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Home Healthcare Provider to Pay $334,807 to Settle False Claims Act Allegations

United States Attorney Jerome F. Gorgon Jr. announced that M&Y Care, LLC (M&Y Care) 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. M&Y Care provides a variety of home healthcare services to Michigan patients, including personal care. The settlement resolves allegations that M&Y Care caused the 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, the United States contends that M&Y Care improperly 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 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.