Massachusetts General Laws

Mass. Gen. Laws ch. 118E, § 36 (2026)

Eligible providers; responsibility for overpayments

✓ current as of July 2026

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Section 36. Participation in the medical assistance programs established under this chapter shall be limited to providers of services who have not been convicted of larceny or fraud or any other crime in connection with such services, or the billing therefor and who:

(1) indicate their intention to the division to so participate;

(2) present evidence, satisfactory to the division, of their qualifications to provide such services;

(3) agree to accept, as payment in full, the amounts paid in accordance with the fee schedules provided for under this chapter;

(4) agree to comply with all laws, rules and regulations governing the operation of the programs;

(5) agree to be responsible for all overpayments owed to the division, including, in the case of transfer of ownership, the overpayments of any and all previous owners.

If any individual or entity has an ownership interest in more than one institutional provider, the division may offset any monetary liability of such individual or entity to the division under this section or otherwise from any amounts the division owes to any such institutional provider. Any individual or entity having an ownership interest in an institutional provider shall be liable to the division for all monetary liabilities of such provider to the division to the extent of such individual's or entity's ownership interest. For purposes of this paragraph, an ''ownership interest'' shall include both direct ownership interests and ownership interests in any entity which has an ownership interest in an institutional provider, and an ''institutional provider'' shall mean any entity which participates in any medical assistance program under this chapter as a provider of nursing facility services or acute, chronic, or rehabilitation hospital services.

Notes of Decisions

Cited in 7 cases, 1997–2012 · leading case: Boston Med. Ctr. Corp. v. Sec'y of the Exec. Off. of Health & Human Servs., 463 Mass. 447 (Mass. 2012).

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Boston Med. Ctr. Corp. v. Sec'y of the Exec. Off. of Health & Human Servs., 463 Mass. 447 (Mass. 2012). · cites it 2× “Under G. L. c. 118E, § 36, and the terms of the REA, a hospital that enters into a contract to accept MassHealth patients must agree to accept, “as payment in full,” the amounts paid under these rates.”

Centennial Healthcare Inv. Corp. v. Comm'r of the Div. of Med. Assistance, 810 N.E.2d 1231 (Mass. App. Ct. 2004). · cites it 2× “” G. L. c. 118E, § 36(3). The regulations further require that the provider must refund to the patient, upon the patient’s request, all sums paid by the patient at the private rate, retroactive to the date of eligibility.”

Perseus of N.E., MA, Inc. v. Commonwealth, 706 N.E.2d 681 (Mass. 1999). “Although G. L. c. 118E, § 36, imposes successor liability on Perseus, that liability is joint and several.”

Haverhill Mun. Hosp. v. Comm'r of the Div. of Med. Assistance, 699 N.E.2d 1 (Mass. App. Ct. 1998). “The hospital, by reason of its agreement to comply with all applicable Federal and State laws, rules, and regulations, see G. L. c. 118E, § 36(4), is an eligible provider of medical services to Medicaid-eligible persons.”

Boston Med. Ctr. Corp. v. Sec'y of Exec. Off. of Health & Human Servs., 28 Mass. L. Rptr. 105 (Mass. Super. Ct. 2010). “BMC contends that it is an exception to this general rule, because the Boston Public Health Act confers on it a mission that, as a practical matter, it cannot fulfill without participation in MassHealth.”

Sylvestre v. Martin, 23 Mass. L. Rptr. 408 (Mass. Super. Ct. 2008). “15; M.G.L.c. 118E, §36, and M.G.L.c. 118G, §7).”

Massachusetts Eye & Ear Infirmary v. Bullen, 7 Mass. L. Rptr. 101 (Mass. Super. Ct. 1997). “See G.L.c. 118E, §36(4) (Medicaid providers must “agree to comply with all laws, rules, and regulations governing the operations of the programs”).”

— Mass. Gen. Laws ch. 118E, § 36(3) — 1 case

Centennial Healthcare Inv. Corp. v. Comm'r of the Div. of Med. Assistance, 810 N.E.2d 1231 (Mass. App. Ct. 2004). “” G. L. c. 118E, § 36(3). The regulations further require that the provider must refund to the patient, upon the patient’s request, all sums paid by the patient at the private rate, retroactive to the date of eligibility.”

— Mass. Gen. Laws ch. 118E, § 36(4) — 2 cases

Haverhill Mun. Hosp. v. Comm'r of the Div. of Med. Assistance, 699 N.E.2d 1 (Mass. App. Ct. 1998). “The hospital, by reason of its agreement to comply with all applicable Federal and State laws, rules, and regulations, see G. L. c. 118E, § 36(4), is an eligible provider of medical services to Medicaid-eligible persons.”

Massachusetts Eye & Ear Infirmary v. Bullen, 7 Mass. L. Rptr. 101 (Mass. Super. Ct. 1997). “See G.L.c. 118E, §36(4) (Medicaid providers must “agree to comply with all laws, rules, and regulations governing the operations of the programs”).”

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