M&Y Care: Billing the Skilled Aide Code Without the Required Training

In the M&Y Care home health settlement, the Michigan provider agreed to pay $334,807 over alleged Medicare and Medicaid billing for insufficiently trained staff from January 1, 2015 through December 31, 2023. The allegation turns on the worker’s qualifications and the claim: the company allegedly collected the higher reimbursement for services that should have been billed as non-skilled care. An aide, training coordinator or biller may recognize the mismatch from a different side of the same visit.

M&Y Care provides home health care, including personal care, to Michigan patients and has its principal place of business in West Bloomfield. The U.S. Attorney’s Office for the Eastern District of Michigan announced the civil settlement on July 11, 2025. The agreement resolved claims brought by a whistleblower under the False Claims Act, with payment owed to the United States and Michigan.

Why a Home Health Aide Billed Under a Skilled Code Without Training Costs More

The government alleged that M&Y Care billed Medicare and Medicaid under G0156 for services by staff lacking the required qualifications. The code covers a home health aide’s services under a home health plan of care.

The price difference carried the allegation. According to the government, the non-skilled-care rate M&Y should have used was about 74% lower than the G0156 reimbursement rates. The agency allegedly billed and received payment at the higher rate despite the training gap.

Higher rate. Missing training. We see taxpayers charged for qualifications the workers allegedly lacked, and patients receiving care from those workers. A higher-paying code cannot supply the missing training.

The broader issue of unqualified home health aides starts with what the worker actually completed and follows that qualification into the service charged. M&Y’s case gives that comparison a specific code and a specific payment consequence.

Why the Worker Behind the Code Matters

The billed service connects the aide’s qualifications to the patient’s plan of care. A training coordinator can know what instruction and supervised practice an aide completed. A supervisor can know who was assigned to the patient. A biller can know which service the agency claimed. We connect those accounts around the same worker and service date.

The qualification question depends on the service and payer. Medicare’s home health aide requirements do not define the qualifications of every Medicaid personal care attendant.

The Health and Human Services Office of Inspector General’s Medicaid personal-care work identifies gaps in attendant identity, qualifications, task authorization and delivery records. Its 2012 portfolio recommended attendant identifiers, stronger screening and better claims and service records.

The federal home health agency standards as of September 4, 2026 illustrate how concrete a qualification question can be. Medicare’s aide training-program route requires at least 75 combined classroom and practical hours. Other competency routes also qualify an aide. We examine the requirements that applied when the worker delivered the service.

Training staff may know whether the course was completed, when practical instruction occurred and which competency route the agency relied on. Their account helps explain what the personnel file meant when the aide was sent to the home.

What Evidence Is Needed to Prove Fraud?

For an allegation like M&Y’s, we connect the worker’s training to the assigned service, visit record, submitted claim and payment. We also examine who knew about the difference, working with the person who knows how the agency operated.

The Personnel File and the Visit

The useful comparison begins with the aide assigned to a particular service and the qualifications that person held at the time. Training and competency records speak to preparation. Employment and assignment dates identify who could have performed the work. The plan and visit documentation show what the agency said that person was doing.

The home health certification and plan-of-care records supply the clinical side of that account. Medicare’s workflow connects the referral, encounter, certification, assessment and plan with the visits that become claim lines. An insider’s knowledge is valuable because it can explain how a name in the personnel system became a service on a claim. We want to understand the handoff between staffing and billing: who identified the worker, what qualification the agency relied on and how that work became the billed service.

The Submitted Claim and the Payment

The Medicare claims workflow connects visit lines and claim coding to payment. The remittance shows what the program actually paid.

Medicare also draws on assessment data alongside claim coding to determine payment. That is why we examine the submitted claim with its supporting records and remittance. For a concern like M&Y’s alleged training mismatch, the question is how the worker’s service reached the claim and what the program paid for it.

An aide may know the work and training firsthand while a billing employee knows the claim. You can bring us the part you understand. Our job is to connect it to the rest of the agency’s account and develop the strongest case the facts support.

When the Hiring File Already Shows the Gap

A separate Michigan complaint shows why personnel records can matter well beyond the personnel department. In the government’s case involving Great Lakes Home Healthcare Specialists, prosecutors alleged that an employee performed medical social work for Medicare patients without the required master’s degree or Michigan license. The government complaint described what the agency’s hiring file already said:

The complaint then alleged that the agency included that employee’s social-work services in a claim Medicare paid. The connection is unusually clear: a qualification disclosed as missing at hiring, services assigned to that employee and a government payment for the care. We look for that connection because it brings what the agency knew into the billing story.

A separate New York settlement involved the same broad problem across company boundaries. In its December 2009 announcement, the Justice Department alleged that Extended Nursing Personnel and Excellent Home Care billed Medicaid for aides supplied by Nursing Personnel who lacked the required training qualifications. Those allegations formed part of combined settlements totaling approximately $24 million for the United States and New York. The supplier held one part of the staffing account. The billing agencies held another. Following the worker connects them.

How Much Does a Home Health Fraud Whistleblower Get Paid?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. M&Y Care’s civil settlement included claims brought through a qui tam case. It connected an alleged staffing deficiency to claims on public healthcare programs: the training question belonged in a whistleblower case because it reached the bill.

You Know the Worker Behind the Code

If the training you saw does not match the service your agency billed, tell our whistleblower experts about that difference. We build the case with you, bring in home health fraud whistleblower lawyers who understand aide qualifications and government billing, and stay beside you as we pursue a recovery.