BeneCare Awarded MassHealth Medicaid Dental Contract After DentaQuest’s Problematic Tenure

MassHealth, the Massachusetts Medicaid Agency, has removed DentaQuest as its Third Party Administrator (TPA) for dental care following numerous public criticisms of DentaQuest.

MassHealth has instead chosen BeneCare Dental Plans to replace DentaQuest in administering services for over 2 million Medicaid-eligible Residents. 

DentaQuest’s Troubled History

The transition to BeneCare comes after a problematic tenure by DentaQuest, which has faced criticism for numerous issues that impacted the quality of care provided to MassHealth members.

Dr. Mouhab Z. Rizkallah, President of the American Alliance for Dental Insurance Quality (AADIQ), has been at the forefront of exposing these issues and advocating for change.

He wrote to MassHealth last August to support Benecare’s bid, stating: “While DentaQuest has done a good job at claims processing, DentaQuest has been an irresponsible TPA (third party administrator) in many other ways, including their harmful policy of utilizing out-of-state consultants to service the unique regulations of the MassHealth dental program.” [see letter below]

The other issues with DentaQuest include:

Medical Discrimination Allegations

DentaQuest, as MassHealth administrator, continues to be at the center of a class action lawsuit filed in 2020 against MassHealth (Dayanne N vs Baker).  The lawsuit alleged that DentaQuest trained their consultants to apply different diagnostic definitions for Medicaid patients than the industry standards defined by the  American Board of Orthodontics. 

The ongoing lawsuit resulted in an emergency injunction against MassHealth for these violations.  The Massachusetts Association of Orthodontists supported the lawsuit, which was filed by Dr. Mouhab Rizkallah, as President of MOMA (Medicaid Orthodontists of Massachusetts Association), on behalf of numerous child patients. 

According to Dr. Rizkallah, “DentaQuest changes these medical definitions in order to obstruct coverage for children.  I liken it to going to an eye-doctor and reading the wall chart, where there is a 5-foot line for Medicaid kids and a 10-foot line for Non-Medicaid Kids.  The Medicaid child does not need glasses if he stands at the 5-foot line, but if you put that child at the standard 10 foot line, that Medicaid child does need glasses.  That is Medical Discrimination in just the same way that a child with a real open bite is ‘redefined’ as not having an open bite just because the child has Medicaid.  That is what DentaQuest promotes.” 

Access to Care Allegations 

As recently as February 2024, Dr. Mouhab Rizkallah led ten Massachusetts organizations, including the Massachusetts Dental Society, to send a DentaQuest non-compliance letter he composed to MassHealth.   

The letter demonstrated that DentaQuest had employed an improper “Minutes to Provider” analysis in violation of Federal statute 42 USC 1396a (30)(a).  “Minutes to provider,” the letter indicated, is a meaningless metric that does not meet the “access to care and services” standard of the Federal Statute. As reported in AADIQ’s previous article about this complaint, “a patient may be 10-minutes away from a provider, yet months away from a cleaning or other procedure.”

Intentional Quality Control Failures

In 2014, DentaQuest was also at the center of an Orthodontic Consultant quality control lawsuit.  While DentaQuest’s contract with MassHealth required them to utilize orthodontists in prior authorizations of child Medicaid orthodontic cases, DentaQuest violated their contract by having non-orthodontists conduct these evaluations. 

The lawsuit (Sam H. vs Patrick) was again filed by Dr. Mouhab Rizkallah, as President of MOMA, on behalf of a class of named Medicaid children.  The result was a settlement, which included a requirement for “Peer Reviews,” whereby a provider could speak to an out-of-state consultant to correct errors that they made – rather than just accept the errors. 

Between 2016 and 2020, Dr. Rizkallah himself “Peer Reviewed” approximately 750 cases denied for orthodontic care, and his records demonstrate that he successfully overturned 62% of those denials—over 450 needy children received care they were improperly denied initially.

“You would think DentaQuest would appreciate that I fixed their errors, but instead DentaQuest’s attorney sent me a letter saying that I alone take more of their Peer Review resources than all other providers in the country combined.  They then removed Peer Reviews from Massachusetts,” Rizkallah said. 

According to Dr. Rizkallah, “Deciding to remove the Peer Review process and hide their 62% error-correction rate, showed to state officers and providers that DentaQuest puts their own embarrassment over the needs of Medicaid children.  Medicaid programs need a program administrator that really believes in the Medicaid laws, rather than their own self-interest.  DentaQuest is not that administrator.” 

Benecare, the incoming MassHealth administrator, has incorporated Peer Reviews into its contract with MassHealth – unlike DentaQuest.

Troubling conflicts of interest 

In June 2014, shortly after the 2014 Sam H vs Patrick lawsuit was filed against MassHealth for improper orthodontic denials, Dr. Brent Martin (then MassHealth Dental Director) left his state position to immediately become a DentaQuest employee, directing DentaQuest’s Tennessee Medicaid Contract. 

Prior to Dr. Martin’s exit, MassHealth Orthodontic providers complained in unison to Dr. Martin about DentaQuest’s denial errors, but Dr. Martin took no action against DentaQuest to improve consultant quality controls.  Providers believe Dr. Brent Martin’s behavior was the result of his relationship with DentaQuest.  Providers believe this relationship constituted a state conflict of interest law violation – between a vendor and a state officer turned employee of the vendor. 

“The conflict of interest was not just about hiding poor consulting, says Dr. Rizkallah.   On Dr. Martin’s watch DentaQuest was given the opportunity to influence a change in the Orthodontic standard of the state, so that it was harder for truly needy kids to get care.  This change in government standard was immediately followed by DentaQuests sister company – Delta Dental of Massachusetts (DDMA) – adopting this new government standard.  DentaQuest was helping Delta through regulatory capture.”    

Regulatory Capture is the situation where a private entity gets control of a government contract that indirectly benefits its private arm.

Dr. Martin continues to work for DentaQuest today.

DentaQuest was also at the center of a 2016-2018 conflict of interest matter, in which the Massachusetts Ethics Commission ultimately fined Stacia Castro, a former MassHealth Director, for accepting financial gifts from DentaQuest.  Castro was fined by the Massachusetts Ethics Commission and left her state position. 

According to Dr. Rizkallah “Conflicts of interest are what I expect from DentaQuest and Delta Dental.  Every state should follow what MassHealth just did – Drop DentaQuest.” 

Enter BeneCare

Lee Serota, President of BeneCare Dental Plans, stated, “BeneCare is very excited to bring its outcomes-based dental care model to the residents of the Commonwealth. We’re looking forward to partnering with Massachusetts state officials, dentists, and other representatives of the oral health community in an effort to help improve MassHealth members’ oral health.”

“I look forward to dealing with Benecare – as a company that really believes in the Medicaid Act as a legal entitlement to care – not just as a virtue signal in the way DentaQuest egregiously demonstrated.” said Dr. Mouhab Rizkallah