State Circuit Judge Kathleen Watanabe sentenced Dr. Terry Allen to a four-year term of deferral and ordered to pay restitution in the amount of $20,878.86 to Hawaii Medical Services Association (HMSA).
He was also ordered to pay a fee of $2,500.00 to the Crime Victims Compensation Fund and other court fees.
Dr. Allen, a dentist on Kauai, was the owner of Kalaheo Dental Group but has since sold the practice.
While in practice, he along with office manager Diane Maldonado fraudulently billed HMSA and Hawaii Dental Service (HDS).
Maldonado was sentenced in July of 2018 by Judge Watanabe and placed on deferral status for four years.
She was ordered to pay restitution in the amount of $3,413.65 to HDS.
One of the schemes she was involved in was utilizing her niece’s dental plan to pay for services rendered to the niece’s boyfriend. Maldonado was also ordered to pay appropriate court fees.
In another scheme, Dr. Allen, a non-participating HMSA physician, used the names and numbers of his dental associate’s, who were participating HMSA physicians, to charge HMSA for work performed.
This caused payment to him higher than what he would receive as a non-participating member.
Finally, another scenario involved patients who had dual coverage.
Dr. Allen would bill both insurers as the primary insurer, causing an overpayment that was credited to the patient’s account and later removed from the credit balance.
No refund was ever issued.
Insurance fraud is not a victimless crime and offenders come from all walks of life.
Insurance companies suffer the loss but ultimately the consumers are affected with the rise of premiums.
To report suspicious activity or for more information on insurance fraud, call the Insurance Fraud hotline at (808) 587-7416.