Press Release: 9/24/2026
AG Campbell Announces $1 Million Settlement With Nursing Facility Operator RegalCare For Medicare And Medicaid Price Hike Scheme
Boston — Massachusetts Attorney General Andrea Joy Campbell, jointly with the U.S. Attorney’s Office for the District of Massachusetts (USAO), today announced a $1 million settlement with RegalCare Management 2.0 LLC and RegalCare Management Group, LLC (collectively, “RegalCare”), resolving allegations that RegalCare falsely increased assessments of patient health statuses to obtain more money from Medicare and MassHealth. Under the terms of the agreement, RegalCare will pay $1 million.
“When nursing facilities falsify patient records and assessments to make more money off Medicare and MassHealth, it threatens the integrity of these essential programs that our most vulnerable residents rely on,” said AG Campbell. “This settlement holds RegalCare accountable for its illegal conduct and abuse of taxpayer dollars.”
RegalCare is a New York-based company that, since 2021, has operated multiple skilled nursing facilities in Massachusetts, including in Holyoke, Greenfield, Worcester, Taunton, Quincy, and Harwich. From April 2018 through February 2021, RegalCare also operated three other Massachusetts facilities: Maplewood Rehab and Nursing in Amesbury; Twin Oaks Rehab & Nursing in Danvers; and Saugus Rehab & Nursing.
This case originated with the filing of a whistleblower complaint in the U.S. District Court for the District of Massachusetts in 2020. In February 2025, the USAO and AGO intervened in the matter and sued RegalCare.
The government’s complaint alleged that, prior to 2019, Medicare programs paid nursing facilities a pre-determined daily rate for each day of skilled nursing and rehabilitation services provided to a patient. These rates were based on the level of care a patient requires, which was measured, in part, using a Resource Utilization Group (RUG) score, which measured the amount of therapy a patient received during an assessment period. Higher RUG scores received higher Medicare reimbursements.
Until 2023, MassHealth used the Management Minute Questionnaire (MMQ) to determine reimbursement rates. Like RUG scores, MMQ scores are driven by the level of care a patient requires.
The USAO and AGO alleged that RegalCare engaged in a scheme to manipulate the RUG and MMQ scores of patients at its facilities to improperly increase Medicare and Medicaid reimbursement. RegalCare did so by pushing as many patients to the highest RUG and MMQ levels as possible. In the complaint, the AGO identified numerous patients whose MMQ scores were, on average, higher under RegalCare’s management than during both the twelve-month periods prior and subsequent to RegalCare’s management.
This matter was handled by Division Chief Kevin Lownds and Senior Healthcare Fraud Investigators Erica Schlain and Mirlinda Sejdiu, all of the AG’s Medicaid Fraud Division. MassHealth and the Department of Public Health provided substantial assistance with the investigation.
The AGO’s Medicaid Fraud Division is a Medicaid Fraud Control Unit, annually certified by the U.S. Department of Health and Human Services to investigate and prosecute health care providers who defraud the state’s Medicaid program, MassHealth. The Medicaid Fraud Division also has jurisdiction to investigate and prosecute complaints of abuse, neglect and financial exploitation of residents in long-term care facilities and of Medicaid patients in any health care setting. Individuals may file a MassHealth fraud complaint or report cases of abuse or neglect of Medicaid patients or long-term care residents by visiting the AGO’s website.
The Massachusetts Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,458,176 for federal fiscal year 2026. The remaining 25 percent, totaling $2,152,724 for FY 2026, is funded by the Commonwealth of Massachusetts.
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