Michigan Ear Care: A Physician’s Number on Physician Assistants’ Work

In the Michigan Ear Care fraud case, Michigan Ear Care PLLC and its physician agreed to pay $2,003,801 to settle False Claims Act allegations of billing Medicare and Medicaid for physician-assistant ear care without required supervision. The Justice Department’s account describes assistants treating patients in nursing facilities and home-health settings while the physician billed under his own National Provider Identifier.

The alleged mismatch put taxpayers on the hook for services billed as the physician’s work without the supervision that billing required. Someone who knew how those visits ran could see what the provider number on the claim concealed.

The Nursing Facility Was the Setting

The Michigan Ear Care allegations concerned an outside ear-care practice’s claims for visits to residents. The nursing home hosted the care, physician assistants performed it, and the practice and its physician settled the billing allegations. That division of work matters to an employee who knows the resident’s care but works for a different business from the one sending the bill.

A nursing home brings together people with different responsibilities for the same resident. Physicians and eligible practitioners supply visits, orders and certifications. Nurses and aides provide continuing care. Service vendors can work alongside the facility’s staff under separate business arrangements. A visiting clinician’s work therefore needs to be understood alongside both the resident’s care record and the supplier’s claim.

The payment arrangements reflect that division. Medicare’s nursing-facility payment bundles room, board, nursing and many outside services. For a bundled service, Medicare pays the facility and the facility’s contract determines payment to the supplier. Physicians’ professional services can instead be paid separately during a covered nursing-facility stay, as CMS’s consolidated-billing overview explains.

That gives an insider a concrete reason to look beyond the facility’s own bill. The visit happens in a resident’s room, but the claim describing that visit can come from a separate practice. In this case, the government’s supervision allegation followed the physician’s billing number into both nursing facilities and home-health settings.

What Evidence Is Needed to Report Fraud?

We build an allegation like this around evidence connecting the clinical visit, the physician’s supervision and the provider number on the claim. Our work on the difference between the chart and the claim starts with the person who knows how the practice operated. The documents gain meaning from that person’s knowledge of the care and the billing decisions behind it.

The Visit and the Physician’s Role

Clinical notes and visit records can show who documented the ear service and what they said they performed. Schedules and facility records may help place that practitioner with the patient. We compare those accounts with the physician’s supervision of the same visit.

An insider may know how supervision worked during ordinary patient visits, beyond the responsibilities described on paper. That knowledge helps us ask the right questions of the records: what work the assistant documented, what involvement the physician had, and how the practice described the service to the payer. We work with the person who knows that arrangement to understand what the documents actually describe.

The Working Arrangement and the Billing Decision

Payroll and contracts can identify who employed or paid a practitioner and the responsibilities assigned. We set them beside schedules and supervision records to connect the working arrangement to the care billed.

The billing side completes the comparison: the service submitted, the provider number attached to it, the payer and the payment history. An insider may also know who selected the billing approach or directed its continued use. Connecting that decision to the bills is how we build the case around what you know.

Eye Care One: A Short Exam Billed as the Longest

Eye Care One offers a parallel involving another specialty practice treating nursing-home residents. In its civil settlement announcement, the Justice Department alleged that patients received a short eye examination or none, while the claims billed the lengthiest and most expensive examination. The practice and its optometrist agreed to a $275,000 civil settlement, announced in August 2015.

The comparison turns on what the claim told the payer about care delivered inside a nursing home. In Eye Care One, the alleged mismatch concerned the examination billed. In Michigan Ear Care, it concerned billing under the physician’s number without required supervision. A person familiar with the visit could help expose either gap. The supplier’s bill deserves the same scrutiny as the facility’s own account of resident care.

Home-Health Billing Has Its Own Patterns

A separate 2026 National Bureau of Economic Research working paper, Medicare Home Health Fraud: How Much, Where, and Who?, paired Medicare claims with federal enforcement records. The home-health agencies it classified as fraudulent were more likely to rely on extremely high-volume referring physicians, provide unusually uniform patterns of care and serve healthier-than-average patients.

For an insider looking at physician-number billing, that study suggests a useful question beyond the individual visit: what recurring relationship between the physician and the provider helps explain the claims? The finding concerns home-health agencies; its value here is the attention it gives to relationships behind the bills.

The Settlement Covered Medicare and Medicaid Claims

The Justice Department announced the Michigan Ear Care settlement on May 8, 2024. It said Michigan would receive $65,993 of the settlement based on the state’s share of alleged Medicaid damages.

For someone with evidence of similar health care billing, a whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We assess how your knowledge of the visits and claims could support a nursing home qui tam case, and discuss the opportunity for a whistleblower reward with you from the first call.

You Know Who Made the Visits

If you know whose work went onto a physician’s bill, speak to one of our whistleblower experts about the visits and claims you know. We build the case around your knowledge of the care, supervision and billing decisions, and bring in Medicare and Medicaid fraud whistleblower lawyers who understand provider billing. We stay beside you through the case, turning your knowledge of the practice into the strongest case we can build together.