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.

Troutman Pepper Locke State Attorneys General Team

	Ashley Taylor – Co-leader and Firm Vice Chair Ashley is co-leader of the firm’s nationally ranked State Attorneys General practice, vice chair of the firm, and a partner in its Regulatory Investigations, Strategy + Enforcement (RISE) Practice Group. He helps his clients navigate the complexities involved with multistate attorneys general investigations and enforcement actions, federal agency actions, and accompanying litigation.
	Clay Friedman – Co-leader Clay co-leads the firm’s State Attorneys General practice and is nationally ranked by Chambers USA for AG Government Relations and in Best Lawyers for Advertising Law. He has dedicated his entire career to state attorney general and federal work, serving for nearly a decade in a senior role and more than 25+ years in private practice. Clay focuses his practice on helping industry-leading companies mitigate the risks associated with state and federal regulatory investigations and associated litigation.
	Chris Carlson Chris advises clients on regulatory, civil, and criminal investigations and litigation. With a background as an assistant attorney general, he provides practical guidance to clients with matters involving state attorneys general and federal regulatory agencies.
	Lauren Fincher Lauren has vast experience handling state attorneys general investigations, navigating complex regulatory compliance matters, and providing strategic counsel in enforcement actions across various industries. She helps clients manage high-stakes regulatory matters and guides them through complex legal landscapes.
	Stephen Piepgrass Stephen leads the firm’s Regulatory Investigations, Strategy + Enforcement (RISE) Practice Group, representing clients in single and multistate enforcement actions, including inquiries and investigations, as well as litigation involving state attorneys general and other state and federal governmental enforcement bodies. He has significant experience handling actions with federal agencies, including the CFPB and FTC, as well as single plaintiff and class action litigation for clients in highly regulated sectors such as financial services, health care, pharmaceutical, and education.
	Michael Yaghi Mike handles high-profile state attorneys general, FTC, and CFPB investigations by advising clients through these complex government inquiries. He assists clients through the entire life cycle of investigations, from regulatory enforcement through formal litigation.
	Matthew J. Berns Drawing on his experience in senior leadership roles in the New Jersey Attorney General’s and Governor’s Offices and as a trial attorney for the U.S. Department of Justice, Matt provides an insider’s perspective when guiding clients through complex government investigations, litigation, and other actions.
	Samuel E. “Gene” Fishel Gene is a former regulator with two decades of experience who has overseen state privacy and cybersecurity regulation enforcement, led national, multistate attorneys general privacy investigations, and prosecuted computer crimes at the state and federal levels. He has served at the forefront of state attorney general and federal enforcement, and utilizes this experience to proficiently represent client interests.
	Jeff Johnson Jeff helps clients navigate complex regulatory and litigation challenges with local, state, and federal authorities. His clients benefit from his decade of broad litigation experience, understanding of emerging state and federal regulatory issues, and strong relationships with attorneys general across the U.S. In addition to handling cases from trial through state or federal appeals, Jeff serves as amicus counsel in advancing legal rules to support his clients’ vital interests.
	Jay Myers Jay assists clients in heavily regulated industries, including health care, energy, insurance, emerging industries, and data privacy. He provides both regulatory legal advice and government relations strategies. Jay’s past and current clients include Fortune 10 companies, startups, nonprofits, industry associations, and advocacy groups. Recognizing that state government matters are often complex and multifaceted, he utilizes regulatory guidance, government advocacy, or both in tandem to deliver tailored solutions for each client’s unique needs.
	Zoe Schloss Zoe represents clients in litigation and government investigations. As former deputy attorney general for the Delaware Department of Justice, she is an experienced litigator who understands the enforcement priorities that impact her clients. Zoe works with individuals and corporate entities in highly regulated industries, including financial services, health care, and energy.
	Jessica Birdsong Jessica is an associate in the firm’s Regulatory Investigations, Strategy + Enforcement Practice Group. She received her J.D. from the University of Richmond School of Law, magna cum laude, where she served as associate articles editor of the Journal of Law & Technology.
	Nick Gouverneur Nick is an associate in the firm’s Regulatory Investigations, Strategy + Enforcement Practice Group. He received his J.D. from the University of Illinois College of Law, where he served as a member of the Journal of Law, Technology & Policy.
	Troy Homesley Troy is an accomplished litigator who has represented and defended clients across a wide range of complex, high-stakes disputes at both the trial and appellate levels. He has represented technology companies, business executives, law firms, investment funds, high-ranking federal officials, international non-profits, and asylum seekers. Troy draws on his broad litigation experience to advise clients before litigation arises, while claims are pending or threatened, and leading up to and through trial and appeals.
	Namrata Kang Namrata (Nam) is an associate in the firm’s Regulatory Investigations, Strategy + Enforcement (RISE) Practice Group, based in the Washington, D.C. office. She routinely advises clients on a wide variety of state and federal regulatory matters, with a particular emphasis on state consumer protection laws relating to consumer financial services and marketing and advertising. Nam’s experience transcends multiple industries, including financial services, telecommunications, media, and sports betting.
	Michael Lafleur Michael is an associate in the firm’s Regulatory Investigations, Strategy, and Enforcement Practice Group. Based out of the firm’s Boston office, Mike has deep experience in litigation, investigations, and other regulatory matters involving state-level regulators and state attorneys general.
	Philip Nickerson Philip represents clients in sectors such as financial, tech, real estate, and energy in a range of litigation matters. He is experienced in matters involving trade secrets, government investigations, commercial contracts, construction and product defect.
	Lane Page Lane specializes in federal and state regulatory investigations and complex civil litigation. He focuses on representing financial institutions and other businesses, with a particular emphasis on consumer protection and fair lending issues.
	Dascher Pasco Dascher is an attorney within the Regulatory Investigations, Strategy, and Enforcement practice, based in the Richmond office. She joined our firm after working in personal injury and medical malpractice for a Virginia trial law firm. Dascher brings varied legal experience to the firm with strong litigation and regulatory strategy capabilities.
	Kyara Rivera Rivera Kyara is an associate in the firm’s Regulatory Investigations, Strategy + Enforcement Practice Group. She received her J.D. from the University of Richmond School of Law, cum laude, where she served as publications and online editor of the Public Interest Law Review.
	Timothy Shyu Timothy is an associate in the firm’s Regulatory Investigations, Strategy + Enforcement Practice Group.
	Trey Smith Trey focuses his practice on representing and advising regulated utilities before state public utility commissions. He routinely helps clients obtain certificates of public convenience and necessity for transmission infrastructure. In this role, Trey works with his clients’ subject-matter experts to manage administrative proceedings, including by preparing initial filings; responding to discovery requests; drafting rebuttal testimony; and litigating any disputed issues.
	Daniel Waltz Dan helps clients navigate all aspects highly regulated relationships between industry participants and federal, state and local governments. Whether engaging with regulators, negotiating transactions or representing clients in the courtroom, he delivers solutions that help his clients achieve their strategic goals.
	Cole White Cole is a member of the firm’s Regulatory Investigations, Strategy and Enforcement (RISE) group. He has a decade of experience working in the attorney general community, having joined the firm from the Wyoming Office of the Attorney General, where he was assistant attorney general.
	Stephanie Kozol Stephanie is Troutman Pepper Locke’s senior government relations manager in the state attorneys general department.