Sam H. & MOMA Versus Patrick (2014–2016) — how Dr. Mouhab Z. Rizkallah unlocked medicaid entitlements for hundreds of thousands of children.
Dr. Mouhab Z. Rizkallah — Leads Thousands of Children to Coverage
President, Medicaid Orthodontists of Massachusetts Association
MOMA Lawsuit #1 (2014–2016):Sam H. & MOMA Versus Patrick
Dr. Mouhab Z. Rizkallah unlocked the medicaid entitlements for hundreds of thousands of children through this advocacy.
This lawsuit was filed after Dr. Brent Martin, then dental director of MassHealth, adopted a new Orthodontic-Severity measurement tool in 2012 that unfairly eliminated coverage for needy underprivileged children. Discovery documents clearly showed that Dr. Martin knew that all orthodontic studies disagreed with his use of the measurement tool. Martin adopted it to obstruct thousands of kids from their rightful Federally mandated coverage. In doing so, he would enable Delta Dental to also drop their coverages for private paying families (Delta did just that). Delta Dental profited significantly by Dr. Brent Martin’s actions as the MassHealth Dental Director. Immediately after Dr. Mouhab Z. Rizkallah reversed these illegal actions, Dr. Brent Martin left MassHealth and was named Dental Director of DentaQuest Tennessee (which is owned by Delta Dental).
Kids suffered between 2012 and 2016. MOMA, led by Dr. Mouhab Z. Rizkallah sued and forced MassHealth into Federal compliance. MOMA settled the case, with MassHealth changing their policy and paying MOMA President (Dr. Mouhab Rizkallah) $50,000 in attorney fees, since he personally funded the lawsuit in excess of $250,000.
in 2012 the changes in the mass health policies uh caused thousands of kids to be underserved by the mass health coverage for orthodontics ultimately i got involved because someone had to stand up for these kids and since i was a child standing up for the underdog has been something i've always been very comfortable with the fact is that mass health is a goliath and it's scary to go against a large governmental agency like mass health but somebody has to do it and it might as well be me knowing that no one else will the the implications to date i am privileged to say has been to give thousands of kids access to orthodontic care that is really medical necessity for them it's not a cosmetic thing it's not i want a pretty smile it's a i'm in pain it's a i am truly needy and these underprivileged kids that are getting treatment today have no idea how much work it took to get to this point but ultimately these kids and for decades forward thousands tens of thousands perhaps hundreds of thousands of kids are going to have had benefits because someone stood up and the privilege doesn't just stop at massachusetts we've already started to see that this impact has gone national where the results of this case are encouraging emboldening attorneys and practitioners from other states to say hey if they could do it in massachusetts the need isn't different here
Transcript
the reason that i'm proud of this case is that we were able to get coverage for thousands of kids who deserved it who federal law entitled to coverage and who were being denied it for no good reason now they're getting it they weren't considering medical necessity medical necessity is the touchstone for medicaid cases a kid is entitled to coverage if there's a medical necessity and what they were doing was they were saying we don't care about medical necessity we're going to give you a number and if you can meet this number then we by definition your case is medically necessary and there was no science that backed up the number i think that now even if a kid look we're not happy with the threshold we ended up with it's better than what it was but it's a settlement all right but i think that what we are happy with is that the state now has to take account of medical necessity so even if a kid doesn't meet their number we can show by other means that there was a real necessity for treatment that added a layer of compassion and humanity back into the problem
Transcript
my name is stephen lopez i'm 21 years old and i had my braces for around two years from 2012 to 2014. my teeth were the upper part of my teeth and the bottom part were right on top of each other normally a person should have them should have an overbite mine were right on top of each other and as i got older i was gonna develop an underbite which not only that it looked bad it would have like health problems like after first of all dr viscalla he's a great person the doctor who like provided the braces for me and he gave me the chance to have him uh and just being around him was a great thing and letting me have those braces gave me like a lot of confidence like after the fact and i really needed them because it was actually like a health problem in the future it was going to be so uh just having the opportunity to have them and you know fix uh my teeth it was just a great opportunity that i'm very grateful to dr viscalla for robert castelluccio and i'm 15 and i've had braces for about two years now and i'm expected to get him off in about a month it has helped me gain confidence because i know once i get these off it'll help a lot more just the look and everything glorious i'm 12 and i have two years with my braces i feel more comfortable smiling because it is better
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