 million $100M–$1B
- $15.00M $15 million $10M–$100M
- $11.00M $11 million $10M–$100M
- $750K $750,000 $100K–$1M
- $320K $320,000 $100K–$1M
- $42K $41,511 $10K–$100K
- person gavin d. southwell
- company health insurance innovations, inc.
- person plans when consumers requested
- agency Securities and Exchange Commission
- company the amount of business generated by simple health plans llc
- Securities And Exchange Commission instituted cease-and-desist proceedings against Health Insurance Innovations, Inc. and Gavin D. Southwell
- Health Insurance Innovations, Inc. made false and misleading statements to investors
- Gavin D. Southwell made false and misleading statements to investors
- Health Insurance Innovations, Inc. concealed extensive consumer complaints about products
- Gavin D. Southwell concealed extensive consumer complaints about products
- Health Insurance Innovations, Inc. falsely stated it had 99.99% consumer satisfaction
- Gavin D. Southwell falsely stated it had 99.99% consumer satisfaction
- Health Insurance Innovations, Inc. understated the amount of business generated by Simple Health Plans LLC
- Gavin D. Southwell understated the amount of business generated by Simple Health Plans LLC
- Health Insurance Innovations, Inc. misrepresented it terminated its relationship with a distributor in 2016
- Gavin D. Southwell misrepresented it terminated its relationship with a distributor in 2016
- Health Insurance Innovations, Inc. re-hired a distributor despite continuing compliance problems
- Gavin D. Southwell disseminated misleading information about compliance to research analysts
- Health Insurance Innovations, Inc. tracked tens of thousands of dissatisfied consumers
- third-party insurance agents made misrepresentations to sell products
- third-party insurance agents failed to cancel plans when consumers requested
- third-party insurance agents charged consumers for products they did not authorize
- Securities And Exchange Commission accepted Offers of Settlement from Respondents
UNITED STATES OF AMERICA
Before the
SECURITIES AND EXCHANGE COMMISSION
SECURITIES ACT OF 1933
Release No. 11084 / July 20, 2022
SECURITIES EXCHANGE ACT OF 1934
Release No. 95323 / July 20, 2022
ADMINISTRATIVE PROCEEDING
File No. 3-20932
In the Matter of
Health Insurance
Innovations, Inc., now
named Benefytt
Technologies, Inc., and
Gavin D. Southwell
Respondents.
ORDER
INSTITUTING
CEASE-AND-DESIST
PROCEEDINGS, PURSUANT
TO SECTION 8A OF THE
SECURITIES ACT OF 1933
AND SECTION 21C OF THE
SECURITIES EXCHANGE
ACT OF 1934, MAKING
FINDINGS, AND
IMPOSING A CEASE-AND-
DESIST ORDER
I.
The Securities and Exchange Commission (“Commission” or “SEC”) deems it appropriate
that cease-and-desist proceedings be, and hereby are, instituted pursuant to Section 8A of the
Securities Act of 1933 (“Securities Act”) and Section 21C of the Securities Exchange Act of 1934
(“Exchange Act”) against Health Insurance Innovations, Inc., now named Benefytt
Technologies, Inc. (“HII” or “Respondent”) and Gavin D. Southwell (“Southwell” or
“Respondent”).
II.
In anticipation of the institution of these proceedings, Respondents have submitted Offers
of Settlement (the “Offers”), which the Commission has determined to accept. Solely for the
purpose of these proceedings and any other proceedings brought by or on behalf of the
Commission, or to which the Commission is a party, and without admitting or denying the
findings herein, except as to the Commission’s jurisdiction over Respondents and the subject
matter of these proceedings, which are admitted, and except as provided herein in Section V,
Respondents consent to the entry of this Order Instituting Cease-and-Desist Proceedings Pursuant
to Section 8A of the Securities Act of 1933 and Section 21C of the Securities Exchange Act of
2
1934, Making Findings, and Imposing a Cease-and-Desist Order (“Order”), as set forth below.
III.
On the basis of this Order and Respondents’ Offers, the Commission finds
1
that:
Summary
1. From March 2017 through March 2020, HII, a technology platform, billing
administrator and distributor of short-term and limited health insurance products, and its CEO
Southwell made a series of false and misleading statements to investors, which concealed
extensive consumer complaints about products being sold through misrepresentations.
2. HII and Southwell falsely told investors that HII held its insurance distributors to
its high compliance standards, which prohibited insurance agents from making
misrepresentations to consumers. HII and Southwell falsely stated that HII had 99.99%
consumer satisfaction and misleadingly stated that state departments of insurance received very
few consumer complaints regarding HII. HII and Southwell understated the amount of
business that had been generated by its most productive distributor, Simple Health Plans LLC
(“Simple Health”), which amassed the most consumer complaints. HII and Southwell
misrepresented that HII had terminated its relationship with a different distributor in 2016 for
compliance failures, when in fact, HII re-hired this distributor despite continuing compliance
problems. These statements were made in reports filed with the SEC, press releases, earnings
calls and other communications with investors. Southwell also disseminated misleading
information about HII’s compliance to research analysts and a subscription news service, which
included the information in research reports and a news article that were distributed to
investors.
3. In reality, throughout the time period, HII tracked tens of thousands of dissatisfied
consumers complaining that third-party insurance agents that contracted with HII made
misrepresentations to sell products, failed to cancel plans when consumers requested and
charged consumers for products they did not authorize. Numerous consumers complained that
these agents deceptively sold limited plans offered on HII’s platform under the guise of
comprehensive medical insurance, leaving some consumers with unpaid medical bills when
they sought treatment.
4. When Southwell joined HII in 2016, he learned that Simple Health and other HII
distributors were misrepresenting to consumers the scope of coverage provided by
insurance products and were not complying with HII’s compliance standards. Beginning
in 2017, Southwell increased funding and staffing for the compliance department and
encouraged tracking of complaints, monitoring of certain consumer calls, conducting
secret shopping calls and agent training. But he continued to receive information
indicating there were persistent problems at HII’s distributors and a large volume of
consumer complaints. Nevertheless, Southwell failed to assess whether HII’s compliance
1
The findings herein are made pursuant to Respondents’ Offers of Settlement and are not
binding on any other person or entity in this or any other proceeding.
3
efforts were effective before making misstatements to investors.
5. The Federal Trade Commission (“FTC”) filed an emergency action in late-October
2018 to shut down Simple Health for defrauding consumers. When HII publicly disclosed the
FTC’s action on November 2, 2018, HII’s stock price dropped. HII and Southwell, however,
never fully disclosed HII’s compliance problems and continued making false and misleading
statements. In February 2019, while HII’s stock price was still inflated, Southwell sold shares
of HII stock. In March 2019, HII’s stock price experienced another significant decline after
Congress announced an investigation into how HII and others were marketing short-term
insurance products to consumers.
6. HII and Southwell violated the antifraud provisions of Section 17(a)(2) and (3) of
the Securities Act of 1933 (“Securities Act”), by making materially false and misleading
statements that operated as a fraud upon investors. HII also violated, and Southwell caused HII’s
violations of, the reporting provisions of Section 13(a) of the Exchange Act and Rules 12b-20,
13a-1, and 13a-11 thereunder, by filing with the Commission annual and current reports
containing materially false and misleading statements.
Respondents
7. Health Insurance Innovations, Inc., which changed its name in March 2020 to
Benefytt Technologies, Inc., is a Delaware corporation, headquartered in Tampa, Florida. From
2013 until August 2020, HII had a class of shares registered pursuant to Section 12(b) of the
Exchange Act and filed periodic reports with the Commission. HII’s shares were listed and
traded on the NASDAQ Global Market. HII filed Forms S-8, including on August 8, 2016 and
August 4, 2017, to register securities to be offered pursuant to its Long Term Incentive Plan.
Both Forms S-8 incorporated HII’s annual and current reports. HII granted restricted stock under
the Incentive Plan on a number of occasions during the pendency of the misconduct. On August
31, 2020, HII terminated its registration of securities when it merged with several private funds
managed by an investment adviser registered with the Commission.
8. Gavin D. Southwell, age 44, is a resident of Florida. Southwell became a
consultant to HII in April 2016, was appointed President of HII in July 2016 and was HII’s Chief
Executive Officer from November 2016 to August 12, 2021. Southwell served on HII’s Board of
Directors and was a member of its Risk and Compliance Committee.
Related Entities
9. Simple Health Plans LLC (also known as Health Benefits One LLC), a Florida
limited liability company, was HII’s largest revenue generating distributor from at least 2015
through 2018. HII helped to fund Simple Health’s operations by providing loans (also called
advanced commissions) of more than $118 million from 2012 to 2019. Simple Health repaid HII
from premium commissions on sales of insurance products on HII’s platform. On October 31,
2018, a federal judge ordered a halt to Simple Health’s operations as a result of a lawsuit brought
by the FTC alleging that Simple Health routinely misled consumers into believing that they were
purchasing comprehensive health insurance. On November 2, 2018, that order and the FTC
lawsuit became public. On April 12, 2019, the court appointed receiver in the FTC’s case
reported that Simple Health’s business was not legally viable because deception permeated the
4
entire relationship between Simple Health and its customers.
10. Distributor A, a Florida corporation, was another one of HII’s distributors. HII
repeatedly stated it had terminated its relationship with this distributor in 2016 for compliance
failures. Despite continuing compliance problems, HII continued working with this distributor.
Facts
HII’s Insurance-Related Business and Southwell’s Role
11. HII is a technology platform, billing administrator and distributor of short-term and
limited health insurance plans and other related products. HII sold products directly to
consumers and also had contractual relationships with third-party distributors that sold products
to consumers. HII handled the customer service and billing functions for products sold through
third-party distributors, had direct contact with consumers who purchased products offered on
HII’s platform, and tracked and received consumer complaints concerning products sold either
directly or through distributors.
12. HII’s platform provided consumers with access to short term and limited duration
insurance plans, as well as limited indemnity benefit plans, life insurance plans and medical
discount plans. These products provided minimal health benefits, did not cover pre-existing
conditions, hospital care or prescriptions, and were not considered qualifying health coverage
under the Affordable Care Act.
13. Southwell was in charge of HII’s business. As Southwell himself explained to a
board member in June 2018, “Every investor, every carrier, every distributor, every initiative
we’ve done has been because of me. All the ideas are mine.” Southwell also oversaw the
compliance department, received compliance updates, was consulted on compliance issues and
made key decisions linked to distributor compliance.
HII and Southwell Misrepresented to Investors that HII Held Distributors to
Its High Compliance Standards
14. HII’s compliance standards prohibited its representatives and third-party agents
from making misrepresentations to consumers and charging consumers after they asked to
cancel products, and required agents to comply with applicable laws, which similarly
prohibited deceptive practices.
15. From 2017 to 2020, HII and Southwell falsely stated to investors that HII held
its distributors to HII’s high compliance standards and had terminated two non-compliant
distributors. HII and Southwell also gave investors and a subscription news service the
misleading impression that HII held distributors to its standards by providing detailed
descriptions of how HII purportedly ensured distributor compliance, including: training
agents; setting metrics; tracking complaints, cancellations and chargebacks (demands by
dissatisfied consumers to their banks or credit card providers to return their money where the
banks or credit card providers then charged HII for those amounts); conducting “secret
shopping” calls (where an independent contractor anonymously contacts a distributor and
5
poses as a typical consumer seeking to purchase insurance); and terminating non-compliant
distributors.
16. HII and Southwell Made the Following Misstatements Regarding Holding
Distributors to HII’s Standards:
Date Type Content
May 4, 2017
Earnings
Call
Southwell stated, “[w]hat we do after [adding new distributors]
is we want to make sure that the distribution is meeting our
compliance standards . . . and so we track them very closely over
that initial period live, the number of sales, the number of
cancellations, the number of customer service calls. There’s a
lot of different metrics in there. So we wait a period of time
after we’ve added new distribution, and we’ve ensured that the
partnership is working the way that we want...”
August 3,
2017
Earnings
Call
Southwell stated that HII “drive[s] compliance to the highest
standard . . . “[W]e set standards for all of our distribution”. “So
the number of calls that people make to the customer service,
number of escalated calls, the number of complaints, the number
of cancellations, the number of chargebacks, we track this very
closely. And if people can't hit these metrics, then sadly they are
not a partner of ours.”
Southwell further stated “during ‘16, we had some very good,
some very well performing distributors, who we no longer do
business with, because we made a conscious decision we are
going to operate in this market, a very highly regulated market in
a way that means when we sit with departments of insurance or
any other stakeholders, we are able to say we have the best
customer service and the best compliance.”
November 1,
2017
Form 8-K
attaching a
press
release
In a press release, which Southwell helped draft and approved,
HII stated it was “upholding the highest standards in customer
service and compliance [and] continu[ing] to enforce the
Company’s policies and procedures with third-party
distributors.”
The press release detailed HII’s compliance measures including:
(1) maintaining distributor-performance score cards measuring
key metrics such as member complaints, escalations and
chargebacks monthly; (2) conducting secret shopping to ensure
adherence to HII’s best in class process and procedures; and (3)
terminating two distributors in 2016 for not meeting compliance
metrics and benchmarks.
6
Date Type Content
December
2017
Southwell
provided an
interview
to a news
service,
whose
subscribers
included
investors
Southwell gave the misleading impression that HII held agents
to its standards by claiming in an interview with a news service
that HII trained agents and secret shopped distributors, and “we
police [thousands of agents] very very carefully.” The news
service included Southwell’s remarks in an article which was
distributed to investors.
May 3, 2018
Earnings
Call
Southwell described HII’s distributors as “highly-compliant”
and stated, “as I’ve often explained, all of our partners must
meet our very high standards to compliance and consumer
satisfaction... The point that we always add in is anybody we
deal with has to go through a process of training, of meeting
and constantly hitting our compliance matrix, our market
leading compliance.”
March 2,
2017
March 1,
2018
March 14,
2019
March 4,
2020
Forms 10-
K for
2016,
2017, 2018
and 2019
HII’s 2016 annual report, which Southwell signed,
represented, “We have terminated, and could continue to
terminate relationships, with distributors for their failure to
follow our compliance standards or their otherwise engaging
in problematic business practices. In 2016, we terminated two
of our largest distributors for failure to comply with our
standards.”
HII made similar representations in the subsequent three
annual reports, which Southwell signed.
17. Contrary to the above statements, HII’s compliance department documented
extensive failures to comply with the company’s compliance standards and applicable laws.
For example, between 2017 and mid-2019, HII documented more than 24,000 consumer
complaints alleging that insurance agents: (1) made misrepresentations to consumers in order to
sell products; (2) failed to cancel plans when consumers requested; and (3) charged consumers for
products whose purchase they had not authorized. HII also monitored certain calls from consumers
asking distributors to cancel products. A large percentage of those calls did not comply with HII’s
standards and involved agent misrepresentations. In addition, HII had records of more than a
dozen secret shopping calls to Simple Health and Distributor A in 2017 and 2018, all of which
indicated that agents of these distributors used deceptive tactics to sell products.
18. In 2016, Southwell learned that Simple Health, Distributor A and other HII
distributors were misrepresenting to consumers the scope of coverage provided by insurance
7
products and were not complying with HII’s compliance standards. Beginning in 2017,
Southwell increased funding for the compliance department and encouraged tracking of
complaints, monitoring of certain consumer calls, conducting secret shopping calls and agent
training. Southwell, however, continued to receive information including emails, spreadsheets
and PowerPoint presentations, indicating there were persistent problems at HII’s distributors
and a large volume of consumer complaints.
19. For example, in July 2017, Southwell was notified that the Attorney General’s
Office of Nebraska issued a scam alert against Simple Health for making misrepresentations to
consumers who found it difficult to cancel services. On July 13, 2017, Southwell was
forwarded emails from an HII vice president expressing concerns that a Nebraska newspaper
was investigating Simple Health and stating she was “seeing high complaints and chargebacks
overall.” In another example, on March 7, 2018, Southwell received a compliance update
showing that HII’s distributors were failing to comply with HII’s standards when dealing with
consumers who wanted to cancel their plans.
20. Additionally, starting in late-2016, Southwell was informed that HII continued to
do business with agents associated with Distributor A, which it had supposedly terminated that
same year. Southwell was informed that these agents were compliant when brought back, but he
also received contradictory information showing agents associated with Distributor A continued to
deceitfully sell insurance products offered on HII’s platform.
21. Notwithstanding the information Southwell received and had access to, he failed
to assess whether HII’s compliance efforts were effective before falsely telling investors that
HII held distributors to its high compliance standards and terminated non-compliant
distributors.
HII and Southwell Provided Investors False and Misleading Information about
Consumer Satisfaction and Complaints
22. HII and Southwell falsely told investors that virtually all consumers were
satisfied and misleadingly stated that consumers had lodged only a few complaints against HII
with state departments of insurance.
23. HII and Southwell Made the Following Misstatements Regarding
Consumer Satisfaction and Complaints:
Date Type Content
August 3,
2017
Earnings
Call
Southwell asserted that “our current customer satisfaction is
99.99%.”
March 1,
2018
Earnings
Call
Southwell stated that “[h]ere at HIIQ, we are committed to the
highest standards in compliance and customer service and
maintaining our high level of consumer satisfaction,” which he
had previously asserted was 99.99%.
8
Date Type Content
May 3, 2018 Earnings
Call
Southwell stated: “This outstanding compliance performance at
HIIQ continues in 2018 with only 6 Department of Insurance
(DOI) complaints in the entire first quarter of 2018. . . [and]
there was a total of 1, DOI complaint upheld against the
company.”
August 2,
2018
Earnings
Call
Southwell gave an update to the figures provided in May and
said there were only 12 complaints to state departments of
insurance, only 3 of which were upheld.
October 30,
2018
Earnings
Call
Southwell asserted that HII could show state departments of
insurance “a very happy consumer base, we can show them, a
very low number of complaints, a very high number customer
satisfaction.”
December 20,
2018
Presentation
at Investor
Analyst Day
in New York
City, in
which
Southwell
participated
HII stated that “[i]n terms of complaints, they are down with the
Department of Insurance complaints at 15 YTD vs. 28 YTD
2017 and only 3 upheld vs. 4 last year.”
A research analyst included HII’s presentation of the low
number of departments of insurance complaints in his December
20, 2018 research report. The report was published and
distributed to institutional investors and also sent to Southwell,
who did not correct or supplement the misleading information.
A different research analyst issued a December 21, 2018 report
stating, “the most power chart of the day” included the low
number of DOI complaints, which are “hardly an operating
concern or a level that would give the short theses any
credibility.”
January 7,
2019 (Form
8-K)
May 22, 2019
Investor
Presentations
(with one
filed with
Form 8-K)
HII stated there were 28 complaints to departments of insurance
in 2017 with only 4 upheld and 15 complaints in 2018 with only
3 upheld.
24. From 2017 to mid-2019, HII documented more than 24,000 dissatisfied consumers
complaining about agent misrepresentations, unauthorized billing and failures to cancel plans. HII
also documented approximately 28,000 chargebacks. HII recognized that many of these
9
chargebacks may have been initiated by consumers who claimed the charges were not authorized.
Thus, HII’s and Southwell’s above statements to investors concerned only a small fraction of the
total number of consumer complaints and dissatisfied consumers that HII tracked. Moreover,
investors were never told that HII itself, not the departments of insurance, designated certain
complaints as “upheld” and HII made those designations without even contacting complaining
consumers.
25. Before making the above statements, Southwell was on notice of a high number of
complaints and chargebacks and a large number of dissatisfied consumers trying to cancel plans.
For instance, in February 2017, Southwell received an email from an insurance carrier noting that
consumer complaints were “becoming more prevalent and requiring more resources.” In addition,
by at least September 2017, Southwell had communicated with the Better Business Bureau
about its “F” rating for HII, which was based on a pattern of consumer complaints alleging
agent misrepresentations. In another example, in September 2017, Southwell received an
email from HII’s compliance and risk officers about a series of reports of consumers
requesting cancellations, where the agents either refused to cancel or said the cancellations
had been made when in fact they were not. Nevertheless, Southwell failed to determine the
magnitude of complaints and chargebacks tracked by HII or otherwise verify that his statements
about consumer satisfaction and complaints were accurate before making them.
HII and Southwell Understated the Amount of Sales Generated by Simple
Health
26. On a November 2, 2017 investor call, an analyst asked Southwell whether HII had
any revenue concentration issues, such as any distributors that originated more than 10% of sales.
Southwell responded, “in 2016, we terminated two large distributors which was about 16% of
sales. And what I can confirm is that we don’t have any third party distributor as large as the guys
we . . . terminated back in 2016.” Several months before the call, Southwell had received HII
statistics showing that one distributor—Simple Health—generated significantly more sales than
the two terminated distributors combined.
27. Additionally, after the FTC’s action against Simple Health became public, on
November 2, 2018, HII issued a press release, with Southwell’s approval, stating that: (1) it was
terminating its relationship with Simple Health; (2) Simple Health was one of 100 sales agencies
working with HII; and (3) Simple Health was the agency of record for less than 10% of submitted
policies in 2018. HII stated at its December 20, 2018 Investor Analyst day presentation that
Simple Health contributed only 8.2% of submitted policies in 2018. Southwell knew these
statements were provided to research analysts who included them in their research reports. HII’s
January 7, 2019 investor presentation, filed on Form 8-K, included a similar statement about
Simple Health contributing 8.2% of submitted policies in 2018. The statements about the
percentage of submitted policies were misleading because Simple Health accounted for well over
20% of HII’s premiums, revenue and profits in just the first ten months of 2018, before Simple
Health was shut down.
10
HII’s and Southwell’s False and Misleading Statements Were Material to
Investors
28. HII’s and Southwell’s false and misleading statements, which involved specific
verifiable facts about its compliance and the amount of business generated by Simple Health, were
material to investors.
29. In SEC filings, HII and Southwell repeatedly highlighted the importance of
compliance as a competitive strength in the highly-regulated insurance industry. HII and
Southwell also acknowledged in the SEC filings that the failure of third-party distributors to
comply with applicable laws and regulations could adversely affect HII’s business.
30. HII’s and Southwell’s false and misleading statements related to an important
component of HII’s business. For example, in May 2016, Southwell was notified by HII’s then-
president that Simple Health’s compliance problem was HII’s biggest financial risk. In 2017,
Simple Health accounted for 31% of premiums collected by HII from consumers, 37% of HII’s
revenue and 27% of its profits. Southwell decided in September 2017 not to terminate Simple
Health, after receiving an internal analysis showing termination would result in a significant loss of
revenue and more than $15 million in loans that Simple Health had not yet repaid to HII. From
January through October 2018, when it was shut down by the FTC’s action, Simple Health
accounted for 21% of premiums collected by HII from consumers, 25% of HII’s revenue and 20%
of its profits.
31. Research analysts and the media included information they received from HII and
Southwell about the company’s compliance in their research reports and articles which were then
distributed to investors.
32. The price of HII stock declined significantly after two negative news
announcements. When the FTC’s lawsuit against Simple Health became public on November 2,
2018, HII’s stock price dropped 8.8% from the prior day’s closing price. HII’s stock price dropped
an additional 14.4% the following trading day. After a March 13, 2019 congressional press release
announcing an investigation into HII and other short-term health insurance sellers, HII’s stock
declined 17.2%.
Southwell’s Sales of HII Stock
33. Southwell sold 80,000 shares of HII stock in February 2019 for proceeds of $3.2
million and profits of $320,000 based on inflation in the stock price as a result of the misconduct
detailed herein.
Violations
34. In light of the information that Southwell received and had access to, Southwell and
HII knew or should have known the statements described above in reports filed with the SEC,
press releases, earnings calls and other communications with investors, research analysts and the
media, were materially false and misleading.
11
35. As a result of the conduct described above, HII and Southwell violated Sections
17(a)(2) and (3) of the Securities Act, which prohibit, in the offer or sale of securities, materially
false and misleading statements and practices that would operate as a fraud or deceit upon the
purchasers of securities. Negligence is sufficient to establish violations of Sections 17(a)(2) and
(3) of the Securities Act. Aaron v. SEC, 446 U.S. 680, 696-97 (1980).
36. As a result of the conduct described above, HII violated Section 13(a) of the
Exchange Act and Rules 12b-20, 13a-1 and 13a-11, which require every issuer of a security
registered pursuant to Section 12 of the Exchange Act to file with the Commission accurate annual
and current reports, which include such further information as may be necessary to make the
required statements not misleading. Scienter is not required for a violation of the reporting
provisions. See SEC v. McNulty, 137 F.3d 732, 740-41 (2d Cir. 1998).
37. As a result of the conduct described above, Southwell caused HII’s violations of
Section 13(a) of the Exchange Act and Rules 12b-20, 13a-1 and 13a-11 by signing and authorizing
the issuance of annual and current reports, when he knew or should have known they were
materially false and misleading. Negligence is sufficient for causing a primary violation that does
not require scienter. See KPMG, LLP v. SEC, 289 F.3d 109, 120 (D.C. Cir. 2002)
Disgorgement
38. The disgorgement and prejudgment interest ordered in Section IV.D below is
consistent with equitable principles, does not exceed Southwell’s net profits from his violations,
and will be distributed to harmed investors to the extent feasible. The Commission will hold funds
paid pursuant to paragraph IV.D in an account at the United States Treasury pending distribution.
Upon approval of the distribution final accounting by the Commission, any amounts remaining
that are infeasible to return to investors, and any amounts returned to the Commission in the future
that are infeasible to return to investors, may be transferred to the general fund of the U.S.
Treasury, subject to Section 21F(g)(3) of the Exchange Act.
IV.
In view of the foregoing, the Commission deems it appropriate and in the public interest
to impose the sanctions agreed to in Respondents’ Offers.
Accordingly, it is hereby ORDERED that:
A. Pursuant to Section 8A of the Securities Act and Section 21C of the Exchange Act, HII
and Southwell cease and desist from committing or causing any violations and any future violations
of Sections 17(a)(2) and (3) of the Securities Act and Section 13(a) of the Exchange Act and Rules
12b-20, 13a-1 and 13a-11 thereunder.
B. Respondent HII shall, within 10 days of the entry of this Order, pay a civil penalty of
$11 million to the Securities and Exchange Commission. If timely payment is not made, interest
shall accrue pursuant to 31 U.S.C. § 3717.
C. Respondent Southwell shall, within 10 days of the entry of this Order, pay a civil
12
money penalty in the amount of $750,000 to the Securities and Exchange Commission. If timely
payment is not made, interest shall accrue pursuant to 31 U.S.C. § 3717.
D. Respondent Southwell shall, within 10 days of the entry of this Order, pay
disgorgement of $320,000 and prejudgment interest of $41,511 to the Securities and Exchange
Commission. If timely payment is not made, additional interest shall accrue pursuant to SEC Rule
of Practice 600.
E. The foregoing payments must be made in one of the following ways:
(1) Respondents may transmit payment electronically to the Commission,
which will provide detailed ACH transfer/Fedwire instructions upon request;
(2) Respondents may make direct payment from a bank account via
Pay.gov through the SEC website at
http://www.sec.gov/about/offices/ofm.htm; or
(3) Respondents may pay by certified check, bank cashier’s check, or United
States postal money order, made payable to the Securities and Exchange
Commission and hand-delivered or mailed to:
Enterprise Services Center
Accounts Receivable Branch
HQ Bldg., Room 181, AMZ-341
6500 South MacArthur Boulevard
Oklahoma City, OK 73169
Payments by check or money order must be accompanied by a cover letter identifying HII or
Southwell as Respondents in these proceedings, and the file number of these proceedings; a copy of
the cover letter and check or money order must be sent to Lisa Deitch, Assistant Director, Division
of Enforcement, Securities and Exchange Commission, 100 F St., NE, Washington, DC 20549.
F. Pursuant to Section 308(a) of the Sarbanes-Oxley Act of 2002, a Fair Fund is created
for the disgorgement, prejudgment interest, and penalties referenced in paragraphs IV. B, C, and D,
above. Amounts ordered to be paid as civil money penalties pursuant to this Order shall be treated
as penalties paid to the government for all purposes, including all tax purposes. To preserve the
deterrent effect of the civil penalty, Respondents agree that in any Related Investor Action, they
shall not argue that they are entitled to, nor shall they benefit by, offset or reduction of any award
of compensatory damages by the amount of any part of Respondents’ payment of a civil penalty in
this action (“Penalty Offset”). If the court in any Related Investor Action grants such a Penalty
Offset, Respondents agree that they shall, within 30 days after entry of a final order granting the
Penalty Offset, notify the Commission’s counsel in this action and pay the amount of the Penalty
Offset to the Securities and Exchange Commission. Such a payment shall not be deemed an
additional civil penalty and shall not be deemed to change the amount of the civil penalty imposed
in this proceeding. For purposes of this paragraph, a “Related Investor Action” means a private
damages action brought against the Respondents by or on behalf of one or more investors based
on substantially the same facts as alleged in the Order instituted by the Commission in this
13
proceeding.
V.
It is further Ordered that, solely for purposes of exceptions to discharge set forth in Section
523 of the Bankruptcy Code, 11 U.S.C. §523, the findings in this Order are true and admitted by
Respondent Southwell, and further, any debt for disgorgement, prejudgment interest, civil penalty
or other amounts due by Respondent Southwell under this Order or any other judgment, order,
consent order, decree or settlement agreement entered in connection with this proceeding, is a debt
for the violation by Respondent Southwell of the federal securities laws or any regulation or order
issued under such laws, as set forth in Section 523(a)(19) of the Bankruptcy Code, 11
U.S.C. §523(a)(19).
By the Commission.
Vanessa A. Countryman
Secretary UNITED STATES OF AMERICA
Before the
SECURITIES AND EXCHANGE COMMISSION
SECURITIES ACT OF 1933
Release No. 11084 / July 20, 2022
SECURITIES EXCHANGE ACT OF 1934
Release No. 95323 / July 20, 2022
ADMINISTRATIVE PROCEEDING
File No. 3-20932
In the Matter of
Health Insurance
Innovations, Inc., now
named Benefytt
Technologies, Inc., and
Gavin D. Southwell
Respondents.
ORDER
INSTITUTING
CEASE-AND-DESIST
PROCEEDINGS, PURSUANT
TO SECTION 8A OF THE
SECURITIES ACT OF 1933
AND SECTION 21C OF THE
SECURITIES EXCHANGE
ACT OF 1934, MAKING
FINDINGS, AND
IMPOSING A CEASE-AND-
DESIST ORDER
I.
The Securities and Exchange Commission (“Commission” or “SEC”) deems it appropriate
that cease-and-desist proceedings be, and hereby are, instituted pursuant to Section 8A of the
Securities Act of 1933 (“Securities Act”) and Section 21C of the Securities Exchange Act of 1934
(“Exchange Act”) against Health Insurance Innovations, Inc., now named Benefytt
Technologies, Inc. (“HII” or “Respondent”) and Gavin D. Southwell (“Southwell” or
“Respondent”).
II.
In anticipation of the institution of these proceedings, Respondents have submitted Offers
of Settlement (the “Offers”), which the Commission has determined to accept. Solely for the
purpose of these proceedings and any other proceedings brought by or on behalf of the
Commission, or to which the Commission is a party, and without admitting or denying the
findings herein, except as to the Commission’s jurisdiction over Respondents and the subject
matter of these proceedings, which are admitted, and except as provided herein in Section V,
Respondents consent to the entry of this Order Instituting Cease-and-Desist Proceedings Pursuant
to Section 8A of the Securities Act of 1933 and Section 21C of the Securities Exchange Act of
2
1934, Making Findings, and Imposing a Cease-and-Desist Order (“Order”), as set forth below.
III.
On the basis of this Order and Respondents’ Offers, the Commission finds1 that:
Summary
1. From March 2017 through March 2020, HII, a technology platform, billing
administrator and distributor of short-term and limited health insurance products, and its CEO
Southwell made a series of false and misleading statements to investors, which concealed
extensive consumer complaints about products being sold through misrepresentations.
2. HII and Southwell falsely told investors that HII held its insurance distributors to
its high compliance standards, which prohibited insurance agents from making
misrepresentations to consumers. HII and Southwell falsely stated that HII had 99.99%
consumer satisfaction and misleadingly stated that state departments of insurance received very
few consumer complaints regarding HII. HII and Southwell understated the amount of
business that had been generated by its most productive distributor, Simple Health Plans LLC
(“Simple Health”), which amassed the most consumer complaints. HII and Southwell
misrepresented that HII had terminated its relationship with a different distributor in 2016 for
compliance failures, when in fact, HII re-hired this distributor despite continuing compliance
problems. These statements were made in reports filed with the SEC, press releases, earnings
calls and other communications with investors. Southwell also disseminated misleading
information about HII’s compliance to research analysts and a subscription news service, which
included the information in research reports and a news article that were distributed to
investors.
3. In reality, throughout the time period, HII tracked tens of thousands of dissatisfied
consumers complaining that third-party insurance agents that contracted with HII made
misrepresentations to sell products, failed to cancel plans when consumers requested and
charged consumers for products they did not authorize. Numerous consumers complained that
these agents deceptively sold limited plans offered on HII’s platform under the guise of
comprehensive medical insurance, leaving some consumers with unpaid medical bills when
they sought treatment.
4. When Southwell joined HII in 2016, he learned that Simple Health and other HII
distributors were misrepresenting to consumers the scope of coverage provided by
insurance products and were not complying with HII’s compliance standards. Beginning
in 2017, Southwell increased funding and staffing for the compliance department and
encouraged tracking of complaints, monitoring of certain consumer calls, conducting
secret shopping calls and agent training. But he continued to receive information
indicating there were persistent problems at HII’s distributors and a large volume of
consumer complaints. Nevertheless, Southwell failed to assess whether HII’s compliance
1 The findings herein are made pursuant to Respondents’ Offers of Settlement and are not
binding on any other person or entity in this or any other proceeding.
3
efforts were effective before making misstatements to investors.
5. The Federal Trade Commission (“FTC”) filed an emergency action in late-October
2018 to shut down Simple Health for defrauding consumers. When HII publicly disclosed the
FTC’s action on November 2, 2018, HII’s stock price dropped. HII and Southwell, however,
never fully disclosed HII’s compliance problems and continued making false and misleading
statements. In February 2019, while HII’s stock price was still inflated, Southwell sold shares
of HII stock. In March 2019, HII’s stock price experienced another significant decline after
Congress announced an investigation into how HII and others were marketing short-term
insurance products to consumers.
6. HII and Southwell violated the antifraud provisions of Section 17(a)(2) and (3) of
the Securities Act of 1933 (“Securities Act”), by making materially false and misleading
statements that operated as a fraud upon investors. HII also violated, and Southwell caused HII’s
violations of, the reporting provisions of Section 13(a) of the Exchange Act and Rules 12b-20,
13a-1, and 13a-11 thereunder, by filing with the Commission annual and current reports
containing materially false and misleading statements.
Respondents
7. Health Insurance Innovations, Inc., which changed its name in March 2020 to
Benefytt Technologies, Inc., is a Delaware corporation, headquartered in Tampa, Florida. From
2013 until August 2020, HII had a class of shares registered pursuant to Section 12(b) of the
Exchange Act and filed periodic reports with the Commission. HII’s shares were listed and
traded on the NASDAQ Global Market. HII filed Forms S-8, including on August 8, 2016 and
August 4, 2017, to register securities to be offered pursuant to its Long Term Incentive Plan.
Both Forms S-8 incorporated HII’s annual and current reports. HII granted restricted stock under
the Incentive Plan on a number of occasions during the pendency of the misconduct. On August
31, 2020, HII terminated its registration of securities when it merged with several private funds
managed by an investment adviser registered with the Commission.
8. Gavin D. Southwell, age 44, is a resident of Florida. Southwell became a
consultant to HII in April 2016, was appointed President of HII in July 2016 and was HII’s Chief
Executive Officer from November 2016 to August 12, 2021. Southwell served on HII’s Board of
Directors and was a member of its Risk and Compliance Committee.
Related Entities
9. Simple Health Plans LLC (also known as Health Benefits One LLC), a Florida
limited liability company, was HII’s largest revenue generating distributor from at least 2015
through 2018. HII helped to fund Simple Health’s operations by providing loans (also called
advanced commissions) of more than $118 million from 2012 to 2019. Simple Health repaid HII
from premium commissions on sales of insurance products on HII’s platform. On October 31,
2018, a federal judge ordered a halt to Simple Health’s operations as a result of a lawsuit brought
by the FTC alleging that Simple Health routinely misled consumers into believing that they were
purchasing comprehensive health insurance. On November 2, 2018, that order and the FTC
lawsuit became public. On April 12, 2019, the court appointed receiver in the FTC’s case
reported that Simple Health’s business was not legally viable because deception permeated the
4
entire relationship between Simple Health and its customers.
10. Distributor A, a Florida corporation, was another one of HII’s distributors. HII
repeatedly stated it had terminated its relationship with this distributor in 2016 for compliance
failures. Despite continuing compliance problems, HII continued working with this distributor.
Facts
HII’s Insurance-Related Business and Southwell’s Role
11. HII is a technology platform, billing administrator and distributor of short-term and
limited health insurance plans and other related products. HII sold products directly to
consumers and also had contractual relationships with third-party distributors that sold products
to consumers. HII handled the customer service and billing functions for products sold through
third-party distributors, had direct contact with consumers who purchased products offered on
HII’s platform, and tracked and received consumer complaints concerning products sold either
directly or through distributors.
12. HII’s platform provided consumers with access to short term and limited duration
insurance plans, as well as limited indemnity benefit plans, life insurance plans and medical
discount plans. These products provided minimal health benefits, did not cover pre-existing
conditions, hospital care or prescriptions, and were not considered qualifying health coverage
under the Affordable Care Act.
13. Southwell was in charge of HII’s business. As Southwell himself explained to a
board member in June 2018, “Every investor, every carrier, every distributor, every initiative
we’ve done has been because of me. All the ideas are mine.” Southwell also oversaw the
compliance department, received compliance updates, was consulted on compliance issues and
made key decisions linked to distributor compliance.
HII and Southwell Misrepresented to Investors that HII Held Distributors to
Its High Compliance Standards
14. HII’s compliance standards prohibited its representatives and third-party agents
from making misrepresentations to consumers and charging consumers after they asked to
cancel products, and required agents to comply with applicable laws, which similarly
prohibited deceptive practices.
15. From 2017 to 2020, HII and Southwell falsely stated to investors that HII held
its distributors to HII’s high compliance standards and had terminated two non-compliant
distributors. HII and Southwell also gave investors and a subscription news service the
misleading impression that HII held distributors to its standards by providing detailed
descriptions of how HII purportedly ensured distributor compliance, including: training
agents; setting metrics; tracking complaints, cancellations and chargebacks (demands by
dissatisfied consumers to their banks or credit card providers to return their money where the
banks or credit card providers then charged HII for those amounts); conducting “secret
shopping” calls (where an independent contractor anonymously contacts a distributor and
5
poses as a typical consumer seeking to purchase insurance); and terminating non-compliant
distributors.
16. HII and Southwell Made the Following Misstatements Regarding Holding
Distributors to HII’s Standards:
Date Type Content
May 4, 2017
Earnings
Call
Southwell stated, “[w]hat we do after [adding new distributors]
is we want to make sure that the distribution is meeting our
compliance standards . . . and so we track them very closely over
that initial period live, the number of sales, the number of
cancellations, the number of customer service calls. There’s a
lot of different metrics in there. So we wait a period of time
after we’ve added new distribution, and we’ve ensured that the
partnership is working the way that we want…”
August 3,
2017
Earnings
Call
Southwell stated that HII “drive[s] compliance to the highest
standard . . . “[W]e set standards for all of our distribution”. “So
the number of calls that people make to the customer service,
number of escalated calls, the number of complaints, the number
of cancellations, the number of chargebacks, we track this very
closely. And if people can't hit these metrics, then sadly they are
not a partner of ours.”
Southwell further stated “during ‘16, we had some very good,
some very well performing distributors, who we no longer do
business with, because we made a conscious decision we are
going to operate in this market, a very highly regulated market in
a way that means when we sit with departments of insurance or
any other stakeholders, we are able to say we have the best
customer service and the best compliance.”
November 1,
2017
Form 8-K
attaching a
press
release
In a press release, which Southwell helped draft and approved,
HII stated it was “upholding the highest standards in customer
service and compliance [and] continu[ing] to enforce the
Company’s policies and procedures with third-party
distributors.”
The press release detailed HII’s compliance measures including:
(1) maintaining distributor-performance score cards measuring
key metrics such as member complaints, escalations and
chargebacks monthly; (2) conducting secret shopping to ensure
adherence to HII’s best in class process and procedures; and (3)
terminating two distributors in 2016 for not meeting compliance
metrics and benchmarks.
6
Date Type Content
December
2017
Southwell
provided an
interview
to a news
service,
whose
subscribers
included
investors
Southwell gave the misleading impression that HII held agents
to its standards by claiming in an interview with a news service
that HII trained agents and secret shopped distributors, and “we
police [thousands of agents] very very carefully.” The news
service included Southwell’s remarks in an article which was
distributed to investors.
May 3, 2018
Earnings
Call
Southwell described HII’s distributors as “highly-compliant”
and stated, “as I’ve often explained, all of our partners must
meet our very high standards to compliance and consumer
satisfaction… The point that we always add in is anybody we
deal with has to go through a process of training, of meeting
and constantly hitting our compliance matrix, our market
leading compliance.”
March 2,
2017
March 1,
2018
March 14,
2019
March 4,
2020
Forms 10-
K for
2016,
2017, 2018
and 2019
HII’s 2016 annual report, which Southwell signed,
represented, “We have terminated, and could continue to
terminate relationships, with distributors for their failure to
follow our compliance standards or their otherwise engaging
in problematic business practices. In 2016, we terminated two
of our largest distributors for failure to comply with our
standards.”
HII made similar representations in the subsequent three
annual reports, which Southwell signed.
17. Contrary to the above statements, HII’s compliance department documented
extensive failures to comply with the company’s compliance standards and applicable laws.
For example, between 2017 and mid-2019, HII documented more than 24,000 consumer
complaints alleging that insurance agents: (1) made misrepresentations to consumers in order to
sell products; (2) failed to cancel plans when consumers requested; and (3) charged consumers for
products whose purchase they had not authorized. HII also monitored certain calls from consumers
asking distributors to cancel products. A large percentage of those calls did not comply with HII’s
standards and involved agent misrepresentations. In addition, HII had records of more than a
dozen secret shopping calls to Simple Health and Distributor A in 2017 and 2018, all of which
indicated that agents of these distributors used deceptive tactics to sell products.
18. In 2016, Southwell learned that Simple Health, Distributor A and other HII
distributors were misrepresenting to consumers the scope of coverage provided by insurance
7
products and were not complying with HII’s compliance standards. Beginning in 2017,
Southwell increased funding for the compliance department and encouraged tracking of
complaints, monitoring of certain consumer calls, conducting secret shopping calls and agent
training. Southwell, however, continued to receive information including emails, spreadsheets
and PowerPoint presentations, indicating there were persistent problems at HII’s distributors
and a large volume of consumer complaints.
19. For example, in July 2017, Southwell was notified that the Attorney General’s
Office of Nebraska issued a scam alert against Simple Health for making misrepresentations to
consumers who found it difficult to cancel services. On July 13, 2017, Southwell was
forwarded emails from an HII vice president expressing concerns that a Nebraska newspaper
was investigating Simple Health and stating she was “seeing high complaints and chargebacks
overall.” In another example, on March 7, 2018, Southwell received a compliance update
showing that HII’s distributors were failing to comply with HII’s standards when dealing with
consumers who wanted to cancel their plans.
20. Additionally, starting in late-2016, Southwell was informed that HII continued to
do business with agents associated with Distributor A, which it had supposedly terminated that
same year. Southwell was informed that these agents were compliant when brought back, but he
also received contradictory information showing agents associated with Distributor A continued to
deceitfully sell insurance products offered on HII’s platform.
21. Notwithstanding the information Southwell received and had access to, he failed
to assess whether HII’s compliance efforts were effective before falsely telling investors that
HII held distributors to its high compliance standards and terminated non-compliant
distributors.
HII and Southwell Provided Investors False and Misleading Information about
Consumer Satisfaction and Complaints
22. HII and Southwell falsely told investors that virtually all consumers were
satisfied and misleadingly stated that consumers had lodged only a few complaints against HII
with state departments of insurance.
23. HII and Southwell Made the Following Misstatements Regarding
Consumer Satisfaction and Complaints:
Date Type Content
August 3,
2017
Earnings
Call
Southwell asserted that “our current customer satisfaction is
99.99%.”
March 1,
2018
Earnings
Call
Southwell stated that “[h]ere at HIIQ, we are committed to the
highest standards in compliance and customer service and
maintaining our high level of consumer satisfaction,” which he
had previously asserted was 99.99%.
8
Date Type Content
May 3, 2018 Earnings
Call
Southwell stated: “This outstanding compliance performance at
HIIQ continues in 2018 with only 6 Department of Insurance
(DOI) complaints in the entire first quarter of 2018. . . [and]
there was a total of 1, DOI complaint upheld against the
company.”
August 2,
2018
Earnings
Call
Southwell gave an update to the figures provided in May and
said there were only 12 complaints to state departments of
insurance, only 3 of which were upheld.
October 30,
2018
Earnings
Call
Southwell asserted that HII could show state departments of
insurance “a very happy consumer base, we can show them, a
very low number of complaints, a very high number customer
satisfaction.”
December 20,
2018
Presentation
at Investor
Analyst Day
in New York
City, in
which
Southwell
participated
HII stated that “[i]n terms of complaints, they are down with the
Department of Insurance complaints at 15 YTD vs. 28 YTD
2017 and only 3 upheld vs. 4 last year.”
A research analyst included HII’s presentation of the low
number of departments of insurance complaints in his December
20, 2018 research report. The report was published and
distributed to institutional investors and also sent to Southwell,
who did not correct or supplement the misleading information.
A different research analyst issued a December 21, 2018 report
stating, “the most power chart of the day” included the low
number of DOI complaints, which are “hardly an operating
concern or a level that would give the short theses any
credibility.”
January 7,
2019 (Form
8-K)
May 22, 2019
Investor
Presentations
(with one
filed with
Form 8-K)
HII stated there were 28 complaints to departments of insurance
in 2017 with only 4 upheld and 15 complaints in 2018 with only
3 upheld.
24. From 2017 to mid-2019, HII documented more than 24,000 dissatisfied consumers
complaining about agent misrepresentations, unauthorized billing and failures to cancel plans. HII
also documented approximately 28,000 chargebacks. HII recognized that many of these
9
chargebacks may have been initiated by consumers who claimed the charges were not authorized.
Thus, HII’s and Southwell’s above statements to investors concerned only a small fraction of the
total number of consumer complaints and dissatisfied consumers that HII tracked. Moreover,
investors were never told that HII itself, not the departments of insurance, designated certain
complaints as “upheld” and HII made those designations without even contacting complaining
consumers.
25. Before making the above statements, Southwell was on notice of a high number of
complaints and chargebacks and a large number of dissatisfied consumers trying to cancel plans.
For instance, in February 2017, Southwell received an email from an insurance carrier noting that
consumer complaints were “becoming more prevalent and requiring more resources.” In addition,
by at least September 2017, Southwell had communicated with the Better Business Bureau
about its “F” rating for HII, which was based on a pattern of consumer complaints alleging
agent misrepresentations. In another example, in September 2017, Southwell received an
email from HII’s compliance and risk officers about a series of reports of consumers
requesting cancellations, where the agents either refused to cancel or said the cancellations
had been made when in fact they were not. Nevertheless, Southwell failed to determine the
magnitude of complaints and chargebacks tracked by HII or otherwise verify that his statements
about consumer satisfaction and complaints were accurate before making them.
HII and Southwell Understated the Amount of Sales Generated by Simple
Health
26. On a November 2, 2017 investor call, an analyst asked Southwell whether HII had
any revenue concentration issues, such as any distributors that originated more than 10% of sales.
Southwell responded, “in 2016, we terminated two large distributors which was about 16% of
sales. And what I can confirm is that we don’t have any third party distributor as large as the guys
we . . . terminated back in 2016.” Several months before the call, Southwell had received HII
statistics showing that one distributor—Simple Health—generated significantly more sales than
the two terminated distributors combined.
27. Additionally, after the FTC’s action against Simple Health became public, on
November 2, 2018, HII issued a press release, with Southwell’s approval, stating that: (1) it was
terminating its relationship with Simple Health; (2) Simple Health was one of 100 sales agencies
working with HII; and (3) Simple Health was the agency of record for less than 10% of submitted
policies in 2018. HII stated at its December 20, 2018 Investor Analyst day presentation that
Simple Health contributed only 8.2% of submitted policies in 2018. Southwell knew these
statements were provided to research analysts who included them in their research reports. HII’s
January 7, 2019 investor presentation, filed on Form 8-K, included a similar statement about
Simple Health contributing 8.2% of submitted policies in 2018. The statements about the
percentage of submitted policies were misleading because Simple Health accounted for well over
20% of HII’s premiums, revenue and profits in just the first ten months of 2018, before Simple
Health was shut down.
10
HII’s and Southwell’s False and Misleading Statements Were Material to
Investors
28. HII’s and Southwell’s false and misleading statements, which involved specific
verifiable facts about its compliance and the amount of business generated by Simple Health, were
material to investors.
29. In SEC filings, HII and Southwell repeatedly highlighted the importance of
compliance as a competitive strength in the highly-regulated insurance industry. HII and
Southwell also acknowledged in the SEC filings that the failure of third-party distributors to
comply with applicable laws and regulations could adversely affect HII’s business.
30. HII’s and Southwell’s false and misleading statements related to an important
component of HII’s business. For example, in May 2016, Southwell was notified by HII’s then-
president that Simple Health’s compliance problem was HII’s biggest financial risk. In 2017,
Simple Health accounted for 31% of premiums collected by HII from consumers, 37% of HII’s
revenue and 27% of its profits. Southwell decided in September 2017 not to terminate Simple
Health, after receiving an internal analysis showing termination would result in a significant loss of
revenue and more than $15 million in loans that Simple Health had not yet repaid to HII. From
January through October 2018, when it was shut down by the FTC’s action, Simple Health
accounted for 21% of premiums collected by HII from consumers, 25% of HII’s revenue and 20%
of its profits.
31. Research analysts and the media included information they received from HII and
Southwell about the company’s compliance in their research reports and articles which were then
distributed to investors.
32. The price of HII stock declined significantly after two negative news
announcements. When the FTC’s lawsuit against Simple Health became public on November 2,
2018, HII’s stock price dropped 8.8% from the prior day’s closing price. HII’s stock price dropped
an additional 14.4% the following trading day. After a March 13, 2019 congressional press release
announcing an investigation into HII and other short-term health insurance sellers, HII’s stock
declined 17.2%.
Southwell’s Sales of HII Stock
33. Southwell sold 80,000 shares of HII stock in February 2019 for proceeds of $3.2
million and profits of $320,000 based on inflation in the stock price as a result of the misconduct
detailed herein.
Violations
34. In light of the information that Southwell received and had access to, Southwell and
HII knew or should have known the statements described above in reports filed with the SEC,
press releases, earnings calls and other communications with investors, research analysts and the
media, were materially false and misleading.
11
35. As a result of the conduct described above, HII and Southwell violated Sections
17(a)(2) and (3) of the Securities Act, which prohibit, in the offer or sale of securities, materially
false and misleading statements and practices that would operate as a fraud or deceit upon the
purchasers of securities. Negligence is sufficient to establish violations of Sections 17(a)(2) and
(3) of the Securities Act. Aaron v. SEC, 446 U.S. 680, 696-97 (1980).
36. As a result of the conduct described above, HII violated Section 13(a) of the
Exchange Act and Rules 12b-20, 13a-1 and 13a-11, which require every issuer of a security
registered pursuant to Section 12 of the Exchange Act to file with the Commission accurate annual
and current reports, which include such further information as may be necessary to make the
required statements not misleading. Scienter is not required for a violation of the reporting
provisions. See SEC v. McNulty, 137 F.3d 732, 740-41 (2d Cir. 1998).
37. As a result of the conduct described above, Southwell caused HII’s violations of
Section 13(a) of the Exchange Act and Rules 12b-20, 13a-1 and 13a-11 by signing and authorizing
the issuance of annual and current reports, when he knew or should have known they were
materially false and misleading. Negligence is sufficient for causing a primary violation that does
not require scienter. See KPMG, LLP v. SEC, 289 F.3d 109, 120 (D.C. Cir. 2002)
Disgorgement
38. The disgorgement and prejudgment interest ordered in Section IV.D below is
consistent with equitable principles, does not exceed Southwell’s net profits from his violations,
and will be distributed to harmed investors to the extent feasible. The Commission will hold funds
paid pursuant to paragraph IV.D in an account at the United States Treasury pending distribution.
Upon approval of the distribution final accounting by the Commission, any amounts remaining
that are infeasible to return to investors, and any amounts returned to the Commission in the future
that are infeasible to return to investors, may be transferred to the general fund of the U.S.
Treasury, subject to Section 21F(g)(3) of the Exchange Act.
IV.
In view of the foregoing, the Commission deems it appropriate and in the public interest
to impose the sanctions agreed to in Respondents’ Offers.
Accordingly, it is hereby ORDERED that:
A. Pursuant to Section 8A of the Securities Act and Section 21C of the Exchange Act, HII
and Southwell cease and desist from committing or causing any violations and any future violations
of Sections 17(a)(2) and (3) of the Securities Act and Section 13(a) of the Exchange Act and Rules
12b-20, 13a-1 and 13a-11 thereunder.
B. Respondent HII shall, within 10 days of the entry of this Order, pay a civil penalty of
$11 million to the Securities and Exchange Commission. If timely payment is not made, interest
shall accrue pursuant to 31 U.S.C. § 3717.
C. Respondent Southwell shall, within 10 days of the entry of this Order, pay a civil
12
money penalty in the amount of $750,000 to the Securities and Exchange Commission. If timely
payment is not made, interest shall accrue pursuant to 31 U.S.C. § 3717.
D. Respondent Southwell shall, within 10 days of the entry of this Order, pay
disgorgement of $320,000 and prejudgment interest of $41,511 to the Securities and Exchange
Commission. If timely payment is not made, additional interest shall accrue pursuant to SEC Rule
of Practice 600.
E. The foregoing payments must be made in one of the following ways:
(1) Respondents may transmit payment electronically to the Commission,
which will provide detailed ACH transfer/Fedwire instructions upon request;
(2) Respondents may make direct payment from a bank account via
Pay.gov through the SEC website at
http://www.sec.gov/about/offices/ofm.htm; or
(3) Respondents may pay by certified check, bank cashier’s check, or United
States postal money order, made payable to the Securities and Exchange
Commission and hand-delivered or mailed to:
Enterprise Services Center
Accounts Receivable Branch
HQ Bldg., Room 181, AMZ-341
6500 South MacArthur Boulevard
Oklahoma City, OK 73169
Payments by check or money order must be accompanied by a cover letter identifying HII or
Southwell as Respondents in these proceedings, and the file number of these proceedings; a copy of
the cover letter and check or money order must be sent to Lisa Deitch, Assistant Director, Division
of Enforcement, Securities and Exchange Commission, 100 F St., NE, Washington, DC 20549.
F. Pursuant to Section 308(a) of the Sarbanes-Oxley Act of 2002, a Fair Fund is created
for the disgorgement, prejudgment interest, and penalties referenced in paragraphs IV. B, C, and D,
above. Amounts ordered to be paid as civil money penalties pursuant to this Order shall be treated
as penalties paid to the government for all purposes, including all tax purposes. To preserve the
deterrent effect of the civil penalty, Respondents agree that in any Related Investor Action, they
shall not argue that they are entitled to, nor shall they benefit by, offset or reduction of any award
of compensatory damages by the amount of any part of Respondents’ payment of a civil penalty in
this action (“Penalty Offset”). If the court in any Related Investor Action grants such a Penalty
Offset, Respondents agree that they shall, within 30 days after entry of a final order granting the
Penalty Offset, notify the Commission’s counsel in this action and pay the amount of the Penalty
Offset to the Securities and Exchange Commission. Such a payment shall not be deemed an
additional civil penalty and shall not be deemed to change the amount of the civil penalty imposed
in this proceeding. For purposes of this paragraph, a “Related Investor Action” means a private
damages action brought against the Respondents by or on behalf of one or more investors based
on substantially the same facts as alleged in the Order instituted by the Commission in this
http://www.sec.gov/about/offices/ofm.htm%3B
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proceeding.
V.
It is further Ordered that, solely for purposes of exceptions to discharge set forth in Section
523 of the Bankruptcy Code, 11 U.S.C. §523, the findings in this Order are true and admitted by
Respondent Southwell, and further, any debt for disgorgement, prejudgment interest, civil penalty
or other amounts due by Respondent Southwell under this Order or any other judgment, order,
consent order, decree or settlement agreement entered in connection with this proceeding, is a debt
for the violation by Respondent Southwell of the federal securities laws or any regulation or order
issued under such laws, as set forth in Section 523(a)(19) of the Bankruptcy Code, 11
U.S.C. §523(a)(19).
By the Commission.
Vanessa A. Countryman
Secretary
22._Michael_John_Grondahl
23._Gavin_D._Southwell
17._Gavin_D._Southwell
18._Operator
19._Mark_Nicholas_Argento
20._Gavin_D._Southwell