Litigation Brings Improved Access to Dental Health Care for Low Income Children in Massachusetts

Litigation Brings Improved Access to Dental Health Care for Low Income Children in Massachusetts

Settlement of Case Results in Generous Recognition of NHeLP’s Work to Improve Dental Care for Children

Carrboro, NC and Boston, MA – The National Health Law Program (NHeLP), a non-profit organization dedicated to ensuring health care rights for those in need, today confirmed a significant donation made to the organization by Dr. Mouhab Rizkallah, a Massachusetts orthodontist who has been a driving force of change in MassHealth’s proper coverage of medically necessary dental care for low-income children.

The $50,000 donation comes from the legal fees that were awarded to Dr. Rizkallah and his legal team (Rosen Law Office of Andover, Massachusetts and the National Health Law Program) after a settlement was reached with MassHealth in September 2016. That case, Sam H. v. Baker (Patrick), US District Court, D. Mass. No. 1:14-cv-10106-MLW, was the result of Rizkallah’s four-year journey challenging MassHealth’s unfair and rights-violating review and rejection of numerous applications for medically necessary orthodontics.

Joel Rosen of Rosen Law Office says: “Dr. Rizkallah personally funded this class action suit on behalf of his clients, generously underwriting $250,000 in legal fees associated with the case.”

NHeLP Legal Director, Jane Perkins, says “We at NHeLP are deeply appreciative that Dr. Rizkallah is willing to contribute this fee award to our program. We proudly accept his donation so that our organization can continue to enforce the legal rights of low-income children and people with disabilities, nationally and in other states.”

About the case:

Over the past four years, low-income children in Massachusetts were routinely denied needed dental care. We tend to think of braces as cosmetic but for many children with impacted teeth or other problematic tooth growth patterns, braces are a medical necessity. In summary:

  • MassHealth employed an unfair scoring system (with one of the highest thresholds in the nation – making it difficult for most cases to be approved);
  • Exacerbated the issue further by assigning improperly licensed professionals to review applications, leading to errors in evaluations; and
  • Provided little to no explanation for the claims that were rejected.

This resulted in children being denied needed dental treatment for conditions that were causing broken/shattered teeth (because of improper overbites), serious jaw problems, and chronic pain.

Dr. Mouhab Rizkallah decided to challenge the system. Frustrated by MassHealth’s continued rejection of his patients’ legitimate claims, Rizkallah began a four-year journey in 2012, personally investigating and contesting MassHealth’s dental review process. In February 2013, he filed a formal complaint against MassHealth and in 2014, personally funded a class action suit on behalf of a group of his patients, against the State of Massachusetts. That suit, led on the plaintiffs’ side by Rosen Law Office and NHeLP, and which personally cost Dr. Rizkallah $250,000, was successfully settled in September 2016. During this time, Dr. Rizkallah treated those patients – at no charge.

Because of the case, MassHealth reduced its evaluation threshold so more medically necessary claims can be approved and is now accountable in a review process for employing licensed dental professionals to review all cases. To put the impact of this victory into perspective, under MassHealth’s unfair rating system, only 12 percent of cases were being approved. After the settlement, dentists and their patients in the state can expect to see 52 percent of cases approved.

Please contact NHeLP’s Director of Communications Jeremy Leaming for more comment about NHeLP’s mission and work.

NHeLP, founded in 1969, protects and advances the health rights of low-income and underserved individuals and families. NHeLP advocates, educates, and litigates at the federal and state levels.

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