Athol Memorial Hospital v. Commissioner of the Division of Medical Assistance

The plaintiffs, acute-care hospitals,2 seek payment from the division of medical assistance3 for inpatient services provided to Medicaid recipients between March 1, 1994, and June 10, 1999, pursuant to their respective provider contracts with the division. In conducting review of the services, the division denied reimbursement on the ground that the services were not “medically necessary.”4 On February 5, 1999, we decided Massachusetts Eye & Ear Infirmary v. Commissioner of the Div. of Med. Assistance, 428 Mass. 805 (1999), which held that the division could not deny, pursuant to its claims…