Massachusetts v. Dartmouth House Nursing Home, Inc. (In Re Dartmouth House Nursing Home, Inc.)

24 B.R. 256, 1982 Bankr. LEXIS 3199, 9 Bankr. Ct. Dec. (CRR) 954
CourtUnited States Bankruptcy Court, D. Massachusetts
DecidedSeptember 30, 1982
Docket19-10634
StatusPublished
Cited by41 cases

This text of 24 B.R. 256 (Massachusetts v. Dartmouth House Nursing Home, Inc. (In Re Dartmouth House Nursing Home, Inc.)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Massachusetts v. Dartmouth House Nursing Home, Inc. (In Re Dartmouth House Nursing Home, Inc.), 24 B.R. 256, 1982 Bankr. LEXIS 3199, 9 Bankr. Ct. Dec. (CRR) 954 (Mass. 1982).

Opinion

*257 MEMORANDUM

JAMES N. GABRIEL, Bankruptcy Judge.

The debtors, Erlin Manor Nursing Home, Inc. (Erlin Manor), St. John’s Nursing *258 Home, Inc, (St. John’s) and Darmouth House Nursing Home, Inc. (Darmouth) filed voluntary petitions under Chapter 11 (Reorganization) of Title 11 of the United States Code, 11 U.S.C. Section 101 et seq. (The Bankruptcy Code) on December 31, 1981.

The Plaintiff, Commonwealth of Massachusetts, by its Department of Public Welfare (Welfare), commenced this adversary proceeding seeking declaratory judgment as to its right to make setoffs of the current monthly medicaid payments and retroactive payments owed the debtors against the debtors’ liabilities for past Medicaid over-payments.

On March 5, 1982, the debtors filed answers. On March 12,1982 the debtors each filed a Motion for Contempt and to Compel Turnover and to Enjoin Setoff, seeking to restrain further setoff by Welfare. On March 12, 1982, a pretrial conference on plaintiff’s complaint was held, at which time the Court heard argument on the Debtor’s motions. Also at this pre-trial conference, the parties agreed that since the adversary proceedings presented no factual disputes, the issues being purely legal, the parties would submit the cases to the Court for decision upon briefs, without further evidence or oral argument.

On March 17, 1982, the Court granted Debtors’ request for a preliminary injunction and issued an Order restraining Welfare from setting off pre-petition debts against current reimbursement due the Debtors. An amended order clarifying the amount of setoff enjoined was issued on March 25, 1982.

The debtors are three individually incorporated nursing homes which furnish a variety of health care services to eligible persons under programs administered by Welfare, including the Massachusetts Medical Assistance Program (Medicaid). Each debt- or is a “provider of health services” within the meaning of Massachusetts General Laws Chapter 6A Sections 31 through 36. The relationship between the debtors and Welfare has been governed by yearly Medicaid provider agreements between provider and Medicaid. Each debtor had been a party to a provider agreement since 1974. In fact, all three debtors rely on Medicaid reimbursement for most of their income; Medicaid payments comprise 52 percent of Dartmouth’s income, 77 percent of Erlin Manor’s income, and 90 percent of St. John’s income.

The provider agreements in effect on the date of the filing of the Petition were entered into by Dartmouth in July 1981, by St. John’s in August 1981, and by Erlin Manor in December 1981.

The provider agreement by its terms exists for a period not to exceed twelve months from the date of acceptance by Welfare. The agreement’s terms also include the provider’s promises to comply with all applicable state and federal regulations, to keep and disclose payment records, to accept the final rate, and to notify Welfare of a change in ownership and bankruptcy. Welfare agrees to pay the provider within a reasonable time, to give notice of a change of certification and accords the provider the right to appeal a payment determination. The Medicaid provider agreements incorporate Welfare’s regulations (106 C.M.R. 456.000 et seq.) which establish the system for setting rates of reimbursement to the providers for servicing patients eligible for public assistance.

The Commonwealth has adopted a “retrospective payment system”, administered by the Massachusetts Rate Setting Commission, which is incorporated into the provider agreement. Under this system, a provider receives payment on the basis of a provisional rate set prospectively. Subsequently, the payments may be adjusted based on actual costs. Mass.Gen.Laws Chap. 6A Sections 31-36.'

The rates of reimbursement are set by the “Rate Setting Commission” (Commission) established pursuant to Mass.Gen. Laws Chap. 6A Section 32. The Commission is obligated to estimate a provider’s interim rate for each fiscal year (July 1 to June 30) and within a reasonable time after the end of the year to set a final rate retrospectively for the calendar year. The interim rate is based on data from the *259 provider’s prior year’s operations and a cost adjustment factor as determined by the regulations. Welfare makes monthly payments to each provider for services rendered to each eligible patient after the end of the month in accordance with the interim rate.

The Commission establishes final rates for the year based on the actual costs incurred in providing health care services as verified by the provider’s actual costs report, or a full field audit. The Commissioner is required to set the final rate within six months of the provider’s submission of data. Depending on the amount of the final rate, the determination of the final rate will indicate either an overpayment or an underpayment to the provider. The regulations also permit the amendment of the Interim Rate, which similarly may result in a retrospective underpayment or overpayment.

If the final rate or corrected interim rate is greater than the interim rate, Welfare becomes liable to pay the underpayment forthwith. If the final rate is lower than the interim rate, the provider is obligated to pay Welfare the amount of overpayments received. At the discretion of Welfare a liability incurred by a provider as a result of an overpayment in a prior year may be recouped by deductions from current and retroactive payments due the provider. See 106 C.M.R. 456,.703.

The disputes in these three adversary proceedings resulted from Welfare’s determinations in late 1981 that the providers had received overpayments for 1975, 1976, 1980, and underpayments for 1981. Welfare’s deduction of the overpayments from current reimbursements precipitated the filing of the Chapter 11 eases.

On September 2, 1981, the Commission increased the Interim Rate for the months of July and August 1981, resulting in a credit owed to Erlin Manor of $38,909.00, a credit of $32,625.95 to St. John’s and a credit of $18,967.80 to Dartmouth House.

On December 17, 1981, nearly five years after the 1976 contract term had ended, 1 the Rate Setting Commission established the 1976 final rate which resulted in a liability of each of these providers to Welfare. Welfare established that Erlin had received an overpayment of $211,756.44 for 1976, that Dartmouth House had received an overpayment of $84,480.00 for 1976, and that St. John’s had received an overpayment of $104,960.56 for 1976. Also on December 17, 1981, the Commission determined that Dartmouth’s 1975 final rate was less than the 1975 interim rate, causing a 1975 overpayment to Dartmouth of $58,-734.09. Dartmouth’s 1980 interim rate was also decreased, resulting in another overpayment of $18,743.67. Total overpay-ments prior to the filing of the Chapter 11 petition were $161,957.92 to Dartmouth, $104,960.56 to St. John’s, and $211,756.44 to Erlin Manor.

The debtors filed appeals from the final rates, which are still pending.

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24 B.R. 256, 1982 Bankr. LEXIS 3199, 9 Bankr. Ct. Dec. (CRR) 954, Counsel Stack Legal Research, https://law.counselstack.com/opinion/massachusetts-v-dartmouth-house-nursing-home-inc-in-re-dartmouth-house-mab-1982.