Press Release: 2021-06-11
AG Healey Sues Orthodontist for Illegally Charging MassHealth Patients for Missed or Cancelled Appointments
AG Healey Sues Orthodontist for Illegally Charging MassHealth Patients for Missed or Cancelled Appointments:
Adds Claims to Existing Lawsuit Against Orthodontist for Millions of Dollars in False Claims Billed to MassHealth, Keeping Children in Braces for Longer than Medically Necessary
FOR IMMEDIATE RELEASE: 6/10/2021
BOSTON — Attorney General Maura Healey’s Office filed an amended lawsuit against an orthodontist for allegedly illegally charging MassHealth patients for missed or cancelled appointments. The new claims were added to a lawsuit already filed against the orthodontist for fraudulently submitting millions of dollars in false claims to MassHealth, including by keeping children in braces for longer than medically necessary and fraudulently billing for mouth guards.
The AG’s Office filed the amended lawsuit in Suffolk Superior Court on Monday 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.
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 complaint from a patient’s guardian.
The AG’s amended complaint adds claims that Dr. Rizkallah and his orthodontic practices charged MassHealth members for missed or cancelled appointments, in violation of MassHealth and federal regulations. As part of its investigation, the AG’s Office determined that the defendants required MassHealth patients to sign a “MassHealth Treatment Contract” in which the patients agreed to a minimum $20 fee for missed or cancelled appointments and for appointments rescheduled on less than 24 hours’ notice. Dr. Rizkallah and his orthodontic practices allegedly charged and collected such fees consistent with those contracts. Under MassHealth regulations, providers are prohibited from charging MassHealth patients out-of-pocket fees for covered services, including any costs associated with appointments that patients are unable to make.
The AG’s Office alleges that since November 2013, the defendants instituted a series of illegal policies and practices with the intent to defraud MassHealth. The AG’s original and amended complaints allege that Dr. Rizkallah instituted various practices to increase the amount of money collected from MassHealth, regardless of whether the services were medically necessary.
The AG’s original lawsuit, filed in February 2021, alleges that Dr. Rizkallah allegedly kept his MassHealth patients, mostly children, in braces longer than medically necessary so he could bill MassHealth for more money. The AG’s lawsuit further alleges that the defendants instituted a practice of fraudulently billing MassHealth for custom-fitted sports mouth guards for MassHealth members receiving comprehensive orthodontic treatment at Dr. Rizkallah’s practices.
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.