RegalCare Settles False Claims Act Case

The Senior Justice Law Firm has announced a $1 million settlement in a False Claims Act case involving RegalCare, a skilled nursing facility. The settlement resolves allegations that RegalCare submitted claims to Medicare and MassHealth for services that were medically unreasonable or unnecessary. The case involved claims submitted to Medicare and Massachusetts Medicaid for skilled nursing rehabilitation and other services.

The settlement stems from a qui tam whistleblower action where the relator was represented by David Brevda, a partner at Senior Justice Law Firm, and Raymond M. Sarola, a partner at Cohen Milstein Sellers & Toll PLLC. The case involved claims submitted to Medicare and Massachusetts Medicaid for skilled nursing rehabilitation and other services. The government alleged that RegalCare and related defendants submitted claims for services that were medically unreasonable or unnecessary.

As part of the settlement, RegalCare, Mirlis, and Caraballo admitted, acknowledged, and accepted responsibility for certain conduct involving Medicare and MassHealth billing. According to the settlement agreement, at various times between 2018 and 2023, RegalCare submitted Medicare claims at Resource Utilization Group (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. On some occasions, he made changes without consulting clinicians. 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.

Under the settlement, the defendants agreed to pay the United States and Massachusetts a combined $1 million, plus interest. Of that amount, $500,000 is designated as restitution. The RegalCare settlement follows a separate March 2026 agreement involving therapy provider Stern Therapy Consultants LLC. Stern Therapy agreed to pay $315,000 to resolve allegations that it conspired with RegalCare and others to cause the submission of false Medicare claims for medically unnecessary skilled nursing rehabilitation therapy services.

The case was brought under the qui tam provisions of the federal and Massachusetts False Claims Acts. These laws permit private individuals with knowledge of suspected fraud to bring claims on behalf of the government and potentially receive a share of the government's recovery. The whistleblower filed the qui tam action in 2020. The United States and the Commonwealth of Massachusetts intervened in the case in November 2024 and filed their 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.). Official U.S.

The Senior Justice Law Firm is the nation's largest law firm dedicated exclusively to representing victims and families affected by elder abuse and neglect in nursing homes, assisted living facilities, hospitals, home health settings, and other long-term care environments. Founded in 2016, the firm has 24 attorneys and represents clients in 28 states. Senior Justice Law Firm also represents qui tam whistleblowers who expose fraud and misconduct affecting residents and government healthcare programs.

Counsel for the Relator The whistleblower was represented by David Brevda of Senior Justice Law Firm and Raymond M. Sarola of Cohen Milstein Sellers & Toll PLLC.

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