American Alliance for Dental Insurance Quality Applauds MassHealth Selection of Benecare for Its Medicaid Dental Program

Medicaid-eligible residents in Massachusetts will receive the quality dental care they deserve, free from the systemic issues under DentaQuest

BOSTON, MA, UNITED STATES, June 13, 2024 /EINPresswire.com/ -- The American Alliance for Dental Insurance Quality (AADIQ) today expressed strong support for MassHealth's decision to replace DentaQuest with BeneCare Dental Plans as the Third Party Administrator (TPA) for its Medicaid dental program.

This change, affecting over 2 million Medicaid-eligible residents in Massachusetts, comes after years of public criticism and legal challenges against DentaQuest's management.

Dr. Mouhab Z. Rizkallah, President of AADIQ, has been a vocal advocate for this change. In a letter to MassHealth last August, he endorsed BeneCare's bid, stating, "While DentaQuest has done a good job at claims processing, DentaQuest has been an irresponsible TPA in many other ways, including their harmful policy of utilizing out-of-state consultants to service the unique regulations of the MassHealth dental program."

DentaQuest's tenure as MassHealth's TPA has been marred by several controversies:

1. Medical Discrimination: A class-action lawsuit (Dayanne N. v. Baker, Middlesex Superior Court, No. 2081CV01893) alleges that DentaQuest trained consultants to apply different diagnostic definitions for Medicaid patients than industry standards set by the American Board of Orthodontics. This lawsuit, supported by the Massachusetts Association of Orthodontists and filed by Dr. Rizkallah as President of MOMA (Medicaid Orthodontists of Massachusetts Association), resulted in an emergency injunction against MassHealth.

2. Access to Care Violations: In February 2024, Dr. Rizkallah led ten Massachusetts organizations, including the Massachusetts Dental Society, in filing a non-compliance letter to MassHealth. The letter demonstrated that DentaQuest's "Minutes to Provider" analysis violates Federal statute 42 USC 1396a (30)(a). "A patient may be 10-minutes away from a provider, yet months away from a cleaning or other procedure," Dr. Rizkallah noted.

3. Quality Control Failures: A 2014 lawsuit (Sam H. v. Baker (Patrick), United States District Court, D. Mass. No. 1:14-cv-10106-ML W) revealed that DentaQuest violated its contract by having non-orthodontists conduct prior authorizations for child Medicaid orthodontic cases. The resulting settlement mandated "Peer Reviews" for providers to correct consultant errors.

4. Conflicts of Interest: In 2014, Dr. Brent Martin, then MassHealth Dental Director, joined DentaQuest immediately after providers complained about DentaQuest's denial errors. According to providers, this gives the appearance that state conflict of interest laws were violated and led to regulatory capture, benefiting DentaQuest's sister company, Delta Dental of Massachusetts.

Additionally, the Massachusetts Ethics Commission fined former MassHealth Director Stacia Castro for accepting financial gifts from DentaQuest.

Lee Serota, President of BeneCare Dental Plans, said, "BeneCare is very excited to bring its outcomes-based dental care model to the Commonwealth. We look forward to partnering with Massachusetts state officials, dentists, and the oral health community to improve MassHealth members' oral health."

Dr. Rizkallah concluded, "I look forward to dealing with BeneCare - a company that believes in the Medicaid Act as a legal entitlement to care. "

The AADIQ believes this change marks a significant step towards ensuring that Medicaid-eligible residents in Massachusetts receive the quality dental care they deserve, free from the systemic issues that plagued DentaQuest's administration.

About the American Alliance for Dental Insurance Quality
The American Alliance for Dental Insurance Quality (AADIQ) originated as the “Committee on Dental Insurance Quality,” which was founded to ensure passage of Massachusetts Question 2 (2022) – the first dental voter ballot in history. The AADIQ is dedicated to improving the quality of private insurance and Medicaid insurance plans in every state.

The Board of Directors:
Dr. Mouhab Rizkallah DDS, President. Dr. Rizkallah is a distinguished orthodontist who was honored as Dentistry Today’s “Person of the Year” in 2022.
Dr. Margaret Scarlett DDS, Vice President. Dr. Scarlett is a renowned dentist, author, and pandemic disease expert.
Dr. David Leader DDS, Treasurer. Dr. Leader is the director of the Tufts University School of Dental Medicine DMD/MPH Dual Degree Program.
Dr. Patricia Brown DDS, Director. Dr. Brown is a Past President of the American Academy of Dental Sciences.
Dr. Andrew Chase DDS, Director. Dr. Chase is a Past President of the Massachusetts Association of Orthodontists.

Joel Rosen, Esq.
Rosen and Goyal, P.C.
204 Andover St
Suite 402
Andover, MA 0181
https://rosengoyal.com/

Dr. Mouhab Rizkallah
American Alliance for Dental Insurance Quality
mrizkallah@dentalinsurancequality.org