AG’s office suing orthodontist for keeping kid’s braces on too long, falsely billing MassHealth

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BOSTON (WWLP) – The Massachusetts Attorney General is charging an orthodontist that filed millions of dollars in false claims to MassHealth, the state’s Medicaid program.

The AG’s Office filed the lawsuit in Suffolk Superior Court against Dr. Mouhab Z. Rizkallah, DDS and two companies through which he owns and operates six orthodontic practices in Massachusetts doing business as “The Braces Place.” The AG’s complaint alleges that since November 2013, the practice defrauded MassHealth.

The AG charges that Dr. Rizkallah kept MassHealth patients, mostly children, in braces longer than medically necessary in order to continue billing the state.

The suit also alleges that the business charged for custom-fitted sports guards for MassHealth members under orthodontic care, but investigators found 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. MassHealth was then billed 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.

According to the lawsuit, the practice also went around MassHealth regulations requiring medical necessity and prior approval for orthodontic treatment. They allege that the Rizkallah obtained prior approval by falsely reporting to MassHealth that the patients had previously been receiving 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.

“The Braces Place,” have locations in Somerville, Boston, Lawrence, Lowell, Framingham, and Lynn.

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