News Summary
The United States Attorney’s Office and Massachusetts Attorney General’s Office have filed a complaint against 19 skilled nursing facilities for engaging in fraudulent billing practices. The complaint alleges that RegalCare Management Group and its affiliates submitted fraudulent claims to Medicare and Medicaid for unnecessary services from 2017 to 2023. The case highlights the efforts to protect vulnerable patients and the role of whistleblowers in exposing healthcare fraud. As legal proceedings unfold, the scrutiny on these facilities is expected to intensify, focusing on safeguarding healthcare resources.
Breaking News from Massachusetts
In a significant legal development, the United States Attorney’s Office, alongside the Massachusetts Attorney General’s Office, has made headlines with the filing of a joint complaint against 19 skilled nursing facilities (SNFs) in Massachusetts and Connecticut. This complaint, lodged on February 26, 2025, accuses these facilities of engaging in serious fraudulent billing practices, specifically in the realm of healthcare.
The Players Involved
At the heart of this case is the RegalCare Management Group, LLC and its affiliate, RegalCare Management 2.0. The complaint alleges that from 2017 to 2023, these companies initiated a scheme that resultantly led to the submission of bogus claims to both Medicare and Medicaid programs for services that patients didn’t actually require. The complaint specifically points fingers at owner Eliyahu Mirlis and executive Hector Caraballo as the masterminds behind this alleged fraud.
How the Scheme Worked
It is claimed that patients at RegalCare facilities were routinely billed for the highest tier of skilled rehabilitation therapy when in fact, these services were medically unnecessary. This troubling scheme reportedly resulted in millions of dollars in damages to government healthcare programs. Even worse, Caraballo allegedly went to great lengths to alter patient records without the necessary credentials, further pushing the boundaries of legality.
The Role of Stern Therapy Consultants
Adding another layer to this story is the involvement of Stern Therapy Consultants, which has been accused of aiding RegalCare as a co-conspirator. Allegations suggest that Stern Therapy actively scheduled unnecessary therapy services and even applied pressure on therapists to comply. Reports indicate that those who refused to provide unwarranted care were met with threats regarding their employment—a serious concern for professionals trying to do what’s right for their patients.
The Whistleblower Influence
An especially interesting twist in this case involves a whistleblower who flagged these dubious practices. Thanks to the qui tam provisions of the False Claims Act, this individual was empowered to bring the issues to light, thereby standing up on behalf of the government and seeking potential recovery of funds misappropriated through fraud. This avenue allows everyday citizens to become a vital part of holding corporate entities accountable for wrongdoing.
The Locations in the Hot Seat
Several RegalCare facilities across Massachusetts are implicated in this complaint, with notable locations including Amesbury, Danvers, Greenfield, Harwich, Holyoke, Lowell, Quincy, Saugus, Taunton, and Worcester. As the investigation unfolds, the focus on these facilities will likely intensify, shedding light on practices that may have jeopardized patient welfare and depleted essential healthcare funding.
Commitment to Protect the Vulnerable
In light of these serious allegations, Massachusetts Attorney General Andrea Joy Campbell has expressed a strong commitment to protecting elders and ensuring strict enforcement of laws against fraudulent claims. The initiative taken to file this complaint reflects the government’s resolve to safeguard healthcare resources, particularly for those in vulnerable positions.
What’s Next?
As the legal proceedings continue, many eyes will be on the outcomes of this complex case. The fallout could have significant repercussions not only for those directly involved but for healthcare practices and regulations across the board. The spotlight on these issues underscores the importance of maintaining integrity within the healthcare system, a goal that ensures equitable and necessary care for all patients.
In a world where healthcare fraud can erode public trust, this complaint serves as a reminder of the necessity for vigilance and accountability in safeguarding our healthcare resources.
Deeper Dive: News & Info About This Topic
- WWLP News
- McKnight’s Long-Term Care News
- Skilled Nursing News
- Telegram
- The Recorder
- Wikipedia: Health Care Fraud
- Google Search: RegalCare Management Group
- Google Scholar: Health Care Fraud
- Encyclopedia Britannica: Health Care Fraud
- Google News: RegalCare Fraud
Author: STAFF HERE BOSTON WRITER
BOSTON STAFF WRITER The BOSTON STAFF WRITER represents the experienced team at HEREBoston.com, your go-to source for actionable local news and information in Boston, Suffolk County, and beyond. Specializing in "news you can use," we cover essential topics like product reviews for personal and business needs, local business directories, politics, real estate trends, neighborhood insights, and state news affecting the area—with deep expertise drawn from years of dedicated reporting and strong community input, including local press releases and business updates. We deliver top reporting on high-value events such as Boston Marathon, Head of the Charles Regatta, and Boston Harborfest. Our coverage extends to key organizations like the Greater Boston Chamber of Commerce and Associated Industries of Massachusetts, plus leading businesses in finance, biotech, and insurance that power the local economy such as Fidelity Investments, Biogen, and Liberty Mutual Insurance. As part of the broader HERE network, we provide comprehensive, credible insights into Massachusetts's dynamic landscape.
