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A Boston Globe Spotlight investigation found that out-of-state chains, led by RegalCare, acquired dozens of Massachusetts nursing homes since 2020, and most saw federal star ratings decline afterward. Spending on nursing care fell while millions were paid to owner-affiliated companies, and state regulators have not rejected an acquisition in seven years.
A Boston Globe Spotlight investigation has found that a buying spree by out-of-state nursing home chains has coincided with declining care quality across Massachusetts facilities, with aggressive cost cutting, reduced nursing hours and millions of dollars redirected to businesses connected to the new owners. The findings, reported by Skilled Nursing News, show that nine chains from New York and New Jersey went from owning 12 Massachusetts nursing homes in 2019 to 61 facilities — about one-fifth of the state’s total — by 2025.
The most prominent acquirer identified is RegalCare, led by CEO Eli Mirlis, which purchased 12 nursing homes in Massachusetts and at least 29 across five states, several of which previously held high federal star ratings. According to the Globe, one nursing home in Taunton fell from 5 stars to 1 star within three years, and a facility in Quincy also dropped from 5 stars to 1. Eight of the nine out-of-state chains saw their facilities’ average federal CMS star ratings decline after acquisition.
The Globe documented aggressive cost cutting at the Taunton facility, where overall operating spending fell by 19%. Registered nurse hours fell by more than half, and licensed practical nurse hours fell by more than a third, according to the report. As nursing services spending dropped by $530,000 between 2021 and 2025 at the property, rent paid to a separate Mirlis-owned company rose to $522,000. In 2025, the Taunton facility paid $1.6 million to related companies — roughly 16% of its operating expenses, the Globe found.
The Globe also reported that New Jersey permanently revoked Mirlis’ nursing home administrator license in 2018 after finding he committed fraud related to continuing education requirements, and that the revocation was not mentioned on his Massachusetts applications. Separately, RegalCare and two executives agreed to pay $1 million to resolve allegations of submitting false claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy, Skilled Nursing News reported. A related therapy company previously settled for $315,000.
Consequences for Residents and Families
The scale of the acquisitions means a large share of Massachusetts nursing home residents are now cared for in facilities owned by chains whose ratings have, in most cases, declined after purchase. The Globe’s findings on staffing cuts are central: reduced RN and LPN hours are among the measures most closely watched by families comparing facilities, and the reported drops at acquired properties occurred alongside falling star ratings.
The pattern of payments to related companies — rent and services flowing to businesses connected to facility owners — is a recurring concern in the nursing home industry because it can move money out of resident care while remaining legally permitted. For Massachusetts residents and families, the report raises questions about whether existing ownership disclosures and licensure reviews catch operators with problematic records in other states.
Massachusetts Oversight Gap Since 2019
The Massachusetts Department of Public Health oversees roughly 340 nursing homes and has the authority to reject buyers it deems irresponsible or unsuitable. However, the Globe found the agency has not denied an acquisition application or revoked a nursing home license in seven years.
Massachusetts Health Commissioner Robbie Goldstein told the Globe that state law historically did not authorize regulators to consider an operator’s out-of-state record, but a law enacted two years ago expands that authority. The Globe’s review drew on CMS ratings, state and federal records, financial reports, lawsuits, inspections and interviews with employees, residents and their families.
“The state’s post-pandemic nursing home market has allowed aggressive new owners like RegalCare to acquire facilities, reduce costs and redirect substantial sums to affiliated businesses while star ratings declined.”
— Boston Globe Spotlight investigation, as reported by Skilled Nursing News
Unanswered Questions on Enforcement
The Globe’s findings establish a correlation between out-of-state acquisitions and declining ratings, but the report does not by itself establish causation for every facility, and industry-wide factors such as workforce shortages and pandemic-era financial pressures also affect staffing and ratings. It is not yet clear how many additional acquisitions are pending before state regulators, nor whether the expanded legal authority described by Commissioner Goldstein has yet been used to reject any buyer.
RegalCare and Mirlis did not concede liability in the $1 million settlement resolving the rehabilitation therapy allegations, according to Skilled Nursing News, and it is not clear whether they have responded publicly to the Globe’s findings regarding the Taunton and Quincy facilities or the omitted New Jersey license revocation.
Tighter Buyer Reviews Ahead
Watch for how the Massachusetts Department of Public Health applies the newly expanded authority to review out-of-state operators’ records in future acquisition applications — the first test of whether the post-2024 law changes agency practice. Lawmakers may face calls to strengthen disclosure requirements, including mandatory reporting of license revocations in other states.
Further developments could include additional regulatory or legal action tied to the Medicare and Medicaid false claims allegations, continued CMS rating changes at the affected facilities, and possible responses from RegalCare and other named chains. Families evaluating facilities can check current CMS star ratings and ownership information on the federal Care Compare website.
Key Questions
How many Massachusetts nursing homes are now owned by out-of-state chains?
According to the Globe, nine chains from New York and New Jersey went from owning 12 Massachusetts nursing homes in 2019 to 61 facilities by 2025 — about one-fifth of the state’s roughly 340 nursing homes.
What happened to care quality at facilities acquired by these chains?
Eight of the nine chains saw their facilities’ average federal star ratings decline after acquisition, the Globe found. A Taunton facility and a Quincy facility each fell from 5 stars to 1 star, and the Taunton home saw operating spending drop 19% with RN hours cut by more than half.
What is RegalCare’s Eli Mirlis accused of?
New Jersey permanently revoked Mirlis’ administrator license in 2018 after finding fraud related to continuing education requirements, which the Globe says was not disclosed on Massachusetts applications. Separately, RegalCare and two executives agreed to pay $1 million to settle allegations of false Medicare and Medicaid claims for medically unnecessary rehabilitation therapy, without conceding liability.
Why didn’t Massachusetts regulators block these purchases?
Health Commissioner Robbie Goldstein told the Globe that state law historically did not allow regulators to consider an operator’s out-of-state record. A law enacted two years ago expands that authority; the agency has not denied an acquisition or revoked a license in seven years.
How can families check a nursing home’s ownership and quality?
Families can review current CMS star ratings, staffing data and ownership information on the federal Care Compare website, and can request inspection records from the Massachusetts Department of Public Health. This reporting is journalistic, not a rating of any individual facility’s current care.
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