Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 450.000 - Administrative and Billing Regulations › Section 450.260 - Monies Owed by Providers

Current through Register 1525, July 5, 2024
(A)
Provider Liability
. A provider is liable for the
			 prompt payment to the MassHealth agency of the full amount of any overpayments,
			 or other monies owed under
			 130 CMR 450.000, including
			 but not limited to
			 130 CMR
			 450.235(B), or under any
			 other applicable law or regulation. A provider that is a group practice is
			 liable for any overpayments owed and subject to sanctions imposed as a result
			 of any violation of any statute or regulation committed by the individual
			 practitioner that provided the service.
(B)
Ownership
			 Liability
. Any owner of an institutional provider is liable for
			 the monetary liability of the institutional provider under 130 CMR 450.260(A)
			 to the extent of the owner's ownership interest. For purposes of 130 CMR
			 450.260, an "owner" is a person or entity having an ownership interest in an
			 institutional provider, as such interest is defined in
			 130 CMR
			 450.221(A)(9)(a), (b), (c), or
			 (f). An "institutional provider" is any
			 provider that provides nursing facility services, or acute, chronic, or
			 rehabilitation hospital services.
(C)
Common Ownership
			 Liability
. Any two or more providers who are or were, at any time,
			 wholly or partly owned by the same person or entity, whether concurrently,
			 sequentially, or otherwise, are jointly and severally liable for each of their
			 obligations to pay the full amount of any monies owed under 130 CMR
			 450.260(A).
(D)
Successor Liability
. Any successor owner of a provider
			 is liable for the obligation of any prior owner to pay the full amount of any
			 monies owed by the prior owner under 130 CMR 450.260(A). For purposes of 130
			 CMR 450.260, a "successor owner" is any successor owner, operator, or holder of
			 any right to operate all or a part of the prior owner's health-care business,
			 which includes, but is not limited to, the business management, personnel,
			 physical location, assets, or general business operations. A successor owner of
			 a nursing facility or hospital includes any successor owner or holder of a
			 license to operate all or some of the beds of a nursing facility or
			 hospital.
(E)
Group
			 Practice Liability
. The individual practitioner who provided the
			 service and the group practice will be jointly and severally liable for each of
			 their obligations to pay the full amount of any monies owed under 130 CMR
			 450.260.
(F)
Recoupment
. If a provider fails to pay the full amount
			 of any monies owed under 130 CMR 450.260(A), the MassHealth agency may recoup
			 up to 100% of any and all payments to the provider, without further notice or
			 demand, until such time as the full amount of any monies owed under 130 CMR
			 450.260(A) is paid in full.
(G)
Set-off
. The MassHealth agency may apply a set-off
			 against payments to a provider in the following circumstances.
(1)
Providers Under Common
			 Ownership
. Whenever any monies are owed by a provider under 130
			 CMR 450.260(A), the MassHealth agency may set off up to 100% of any and all
			 payments to any providers who are or were, at any time, wholly or partly owned
			 by the same person or entity, whether concurrently, sequentially, or otherwise,
			 without further notice or demand, until such time as the full amount of the
			 monies owed under 130 CMR 450.260(A) is repaid in full.
(2)
Successors
. Upon
			 the sale or transfer of all or part of a provider, the MassHealth agency may
			 set off up to 100% of any and all payments to any successor owner, without
			 further notice or demand, until such time as the full amount of any monies owed
			 by any prior owner under 130 CMR 450.260(A) is repaid in full.
(3)
Group Practices
.
			 Whenever monies are owed by a group practice under 130 CMR 450.260(A), the
			 MassHealth agency may set off up to 100% of any and all payments to the
			 individual practitioner who provided the service, without further notice or
			 demand, until such time as the full amount of any monies owed by the group
			 practice under 130 CMR 450.260(A) is repaid in full. Whenever monies are owed
			 by an individual practitioner who is a member of a group practice under 130 CMR
			 450.260(A), the MassHealth agency may set off up to 100% of any and all
			 payments to the group practice, without further notice or demand, until such
			 time as the full amount of any monies owed by the individual practitioner under
			 130 CMR 450.260(A) is repaid in full.