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RegalCare and two executives to pay $1 million over nursing home therapy billing

Federal prosecutors and the Massachusetts attorney general's office said the skilled nursing operator, its owner and an executive admitted billing Medicare and MassHealth for rehabilitation therapy that patients did not need.

Skilled nursing facilities run by RegalCare Management Group and RegalCare Management 2.0, along with two company executives, have agreed to pay $1 million to settle claims that they billed Medicare and Massachusetts Medicaid for rehabilitation therapy that was not medically necessary, the U.S. attorney's office in Boston said Wednesday.

The settlement covers RegalCare, owner Eliyahu Mirlis and executive Hector Caraballo. It resolves a False Claims Act complaint that the federal government and the state filed in U.S. District Court in Massachusetts in February 2025, accusing the defendants of inflating the nursing homes' claims to the two programs.

As part of the deal, the three admitted that between 2018 and 2023 RegalCare submitted claims to Medicare and MassHealth for skilled nursing rehabilitation therapy that was medically unreasonable and unnecessary, prosecutors said. At the direction of Caraballo and Mirlis, the company submitted claims that were not supported by what patients needed, according to the settlement.

Caraballo changed nursing home records to support billing Medicare at its highest therapy rate, though his license did not allow him to do so, and did so without assessing or speaking to patients or consulting clinicians, prosecutors said. Mirlis told the company's billing firm to submit claims before patients' assessment forms had been finalized, they said.

RegalCare operates nursing homes in Massachusetts and previously in Connecticut.

The case began as a whistleblower suit. The person who brought it will receive $165,000 from the settlement.

In March, the government announced a separate settlement with RegalCare's therapy provider, Stern Therapy, over allegations that it conspired with RegalCare to cause false claims to be submitted to Medicare.

This brief was drafted by AI from a public agency press release and published by The New England Signal. Why we use AI for stories like this one.

Massachusetts