Massachusetts nursing home operator RegalCare Management Group and two of its executives have agreed to pay $1 million to resolve allegations that the company submitted false claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy, federal prosecutors said Wednesday.
RegalCare, owner Eliyahu Mirlis and executive Hector Caraballo admitted that, between 2018 and 2023, their company submitted claims for skilled nursing rehabilitation services that were not supported by individual patients’ medical needs, according to a settlement announced by the U.S. Attorney’s Office for Massachusetts.
“At various times, Caraballo modified SNF records to support the submission of Ultra High RUG claims to Medicare, and without assessing or speaking to the patients, or even consulting with clinicians,” noted a press release from the U.S. Attorney’s Office.
Meanwhile, Mirlis also directed RegalCare’s billing company to submit claims for patients before the patients’ assessment forms were even finalized in the billing system.
The allegations were originally filed in a 2025 federal lawsuit under the False Claims Act, which allows private whistleblowers to sue on behalf of the government. The whistleblower, identified in court records as McCormick, will receive $165,000 from the settlement.
The settlement follows a separate agreement announced in March involving Stern Therapy, RegalCare’s therapy provider. That settlement resolved allegations that Stern Therapy conspired...
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