United States Attorney Jerome F. Gorgon Jr. announced that M&Y Care, LLC has agreed to pay $334,807.20 to resolve allegations of violating the False Claims Act. The company, based in West Bloomfield, Michigan, provides home health care services.
The settlement addresses claims that M&Y Care improperly billed Medicare and Medicaid for services rendered by unqualified staff between January 1, 2015, and December 31, 2023. Specifically, it is alleged that M&Y Care used CPT code G0156 for services requiring skilled care but provided non-skilled care instead. The reimbursement rate for non-skilled care is about 74% lower than for CPT code G0156.
The settlement resolves claims brought under the qui tam provisions of the False Claims Act in the case 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 this act, private parties can file actions on behalf of the government and receive a portion of any recovery.
This resolution resulted from collaboration among the United States Attorney’s Office for the Eastern District of Michigan, the U.S. Department of Health and Human Services – Office of Inspector General, and the Michigan Attorney General’s Health Care Fraud Division. Assistant United States Attorney John Postulka handled the matter.
The investigation highlights efforts to combat health care fraud using tools like the False Claims Act. Tips on potential fraud can be reported to the U.S. Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
It should be noted that these are allegations only; no liability has been determined.
