The sheer volume of names of national healthcare fraud committees Nicholas J. Messuri has chaired would occupy the bulk of the space in this article. The vice president and deputy general counsel for fraud prevention and recovery at DentaQuest has been called on by virtually every antifraud healthcare organization that exists, and his extensive pedigree in Medicare and Medicaid fraud investigation is in a league of its own.
Messuri was appointed to the board and then as board chair for the National Health Care Antifraud Association, head of the National False Claims Act Task Force, one of the first cochairs of the National Healthcare Fraud Prevention Partnership, and—back in his attorney general’s office days—was national president of the state attorney general’s Medicaid Fraud Control Units. That’s the beginning of the list.
The son of a blue-collar father who worked three jobs in order to ensure his kids would have a better life, he has spent the bulk of his career working to secure justice for those who need it most. He served first as a Middlesex County assistant district attorney, then in the Massachusetts attorney general’s office, and now on behalf of the over thirty million predominantly Medicaid/CHIP members whom DentaQuest represents.
His first twenty years were entirely in the public sphere, but Messuri would eventually move into increasingly wider private roles, first at Tufts Health Plan in Massachusetts and, most recently, at DentaQuest, whose national presence has members in thirty states.
While Messuri has spent the better part of his career fighting bad actors, his relationship to his work is not nearly as fire and brimstone as it may first appear. “People sometimes think of a prosecutor as someone who holds people accountable and sends them to jail,” Messuri says. “It was never like that for me. It was about helping the people that were on the receiving end of those that commit the bad acts, and making sure the ones who committed those crimes get a fair shake and are treated fairly within the criminal justice system.”
That said, one doesn’t spend twenty years in the public sector fighting fraud without some skin in the game. “I’ve always wanted to be a champion for the underdog,” Messuri says. “I wanted to stand up for people with no voice. DentaQuest is in the business of protecting government taxpayer dollars and making sure it is looking out for the people who are supposed to receive its services.”
“The vast majority of Medicaid benefits are going to children, and if they’re on Medicaid, there’s a good chance they need help.”
DentaQuest’s mission is especially important to Messuri because its members require the loudest advocates available. “The vast majority of Medicaid benefits are going to children, and if they’re on Medicaid, there’s a good chance they need help,” the VP says. Messuri’s team of clinical investigators is trained to analyze data, look for outliers, and work to examine the root causes of what may be going wrong.
“Maybe our members weren’t billed correctly, maybe the services weren’t medically necessary, maybe the quality is subpar; we’re going to have our internal dentists and consultants look at those cases that need to be brought to the government’s attention,” Messuri explains.
Awareness and training are also a significant part of DentaQuest’s oversight. “We make sure our internal teams are training our providers’ staff, our customer service people, and our provider engagement professionals so if they’re in the field and they see something, it can be identified and brought back to my team for review,” the VP says.
Messuri says that DentaQuest’s investment in data analytics decades ago has continued to put their organization well ahead of the curve in identifying cases earlier in the process. “I believe we are a leader and one of the largest and successful Medicaid dental administrators in the country because we embraced the value of data analytics twenty years ago,” Messuri says. “Before the talk about big data or artificial intelligence, we were one of the first dental managed care plans that was thinking about the value presented here by these technologies, and what it meant to providing quality health care at the lowest appropriate cost.”
That early investment hasn’t meant DentaQuest is resting on its laurels. “We’re on the cusp of hiring a company that is going to take our analytic efforts to a whole new level by using the best artificial intelligence out there to identify bad actors and bad outcomes even sooner,” Messuri says. “The company I work for has given me the tools that I need to do this job and has created this amazing culture of never being satisfied. It fits my personality and I’m fortunate to work for a company that embraces learning and growing and getting better.”
Messuri says the mission of DentaQuest is too important to take lightly. “There is so much written about the correlation between our gums, our teeth, and the health of our mouths, and how it’s all connected to other healthcare problems and the potential issues that can develop,” the VP explains. “We’ve got some of the best dentists in the world here working to make sure as many people as possible can obtain the dental benefit they need. We’re here to support them.”
The Preventistry Approach
DentaQuest’s purpose is to not only ensure access to care for its millions of members, including roughly twenty-three million Medicaid/Medicare and seven million commercial members, but also to give them the tools to maintain optimal oral health. Its prevention-focused approach—Preventistry—does just that by promoting cost-effective, quality care through a network of more than eighty oral health centers in six states and nearly forty-thousand provider partners across all fifty states.
In addition to offering alternative financing and innovative care delivery options, DentaQuest has invested more than $230 million to help grow access to oral healthcare and create healthier communities.