Case Title: Suburban Home Health Care, Inc. v. Executive Office of Health and Human Services, Office of Medicaid

Citation: 

Docket Number: SJC-13051

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2021-09-03T00:00:00Z

Document:
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SJC-13051 
 
SUBURBAN HOME HEALTH CARE, INC.  vs.  EXECUTIVE OFFICE OF HEALTH 
AND HUMAN SERVICES, OFFICE OF MEDICAID. 
 
 
 
Suffolk.     April 9, 2021. - September 3, 2021. 
 
Present:  Budd, C.J., Lowy, Cypher, Kafker, Wendlandt, 
& Georges, JJ. 
 
 
Medicaid.  MassHealth.  Limitations, Statute of.  Practice, 
Civil, Statute of limitations.  Administrative Law, 
Exhaustion of remedies. 
 
 
 
Civil action commenced in the Superior Court Department on 
October 7, 2019. 
 
A motion to dismiss was heard by Kenneth W. Salinger, J. 
 
The Supreme Judicial Court on its own initiative 
transferred the case from the Appeals Court. 
 
 
Brian T. Kelly for the plaintiff. 
David R. Marks, Assistant Attorney General, for the 
defendant. 
 
 
 
KAFKER, J.  The primary issue presented in this case is 
whether the six-year statute of limitations for civil actions in 
contract applies when the Executive Office of Health and Human 
2 
 
Services, Office of Medicaid (MassHealth), attempts to collect 
overpayments made to providers in the State Medicaid program, or 
whether no statute of limitations whatsoever applies to these 
administrative proceedings, thereby allowing them to be brought 
indefinitely.  In late 2005, MassHealth sent an audit notice to 
one such provider, Suburban Home Health Care, Inc. (Suburban), 
but took no further action at that time.  Then, more than a 
decade later in 2016, MassHealth initiated recovery proceedings, 
alleging that Suburban received approximately $75,000 in 
overpayments over a three-month period in 2005.  Suburban sought 
declaratory relief in the Superior Court, arguing that the 
proceedings were time barred because the statute of limitations 
for "actions of contract" in G. L. c. 260, § 2, applied to 
MassHealth's overpayment recovery proceedings.  A Superior Court 
judge rejected Suburban's arguments, concluding that the 
administrative proceedings to collect these overpayments could 
never be considered civil actions and therefore no statute of 
limitations applied. 
 
Statutes of limitations serve fundamental purposes ensuring 
the efficient, accurate, and equitable resolution of disputes, 
and the Legislature has established time frames based on the 
nature of the dispute.  Where a statutory scheme is silent or 
ambiguous as to a statute of limitations, we generally look to 
the essential nature of the rights involved to determine which 
3 
 
statute of limitations applies.  Silence or ambiguity alone is 
not sufficient to support the conclusion that there is no 
statute of limitations whatsoever.  Rather, we require express 
or at least clear legislative guidance to that effect.  In the 
instant case, the essential nature of the right is contractual, 
and the Legislature has not expressed a clear intention that no 
statute of limitations applies.  Accordingly, we reverse the 
judgment that no statute of limitations applies to the 
administrative proceedings at issue here.  We hold that the six-
year statute of limitations for contract actions governs, and 
that MassHealth's decades-old attempt to collect the overpayment 
in this case is time barred. 
1.  Background.  a.  Medicaid and reimbursement.  
MassHealth administers the Medicaid program for the 
Commonwealth.  Daley v. Secretary of the Exec. Office of Health 
& Human Servs., 477 Mass. 188, 190 (2017).  States that 
participate in the Medicaid program "must comply with certain 
requirements imposed by [Federal statute] and regulations 
promulgated by the [United States Secretary of Health and Human 
Services] through [the Centers for Medicare and Medicaid 
Services]."  Id.  As part of its administration of the 
Commonwealth's program, MassHealth is required to enter into 
agreements with the companies that provide medical service to 
covered individuals.  See G. L. c. 118E, § 36.  MassHealth pays 
4 
 
the provider directly for the eligible care and services it 
provides.  G. L. c. 118E, § 30.  Providers have ninety days from 
the date the services or goods are provided to send MassHealth a 
bill, and MassHealth must verify at least ten percent of the 
bills with the recipient.  G. L. c. 118E, § 38.1  Suburban is a 
Medicare and Medicaid certified home health agency that provides 
in-home nursing and rehabilitative therapy services.  It first 
entered into a provider agreement with MassHealth in 1994. 
The agreement is relatively straightforward.  Suburban 
promised "[t]o comply with all state and federal statutes, 
rules, and regulations applicable to the Provider's 
participation in the Medical Assistance Program."  Suburban also 
agreed "[t]o keep such records as are necessary to disclose 
fully the extent of the services to recipients and to preserve 
these records for a minimum period of four years"2 and to provide 
any information upon request regarding services for which it 
claimed payment.  In exchange, MassHealth agreed to pay Suburban 
"for all reimbursable services and goods actually and properly 
delivered to eligible recipients and properly billed to 
 
1 The provider must retain proof of the "actual delivery to 
recipients of services and goods for which bills are submitted."  
G. L. c. 118E, § 38. 
 
2 Under 130 Code Mass. Regs. § 450.205(G) (2017), providers 
are required to retain records for at least six years or for 
such length of time as is required by regulation of a governing 
agency, whichever is longer. 
5 
 
[MassHealth] both in accordance with the terms of this Provider 
Agreement and in accordance with all applicable federal and 
state laws, regulations, rules, and fee schedules." 
An overpayment results when a provider's reimbursement 
exceeds that to which the provider is legally entitled.  See 130 
Code Mass. Regs. § 450.235(A) (2018) (identifying categories of 
overpayments).  MassHealth has a legal obligation to recoup the 
overpayment.  See 42 C.F.R. § 433.312.  The procedures governing 
the recovery of overpayments -- found in G. L. c. 118E, § 38, 
and 130 Code Mass. Regs. § 450.237 (2017) -- are among the many 
applicable laws and regulations to which providers agree when 
they execute a provider agreement. 
The recoupment proceeding begins when MassHealth sends an 
initial notice of overpayment to the provider when it believes 
that an overpayment has been made.  130 Code Mass. Regs. 
§ 450.237(A).3  The notice must include the amount believed to 
have been overpaid and the basis for concluding that it is an 
overpayment.  Id.  The provider has thirty days to respond to 
the initial notice.  130 Code Mass. Regs. § 450.237(B).  In its 
 
3 The overpayment can be based on a determination by 
MassHealth, another State agency, or a Federal agency.  130 Code 
Mass. Regs. § 450.237(A) (2017).  If the determination is not 
made by MassHealth, MassHealth must tell the provider which 
agency made the determination.  Id.  Providers also have an 
obligation to self-report any overpayment within sixty days of 
the provider identifying the overpayment.  130 Code Mass. Regs. 
§ 450.235(B) (2017). 
6 
 
response, the provider must contest any allegations in the 
initial notice with which it disagrees.  Id.  It also may 
provide data or argument in support of its claim for payment.  
Id.  The provider must submit any documentary evidence it wants 
MassHealth to consider with its reply.  Id.  MassHealth then 
reviews the information it requested as well as any information 
submitted by the provider in its reply.  130 Code Mass. Regs. 
§ 450.237(C).  If MassHealth determines that the provider has 
been overpaid, it must send the provider a notice of its final 
determination.  Id.  The provider can then appeal from the final 
determination in an adjudicatory hearing before the board of 
hearings.  130 Code Mass. Regs. § 450.237(D). 
b.  Audit of Suburban.  On December 2, 2005, MassHealth, 
through its noninstitutional provider review unit, informed 
Suburban that it would be initiating an audit (a "retrospective 
utilization review and peer review of services") of services 
rendered to MassHealth.4  On December 27, MassHealth's third-
party vendor at the time, MassPRO, contacted Suburban regarding 
 
4 The regulations provide that MassHealth can initiate 
overpayment recovery procedures if such a utilization review 
uncovers overpayments.  See 130 Code Mass. Regs. § 450.205(H) 
(2017) ("In cases where audits or other reviews reveal provider 
noncompliance . . . , [MassHealth] may seek to pursue recovery 
of overpayments and to impose sanctions in accordance with the 
provisions of [130 Code Mass. Regs. §§ 450.000]").  Once 
MassHealth initiates an audit or other review of a provider, the 
provider must retain the records at issue indefinitely.  130 
Code Mass. Regs. § 450.205(G). 
7 
 
the audit.  This audit concerned the period from June 1, 2005, 
through August 30, 2005.  MassPRO requested thirteen specific 
categories of documents as well as all other "pertinent" 
documents.  MassPRO gave Suburban twenty-one days to provide the 
information.  According to Suburban, it provided MassPro with 
the requested documents in early 2006.  Suburban alleges that, 
also in early 2006, MassPRO auditors held a "close-out" meeting 
with Suburban's director of nursing and informed Suburban that 
its review had not identified any concerns.  This was the last 
time that MassPRO communicated with Suburban. 
Over ten years passed during which neither MassHealth nor 
its vendors took any further action on the audit.  Then, on 
November 8, 2016, Suburban received an initial notice of 
determination of overpayment from MassHealth arising out of the 
audit.  MassHealth determined that several violations resulted 
in overpayments totaling $95,291.38.  It directed Suburban to 
contact its new vendor, MAXIMUS Federal Services, Inc. 
(MAXIMUS), and respond to the notice within thirty days.  On 
December 6, 2016, Suburban sent MAXIMUS its written response, 
asserting various equitable and statutory arguments challenging 
the ability of MassHealth to collect the overpayments.  
MassHealth and Suburban held an informal conference on December 
7, at which, Suburban alleges, MassHealth represented that 
MAXIMUS would issue a final notice within thirty days.  About 
8 
 
ninety days later, Suburban contacted MassHealth regarding the 
review.  MassHealth responded that MAXIMUS was in the final 
stages of completing its review of the initial notice.  Suburban 
followed up again in May 2017 but did not receive a response. 
Again, a long time passed without a word from MassHealth or 
MAXIMUS.  Finally, on September 9, 2019, over two years after 
its last communication with MassHealth, Suburban received a 
final notice of determination of overpayment.  In the final 
notice, MAXIMUS informed Suburban that the final amount of 
overpayments was $75,538.49.  Suburban filed for an adjudicatory 
hearing with the MassHealth board of hearings on October 7, 
2019.5 
That same day, Suburban also filed its complaint seeking 
declaratory and injunctive relief in the Superior Court.  
Suburban's complaint argued that MassHealth's overpayment 
procedure is subject to the six-year statute of limitations for 
"actions of contract" in G. L. c. 260, § 2, and therefore is 
time barred.  MassHealth moved to dismiss the complaint, arguing 
that Suburban failed to exhaust its administrative remedies and 
that the statute of limitations only applied to civil actions 
and not to administrative collection procedures.  The judge 
 
5 As of the time of briefing in this case, the hearing 
before the board of hearings has not been held.  According to 
Suburban, these hearings are "typically scheduled two to three 
years after" a hearing is sought. 
9 
 
agreed that the statute of limitations did not apply and 
dismissed the complaint.  Suburban appealed, and we transferred 
the case to this court on our own motion. 
2.  Discussion.  In reviewing a motion to dismiss, we 
accept as true the allegations in the complaint and draw every 
reasonable inference in favor of the plaintiff.  See Curtis v. 
Herb Chambers I-95, Inc., 458 Mass 674, 676 (2011).  This appeal 
raises two issues.  First, we must determine whether Suburban 
failed to exhaust its administrative remedies before seeking 
judicial review.  Second, we must determine whether the 
overpayment recovery procedures are "actions of contract" and 
therefore subject to the six-year statute of limitations in 
G. L. c. 260, § 2.  We address each issue in turn. 
a.  Exhaustion of administrative remedies.  MassHealth 
argues that Suburban has failed to exhaust its administrative 
remedies before seeking judicial review.  In this context, 
MassHealth argues that exhaustion requires Suburban to first 
proceed before the board of hearings.  Suburban can then seek 
judicial review of the board's order under G. L. c. 30A. 
"As a general rule, we require parties to exhaust their 
administrative remedies prior to seeking judicial relief."  
Luchini v. Commissioner of Revenue, 436 Mass. 403, 404–405 
(2002).  This rule is "not a mere procedural device to trap the 
unwary litigant; rather, it is a sound principle of law and 
10 
 
jurisprudence aimed at preserving the integrity of both the 
administrative and judicial processes."  Assuncao's Case, 372 
Mass. 6, 8 (1977).  Indeed, "allowing the administrative process 
to run its course . . . gives the administrative agency in 
question a full and fair opportunity to apply its expertise to 
the statutory scheme."  Hingham v. Department of Hous. & 
Community Dev., 451 Mass. 501, 509 (2008), quoting Gill v. Board 
of Registration of Psychologists, 399 Mass. 724, 727 (1987).  It 
also preserves judicial resources.  See Massachusetts 
Respiratory Hosp. v. Department of Pub. Welfare, 414 Mass. 330, 
337-338 (1993) (not requiring parties to exhaust administrative 
remedies "would unfairly undermine the role of administrative 
agencies and unreasonably burden judicial resources"). 
There are, however, "rare" exceptions to this rule.  See 
Athol Memorial Hosp. v. Commissioner of the Div. of Med. 
Assistance, 437 Mass. 417, 426 (2002).  When considering whether 
to excuse the failure to exhaust administrative remedies, we 
look at "whether resort to the administrative remedy would be 
futile; whether the case raises important public questions whose 
resolution will affect people beyond the parties to the case; 
whether pursuing the administrative remedy will result in 
irreparable harm to either party; and whether there is a 
question of law peculiarly within judicial competence" 
(quotation and citations omitted).  Temple Emanuel of Newton v. 
11 
 
Massachusetts Comm'n Against Discrimination, 463 Mass. 472, 479–
480 (2012). 
The judge below concluded that exhaustion was not required 
in this case.  He reasoned that "the case presents a purely 
legal question of wide public significance."  He also explained 
that "[w]hether MassHealth's recoupment efforts are barred by a 
statute of limitations, and whether MassHealth may offset the 
alleged overpayments against future amounts owed before 
completing its administrative hearing process, reduce to 
questions of law because the underlying facts are not in 
dispute." 
We agree that this is a rare case in which the party 
seeking declaratory relief need not exhaust the administrative 
process.  Whether overpayment recoupment proceedings are 
governed by a statute of limitations is a question of law 
"peculiarly within judicial competence" (citation omitted).  
Temple Emanuel of Newton, 463 Mass. at 479–480.  This question 
also has significance beyond just this case.  Id.  Moreover, 
none of the material facts relevant to the statute of 
limitations question is disputed.  It would make little sense to 
force Suburban to spend several years litigating before the 
board of hearings if MassHealth is clearly barred by a statute 
of limitations.  Given the importance, uncertainty, and 
12 
 
dispositive nature of the purely legal issue before us, we 
conclude that exhaustion is not required. 
Athol Memorial Hospital is not to the contrary.  There, 
providers sued the division of medical assistance (division) 
after the division declined to reimburse the providers for 
certain Medicaid claims.  Athol Memorial Hosp., 437 Mass. at 
418.  The providers commenced their lawsuit without exhausting 
the regulatory procedures for challenging the division's 
rejection of their reimbursement.  Id. at 420.  We affirmed a 
judgment for the division because the providers failed to 
exhaust their administrative remedies.  Id. at 418.  In doing 
so, we explained that the failure to exhaust their 
administrative remedies was fatal because the Legislature 
clearly intended that "factual disputes under the medical 
assistance program [be] resolved in the first instance by the 
division" (emphasis added).  Id. at 427.  In the underlying 
complaint in this case, Suburban is not contesting the 
underlying overpayment determination or the factual basis for it 
at this time;6 it instead challenges MassHealth's legal right to 
recoup the overpayment at all. 
 
6 We do recognize that Suburban has filed an appeal to the 
board of hearings.  We emphasize that if it were not for the 
importance, novelty, and dispositive nature of the legal issue 
before us, we would require the administrative process to be 
completed first. 
13 
 
Accordingly, we conclude that Suburban was not required to 
exhaust its administrative remedies. 
b.  Statute of limitations.  i.  Purposes of limitations on 
claims.  Before considering the applicability of a statute of 
limitations to these proceedings, it is helpful to review their 
fundamental purposes.  They promote the efficient, accurate, and 
equitable resolution of disputes, requiring parties to proceed 
within a reasonable amount of time of notice of the claim when 
evidence is available and before memories fade.  See Klein v. 
Catalano, 386 Mass. 701, 709 (1982), quoting Rosenberg v. North 
Bergen, 61 N.J. 190, 201 (1972) ("There comes a time when . . . 
'evidence has been lost, memories have faded, and witnesses have 
disappeared'").  They discourage plaintiffs from sleeping on 
their rights and provide defendants with the ability to defend 
themselves.  See Artis v. District of Columbia, 138 S. Ct. 594, 
608 (2018) (primary purposes of statutes of limitations are 
"preventing surprises to defendants and barring a plaintiff who 
has slept on [its] rights" [quotations and citation omitted]).  
This in turn helps preserve the integrity and accuracy of the 
judicial process by ensuring that courts have sufficient, 
reliable evidence to decide cases.  See, e.g., Order of R.R. 
Telegraphers v. Railway Express Agency, 321 U.S. 342, 348–449 
(1944) ("Statutes of limitation . . . are designed to promote 
justice by preventing surprises through the revival of claims 
14 
 
that have been allowed to slumber until evidence has been lost, 
memories have faded, and witnesses have disappeared").  
Ultimately, statutes of limitations represent a policy 
determination by the Legislature as to the point at which even 
meritorious claims should be barred.  See Board of Regents of 
the Univ. of N.Y. v. Tomanio, 446 U.S. 478, 487 (1980) ("Thus in 
the judgment of most legislatures and courts, there comes a 
point at which the delay of a plaintiff in asserting a claim is 
sufficiently likely either to impair the accuracy of the fact-
finding process or to upset settled expectations that a 
substantive claim will be barred without respect to whether it 
is meritorious"). 
Reflecting the important purposes of statutes of 
limitations, G. L. c. 260 sets out numerous statutes of 
limitations, with different time frames selected for different 
types of actions.  For example, the statute of limitations for 
personal injury tort actions is three years, see G. L. c. 260, 
§ 2A, whereas the statute of limitations for "[a]ctions arising 
on account of violations of any law intended for the protection 
of consumers" is four years, see G. L. c. 260, § 5A.  These, 
along with the multitude of other statutes of limitations in 
G. L. c. 260, demonstrate how the Legislature has balanced the 
considerations for different types of actions and determined the 
most appropriate period. 
15 
 
ii.  Discerning an appropriate statute of limitations.  
With these purposes and provisions in mind, we now consider 
whether overpayment recoupment proceedings are subject to a 
statute of limitations.  In doing so, our task is to discern 
whether the Legislature intended for such claims to be subject 
to a statute of limitations and, if so, which one.  Given the 
fundamental purposes of statutes of limitations, and the 
Legislature's consideration and division of them into many 
different categories, we are most hesitant to conclude that the 
Legislature intended no statute of limitations to apply, absent 
express guidance to that effect.  As we explained in Nantucket 
v. Beinecke, 379 Mass. 345, 347-348 (1979), 
"We find nothing in the legislative history . . . which 
would suggest that the Legislature, by not specifically 
prescribing a period of time within which an action under 
[the statute] must be brought, intended that actions not be 
time-limited.  If such a result had been intended, it would 
have been natural for the Legislature to express such an 
intention." 
See DelCostello v. International Bhd. of Teamsters, 462 U.S. 
151, 158 (1983) (where "there is no federal statute of 
limitations expressly applicable to this suit," court does "not 
ordinarily assume that Congress intended that there be no time 
limit on actions at all").  Instead, where, as here, the 
statutory scheme does not contain an express statute of 
limitations, we generally look to the "essential nature of the 
right" at issue.  Beinecke, supra at 347.  See DelCostello, 
16 
 
supra (in absence of express statute of limitations, court has 
"generally concluded that Congress intended that the courts 
apply the most closely analogous statute of limitations"). 
Suburban argues that the statute of limitations in G. L. 
c. 260, § 2, which applies to "actions of contract," applies to 
overpayment recoupment actions by MassHealth.  We agree that the 
essential nature of the right at issue in this case is, 
essentially, a contractual one.  The relationship between 
MassHealth and providers like Suburban is governed by the 
provider agreement, which in turn incorporates the complex 
statutory and regulatory frameworks governing Medicaid.  In the 
agreement, Suburban promised to provide goods and services, 
comply with all applicable laws, and maintain the necessary 
records and provide them upon request.  In return, MassHealth 
promised to reimburse Suburban.  This relationship is most 
analogous to that of private contracting parties.  Notably, this 
is the type of relationship that the Legislature contemplated 
when it mandated that providers enter into agreements with 
MassHealth.  See G. L. c. 118E, § 36 (3)-(5) (providers must 
agree to various terms). 
Moreover, most, if not all, of the concerns underlying 
statutes of limitations are implicated here.  There is no reason 
why the Legislature would not have wanted MassHealth to proceed 
expeditiously and diligently to enforce its rights, as it has a 
17 
 
financial incentive to detect and recover all overpayments as 
quickly as possible.  Likewise, the providers have an interest 
in avoiding untimely processing of these disputes that would 
make their defense and resolution more difficult.  See Colorado 
Springs v. Timberlane Assocs., 824 P.2d 776, 782-783 (Colo. 
1992), quoting Shelbyville v. Shelbyville Restorium, Inc., 96 
Ill. 2d 457, 463 (1983) ("We agree . . . that '[l]ong delays by 
the government in instituting suit, of course, cause harm to the 
defendant and are in the interest of no one'").  There is no 
obvious justification for giving MassHealth an unlimited period 
of time to collect overpayments, and we will not assume that the 
Legislature intended to do so absent express guidance to that 
effect. 
Therefore, because the nature of the right asserted by 
MassHealth against providers is closely analogous to an "action 
of contract," we conclude that MassHealth is subject to the six-
year statute of limitations in G. L. c. 260, § 2.  MassHealth 
therefore has six years from the date its action against the 
provider accrues to commence its administrative proceedings.  
See Anawan Ins. Agency, Inc. v. Division of Ins., 459 Mass. 592, 
595, 598 (2011) (date agency initiated action with show cause 
order is relevant date for purposes of limitations period).  See 
also 130 Code Mass. Regs. § 450.237(A) (recoupment proceeding 
initiated by initial notice sent to provider).  Here, the cause 
18 
 
of action accrued, at the very latest, when MassHealth sent 
Suburban the audit notice and received records for the relevant 
time period in late 2005 and early 2006.  See Melrose Hous. 
Auth. v. New Hampshire Ins. Co., 402 Mass. 27, 32 (1988) 
("contract claim accrues at the time of the breach").7  Once 
MassHealth had these records, it had more than enough time 
within the limitations period to identify the overpayments and 
initiate the recovery proceedings.  MassHealth did not give 
Suburban the initial notice within that six-year period, instead 
waiting over ten years.  Thus, MassHealth's proceedings against 
Suburban are barred by the statute of limitations.8 
 
7 We need not address today whether the statute of 
limitations in overpayment recovery proceedings is subject to a 
discovery rule or any other tolling doctrines.  See, e.g., 
Williams v. Ely, 423 Mass. 467, 473 (1996) (statute of 
limitations in some cases does not run "until the plaintiff 
knows or reasonably should know that he or she has been 
harmed").  See also SiOnyx, LLC v. Hamamatsu Photonics K.K., 332 
F. Supp. 3d 446, 467 (D. Mass. 2018) (applying discovery rule to 
breach of contract claim and discussing various other tolling 
doctrines). 
 
8 Because we conclude that MassHealth's overpayment recovery 
efforts are time barred in this case, we do not address 
Suburban's alternative argument that MassHealth is barred from 
collecting the overpayment by the doctrine of laches.  We have 
not, however, applied the doctrine of laches against the 
Commonwealth in these circumstances.  See Board of Health of 
Holbrook v. Nelson, 351 Mass. 17, 19 (1966) ("The defence of 
laches is not available to the defendants where the proceeding 
is brought by an authorized public agency to enforce the laws of 
the Commonwealth"). 
19 
 
MassHealth makes a number of arguments as to why no statute 
of limitations applies, none of which is persuasive.  MassHealth 
first relies on a line of cases holding that an administrative 
proceeding is not an "action" as that word is used in G. L. 
c. 260.  See Sisson v. Lhowe, 460 Mass. 705, 709 (2011); State 
Bd. of Retirement v. Woodward, 446 Mass. 698, 706 (2006); 
Shafnacker v. Raymond James & Assocs., Inc., 425 Mass. 724, 729-
730 & n.6 (1997).  See also West v. Gibson, 527 U.S. 212, 220 
(1999) ("the word 'action' often refers to judicial cases, not 
to administrative 'proceedings'"); New York Gaslight Club, Inc. 
v. Carey, 447 U.S. 54, 60–62 (1980) (explaining difference 
between "actions" and administrative "proceedings").  It 
specifically argues that overpayment recoupment proceedings 
under G. L. c. 118E, § 38, and 130 Code Mass. Regs. § 450.237 
are not "actions of contract" under G. L. c. 260, § 2.  
MassHealth argues more generally that no administrative 
proceedings would be subject to statutes of limitations that 
refer to "actions."9  We disagree. 
 
9 We note that the Legislature did not use the term "court 
action"; it simply used the term "action."  G. L. c. 260, § 2 
(chapter title, "limitations of actions;" section title, 
"contract actions").  Moreover, courts have long indicated that 
the plain meaning of "action" is broader and depends upon 
context.  See, e.g., Vieira v. Menino, 322 Mass. 165, 168 (1947) 
("the word action is used in its comprehensive sense as meaning 
the pursuit of a right in a court of justice without regard to 
the form of legal proceedings . . . and not in the narrow 
significance in which it is sometimes employed to indicate a 
20 
 
We previously have determined that statutes of limitations 
apply to certain administrative proceedings.  In Zora v. State 
Ethics Comm'n, 415 Mass. 640, 646-648 (1993), for example, we 
concluded that proceedings brought by the State Ethics 
Commission under G. L. c. 268A were subject to the three-year 
statute of limitations in G. L. c. 260, § 2A.  Similarly, in 
 
specific remedy at law" [quotation and citation omitted]); 
Matter of Keenan, 287 Mass. 577, 581 (1934) ("It is manifest 
that the word 'action' is not used in any narrow sense," and 
Legislature intended term action "to embrace civil proceedings 
in general without special regard to the form"); Pigeon's Case, 
216 Mass. 51, 56-57 (1913) (rejecting narrow definition of 
"action" and applying it to any situation where "proceeding 
under the act contemplates ultimate enforcement in a judicial 
court").  For example, courts regularly refer to administrative 
actions in addition to and alongside judicial actions.  See, 
e.g., Walpole v. Secretary of the Exec. Office of Envtl. 
Affairs, 405 Mass. 67, 72 (1989) (referring to certiorari after 
exhaustion of administrative remedies as action); Manzaro v. 
McCann, 401 Mass. 880, 883 (1988) (tenant may "seek[] relief in 
any judicial or administrative action"); J. & J. Enters., Inc. 
v. Martignetti, 369 Mass. 535, 541 (1976) (referring to "cases 
where judicial action should await administrative action"); 
Clark & Clark Hotel Corp. v. Building Inspector of Falmouth, 20 
Mass. App. Ct. 206, 209 (1985), quoting Nelson v. Blue Shield of 
Mass., Inc., 377 Mass. 746, 752 (1979) ("The general rule, even 
where there is an alternate judicial or statutory remedy 
providing access to the courts, is that, if administrative 
action 'may afford the plaintiffs some relief, or may affect the 
scope or character of judicial relief, exhaustion of the 
possibilities [of such administrative action] should ordinarily 
precede independent action in the courts'").  The Legislature 
also uses the term "administrative action" to refer to 
administrative proceedings.  See, e.g., G. L. c. 6A, § 16CC 
(defining "administrative action" as "an action taken to resolve 
issues through negotiation and mediation with a long term care 
facility or assisted living residence"); G. L. c. 175, § 177W 
(authorizing "administrative action against a reinsurance 
intermediary" "in addition to" other remedies); G. L. c. 176W, 
§ 6 (referring to "any judicial or administrative action"). 
21 
 
Anawan Ins. Agency, Inc., 459 Mass. at 597-598, we concluded 
that the administrative enforcement action brought by the 
Division of Insurance against an insurance agency for employing 
an unlicensed agent was subject to the statute of limitations in 
G. L. c. 260, § 5A.  In both cases, when confronted with a 
statutory scheme that was silent as to a statute of limitations 
for administrative actions, we examined the nature of the right 
or claim at stake to determine the applicability of a statute of 
limitations.10 
Furthermore, in cases where we determined that no statute 
of limitations whatsoever was provided, we had clear legislative 
guidance to that effect.  In Woodward, 446 Mass. at 699-700, a 
case on which MassHealth and the Superior Court heavily relied, 
the State Board of Retirement initiated proceedings to terminate 
a former State representative's pension.  The State 
representative had been convicted of various fraud and bribery 
offenses.  Id. at 699.  We concluded that the proceedings were 
 
10 MassHealth posits a simple binary distinction between 
court actions and all other proceedings.  We have never adopted 
such a simple test.  If we had, all of the cases MassHealth 
cites for this proposition could have been decided in one or two 
sentences:  the court could have essentially written that the 
case was an administrative proceeding and not a court action and 
therefore the absence of an express limitation meant that there 
was no limitation, period.  That has never been the case.  
Rather, we thoroughly examine the essential nature of the right 
and proceedings to determine whether a statute of limitations 
applies or not. 
22 
 
not subject to a statute of limitations.  Id. at 708.  In doing 
so, we placed great weight on the unequivocal language in the 
statute providing that "[i]n no event shall any member after 
final conviction . . . be entitled to receive a [pension]" 
(emphasis added).  Id., quoting G. L. c. 32, § 15 (4).  Indeed, 
we said that forfeiture under § 15 (4) "is mandatory and occurs 
by operation of law" and that it "is an automatic legal 
consequence of conviction of certain offenses," allowing no 
discretionary decision-making by the administrative agency 
(citation omitted).  Woodward, supra at 705.  Finally, we 
stressed that "[i]t would be illogical to permit the board to 
accomplish by inattention or inaction what it is prohibited from 
doing as a matter of discretion."  Id. at 708. 
We also are struck by the absurd consequences of 
MassHealth's argument.  Taken to its logical conclusion, 
MassHealth's argument would mean that no administrative 
proceeding would have a time deadline for commencement or 
conclusion unless the Legislature expressly imposed a statute of 
limitations.  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. 
23 
 
MassHealth makes several other arguments why no statute of 
limitations applies to its actions to recoup overpayments.  It 
points to G. L. c. 118E, § 44, which contains a six-year statute 
of limitations on civil actions brought by the Attorney General 
or district attorneys for violations of c. 118E.  G. L. c. 118E, 
§ 44 ("No action shall be brought under this section more than 
six years after it accrues").  Unlike MassHealth, they are not 
parties to the provider agreement.  MassHealth argues that the 
omission of MassHealth from this statute of limitations 
provision demonstrates that the Legislature could have subjected 
MassHealth to a statute of limitations but deliberately chose 
not to do so. 
We conclude that the Legislature's express inclusion of a 
six-year statute of limitations in a related proceeding is 
informative but not dispositive.  In expressly selecting a 
statute of limitations period for these causes of actions, the 
Legislature settled on the six-year period applicable to 
contract actions.  It did so even though the cause of action 
created by § 44 applies to any violation of many provisions in 
c. 118E, not just the overpayment recoupment provisions.  In one 
sense, this supports our conclusion that the Legislature would 
consider a six-year statute of limitations appropriate for the 
claims at issue here, as MassHealth's claim against Suburban is 
24 
 
more akin to a traditional contract action than the type of 
government enforcement action created by § 44. 
That being said, MassHealth correctly points out that the 
Legislature expressly stated that the six-year statute of 
limitations applied to § 44 actions and was silent about the 
administrative claims at issue here.  Although this difference 
gives us pause, we conclude that, on balance, § 44 provides 
little to no guidance, and the limited guidance it does provide 
counsels in favor of a six-year statute of limitations for the 
claims here.  Given the fundamental purposes of statutes of 
limitations, and the absurd consequences of not including any 
statute of limitations whatsoever for administrative 
proceedings, we discern no reason why the Legislature would not 
want to impose a statute of limitations.  As explained above, we 
require express guidance from the Legislature to conclude that 
no statute of limitations whatsoever applies.  Presented with 
silence or some ambiguity, as here, we look to the essential 
nature of the right, which in this case we conclude is 
contractual. 
MassHealth also argues that the Legislature intended for 
providers to be liable for "all overpayments owed to the 
division."  G. L. c. 118E, § 36 (5) (providers must "agree to be 
responsible for all overpayments owed to the division, 
including, in the case of transfer of ownership, the 
25 
 
overpayments of any and all previous owners").  It argues that 
the phrase "all overpayments" cannot be read to mean that 
MassHealth can only recover overpayments within a limited period 
of time.  We do not read this language so broadly.  Instead, we 
think the more natural reading is that it ensures that providers 
are liable for the full amount of any overpayment timely 
identified by MassHealth. 
Finally, MassHealth argues that our interpretation should 
be guided by the Federal scheme, which MassHealth contends does 
not contain any statute of limitations on the Federal 
government's ability to recoup overpayments from the States,  
see 42 C.F.R. §§ 433.300-433.322, as it does not include any 
express language adopting a statute of limitations.  MassHealth 
presents no Federal case law to support this unlimited, open-
ended interpretation of Federal recovery proceedings, just 
administrative agency decisions.  See id. (omitting any statute 
of limitations in Federal overpayment recoupment procedure).  
Regardless, this argument conflates the relationship between the 
Federal government and the States on one hand and the States and 
the providers on the other.  These two relationships are 
distinct and governed by different sets of rules.11  As a result, 
 
11 Notably, States are given some discretion in structuring 
their State plans as long as the plans are consistent with 
Federal law.  See Atlanticare Med. Ctr. v. Division of Med. 
Assistance, 485 Mass. 233, 235-236 (2020). 
26 
 
even if the Federal government does not provide for a statute of 
limitations on its recovery from the State, a proposition that 
has by no means been established by MassHealth's briefing to 
this court, the rules that govern the Federal-State relationship 
do not compel a particular interpretation of whether there is a 
statute of limitations governing recoupment proceedings under 
G. L. c. 118E. 
3.  Conclusion.  For the foregoing reasons, we reverse the 
order dismissing the case and conclude that the claim is time 
barred.  We remand the case for further proceedings consistent 
with this opinion. 
 
 
 
 
 
 
So ordered.