DELTA DENTAL SHOULD NOT RUN MASSHEALTH – IT IS A CONFLICT OF INTEREST:
I. THE CONFLICT OF INTEREST:
- MassHealth is funded by the Federal Government under the Medicaid Act.
- MassHealth is supposed to follow Medicaid Act rules, without regard to cost.
- Delta Dental must follow Insurance Law rules, and they care about cost.
- Delta Dental can defend reduced coverages in private sector whenever MassHealth uses the same rules, by saying to the Insurance Overseers: “Look MassHealth does it, and they are theoretically not cost-focused. So we must be in bounds.”
- Enter DentaQuest – 2009
- Delta Dental owns DentaQuest.
- DentaQuest administers the MassHealth dental program.
- DentaQuest advises MassHealth’s “Dental Director” to make policy changes that save money.
- MassHealth is allowed to save money only if it is still following Medicaid Act rules of coverage.
- DentaQuest benefits if MassHealth saves money even when it violates the Medicaid Act rules.
- MassHealth changes policies and violates the Medicaid Act rules through corrupt practices (see below).
- Delta Dental then adopts those violative changes into private insurance plans (and is protected).
- Result: Delta saves tens of millions of dollars by controlling the MassHealth dental program.
II. METHOD OF CORRUPT CONTROL THAT ARE VISIBLE:
Dr. Brent Martin was the Dental Director of MassHealth from 2012 to 2014.
Curiously, after leaving MassHealth in 2014, Dr. Martin went to work for DentaQuest, as shown in the link below: This is a conflict of interest.
Before he left, Dr. Brent Martin devastated the MassHealth orthodontic program by implementing an orthodontic clinical analysis which all scientific studies indicated would predictably fail to recognize children that medically needed orthodontic care. Coverage was essentially eliminated by Dr. Brent Martin’s system.
Delta Dental promptly adopted this identical system into private insurance plans, and saved millions of dollars by denying care in the private sector (under the protection that they are following the MassHealth standards).
Dr. Mouhab Rizkallah and his orthodontist compatriots gathered volumes of research and presented them to MassHealth, but MassHealth refused to change course.
Dr. Mouhab Rizkallah reached out to the legislature and brought children to meet State Senators, who agreed that their legislation was not being followed. They reached out to MassHealth, but MassHealth did not change course.
Dr. Mouhab Rizkallah conducted a presentation at the Board of Registration in Dentistry (BORID), and the doctors on the board were disturbed by the egregious failures to cover kids with obvious medical needs. But the attorneys at the BORID advised the board that this was not in the BORID’s jursidiction.
Seeing no other option, MOMA sued MassHealth and forcibly restored the orthodontic program in 2016.
In the lawsuit discovery process, Dr. Mouhab Rizkallah obtained Dr. Martin’s internal records. It became apparent that Dr. Martin had all the studies that showed that his changes were scientifically unsupported and would unfairly eliminate coverage for needy children. Just before Dr. Rizkallah was about to expose Dr. Martin’s behavior, Martin abruptly left MassHealth and resurfaced as an employee of DentaQuest. The conflict of interest became clear and explained the strange behavior of MassHealth.
III. FULLY EXPOSING DENTAQUEST IS IMPOSSIBLE:
One of the critical reasons that Delta Dental should not be running any Medicaid program is that they are not subject to any Public Records Requests or litigation.
A. DentaQuest is immune to Public Records Requests:
- We have made numerous public records requests, and always fail to get it.
- DentaQuest always replies with the position that it is a “private company,” even though it administers a public program and is funded by the government.
- They are legally correct, but it should mean that they are not allowed to administer the government.
- DentaQuest is beyond the reach of Public Records Requests.
B. DentaQuest is immune to a Lawsuit:
- We have tried to sue DentaQuest and MassHealth.
- We always end up removing DentaQuest from the lawsuit (We can only sue MassHealth).
- Even if DentaQuest does terrible things to children of Massachusetts, only MassHealth can sue DentaQuest, because DentaQuest works for MassHealth (not the people).
- MassHealth will not sue DentaQuest, because of the conflict of interest.
- DentaQuest is beyond the reach of the law.
RESULT: The relationship between MassHealth and DentaQuest is invisible. Evaluating corruption is impossible, though we clearly see the conflict of interest.
Dr. Mouhab Rizkallah and MOMA believes that there should be laws to solve this:
LAW PROPOSAL 1: Third party government administrators of the government should be subject to the same public records accesses as government administrators.
LAW PROPOSAL 2: Dental Insurance Companies should have the same profit limitation as medical insurance companies, known as a “medical loss ratio.” Medical Insurance is currently capped at 12% profit. Dental Insurances have no cap and data shows they are at about 50% profit, and growing.
Until at least one of these laws is in place, Delta Dental Should not be administering MassHealth.
It is a significant conflict of interest.