Atlanticare Medical Center v. Commissioner of the Division of Medical Assistance

Marshall, CJ.

At issue in this case is whether the division of medical assistance (division), the Commonwealth’s administrator of its Medicaid program, has the authority to enforce its reimbursement regulation, 130 Code Mass. Regs. § 450.316(E) (1998) (reimbursement regulation), which requires that healthcare providers return payment to the division in the event that a liable third party is identified after the division has paid the provider for services.2 At issue are only those cases where the healthcare provider properly complied with the division’s due diligence regulation, which requires…