Haverhill Manor, Inc. v. Commissioner of Public Welfare

330 N.E.2d 180, 368 Mass. 15, 1975 Mass. LEXIS 962
CourtMassachusetts Supreme Judicial Court
DecidedJune 4, 1975
StatusPublished
Cited by48 cases

This text of 330 N.E.2d 180 (Haverhill Manor, Inc. v. Commissioner of Public Welfare) is published on Counsel Stack Legal Research, covering Massachusetts Supreme Judicial Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Haverhill Manor, Inc. v. Commissioner of Public Welfare, 330 N.E.2d 180, 368 Mass. 15, 1975 Mass. LEXIS 962 (Mass. 1975).

Opinion

Tauro, C.J.

In this suit for declaratory relief, Haverhill Manor, Inc. (Haverhill Manor), challenges the refusal of the Commissioner of Public Welfare (commissioner) to remit to Haverhill Manor certain sums owed Haverhill Manor for the provision of health services. Haverhill Manor asserts that the administrative procedures employed by the commissioner in reaching his determination abridged its rights under the due process clause of the Fourteenth Amendment to the United States Constitution and under the State Administrative Procedure Act (APA), G. L. c. 30A, and that the commissioner had no legal right to treat Haverhill Manor and three affiliated nursing home corporations as a single corporate entity in order to collect past overpayments to the affiliated homes from money owed to Haverhill Manor. The case comes before us on the reservation and report, without decision, of a single justice of this court.

Briefly, the facts appearing in the parties’ statement of agreed facts, which amounts to a case stated, are these. Haverhill Manor, a Massachusetts corporation licensed to do business as a nursing home, furnishes a variety of health care services to eligible persons under programs administered by the Department of Public Welfare (department) and, as a consequence, is deemed a “provider of health services” under G. L. c. 7, §§ 30K- *17 30P. 2 Haverhill Manor receives payments for health services provided pursuant to G. L. cc. 118, 118A, 118C, 118D 3 and 118E, in accordance with rules and regulations adopted thereunder.

Haverhill Manor and three other individually incorporated nursing homes (affiliated homes) which also supply health services under the above statutes are wholly-owned subsidiaries of Century Convalescent Centers, Inc. (Century), a Massachusetts corporation. Century, in turn, is a wholly-owned subsidiary of Carex International, Inc. (Carex), a Delaware corporation with its principal place of business in Los Angeles, California. Carex, for a management fee, performs accounting, managerial and administrative services for Haverhill Manor and the affiliated homes. All such services are performed, and original financial records are kept, in California. The funds of each of the corporations (with the exception of petty cash accounts maintained separately in Massachusetts) are commingled by Carex with its own funds and the funds of its other subsidiaries. The Massachusetts corporations and Carex file consolidated tax returns for Massachusetts and Federal tax purposes. However, Haverhill Manor and the affiliated homes have individual identification numbers with the United States Internal Revenue Service and individual vendor numbers with the department.

The rates of payment for the health services provided by Haverhill Manor and the affiliated homes pursuant to the above mentioned programs are prescribed by the Rate *18 Setting Commission (commission) pursuant to G. L. c. 7, § 30L. For each year, the commission determines an interim rate for each provider of health services based on data from a prior year’s operations and on regulations which the commission promulgates. The department makes payments to each provider in accordance with these interim rates. The commission establishes final rates 4 for the year based on actual costs incurred in the provision of health services and verified by a full field audit. 5 The final rate determination may result in an adjustment of the amounts owed a provider for a given year or indicate that the department has overpaid the provider for the year. The efforts of the commissioner, acting for the department, 6 to recover overpayments made to Haverhill Manor and the affiliated homes by deducting the amounts of such overpayments from sums owed to Haverhill Manor for services performed in 1973 have given rise to the instant litigation.

Initially, the commission issues interim and final rates without affording the provider notice or opportunity to be heard. A provider who is “aggrieved” by any interim or final rate may appeal and will receive a full hearing before a hearing officer or a member of the commission in accordance with G. L. c. 30A. 7 G. L. c. 7, § 300. A provider who is aggrieved by a decision of the commission after such hearing may petition for review in the Superior Court for Suffolk County. See G. L. c. 7, § 300.

*19 The commission established interim rates severally applicable to Haverhill Manor and the three affiliated homes for the years 1968 through 1971. Necessary appeals have been filed, hearings held, and decisions rendered as to these interim rates. 8 Final rates, computed after a full field audit, have been issued for Haverhill Manor and the affiliated homes for the same years. Appeals are pending with respect to the 1970 9 and 1971 final rates. On the basis of these final rates for the years 1968 through 1971, the commissioner has determined that Haverhill Manor and the three affiliated homes were overpaid substantial sums in the years prior to 1973. 10 As a consequence, he has refused to authorize payments to Haverhill Manor for health services rendered in 1973 until the overpayments have been recaptured. 11 The commissioner asserts that he can offset all amounts due to the Commonwealth from Haverhill Manor against amounts owed to Haverhill Manor for 1973. He asserts further that he can offset amounts owed by the three affiliated homes to the Commonwealth against amounts owed to Haverhill Manor for 1973. The commissioner’s procedure would preclude any payments to Haverhill *20 Manor until the alleged overpayments have been recovered by the Commonwealth.

In the instant proceeding, Haverhill Manor contests the commissioner’s right to utilize his offset procedure. Haverhill Manor presents four specific objections: It alleges that (1) the decision to offset overpayments against current amounts due to Haverhill Manor constitutes a regulation, as that term is defined in the APA, G. L. c. 30A, § 1 (5), and was improperly promulgated and implemented without a hearing; (2) the commission’s failure to provide a post-audit evidentiary hearing concerning the final rate for 1971 12

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Bluebook (online)
330 N.E.2d 180, 368 Mass. 15, 1975 Mass. LEXIS 962, Counsel Stack Legal Research, https://law.counselstack.com/opinion/haverhill-manor-inc-v-commissioner-of-public-welfare-mass-1975.