AG sues Lowell doctor
Deceptive billing practices alleged
COSTON » The office of Attorney General Maura Healey has filed a lawsuit against an orthodontist with an office in Lowell for allegedly submitting millions of dollars in fraudulent MassHealth claims.
According to Healey’s office, Dr. Mouhab Z. Rizkallah, who operates six orthodontic practices in Massachusetts, including one in Lowell, allegedly kept children in braces for longer than medically necessary and deceptively billed patients for mouth guards they could have bought in retail stores for a fraction of the cost.
The lawsuit was filed Monday in Suffolk Superior Court against Rizkallah and two companies, Dr. Mouhab Z. Rizkallah DDS MSD PC and The Braces Place of Lawrence LLC, through which he owns and operates locations in Lowell, Somerville, Boston, Lawrence, Framingham and Lynn.
The lawsuit alleges that since November 2013, the defendants instituted a series of illegal policies and practices with the intent to defraud the state’s Medicaid program, MassHealth.
“For years, this orthodontist used his young patients as pawns to steal millions of dollars from the state,” Healey said in a statement. “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.”
Healey’s office began an investigation after receiving a patient complaint, followed by a related MassHealth referral.
Rizkallah allegedly instituted various practices to increase the amount of money collected from MassHealth, including keeping patients who were mostly children in braces longer than medically necessary so he could bill
MassHealth for more money. One such practice allegedly included putting braces only on a child’s top teeth to start, despite there being no medical justification to delay putting braces on the bottom teeth, significantly extending the patient’s treatment time.
“Delaying full banding of a patient absent any medical justification for doing so is not consistent with professionally recognized standards for orthodontic health care,” the lawsuit states.
“Keeping a patient in braces for longer than medically necessary can
cause harm to a patient’s teeth and/or oral health.”
The lawsuit alleges that Rizkallah instructed staff not to remove braces from MassHealth patients receiving comprehensive orthodontic treatment, even if treatment was complete, until after the amount paid by MassHealth met or exceeded $3,500.
Rizkallah allegedly billed MassHealth for “custom-fitted” sports mouth guards for patients who did not need, request or receive the guards.
For those who did receive them, Rizkallah allegedly often gave his patients mouth guards sold in retail stores for $10, instructing his staff to cut the price off the packaging,
and billed MassHealth between $85 and $95 for each mouth guard, amounting to $1.09 million in the period the lawsuit covers.
According to the lawsuit, Rizkallah had his staff bill MassHealth “for at least one and as many as three custom-fitted sports mouth guards for each MassHealth member” that already had prior authorization for comprehensive orthodontic treatment.
Between Nov. 1, 2013, and the present, the defendants allegedly billed MassHealth for at least one such mouth guard for at least 8,901 unique MassHealth members, of which at least 1,896 were billed for more than one.
“Many of these claims for payment were false in that many MassHealth members as to whom MassHealth was billed for a custom-fitted sports mouth guard did not receive a mouth guard at all while others received a mouth guard that would be ineligible for payment by MassHealth, even if the member had been engaged in a contact sport at the time the mouthguard was provided,” the lawsuit
states.
The lawsuit also alleges Rizkallah and his companies routinely circumvented MassHealth regulations requiring medical necessity and prior approval for comprehensive orthodontic treatment. An employee who answered the phone at the Lowell location of The Braces Place early Tuesday afternoon directed a reporter to the Somerville location, where Rizkallah primarily works. A message left with an employee at the Somerville location seeking comment from Rizkallah was not immediately returned.
According to a biography on The Braces Place website, Rizkallah is president of the Medicaid Orthodontists of Massachusetts Association and a member of numerous professional societies, including the World Federation of Orthodontists.
The case is being handled by members of the AG’s Medicaid Fraud Division, including Assistant Attorneys General Stephany Collamore and Matthew Turnell, Senior Health Care Fraud Investigator Andrew Lutynski and Investigator William Welsh.