Massachusetts healthcare facilities facing allegations of fraud.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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