Outside chains like RegalCare transformed Mass. nursing homes. Quality fell.

The red-brick nursing home tucked off a busy road in Taunton used to be a rare jewel in a beleaguered industry, polished to a high sheen.

Floors gleamed from daily scrubbing. Residents’ clothes came back fresh and neatly folded. Employees stayed for decades. In early 2020, the 100-bed home earned the federal government’s highest quality rating — five stars — and held it for more than two years.

Then Eli Mirlis swept in from New Jersey and everything changed.

The Taunton purchase was one of many by Mirlis — so many that, over the past five years, he has become one of the largest nursing home operators in Massachusetts. During that stretch, his company, RegalCare, hacked at budgets so aggressively that basic supplies ran short, and veteran employees quit in frustration.

Beyond anything else, Mirlis went after the heart of any nursing home, cutting the hours of nursing staff at Taunton by nearly half, records show.

RegalCare’s corporate motto promised elderly and disabled residents they would “Rehab like Royalty.” But amid the squeeze, many experienced something far different: They pressed call buttons that went unanswered and sat in soiled diapers for hours. A transplant patient in Taunton was never given 40 doses of a medication to prevent organ rejection, according to federal records, and the hospital nurse who caught it couldn’t reach anyone at RegalCare for two weeks.

Eli Mirlis, CEO of RegalCare.

Within three years of Mirlis buying the Taunton home, federal regulators had knocked its coveted five-star quality rating down to one star, the lowest possible.

“We all worked very hard to get that building to a five-star,” said Joe Chaves, who ran maintenance and housekeeping in Taunton. He worked there 29 years, the last three under RegalCare’s ownership. “They came in, and it went out the window.”

The Boston Globe Spotlight Team found Mirlis fueled his breakneck ascent in Massachusetts with grim cuts to resident care while steering millions of dollars from his nursing homes’ revenue into a constellation of real estate and management businesses that he also owns.

By 2025 at the Taunton facility, for example, RegalCare was spending about $530,000 less on nursing services than the previous owners, records show. That same year, his real estate company charged the nursing home rent of $522,000, a bill more than four times higher than before he took over.

Aren’t these places regulated? Shouldn’t people be making them safe? Who’s dropping the ball here?

—Theresa Walsh Jr., whose mother was a resident in RegalCare’s Holyoke facility

In addition, Mirlis has claimed credentials he doesn’t have, with online bios listing universities he didn’t attend and a LinkedIn profile touting licenses he no longer holds. In 2018, New Jersey regulators determined he lied about completing continuing education requirements and permanently revoked his nursing home administrator license.

Still, on multiple Massachusetts applications — at least seven times since 2020 — Mirlis has checked a box stating he’d never had a professional license revoked.

Mirlis now owns or controls 12 nursing homes in Massachusetts, his strongest foothold in a fast-growing empire that includes at least 29 homes in five states. Every year, his company is responsible for the care of thousands of residents in this state alone.

It’s been a stunning rise from humble beginnings for Mirlis, who is 38 and once said he got into the industry to find a measure of financial security. In court several years ago, he estimated his net worth was $47 million.

Mirlis declined repeated interview requests and did not answer a list of questions about his credentials, finances, and the chain’s performance, including specific allegations of negligence raised by government inspectors and families. “I am not going to talk to you,” he told a Globe reporter in a brief phone conversation this summer. “You’ll make RegalCare look bad.”

Last week, he sent an email to the Globe that responded to questions about his nursing home funding — “RegalCare is not ‘private equity’ backed,” he wrote — and broadly defended his company’s values.

RegalCare strives “for the highest level of care for every single patient and an excellent experience for families,” he wrote. He partners “closely with the Department of Public Health and others to constantly improve the patient experience,” he added, including to quickly correct any problems that arise.

A Globe analysis of years of safety and health violations shows that problems regularly arise in Mirlis’s Massachusetts facilities.

A RegalCare nursing home in Quincy, rated five stars for quality when Mirlis bought it, has dropped to one star. There, in 2023, a blind, wheelchair-bound patient crashed to the bottom of an unblocked ramp, suffering a brain hemorrhage and multiple bone fractures, according to a federal inspection report.

Within a year of purchasing two Medford facilities, in 2024, RegalCare ran up more than $400,000 in federal fines for lapses in the care of more than two dozen patients.

A three-star facility Mirlis bought in 2022 in Holyoke fell to one star by 2024, and has stayed there ever since.

Theresa Walsh Jr. (left) and her sister, Tina Walsh, allege that their mother died from a medication error made at RegalCare’s Holyoke facility. (Suzanne Kreiter/Globe Staff)

In the middle of that decline in Holyoke, sisters Tina and Theresa Walsh Jr. entrusted the facility with their mother’s care for a stint in rehab. For two weeks, staff gave Theresa Walsh Sr. two types of antidepressants, when she normally only received one. A RegalCare physician assistant wrote in a report that she suspected the hospital where Walsh Sr. had previously been changed her typical antidepressant, and she “ended up on both here.”

“I was so angry, my whole body was shaking,” Theresa Walsh Jr. told the Globe. “In my heart, I felt like that was going to kill her.”

She died at Walsh Jr.’s home seven weeks later of serotonin syndrome, the death certificate says. In an ongoing lawsuit against RegalCare and others, her daughters allege that an overdose of serotonin from the antidepressants triggered delirium that their mother, already weakened, could not withstand.

“Aren’t these places regulated? Shouldn’t people be making them safe?” Theresa Walsh Jr. asked a reporter. “Who’s dropping the ball here?”

The answer to that question, the Globe found, is the Massachusetts Department of Public Health.

Theresa Walsh Jr. in the living room of her South Hadley home, in front of a family photograph including her mother. (Suzanne Kreiter/Globe Staff)

Theresa Walsh Sr. favored this chair on her daughter’s deck. (Suzanne Kreiter/Globe Staff)

A regulatory agency of more than 3,200 employees, with a $1.1 billion annual budget, the Massachusetts Department of Public Health oversees the state’s roughly 340 nursing homes. Among other powers, it can reject a nursing home purchase — if it finds a prospective buyer not “responsible and suitable,” as state statute puts it — and revoke a license it has already granted.

But the agency has not denied a single application to acquire a nursing home, or revoked a license, in at least seven years.

In this regulatory environment, the Globe found, Mirlis’s RegalCare and eight other chains from New York and New Jersey have gone on a buying spree in Massachusetts. All had a limited presence in this state before the pandemic upended the nursing home industry. In 2019, the companies owned 12 facilities here. Now they control 61 — nearly one in five nursing homes in the state.

The performance of these nine chains, some of which had poor track records in other states, could signal deeper problems ahead. Eight of these chains saw the quality ratings of their Massachusetts homes decline since they began operating here. The ninth company, which operates a group of homes that was rated below average to begin with, has not improved.

Some of the owners told the Globe their homes are getting better and expect future federal ratings to rise.

Few of the nursing-home operators have left a trail of decline as stark — or as visible — as Mirlis.

When he sought approval to buy the two Medford homes in 2024, he disclosed that a majority of the nine Massachusetts homes he had owned ranked among the bottom 12 percent of all facilities in the state. Two of them ranked in the bottom 1 percent. The Department of Public Health let him buy the homes anyway.

A pattern has emerged: Rather than slow Mirlis down, state regulators keep waving him along to his next purchase. They let him buy three more homes in the past five months.

When presented with the Globe’s findings on RegalCare, Massachusetts Health Commissioner Dr. Robbie Goldstein acknowledged he was aware of the chain’s record of low-quality care. He insisted he is dedicated to improvements on behalf of the state’s elderly and vulnerable.

“We owe the families who trust us and who are putting their loved ones into these facilities,” Goldstein said. “We have to do better to maintain the quality and safety standards.”

Massachusetts Public Health Commissioner Robbie Goldstein. (Jessica Rinaldi/Globe Staff)

Goldstein did not indicate how RegalCare’s record factored into decisions to approve Mirlis’s purchases, but suggested the agency has to weigh many variables — including community need — before giving a nursing home operator the green light to buy a home.

It was ultimately not the Department of Public Health, but a whistleblower, that brought Mirlis under the glare of government scrutiny in Massachusetts. In 2025, the US attorney’s office in Boston and the state attorney general’s office joined the former employee’s insurance-fraud suit against Mirlis, RegalCare, and others.

They were accused of inflating Medicare and Medicaid bills by pushing intensive physical therapy on elderly and frail residents, whether they needed it or not.

In his own way, Liberation Iannillo tried to sound an alarm about conditions he saw in one of RegalCare’s Medford facilities. His father, Michael Fothergill, arrived in 2024 and repeatedly told him that his calls for help to the nursing desk went unanswered. Iannillo once watched his father’s wounds get dressed by an employee who wasn’t wearing gloves.

Liberation Iannillo holds a photograph of his parents. (Suzanne Kreiter/Globe Staff)

Iannillo in front of RegalCare’s Glen Ridge facility in Medford, where his father lived for two years. (Suzanne Kreiter/Globe Staff)

Worried about the safety of his father, then in his early 70s, Iannillo moved from New York to Medford to keep a closer eye on his care. He didn’t like what he saw. Iannillo wrote complaints on the home’s Facebook page about lousy food, indifferent staff, and other concerns. And he filed complaints with the Department of Public Health, twice, imploring them to do something.

“Please,” Iannillo begged regulators in the second, “thoroughly investigate this place.”

He never heard back.

Liberation Iannillo repeatedly raised concerns about his father’s care at a Medford nursing home, but says his pleas went unanswered. (Raphael Chinca/Globe Staff)

Mirlis generally stays out of the public eye. Records suggest he runs his network of businesses out of his home, located in a modest suburban neighborhood in Edison, N.J. It’s rare to see photos of him online, save for a smiling portrait from a trade magazine that in 2020 named him one of the skilled-nursing industry’s “Future Leaders.”

Chaves, the former Taunton maintenance supervisor, said in three years of working for RegalCare he only saw Mirlis at the facility once.

But there are places that afford glimpses of his biography.

One is the website under his name, where a handful of blog posts position him as a thought leader in his field. They share his insights on subjects such as his work philosophy (“People First, Always”) and how to maximize your net worth (look for “joint ventures, collaborative projects, or strategic alliances.”)

Then there is the information on Mirlis that shows up in state records, business filings, and court documents, related to topics both professional and deeply personal.

Mirlis grew up in New York, one of eight children in a financially struggling family. As a teen, he was awarded a scholarship to the Yeshiva of New Haven, a Connecticut boarding school founded and run by Daniel Greer, then a prominent rabbi in his 60s. Greer also owned dozens of rental properties in the neighborhood.

After graduation, Mirlis attended two higher education institutions focused on religious studies, one in Israel and another at Sh’or Yoshuv Institute in Lawrence, N.Y., where he earned a degree in Talmudic law. He married and started a family.

On the lookout “for a job that offered financial security, he decided to become a nursing home administrator,” says a post on his website. Mirlis borrowed $25,000 from Greer’s yeshiva for the training, and by 2011 was working as an administrator at a home in New Jersey.

In 2017, Rabbi Daniel Greer, then 77, left New Haven Superior Court while facing charges of abusing Mirlis, his former student. (Peter Hvizdak/New Haven Register via AP)

While he was building his career, Mirlis made a difficult decision to confront a painful chapter from his teen years.

In 2016, when he was in his late 20s, he filed a civil lawsuit against Greer, accusing the rabbi of repeatedly raping him during his years as a student. He said Greer plied him with alcohol, and sometimes assaulted him in vacant rental properties. Greer denied all the allegations.

The case was extensively covered by news organizations, which usually don’t name survivors of sexual abuse, but a lawyer for Mirlis told a reporter his client wanted to come forward to dissuade future abusers.

In the end, the jury awarded Mirlis $20 million in damages, though he’d spend about six years in court trying to compel Greer to pay. In a subsequent criminal case, Greer was convicted and sentenced to 20 years in prison and would serve about six.

Mirlis was left deeply scarred by the years of abuse, he testified during the civil trial. He said the betrayal changed how he viewed the world.

“I don’t trust anybody,” he said. “I second-guess everybody.”

During the years of litigation, Mirlis made a leap from nursing home administrator working for someone else to an owner. He launched RegalCare in 2016 and before long, thanks to an infusion of outside investment, had acquired five facilities in Connecticut.

Today, government records examined by the Globe list Mirlis as the sole operator of most of his Massachusetts nursing homes, as well as the related limited liability companies he’s set up to own the properties and manage them. But other documents offer a window into his early backers and the lawsuits that entangled them.

Among the investors in Mirlis’s Connecticut properties was Benjamin Landa, a controversial nursing home magnate from New York with interests in dozens of facilities across the country. President Trump last year nominated Landa as his ambassador to Hungary, but the Senate has yet to approve him.

At one point, Landa successfully sued Mirlis to enforce a contract that would insulate Landa from loans, debts, and other financial obligations.

When reached by phone, Landa said he did not not know Mirlis well and hasn’t kept in touch with him. “I didn’t even know he had nursing homes in Massachusetts,” he said.

Another co-investor was Jacob Sod, though it’s not clear whether he invested personally or on behalf of his family-backed private investment firm Milrose Capital, which controls a more than $2 billion portfolio of nursing homes, real estate, and other properties. In 2021, an investor group alleged that Mirlis and Sod had a secret business arrangement: Mirlis wired Sod $2.5 million in exchange for cheaper rent for his Connecticut facilities.

Sod did not respond to a Globe interview request. Court documents show he disputed the accusations, Mirlis didn’t offer a response, and the suit was privately settled.

As Mirlis grew his business, web pages bearing his name claimed educational credentials he didn’t have. These include degrees from Fairleigh Dickinson University and “Yeshiva University’s Stern School of Business.”

Fairleigh Dickinson told the Globe it had no record of Mirlis being a student there. Neither did Yeshiva University, which does not have a Stern School of Business. (New York University, which does, also found no records of Mirlis attending.)

The Globe found no evidence that Mirlis used those credentials on his Massachusetts nursing home applications, which do not include questions about educational backgrounds. He did, however, attest on at least seven nursing-home applications that he never had a professional license revoked, despite a record in New Jersey showing otherwise.

During an investigation there, Mirlis told regulators he had lost the paperwork showing he completed 60 hours of mandatory continuing education, including four on ethics. The New Jersey officials concluded he had “practiced fraud, deceit or misrepresentation” and, in 2018, permanently revoked the license.

An administrator’s license, however, is not required to buy a nursing home in Massachusetts, or in many other states. Yet Mirlis continues to present himself as a licensed administrator, even though court records say his two other licenses, in New York and Connecticut, have lapsed.

Mirlis declined to answer the Globe’s questions about discrepancies in his credentials. Goldstein, the Massachusetts health commissioner, told the Globe he was unaware of Mirlis’s failure to disclose his license revocation on his applications.

By 2018, Mirlis had moved into Massachusetts, acquiring properties in Amesbury, Danvers, and Saugus. His apparent willingness to bend the rules — or break them — would resurface in how he ran some of his Massachusetts facilities, according to the whistleblower lawsuit filed by Michelle McCormick, a former physical therapist at RegalCare in Amesbury.

A view of the RegalCare facility in Holyoke. (Suzanne Kreiter/Globe Staff)

Her civil suit, joined by state and federal authorities, alleged a scheme that took place in 19 facilities in Massachusetts and Connecticut: Mirlis and other business associates ordered unnecessary and intensive physical therapy on frail residents to boost Medicare and Medicaid reimbursements.

Physical therapists were instructed to go “shopping” around the facility for patients, the government alleged, and at times forced treatments “in direct contradiction to those patients’ best interests.”

Mirlis and RegalCare were accused of acting in concert with Stern Therapy Consultants, which is related to another out-of-state nursing home chain that has expanded in Massachusetts. Government lawyers alleged that Stern Therapy and RegalCare operated “effectively as one company,” and said the defendants received “excessive and improper reimbursement from Medicare and Medicaid” worth millions of dollars.

In March, Stern Therapy settled the allegations against it, agreeing to pay $315,000. Last week, so did Mirlis, agreeing to pay a $1 million fine and acknowledging that he played a personal role in the billing scheme.

According to emails filed in the case, Mirlis once lost his temper when some inflated bills weren’t immediately accepted by a third-party billing company.

“I want a phone call!” he demanded in an email chain with the billing company and his employee. “Why all of a sudden are we having this retarded miscommunication?”

The lawsuit also describes a troubling 2019 episode at a RegalCare facility in Waterbury, Conn.

A 91-year-old woman, referred to in the documents as G.C., had been hospitalized for pneumonia, severe malnutrition, and congestive heart failure. Her family had expressed interest in hospice.

When she came to RegalCare, company managers allegedly ordered therapists to give the woman the most intensive level of physical therapy, classified as “Ultra High.” It typically involves, at minimum, sessions five days a week for a total of at least 12 hours.

During the sessions, G.C. was repeatedly “confused,” “weak,” and “scared,” therapists documented in their notes. She wanted to stop, she told them.

G.C. died four weeks after entering the nursing home. Medicare paid RegalCare more than $17,000 for her therapy, which the government said was neither reasonable nor medically necessary.

Kathy Ciliberto says her father, William Overton, was a proud man whose dignity wasn’t honored by staff at a Taunton nursing home. (Raphael Chinca/Globe Staff)

Mirlis began making changes at his Taunton nursing home, previously known as Longmeadow, soon after he took control in 2022.

Chaves, the former head of maintenance and housekeeping, said he used to be able to spend up to $1,000 without asking his Longmeadow bosses. Under RegalCare, he needed permission to buy even a gallon of paint. Broken machines like a floor buffer went unrepaired. Employees sometimes had to scramble to the supermarket because the kitchen ran out of bread or milk.

“RegalCare is great at cutting corners,” said Chaves, who decided in 2025 that it was time to retire.

Against the backdrop of budget cuts, RegalCare has held lavish holiday parties at Mohegan Sun casino in Connecticut. It’s been an invitation-only affair, with an open bar, a live band, and a guest list of mostly managers and executives.

A social media post from last year’s event shows the otherwise fiercely private Mirlis among those dancing to a remix of 50 Cent’s “In Da Club.” One former manager, who asked to remain anonymous to protect his future job prospects, recalled Mirlis taking the microphone at a previous party to hand out designer handbags and other expensive gifts.

“You’re more than willing to throw around all this money, all this cash, all this show. But you’re cutting supply orders?” the former manager said. “They don’t care. They’re all about money. They want profit.”

In his email to the Globe last week, Mirlis said he uses gifts to show his appreciation for his staff’s hard work.

“We are grateful for the efforts of our caregivers,” he said. “Yes, we occasionally hold recognition events for our staff and sometimes reward their compassion and dedication with modest gifts (things like TVs).”

A Globe analysis of state financial reports for the Taunton facility bears out much of the budget cutting that Chaves and other employees described.

Eli Mirlis began making cuts as soon as his company RegalCare took control of this Taunton nursing home. (Olivia Yarvis/Globe Staff)

From 2021, the year before RegalCare took over, to 2025, spending on facility operations fell 19 percent, cost reports show. The budget for dietary expenses fell 17 percent.

Cuts to nursing hours and staff ran even deeper. The hours worked by registered nurses fell by more than half, and those by licensed practical nurses by more than a third.

Over time, Mirlis directed a growing share of the money he squeezed out of the nursing home to the separate management, real estate, and therapy companies he owned.

Last year, according to a Globe analysis, Taunton paid $1.6 million to related companies — about 16 percent of the facility’s operating expense. That’s almost seven times the amount spent on food.

Goldstein, the Massachusetts health commissioner, called the 16 percent figure “concerning.” He added, “That’s a lot of money that is being diverted away.”

Such transactions, known as related-party payments, are common in the nursing home industry. Regulators require them to be disclosed because they can create opportunities for profiteering by owners.

“I felt like it was my fault for putting her in that place.”

—Hope Cayouette, whose grandmother was a resident in RegalCare’s Taunton facility

Related-party payments are central to a civil lawsuit brought against nursing-home operator Ephram Lahasky and others by the New York attorney general. Lahasky is among the out-of-state owners whose affiliated companies bought multiple homes in Massachusetts since the pandemic. Authorities alleged Lahasky and business colleagues turned a New York nursing home into a “profit machine,” diverting millions in Medicare and Medicaid taxpayer money to their other companies as care suffered. Lahasky has denied the allegations.

In Mirlis’s nursing home in Taunton, one line item that increased steeply was rent — which went to a company Mirlis owned.

The year before he acquired the facility, it paid about $119,000 a year to its landlord. When Mirlis took over, he created a separate limited liability company to lease the property to his nursing home, then started jacking up the annual rent.

Between 2021 and 2025, he quadrupled the rent to $522,000, while cutting spending on nursing care by more than $530,000.

Former employees say that they — and the residents they cared for — were absorbing the damage from the cuts.

A former infection preventionist at Taunton, who did not want to be named for fear of professional repercussions, said staffing was sometimes so anemic that she was expected to do her own job while also covering vacant nursing shifts.

Kathy Ciliberto said that when her father, William “Terry” Overton, arrived, she quickly grew distressed over the quality of care. Overton, then 91, took pride in his appearance, favoring L.L. Bean khakis and button-downs, but day after day his daughter found him in a hospital gown and diaper, though he wasn’t incontinent.

“He was a very proud, dignified man. And I just couldn’t understand how that was just not being honored,” Ciliberto said. “It was just easier to leave him in a diaper in his wheelchair until he was wet or soiled.”

Even with lower staffing, RegalCare homes rarely seemed to turn away prospective residents so long as they qualified for Medicare or Medicaid, former employees said. One said the corporate directive was blunt: “Fill all the beds.”

Hope Cayouette (right), her husband, Jordan, and daughter, Vanna, looked at photos of her late grandmother, Carol Lessard. (Suzanne Kreiter/Globe Staff)

In spring 2025, Hope Cayouette combed through inspection reports and reviews before placing her beloved 85-year-old grandmother, Carol Lessard, in an available bed in Taunton.

At the time, the facility still had a three-star rating, but it was soon reduced to one after a dismal state inspection. As a penalty for a so-called “immediate jeopardy” finding, the state banned the facility from accepting new residents for more than a month. (The most recent inspection, in late June, showed improvement on some measures.)

Carol Lessard held her great-granddaughter Vanna during a visit to RegalCare’s facility in Taunton. (Courtesy of Hope Cayouette)

Cayouette said RegalCare staff failed to diagnose her grandmother’s pneumonia, despite increasingly distressing signs — it took a visit to an outside doctor who, seeing Lessard’s condition, called an ambulance.

While watching Lessard recover in the hospital, she composed an email to several RegalCare managers and clinical staff.

“I just want to make it absolutely clear that I am losing faith in this facility’s ability to provide basic proper patient care,” she wrote. “I am scared to death of my grandmother returning to this facility.”

But Cayouette, with no other options, had to bring her grandmother back.

Two weeks later, Lessard fell out of her bed and a nurse found her on the floor at 4:30 a.m. No one called Cayouette for about two hours, records show. Cayouette insisted her grandmother be taken to the hospital, which took another hour and a half.

Surgery for an internal bleed, likely preceding the fall, would require Lessard being put on a ventilator, which she never wanted. She died later that day.

“I felt like it was my fault for putting her in that place,” Cayouette told the Globe.

Carol Lessard in an undated picture. (Courtesy of Hope Cayouette)

Cayouette wears a ring that belonged to her late grandmother. (Suzanne Kreiter/Globe Staff)

Hope Cayouette in her Providence home. (Suzanne Kreiter/Globe Staff)

Nursing homes can be a brutal business, with slim margins and medically fragile residents. But there are upsides, including a vast and steady stream of public dollars, virtually guaranteed. Medicaid alone pays out $2 billion for long-term care in Massachusetts every year.

Researchers say Massachusetts is also especially attractive to investors because of its relatively generous state-level government reimbursements and an unusually large pool of elderly residents who can afford to pay out of their own pockets.

After the pandemic sent the local nursing-home industry reeling, many longtime operators chose to sell. From 2023 to 2025, 69 Massachusetts nursing homes changed hands, a rate more than double the prior three years, a Globe analysis found.

Amid the churn, many entrepreneurs from New York and New Jersey saw opportunity. The result, in many cases, was declining care.

Unlike mega corporations or private-equity backed chains that have drawn legislative scrutiny, the nine chains identified by the Globe that are buying up nursing homes here are an unusual group: They keep a low profile and have largely escaped notice. Their companies are also generally small to midsize and, in some cases, family-run, with opaque sources of funding.

All nine report on federal disclosures that they have no private-equity backing. Entities that do accept such funding tend to attract more criticism from nursing home advocates.

And there is another unusual aspect to these chains.

They appear to be only competitors, vying for residents on the strength of factors like price and quality of care. But some of the company owners, Mirlis included, have also repeatedly done business together. A Globe analysis of property and court records found executives taking out multimillion-dollar loans together, consulting for one another, and partnering in related ventures.

A Globe search of property records, corporate filings, and lawsuits found business relationships linking six of the ownership groups.

Some of these nursing home operators look like competitors, but have partnered in other ventures

(related to Stern Consultants)

State and federal lawyers

accused Stern and RegalCare of

operating “effectively as one

company” in an alleged

insurance fraud scheme.

Mirlis and Lieberman

held loans together to

buy assisted living

facilities in Mass.

Lieberman was a consultant

for about a year.

Azriel Lieberman

Owner, Azure Healthcare

Lieberman acted as a

registered agent for Vantage

Care’s Reading nursing home.

Co-owner, 2024, Vantage Care

Management Company

Lahasky and Arem were

business partners in

other states.

Ephram Lahasky

Founder, Ephram Lahasky chain

(related to Stern Consultants)

State and federal lawyers

accused Stern and RegalCare of

operating “effectively as one

company” in an alleged

insurance fraud scheme.

Mirlis and Lieberman

held loans together to

buy assisted living

facilities in Mass.

Lieberman was a consultant

for about a year.

Azriel Lieberman

Owner, Azure Healthcare

Lieberman acted as a

registered agent for

Vantage Care’s Reading

nursing home.

Co-owner, 2024, Vantage Care

Management Company

Lahasky and Arem were

business partners in

other states.

Ephram Lahasky

Founder, Ephram Lahasky chain

(related to Stern

Consultants)

State and federal

lawyers accused Stern

and RegalCare of

operating “effectively

as one company” in

an alleged insurance

fraud scheme.

Mirlis and Lieberman

held loans together to

buy assisted living

facilities in Mass.

Lieberman was a

consultant for

about a year.

Azriel Lieberman

Owner, Azure Healthcare

Lieberman acted as a

registered agent for

Vantage Care’s Reading

nursing home.

Co-owner, 2024, Vantage Care

Management Company

Lahasky and Arem were

business partners in

other states.

Ephram Lahasky

Founder, Ephram Lahasky chain

When the Globe described the ties to several experts, they said hidden alliances can stifle competition — leaving Massachusetts residents with fewer choices — invite price collusion, and obscure who really controls the chains from prospective customers and regulators alike.

“States don’t know what these nursing homes are doing,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy.

Several of the companies have no corporate website, office, phone number, or central email.

Even ambulance providers have struggled to track down some owners over unpaid bills, said Dennis Cataldo, president of the Massachusetts Ambulance Association. Richard Raymond, a member of the group, said RegalCare owed his company $65,000, but frustratingly couldn’t reach anyone to get it paid.

“I was going to drive there, five hours to New Jersey, and just hand them the invoices,” Raymond said. He sued the company instead, and the parties eventually reached a settlement.

Beyond Mirlis, when the Globe asked owners of the eight other chains about their declining or below-average federal ratings, or cases in which they had intertwining relationships, three responded. They all emphasized they are dedicated to delivering top-quality care in Massachusetts.

Full statements from representatives of RegalCare, Ephram Lahasky, Azure Healthcare, and AdviniaCare in response to Globe inquiries.

AdviniaCare and Lahasky both said recent state inspections showed improvements that were not yet reflected in the federal star ratings.

AdviniaCare called the star ratings a “lagging indicator” and cited a recent deficiency-free inspection at its Salem home. Lahasky said his facilities take in a “highly underserved MassHealth population” and pointed to improving inspections at several homes.

Azure said its latest surveys showed progress but did not cite specific inspections. The company’s founder, Azriel Lieberman, did not address another Globe finding: He and Mirlis have been in business together for years.

In 2020, the men bought two Massachusetts assisted-living facilities together. At one, Monastery Heights in West Springfield, they fell behind on taxes and other municipal fees. The town threatened to seize the property in 2023. For a time, the hot water wasn’t working. By late 2025, unpaid tax, water, and sewer bills had swelled to more than $541,000.

Eventually, Mirlis and Lieberman took out a loan to pay off the debt, but only after a bitter dispute with West Springfield officials.

After months of messages went largely ignored, town attorney Kate Scott warned Mirlis in an email that officials were preparing to revoke the facility’s food permit.

Mirlis replied within six minutes. “We will empty out all the elderly and the property can sit empty,” he threatened. “I guess it’s worth more to you that way.”

Scott responded that the town wanted Mirlis’s business to succeed, but could no longer “let you profit at the expense of West Springfield’s taxpayers.”

“What a fallacy,” Mirlis shot back. “What profit are you talking about????”

As Mirlis’s nursing home acquisitions grew, so did the paper trail of troubles inside them. And those state and federal records, in several instances, show a marked plunge in resident care within just a few years.

“That’s so egregious in a relatively short period of time,” said David Grabowski, a Harvard Medical School professor who has studied nursing home quality and regulation for decades.

Grabowski called the decline of facilities under RegalCare “extreme,” compared against the larger industry. Any home plunging from 5 stars to 1 within several years should warrant strong action from regulators, he said, including potentially blocking them from future acquisitions.

But a Globe review of Mirlis’s change-of-ownership applications over the years found little evidence of meaningful vetting of RegalCare by the Department of Public Health.

The company’s dismal track record would not have been difficult to find. Four of Mirlis’s six Connecticut facilities had landed on a federal list of the nation’s worst nursing homes by the end of 2021. The next year, Massachusetts regulators approved him to buy six more — four of those now carry Medicare’s one-star rating.

Department records show no indication that Massachusetts officials contacted other states where RegalCare has homes or otherwise investigated the company’s performance or quality metrics before approving his purchases.

Health Commissioner Goldstein acknowledged his department has not outright denied any applications for a nursing home license since 2019. But in 12 instances during that span, he said, applicants facing tough questions have bowed out before regulators made a decision.

Goldstein also said his department has been hamstrung by state law that did not explicitly give regulators authority to consider the record of nursing homes in other states. He said factoring in that material might have exposed Massachusetts to a lawsuit claiming that it exceeded its authority.

Two years ago, a law clearly granting Massachusetts regulators the power to look nationally was enacted. Goldstein said his department has been working toward implementing it, but wouldn’t commit to a deadline.

“You’re not going to get me on the record saying that,” he said.

The state didn’t need the new law to examine a chain’s national track record, said Gisela DaSilva, a trial attorney at Keches Law, a firm specializing in nursing home litigation. The new law is broader, but DaSilva sees no language in the old one suggesting “that the DPH would have exceeded its authority simply by considering a prospective licensee’s out-of-state record.”

While the Massachusetts Department of Public Health continued signing off on Mirlis’s expansion, the fraud case against RegalCare and Stern Therapy Consultants at the federal courthouse in Boston was being litigated.

As Mirlis dealt with the government allegations, he was filing a flurry of applications to acquire more Massachusetts facilities: a Wakefield home in December, a Whitinsville one in January. In June, he applied for a 142-bed nursing home in Sudbury that would include a new unit for people with dementia, whose care is complex and costly.

Three applications landed before the Department of Public Health within six months, so the agency could assess whether RegalCare was “responsible and suitable ” to own them.

By Sept. 1, Mirlis was the owner of three more nursing homes.

RegalCare’s Taunton facility. (Danielle Parhizkaran/Globe Staff)

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Methodology

The Globe analyzed monthly nursing home ratings data from the US Centers for Medicare & Medicaid Services. The snapshots record each home’s star ratings and the ownership and chain affiliations on file at the time. The overall ratings are based on health inspection scores, as well as staffing and quality measures.

The analysis focused on nursing home chains that have bought at least five nursing homes in Massachusetts from 2020 through 2025 and had limited presence here before 2020. To examine changes in quality, we looked only at homes those chains still owned as of July 2026. For each home that changed ownership from 2020 through 2025, we used federal change-of-ownership records to identify when the change took effect, then compared the home’s overall CMS rating in the most recent monthly snapshot before that date with its July 2026 rating.

The Globe supplemented federal change-of-ownership records with Massachusetts state records and, in several cases, ownership association dates reported in CMS’s monthly snapshots when the federal file did not accurately reflect when a home changed hands. We also manually identified several facilities whose ownership affiliations were not accurately reflected in CMS chain names, and excluded homes that had not undergone a standard health inspection since being acquired.

For homes the chains already owned before 2020, we used March 2023 — the median acquisition month among homes that did change hands — as a comparison point. We also compared March 2023 and July 2026 ratings for nursing homes statewide, excluding the chain homes in the analysis. Marquis Health Services was not included. It bought more than five Massachusetts homes from 2020 to 2025, but a majority of its current homes were acquired before 2020.

*Five Alpha Healthcare Management homes entered receivership in October 2024. We treated that month as the end of Alpha’s operating period and used their October 2024 ratings instead of July 2026 ratings.

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