Nursing Home In Worcester Part Of Company Sued By U.S. Gov't And MA AG

WORCESTER, MA - The U.S. Attorney's Office filed a joint complaint with the Massachusetts Attorney General's Office against 19 skilled nursing facilities under RegalCare in Massachusetts and Connecticut.

According to a news release from the U.S. Department of Justice, federal healthcare programs reimburse providers for medically reasonable and necessary services given to patients. The complaint alleges that between 2017 and 2023, RegalCare fraudulently caused the submission of claims for such services to patients at its facilities.

The fraudulent claims reportedly came from the direction of the owner and an executive from RegalCare, Eliyahu Mirlis and Hector Carabello.

Patients were apparently billed for the highest level of skilled rehabilitation therapy services despite never receiving them. Carabello helped facilitate the plan by adding services onto patients' bills without speaking to them. Mirlis and Carabello are also accused of directing RegalCare's third-party billing company to bill Medicare for those therapy services before the necessary clinical documentation was complete.

The rabbit hole goes deeper, as the complaint accuses Stern, a New York consulting company, of conspiring with RegalCare to cause the submission of these claims by scheduling therapists to provide unnecessary, often unreasonable, services.

The state of Massachusetts contends that RegalCare also submitted inflated claims to MassHealth for patients' services at locations across the state.

From 2017 to 2023, RegalCare operated in Amesbury, Danvers, Greenfield, Harwich, Holyoke, Lowell, Quincy, Saugus, taunton and Worcester.