In a significant financial settlement, M&Y Care, LLC, a home health care service provider, has agreed to pay $334,807.20 to both the United States and the State of Michigan. This decision comes as a resolution to allegations that the company billed Medicare and Medicaid for services administered by unqualified staff. According to the U.S. Attorney's Office, M&Y Care, based in West Bloomfield, Michigan, provided various health services, including personal care, to patients by individuals who did not meet the required training guidelines between January 1, 2015, and December 31, 2023.
In exact terms, the accusations leveled assert that M&Y Care inappropriately used the Current Procedural Terminology (CPT) code G0156. The Code is designated for services that are to be performed by a skilled home health aide as part of a comprehensive home health plan. Instead, the staff who executed the services were allegedly not trained adequately and should have billed for non-skilled care, which carries a reimbursement rate about 74% lower than the skilled rate.
The settlement includes claims presented under the whistleblower provisions of the False Claims Act, stemming from a case titled United States and the State of Michigan ex rel. DeCarlo v. M&Y Care, LLC, et al., Case No. 19-11032 (E.D. Mich.). The Act allows private parties to sue on behalf of the government and potentially share in any financial recovery that results from these lawsuits.
The coordinated effort that brought about this resolution involved the U.S. Attorney’s Office for the Eastern District of Michigan, the U.S. Department of Health and Human Services - Office of the Inspector General, and the Michigan Attorney General’s Health Care Fraud Division. Assistant United States Attorney John Postulka, handling the case from the U.S. Attorney’s Office for the Eastern District of Michigan, was lauded for his work in this.
The government encourages the public to report any suspicions of fraud, waste, abuse, or mismanagement. Such concerns can be disclosed to the U.S. Department of Health and Human Services via their hotline at 800-HHS-TIPS (800-447-8477).
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