DETROIT—United States Attorney Jerome F. Gorgon Jr. announced that M&Y Care, LLC (M&Y Care), a provider of home health services to Michigan patients, agreed to pay a total of $334,807.20 to the United States and the State of Michigan to resolve allegations that it violated the False Claims Act.
The company's principal place of business is in West Bloomfield, Michigan. The settlement resolves allegations that M&Y Care caused Medicare and Medicaid Programs to be billed for services provided by staff who lacked the requisite qualifications during the period of January 1, 2015, through December 31, 2023.
Specifically, prosecutors contend that M&Y Care allegedly billed the Medicare and Medicaid Programs using Current Procedural Terminology (CPT) code G0156 for services provided by individuals who were insufficiently trained. When properly used, this CPT code pertains to the services of a home health aide under a home health plan of care. The United States alleges that the defendant should have billed for non-skilled care, instead of billing and being paid for services under CPT code G0156. The non-skilled care rate was about 74% lower than the reimbursement rates for CPT code G0156.
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act, in the case captioned United States and the State of Michigan ex rel. DeCarlo v. M&Y Care, LLC, et al., Case No. 19-11032 (E.D. Mich.). Under the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of any recovery.