Massachusetts nursing homes, RegalCare, allegedly billed patients for unnecessary care
The complaint was filed on Tuesday under the federal and Massachusetts False Claims Act against these SNFs and their present and former management companies, RegalCare Management Group, LLC, and RegalCare Management 2.0.
SNFs serve as inpatient facilities providing transitional care to patients following a hospital stay. Federal healthcare programs like Medicare or Medicaid reimburse providers for medically necessary services provided to patients.
Mass. man charged in connection with $30 million healthcare fraud scheme
This joint complaint alleged that between 2017 and 2023, RegalCare fraudulently submitted claims to Medicare and Medicaid under the direction of owner Eliyahu Mirlis and executive Hector Caraballo. The claims were allegedly submitted for medically unnecessary and unreasonable services to RegalCare's SNF patients.
The documents also state that Stern Therapy Consultants, who works for RegalCare, allegedly aided the company as a co-conspirator.
usa_v._regalcare_et_al_-_complaint_and_exhibits-1Download
The scheme allegedly resulted in millions of dollars of damages to the Medicaid and Medicare programs as a result.
RegalCare, at Mirlis' direction, was alleged to have caused Medicare to be billed for the highest level of skilled rehabilitation therapy services at these SNFs in Massachusetts and Connecticut, despite the patients not needing those services. Caraballo allegedly altered and amended records to ensure that patient records matched the billing.
The United States further stated that Stern Therapy Consultants scheduled therapists to provide unnecessary services for RegalCare patients and that Stern managers would threaten therapists if they refused to comply with the scheme.
'I am proud of our team's partnership with the USAO in this case, which advances elder justice and safeguards crucial nursing home funds,' said Massachusetts Attorney General Andrea Joy Campbell. 'My office will continue to work aggressively to protect our elders and hold companies accountable that seek to harm them or violate our false claim laws.'
The U.S. and Massachusetts governments filed the complaint in a lawsuit originally filed by a whistleblower under the qui am provisions of the False Claims Act, which allows a private citizen to sue on behalf of the United States or Mass. and share in any recovery.
In Massachusetts, RegalCare has facilities in Amesbury, Danvers, Greenfield, Harwich, Holyoke, Lowell, Quincy, Saugus, Taunton and Worcester.
WWLP-22News, an NBC affiliate, began broadcasting in March 1953 to provide local news, network, syndicated, and local programming to western Massachusetts. Watch the 22News Digital Edition weekdays at 4 p.m. on WWLP.com.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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