Boston, MA. Nixon Peabody secured an important win for client Suburban Home Health Care, Inc. (SHHC) in Massachusetts’ highest court, a decision that will have wide-ranging implications for health care providers doing business in Massachusetts.
On September 3, 2021, the Massachusetts Supreme Judicial Court (SJC) ruled in favor of home health care agency SHHC in its appeal that a 2016 Executive Office of Health and Human Services, Office of Medicaid (MassHealth), attempt to recoup alleged overpayments was barred by a statute of limitations. This decision effectively sets a limit by which MassHealth can seek to recoup alleged overpayments from providers across the state.
In 2005, MassHealth sent an audit notice to SHHC, but took no further action at that time. More than a decade later, in 2016, MassHealth initiated recovery proceedings, alleging that SHHC received overpayments during a three-month period in 2005. In response, SHHC sought a declaratory judgment in Massachusetts Superior Court (trial level) that MassHealth’s attempt to recoup alleged overpayments was barred by the statute of limitations. The Superior Court denied SHHC’s request, finding that no statute of limitations applied.
Nixon Peabody appealed and the SJC on its own initiative transferred the case from the Appeals Court. On appeal, which included oral argument in April 2021, the Nixon Peabody team argued that common sense and basic notions of fairness compelled the conclusion that MassHealth’s claim for recoupment cannot remain actionable after an 11-year delay.
“Congratulations to Suburban Home Health Care on this win, which also provides a level of certainty on this matter for other providers in the state,” said Brian Kelly, partner with Nixon Peabody’s Government Investigations and White-Collar Defense practice.
In its opinion, the SJC was “struck by the absurd consequences of MassHealth’s argument.” The SJC stated: “Like Rip Van Winkle, an administrative agency could wake up twenty or even a hundred years later and bring enforcement proceedings against a provider or other party doing business with the government. We do not believe that was the Legislature’s intention.”
In addition to Brian Kelly, the Nixon Peabody team includes partner Joshua Sharp and associate Lauren Maynard, both of the Government Investigations and White-Collar Defense practice in Boston.