A few weeks ago, it was announced that Benecare Dental Plans has taken over the contract as a third-party payer for the Medicaid program in Massachusetts under MassHealth. DentaQuest lost the contract, which it had held for at least a decade.
Needless to say, DentaQuest is one of the three Texas dental maintenance organizations.
Controversy
According to a release sent out by the American Alliance for Dental Insurance Quality, which also has a story on its website, DentaQuest’s tenure as the third-party payer was filled with controversy.
The release states:
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.
Dr. Mouhab Rizkallah is the president of the American Alliance for Dental Insurance Quality. In 2022, Dentistry Today honored him as its “Person of the Year,” and Incisal Edge named him the 2023 Most Influential Person in Dentistry, acknowledging his remarkable contributions and leadership in the field.
Did a good job of claims processing
Dr. Rizkallah stated in the release, “While DentaQuest has done a good job at claims processing, DentaQuest has been an irresponsible TPA in many other ways.”
Massachusetts head office but Canadian-owned
DentaQuest has its head office just outside of Boston and was purchased by the Canadian insurer Sun Life in 2021.