BOSTON — Attorney General Maura Healey’s office is suing an orthodontist for submitting millions of dollars in false claims to the state’s Medicaid program, MassHealth, after a patient complained.
The AG’s office filed a lawsuit against Dr. Mouhab Z. Rizkallah, DDS, and two other companies that he owns. The companies, Dr. Mouhab Z. Rizkallah DDS MSD PC and The Braces Place of Lawrence LLC, have six practices throughout Lynn, Boston, Framingham, Lawrence, Lowell and Somerville.
The AG’s complaint alleges that the defendants were practicing illegal policies with intent to defraud MassHealth since November 2013.
“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.”
The AG’s complaint says that Rizkallah instituted various unnecessary medical practices to increase the amount of money received from MassHealth.
Healey’s office believes that Rizkallah purposefully extended the patient’s treatment time and increased the amount of money collected from MassHealth.
For example, he kept his MassHealth patients, mostly children, in braces longer than medically necessary so he could receive more money from MassHealth. He did this by applying braces only to the top teeth at first, even though there is no medical justification for delaying putting braces on the bottom teeth, the AG’s office said.
The lawsuit also alleges that Rizkallah requested custom-fit mouth guards for sports, when many patients did not request or even receive them. Sports mouth guards can only be billed to MassHealth when they are custom-fitted and the patient is engaged in a contact sport, but some patients received mouth guards that were the type sold in retail stores for around $10, as opposed to the $85 to $90 that he billed MassHealth for.
Rizkallah allegedly told his staff to cut the price off of the packaging before giving it to the patient and claiming that they were custom-fitted. It is believed that MassHealth paid Rizkallah’s orthodontist practices over $1 million for those mouth guards.
The AG’s office also alleges that Rizkallah received prior approval for certain MassHealth patients by intentionally misrepresenting to MassHealth that the patient had prior orthodontic treatment from another provider or was previously covered by another insurer.
MassHealth claims that these actions violate the state False Claims Act and Medicaid False Claims Act, constitutes a breach of contract by the two companies, and resulted in the unjust enrichment of the defendants.
The 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 lawsuit seeks treble damages and civil penalties.
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.
