Senior Justice Law Firm announces $1 million RegalCare settlement

Senior Justice Law Firm says a whistleblower case over skilled nursing claims to Medicare and MassHealth ended with RegalCare and related defendants agreeing to pay $1 million. The settlement resolves allegations of medically unnecessary billing and adds to earlier government enforcement involving therapy claims tied to RegalCare.

Why it matters: - The settlement resolves allegations that skilled nursing claims were billed to Medicare and Massachusetts Medicaid, known as MassHealth, for services that were medically unreasonable or unnecessary. - The case highlights the role of whistleblowers in exposing alleged overbilling in long-term care programs funded by taxpayers. - Half of the $1 million settlement is designated as restitution.

What happened: - Senior Justice Law Firm announced a $1 million settlement in a False Claims Act case involving RegalCare Management Group, LLC, RegalCare Management 2.0, LLC, owner Eliyahu Mirlis, executive Hector Caraballo, and skilled nursing facilities managed by RegalCare. - The settlement resolves a qui tam whistleblower action brought under the federal and Massachusetts False Claims Acts. - The whistleblower was represented by David Brevda of Senior Justice Law Firm and Raymond M. Sarola of Cohen Milstein Sellers & Toll PLLC. - The defendants agreed to pay the United States and Massachusetts a combined $1 million, plus interest. - The whistleblower filed the action in 2020. - The United States and the Commonwealth of Massachusetts intervened in November 2024 and filed a complaint in intervention in February 2025. - The case is United States and Commonwealth of Massachusetts v. RegalCare Management 2.0, LLC, et al., No. 20-cv-11805-IT (D. Mass.). - The source announcement includes an official U.S. Department of Justice link: official settlement announcement.

The details: - The government alleged RegalCare and related defendants submitted claims for services that were medically unreasonable or unnecessary. - From 2018 through 2023, RegalCare submitted Medicare claims at Resource Utilization Group, or RUG, levels that were not supported by individual patient needs and should have been billed at lower levels. - Caraballo admitted that he reviewed and modified patient assessment records used to support Ultra High RUG claims without personally assessing or speaking with the patients. - Caraballo also made changes without consulting clinicians on some occasions. - Mirlis admitted that, on some occasions, he directed RegalCare’s billing company to submit claims before patient assessment forms were finalized in the billing system. - RegalCare, Mirlis, and Caraballo admitted, acknowledged and accepted responsibility for certain conduct involving Medicare and MassHealth billing. - A separate March 2026 agreement involved Stern Therapy Consultants LLC, which agreed to pay $315,000 to resolve allegations that it conspired with RegalCare and others to cause false Medicare claims for medically unnecessary skilled nursing rehabilitation therapy services.

Between the lines: - The admissions focus on how billing levels were supported, not just whether services were provided. - The timing suggests a broader enforcement pattern around skilled nursing documentation, therapy billing, and upcoding in government healthcare programs. - The whistleblower provisions allowed private parties with knowledge of suspected fraud to bring the case on behalf of the government and potentially share in any recovery.

What's next: - The settlement closes the RegalCare matter, but the broader scrutiny of skilled nursing billing practices is likely to continue. - The DOJ and Massachusetts may continue using False Claims Act cases to target overbilling tied to patient assessments and therapy documentation. - Senior Justice Law Firm says it also represents whistleblowers in elder abuse and fraud matters, including cases affecting government healthcare programs.

The bottom line: - RegalCare and related defendants resolved allegations of improper skilled nursing billing for $1 million, with the case underscoring how whistleblower suits can drive recoveries in healthcare fraud cases.