Lawsuit claims orthodontist overcharged state by millions

Jill Harmacinski, The Eagle-Tribune, North Andover, Mass.
·3 min read

Mar. 2—An orthodontist with a Lawrence practice is being sued by the attorney general for fraudulently billing Medicaid for millions of dollars, including keeping children in braces for too long and deceptively overbilling for mouth guards.

Attorney General Maura Healey's office on Monday filed the lawsuit against Dr. Mouhab Z. Rizkallah, DDS, and two companies — Dr. Mouhab Z. Rizkallah DDS MSD PC and The Braces Place of Lawrence LLC — according to a statement.

Filed in Suffolk Superior Court, the lawsuit claims that since November 2013, Rizkallah instituted a series of illegal 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," Healey stated. "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."

Rizkallah operates six orthodontic practices that currently do business as The Braces Place, with locations in Lawrence, Somerville, Boston, Lowell, Framingham, and Lynn.

Healey's office began an investigation after receiving a patient complaint and subsequently a related MassHealth referral.

Rizkallah is accused of instituting various practices to increase the amount of money collected from the state, 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," according to the statement. "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 lawsuit further states that Rizkallah instituted a practice of billing MassHealth for custom-fit sports mouth guards. But under MassHealth regulations, a claim for payment for an athletic mouth guard is payable only if it is is custom-fit and the recipient plays a contact sport.

"However, the AG's investigation determined that many patients did not request, need, or receive these mouth guards," according to the complaint. "And if they did receive them, they were not custom-fit."

Rizkallah is accused of billing between $85 and $95 for mouth guards sold in retail stores for $9.99, according to Healey's office.

"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 statement.

Further, the AG says, Rizkallah also "routinely and intentionally circumvented MassHealth regulations requiring medical necessity and prior approval for comprehensive orthodontic treatment."

The conduct, according to Healey, violates the 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 lawsuit seeks treble damages — meaning three times the actual damage — and civil penalties.

Follow staff reporter Jill Harmacinski on Twitter @EagleTribJill.