Misdiagnosis – Injunction

Underprivileged Kids need the same quality of care as privileged kids.

If a Medicaid child having the same problem as a Non-Medicaid child receives a different diagnosis just because the Medicaid child has Medicaid, that is called Medicaid Discrimination (defined at 130 CMR 450.202).

Who would commit such a crime?  MassHealth and DentaQuest did it.  Attorney General Maura Healey defended it in 2020.  See Maura Healey’s defense of MassHealth actions here.

Dr. Mouhab Rizkallah sued and was awarded this historic injunction against MassHealth.

Page 10 says:  “….the defendants [MassHealth] likely violated the state law.”

In June 2020, MassHealth adopted a policy that was forcing orthodontists to intentionally misdiagnose ONLY children that have MassHealth.  They did this by re-defining standard diagnostic terms for  MassHealth kids.

Their goal was to reduce the number of kids getting Federal Entitlement to Medicaid care.

When they defended themselves in court, they lied and argued that these were insignificant technical edits.

Page 8 of the judge’s decision explains:  DentaQuest and MassHealth “were aware” approvals would drop for the kids.  Therefore, these were not insignificant edits.  The judge caught them in their deception.

Page 11:  The judge’s historic injunction forced them to go back to the old definitions as a court order.

MOMA has protected the Medicaid Entitlements of tens of thousands of children under the guidance of Dr. Mouhab Z. Rizkallah, President.  MOMA has sued MassHealth three times and has forced them back into compliance with the Federal Medicaid Act each time.

This latest historic injunction embarrassed MassHealth and Attorney General Maura Healey, because it exposed that they are willing to break the law to undermine children’s entitlement rights.  To find out why, read Delta Dental Should Not Run MassHealth.

MOMA’s next step is to continue this latest litigation to find out WHO EXACTLY instituted these illegal changes.  To date, MassHealth and Attorney General Maura Healey refuse to indicate who changed the terms, because that person would be subject to discrimination and other charges.  This “someone” would have been someone who has power in MassHealth.

We know this change occurred somewhere between the exit of Dr. Donna Jones and the entrance of Dr. Catherine Hayes as Dental Director of MassHealth.  Dr. Jones cannot be reached for comment.  When Dr. Rizkallah asked Dr. Hayes if she made the change, she denied it and said it was in place prior to her appointment as MassHealth Dental Director.  When Dr. Rizkallah asked Hayes who made the change, she said she did not know.  When Dr. Rizkallah asked her reverse the change, since it was illegal, she indicated that the MassHealth Counsel told her it was legal.  So who is this MassHealth counsel?

It is possible that this was done by Attorney Russell Leino, Deputy General Counsel of MassHealth.

He has spent the last 5+ years terrorizing the MassHealth Orthodontics program.  In fact, on April 17, 2018, MOMA filed a Reassignment Request to Governor Baker against Attorney Russell Leino for his abusive attorney activities, including violation of Supreme Judicial Court’s Rule 4.1 (Truthfulness in Statements to Others).

Page 4 of the Reassignment Request indicates that Attorney Leino falsely stated that a rate change was just a “clarification.”

This “clarification” trick is quite similar in form to the “technical edits” trick of the injunction.  The first trick was reversed as an Emergency Amendment (2018), and the second trick was reversed as the Historic Injunction (2020).

So it is quite possible that Attorney Russell Leino approved the illegal change of the diagnostic terms.

In February 2021, it became apparent that MassHealth was violating the 2020 Historic Injunction.  Dr. Mouhab Rizkallah sent an email to MassHealth and the Attorney General’s office, indicating that Dr. Mouhab Rizkallah would file a Contempt of Court complaint if this was determined to be true, and asked MassHealth to respond to confirm it is following standard diagnostic terms definitions.  MassHealth did not respond.

On February 15, 2021, President Dr. Mouhab Rizkallah informed MassHealth and the Attorney General that MOMA would be filing a Contempt of Court complaint if he did not hear back from them by Feb 24th.

They did not respond, but instead began an abusive media campaign against Dr. Mouhab Z. Rizkallah.

After losing in court repeatedly, and under the new threat of Contempt of Court on February 15, 2021 from MOMA, Attorney General Maura Healey launched a media campaign against President Dr. Mouhab Z. Rizkallah, accusing him of MassHealth violations that are simply not violations in the regulations. 

Rizkallah has no concerns about the legal basis of the violation claims, but the harm to his reputation, his practice, and his family are real.  Healey is abusing her position to chill the activities of her opponent. 

Rizkallah is suing Attorney General Healey for Defamation, and expects to win on that claim. 

For more on the Attorney General’s abuse, go to: 

The Attorney General Abused Her Power By Attacking MOMA Advocates