Private Duty Fraud Enforcement

Admin

by Elizabeth E. Hogue, Esq. | Sep 4, 2026 | Admin, Clinical, Home Care, Medicaid, Waste Fraud and Abuse

by Elizabeth E. Hogue, Esq.

The Future of Private Duty/Home Care

It Begins with Fraud Enforcement

Use of private duty/home care services continues to increase. It has become increasingly clear, however, that companies will not be permitted to care for patients who need these services without considerable additional oversight.

The proverbial “bottom line” is that private duty/home care companies will be under greater scrutiny and regulation. The instances of gross mistreatment of patients, some of which we have described in previous articles, are too shocking and lurid. And caregivers about whom lip service is given about their need for support have been mistreated by private duty companies.

And Then There's This:

The feds are convinced that there is rampant fraud in state Medicaid Programs to the tune of millions, if not billions, of dollars that has not been addressed. The number of fraud strike forces, task forces, etc. targeting companies that provide services to Medicaid recipients are now too numerous to count.

Fraud enforcement is definitely “in fashion” and enforcers are eager to put private duty/home care companies in the color orange! If this a fashion statement you want to make?

To Illustrate:

The National Fraud Enforcement Division of the U.S. Department of Justice (DOJ) recently announced that it has prosecuted 6200 defendants who collectively billed federal health care programs, including Medicaid, TriCare, the VA and others, $45 billion.

In a press release issued on August 4, 2026, the Division stated:

“Home care fraud is everywhere, and the victim is all of us taxpayers. Medicaid claims date and the experience of veteran prosecutors all point to the systematic exploitation of reimbursable home care programs….Today. we sound the alarm on the scale of this fraud by announcing some truly egregious cases, in which numerous people are charged with filing fraudulent claims for caregivers who were not actually providing home care services, but in fact were dead, in prison, or trafficking drugs. This racket ends today.”

And There's More!

“Let today’s announcement be a warning to those engaging in similar activity: if you seek to exploit our health care systems for personal profit, you should expect the FBI and our partners to uncover your scheme and bring it to an end. Every dollar stolen through fraud is a dollar diverted from patient care, and the FBI will continue its work to safeguard the public’s trust and hold accountable those who abuse these vital programs.”

Finally the press release promises that enforcers “…will pursue anybody who seeks to profit at the expenses of American taxpayers, regardless of whether the wrong doing is in the boardroom or in the sickroom.”

In other words, it’s not just the perpetrators who will be punished. The companies, owners and managers will also face punishment.

So, what are some of the offenses pursued so far?

One of the defendants was captured on tape:

”This home health care is the best kept secret…I made a buck plus (each of) the last five years. That’s a half million dollars… ain’t checking on nobody.”

It may be tempting for owners and managers to say: “That’s on them.” Not so! Companies and management will be held accountable for the actions of their employers and contractors.

Private duty/home care companies will see a tsunami of regulation. Use of fraud and abuse prohibitions is just the beginning.

# # #

Elizabeth E. Hogue, Esq The Rowan Report

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©2026 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

HHAeXchange Launches RCM Services

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by Kristin Rowan | Sep 4, 2026 | Admin, Home Care, Medicaid, Partner News, Vendor Watch

by Kristin Rowan, Editor

HHAeXchange Announces RCM Services

An Interview with Phil Feldman

In April of 2026, HHAeXchange unveiled their new end-to-end Revenue Cycle Management (RCM) service. HHAeXchange is a leading provider of homecare program management designed for Medicaid Home and Community-Based Services. (HCBS).

Addressing Top Concerns

HHAeXchange’s 2025 Provider Voice Survey asks homecare agencies about the pain points facing the industry. Administrative workload and cost are significant areas of concern for homecare agencies, cited by 41% of providers. RCM services address these concerns by removing administrative tasks from agencies, freeing up personnel to focus on growth, community outreach, referrals, and caregiver training.

“Homecare providers are navigating diverse payers, rising costs, growing administrative demands, and an increasingly complex financial and regulatory environment. RCM Services relieves agencies of the operational burden of billing and collections while improving cash flow and business performance. By offloading revenue cycle management to experts who deeply understand homecare and the HHAeXchange platform, agencies gain clarity, efficiency, and more time to focus on care.”

Paul Joiner

CEO, HHAeXchange

From Submission to Resolution

End-to-end RCM services handle the full revenue cycle. The RCM Services team at HHAeXchange handles everything from the initial claim submission to handling discrepancies, resolving rejections, appealing denials, and shortening the cycle of aging receivables.

Improved Cash Flow

RCM services go beyond billing and collections. HHAeXchange uses operational intelligence to track denial trends, authorization issues, and payer challenges. With these issues addressed at the beginning, claims are cleaner, denials are reduced, and agencies stay in compliance. These are issues cited by 70% of homecare agencies.

With improved cashflow, agencies have the resources to grow, to invest in their staff, to scale operations, and to create a more stable work environment.

Phil Feldman, National Director of RCM

The Rowan Report sat down with Phil Feldman, the National Director of RCM for HHAeXchange. Feldman, and the RCM service platform, came from Sandata and joined HHAeXchange in the acquisition in 2024. We asked Feldman about RCM services:

The Rowan Report:

What makes HHAeXchange’s RCM different?

Phil Feldman:

The RCM service platform is specific. It is specific to home care, specific to Medicaid, and specific to HHAeXchange. Agencies are connected to resources within the organization. We have existing relationships with payors that we can resolve directly. And the customer-facing team, the experts handling your revenue cycle, are employees of HHAeXchange, not a partner or a 3rd party.

RR:

What is the agency experience with HHAeXchange’s RCM service?

Feldman:

We are currently only offering the RCM services within the HHAeXchange platform. You have one vendor and one platform. When there’s a finger to point, it points right back at us.

Every account has at least one RCM advisor who serves as the primary point of contact, working with the agency on their billing schedule, their time-keeping week, and the whole process from close to claim.

The intelligence in the platform goes beyond mechanically processing claims and takes a holistic approach. The system checks for demographic descrepancies from intake like member IDs, gender alignment, ID updates from new payors, overservicing on claims, providing services past the end date or outside allotted days. We look directly at the agency’s denial trends and go upstream in the revenue cycle to fix the whole process, not just one claim.

Results

With just under five months since the full launch, and nearly a year of data from beta test agencies, Feldman says their agency claims are in the 90% collection rate. Claim denials, clawbacks, and remit time are trending down. A full data set is forthcoming, but for now, Feldman is relying on anectodal evidence: Their customers are referring agencies that are looking for RCM solutions.

“You’re the best thing ever. I have a lot of friends that I consult with and help them run their business. I want to introduce them to you.”

– An Indiana Agency Owner

Final Thoughts

Hiring and retention issues, reimbursement rates, administrative workload, operational costs, denials, payor compliance, authorizations…these issues are universal across home care and aren’t going away any time soon. If you’re looking for ways to optimize your current workforce, reduce overhead costs and tasks, and create a steady cash flow for your agency, outsourcing RCM is one way to do it. If you’re already an HHAeXchange customer, well, it just makes good sense to work within the system you know, with advisors who take time to understand your agency, and the backing of decades of experience.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

The Broadway Secret

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by Rowan Report | Aug 7, 2026 | Admin, Home Care, Home Health, Hospice

by Aaron Marcum

The Home Care Back Stage

The Broadway secret every home care owner needs to know

A few years ago, I took my daughter to see “Wicked” in London’s West End.

From the moment the lights dimmed, we were transported. The performances were flawless, the choreography mesmerizing, and the vocals spine-tingling. For two and a half hours, we sat captivated by what appeared to be theatrical magic.

It looks like magic

But here’s what struck me as I watched: what we were experiencing wasn’t magic at all. It was the result of an incredibly sophisticated operation happening behind that curtain—an operation most audience members never think about.

Dan Sullivan, founder of Strategic Coach, calls this the “Front Stage” and “Back Stage” of your business. And it’s a framework that every home care owner needs to understand.

What Makes Broadway, Broadway?

When you pay for a West End ticket, you’re not just paying for talented actors. You’re paying for a lighting crew coordinating hundreds of cues per show, costume designers managing dozens of quick changes, sound engineers balancing multiple wireless microphones in real-time, stage managers calling hundreds of technical cues with split-second precision, and a production team that rehearsed for months before opening night.

The Front Stage—what the audience sees—only shines because of an exceptional Back Stage.

Your home care business has the same dynamic

Front and Center

In our industry, the Front Stage is your care professional arriving at Mrs. Johnson’s home at 9 AM. It’s the smile, the gentle assistance with morning medication, the conversation during breakfast, and the compassionate help with bathing and dressing.

That’s what your clients see. That’s what their families remember. That’s how your business gets judged.

But we all know that caregiver showing up prepared, on time, and trained isn’t an accident.

Behind the Scenes

Your Back Stage makes it possible:

Care Coordination ensures the right caregiver with the right skills is scheduled for the right client. When this system fails, clients feel it immediately.
Billing Systems that work seamlessly mean caregivers get paid accurately and on time—because nothing destroys Back Stage morale faster than payroll errors.
Compliance Infrastructure keeps you operating legally and safely, protecting both your clients and your business.
Recruitment and Hiring processes that attract quality candidates. With projections showing a national shortage of 151,000 caregivers by 2030 and 355,000 by 2040, your Back Stage recruiting determines whether you have anyone to put on the Front Stage. As a side note, I personally believe the shortages are greater than this.
Training Programs that don’t just check boxes but actually prepare caregivers for real situations. The 2025 Activated Insights Benchmarking Report found that agencies offering 8+ hours of orientation training had median revenue of $2.4 million compared to $2.03 million for those with 3 or fewer hours.
Retention Strategies because the average caregiver costs $2,600 to replace Activated Insights. Your Back Stage culture determines whether caregivers stay or leave.

The Numbers Tell a Sobering Story

Here’s the reality: the home care industry’s turnover rate reached 79.2% in 2023 Home Health Care News—the highest it’s been in five years. Think about that. In an agency with 100 caregivers, you’re replacing nearly 80 of them every single year.

But it gets worse. Nearly four out of five caregivers leave their job within the first 100 days of employment. That means the caregivers you just spent weeks recruiting, screening, and training? Most of them won’t even make it through their first three months.

When your Back Stage is weak, these statistics become your reality.

The "Community Theater" Problem

We’ve all attended shows where you could tell the Back Stage was struggling.
Maybe you’ve seen a local production where an actor missed their entrance, the lighting was off, a scene change took too long, or the sound cut out.

You couldn’t see the Back Stage problems, but you absolutely felt them.
The same thing happens in home care.

A weak back stage

When your Back Stage is weak:

Caregivers show up late (or not at all) because scheduling is chaotic
Families receive incorrect bills because systems are disconnected
Care quality suffers because training is inconsistent
Your reputation erodes one Front Stage failure at a time

Your clients might not know your payroll system crashed or that your care coordinator called in sick for the 4th time this month, but they experience the consequences.

The Broadway Standard Question

So here’s the question every home care owner must ask:

Is your business operating at Broadway standards, or community theater? Be honest.

When you look at your Back Stage operations:

Can your care coordinators instantly access complete client information?
Do your caregivers have clear protocols for every situation they might encounter?
Is your billing accurate enough that families rarely question an invoice?
Do you have documented processes, or is everything “in someone’s head”?
Could your business run smoothly if your top coordinator was suddenly unavailable?

The best home care agencies—the ones with waiting lists and stellar reputations—aren’t just lucky. They’ve built Broadway-quality Back Stage operations.

They’ve invested in systems, training, and processes. They’ve documented their playbook. They’ve made the Back Stage so strong that the Front Stage can shine consistently, every single day.

Because here’s what I learned watching “Wicked”: excellence isn’t about one amazing moment. It’s about a thousand excellent decisions that happen when no one is watching.

The question is: what's happening in your Back Stage?

Want to build your Broadway-worthy Back Stage?

Stay in the know with strategies, insights, and practical resources designed specifically for home care owners. Subscribe to receive updates, newsletters like this, and tools that will help you elevate both your Front Stage performance and Back Stage excellence. Because your caregivers—and your clients—deserve a five-star experience every single time.

# # #

Aaron Marcum is an entrepreneur and thought leader who has dedicated his career to transforming the home care industry and nurturing business leaders.

As the founder of Home Care Pulse (now Activated Insights), he pioneered the Best of Home Care® program, revolutionizing quality standards in senior care across North America. His expertise as a Certified Blue Ocean Strategy practitioner and former Certified EOS Implementer has helped shape some of home care’s most respected brands.

Healthcare Workers May be Deported

Home Care

by Tim Rowan | Jul 31, 2026 | Home Care, Home Health, Regulatory

by Tim Rowan, Editor Emeritus

Author’s note: This analysis does not address the right and wrong of legal asylum status, but will focus only on the impact of deporting tens of thousands of healthcare workers.

Thousands of Healthcare Workers Could be Deported

Florida Will Be Hit Hardest

Denise Bellville is alarmed by looming unintended consequences of this administration’s border protection policy. The Executive Director of the Home Care Association of Florida has good reason. She estimates that 35,000 Haitians work in healthcare in her state, a full third of the U.S. total. Some are in-home caregivers; a few are home care agency owners.

As of last week, all are at risk of being sent back. Temporary Protected Status, given to asylum applicants from dangerous countries, has been canceled for immigrants from specific countries. Among them are 353,000 Haitians, along with applicants from eight other countries. The Supreme Court is yet to rule on four more nations named in the DHS removal request.

“Broward County is one of about six counties that will be hit especially hard and have already begun to feel the effects of the July 24 SCOTUS decision,” she told us. “Two [agencies] there have already closed. One determined that 85 of its 86 caregivers are vulnerable for deportation. The other said that Creole-speaking clients made up 80 percent of its business.”

When the Department of Homeland Security announced “Termination of Temporary Protected Status for Haiti,” the order included a little more than 353,000 Haitian asylum applicants, more than 112,000 of whom work in the U.S. healthcare system. Industry estimates indicate one-third of these healthcare workers, roughly 35,000 Haitians, live and work in Florida.

Why So Many in Florida?

There is a large population of Haiti-born U.S. citizens in Florida. Some have been there for generations. They still speak a unique version of French and hold onto ancient Creole culture. “Caregivers from their own country, who understand both the language and the traditions of these now-elderly citizens are the only ones who can effectively care for them in all settings: home, hospital, and skilled nursing facility,” Bellville said. “When these 35,000 healthcare workers are gone, there are no others who can provide that level of care,” she asserted. “The problem will exacerbate what was already our critical in-home caregiver shortage.” She referred to a disturbing Florida reality:

Florida’s population is over 23.5 million
22.8 percent are over 65 years of age, roughly 5.35 million residents
The national average is 18.9 percent
The state has 16 caregivers per thousand residents
The national average is 65 caregivers per thousand

When asked what recourse is available, Ms. Bellville said an association cannot do much. “We even talked with Hospital and LTC associations about working together,” she said. “All of them responded that, sadly, even if we work together, we do not have sufficient clout to make a difference.”

Legal Battle Background

How Asylum Became Expulsion

The U.S. welcomed Haitians when life became dangerous in their home country. Gang violence, a problem for decades, led to the assassination of President Jovenel Moïse in 2021. In the absence of leadership, street gangs took over. Life became cheap. Good people, even if unrelated to any gang, were murdered at random. Due to the rampant violence, the U.S. State Department maintains a Level 4 “Do Not Travel” warning for Haiti. Unemployment is 15 percent; among youth, it is more 37 percent.

The Biden administration processed asylum applications by the thousands. Border Patrol accepted most claims of danger back home. For four years, hopeful applicants, including Haitians, waited for their court asylum hearings. While they were waiting, they legally sought jobs in various sectors, more than a third of them in healthcare.

Decades into a seemingly unsolvable, unending caregiver shortage, Home Care agency owners welcomed these new arrivals, trained them, and sent them out to care for the elderly in their homes, skilled nursing facilities, and rehab hospitals. Their fluency in Creole French and familiarity with Haitian culture made them invaluable in those communities.

On June 24, 2026, the Supreme Court issued a 6-3 ruling in Mullin v. Doe, denying a challenge to the terminations of TPS for Haiti and Syria. The decision granted DHS permission to move forward with implementing the terminations of TPS for those countries and eight others. Four more countries on the DHS list are expected to follow.

Epilogue

The $tats

The eventual loss of 112,000 healthcare workers will create a gaping hole in the availability of services. It will also have an impact on the U.S. Treasury and the overall economy. According to a report from Fwd.us, Haitian TPS holders contribute $5.9 billion to the U.S. economy annually. In Springfield, Ohio, where Haitian refugees were invited by the city to live and work, they added $91 million to that town’s economy. They pay over $1.5 billion per year in federal, payroll, state, and local taxes.

Based on DHS published estimates of the cost of deportation ($17,121 per person), sending 353,000 Haitians back to their island will require an expenditure of $6.04 billion. Some of that cost may be reduced by voluntary deportations that do not involve the cost of law enforcement.

Anyone choosing to self deport may have to hurry. Enforcement has already begun. HCAF Director Denise Bellville told us that some of her member agencies have reported ICE agents have started knocking on their doors unannounced, demanding to conduct I-9 audits.

# # #

Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com