BOSTON – Massachusetts Attorney General Maura Healey’s Office today, March 1, filed a lawsuit against an orthodontist for fraudulently submitting millions of dollars in false claims to the state’s Medicaid program, MassHealth, including by keeping children in braces for longer than medically necessary and deceptively billing for mouth guards.
The AG’s Office filed the lawsuit in Suffolk Superior Court against Dr. Mouhab Z. Rizkallah, DDS and two companies—Dr. Mouhab Z. Rizkallah DDS MSD PC and The Braces Place of Lawrence LLC—through which he owns and operates six orthodontic practices in Massachusetts.
There is a The Braces Place on Route 126 in Framingham.
The AG’s complaint alleges that since November 2013, the defendants instituted a series of illegal policies and practices with the intent to defraud MassHealth.
“For years, this orthodontist used his young patients as pawns to steal millions of dollars from the state,” said Healey. “This illegal behavior harmed families from low-income communities and communities of color who rely on MassHealth for health care coverage. We are suing to hold Dr. Rizkallah accountable for these exploitative practices that victimized vulnerable residents in Massachusetts.”
Dr. Rizkallah operates six orthodontic practices that currently do business as “The Braces Place,” with locations in Somerville, Boston, Lawrence, Lowell, Framingham, and Lynn. The AG’s Office began an investigation after receiving a patient complaint, and subsequently a related MassHealth referral.
The AG’s complaint alleges that Dr. Rizkallah instituted various practices to increase the amount of money collected from MassHealth, regardless of whether the services were medically necessary. For example, Dr. Rizkallah allegedly kept his MassHealth patients, mostly children, in braces longer than medically necessary so he could bill MassHealth for more money. To do this, he often put braces only on a child’s top teeth at the beginning of comprehensive orthodontic treatment, even when there was no medical justification for delaying putting braces on the bottom teeth. This significantly extended the patient’s treatment time and increased the amount of money collected from MassHealth.
The AG’s lawsuit further alleges that the defendants instituted a practice of billing MassHealth for custom-fitted sports mouth guards for MassHealth members receiving comprehensive orthodontic treatment at Dr. Rizkallah’s practices. Under MassHealth regulations, a claim for payment for an athletic mouth guard is payable by MassHealth only if the mouth guard is custom-fitted and the member is engaged in a contact sport. However, the AG’s investigation determined that many patients did not request, need, or receive these mouth guards, and if they did receive them, they were not custom-fitted.
In fact, when provided at all, the mouth guards given to patients were the type sold in retail stores for $9.99 and Dr. Rizkallah allegedly instructed his staff to cut the price off the packaging before giving it to the patient. Dr. Rizkallah billed MassHealth between $85 and $95 for each mouth guard. During this time, the AG’s Office alleges that MassHealth paid Dr. Rizkallah’s orthodontic practices more than $1 million for these mouth guards.
The AG’s lawsuit also alleges that the defendants routinely and intentionally circumvented MassHealth regulations requiring medical necessity and prior approval for comprehensive orthodontic treatment. The AG’s Office alleges that for certain MassHealth patients, the defendants obtained prior approval by intentionally misrepresenting to MassHealth that the patients had previously been receiving comprehensive or interceptive orthodontic treatment from another provider or had previously had their treatment covered by an insurer other than MassHealth.
The AG’s Office alleges that this conduct violates the state False Claims Act and the state Medicaid False Claims Act; constitutes a breach of contract by the two companies; and resulted in the unjust enrichment of the defendants. The lawsuit seeks treble damages and civil penalties.
This matter is being handled by Assistant Attorneys General Stephany Collamore and Matthew Turnell, Senior Healthcare Fraud Investigator Andrew Lutynski, and Investigator William Welsh, all of the AG’s Medicaid Fraud Division.
The AG’s Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts