Private Duty Fraud Enforcement

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.

Update: CMS Response to Arizona Hospice

by Tim Rowan | Aug 7, 2026 | Admin, Advocacy, CMS, Hospice, Waste Fraud and Abuse

by Tim Rowan, Editor Emeritus

Update: CMS Sides with NGS in Arizona Hospice Case

Letter Says "Typos Count"

We are sad to have to report that CMS has rejected the evidence that a hospice’s report of change of ownership was due to a typo. The consultant retained to help with their appeal received this letter.

The CMS Letter

Thank you for your email. Based on our review, we do not see any issues with the revocation decision. The provider did file a reconsideration, and on May 6, 2026, we issued a decision upholding the 42 C.F.R. § 424.535(a)(8)(ii) revocation. Their main argument is that there was no change in ownership and, as a result, they should not have been subject to PPEO. However, the applications submitted by the provider clearly reflected 100% changes in ownership. In addition, the provider had an 80% PPEO claim denial rate, and none of these denials were overturned on claim appeal. Please note that the provider filed an appeal with the ALJ on June 18th. Given that the case is pending, we should not take any other action until the appeal has concluded.

Best Regards,

Anaga Nmagu, JD.
Director, Division of Provider Enrollment Appeals
Provider Enrollment & Oversight Group
Center for Program Integrity
Centers for Medicare & Medicaid Services
Office: (410) 786-4690
Email: anaga.nmagu1@cms.hhs.gov

Home Health and Hospice Respond

The more stories we can collect about CMS contractors overstepping their authority, improperly denying claims, up to and including putting honest providers out of business, the more convincing we will be when we confront the perpetrators. We urge you to tell us your stories. We will never publish your name.

If you, a client, or someone you know has stories about CMS contractors, please reach out to editor@therowanreport.com or tim@rowanresources.com.

# # #

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

©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

Healthcare Workers May be Deported

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.

# # #

The Caregiver’s Mindset

by Rowan Report | Jul 24, 2026 | Partner News

by Roger McManus, MBA

This chapter is part of the upcoming book, The Intuitive Caregiver. It is designed to strengthen in-home caregiving skills with clear, practical, real‑world guidance.

The Caregiver's Mindset

Professional care begins long before knocking on the door

Caregiving does not start with a task list, nor does it begin when you help someone stand, prepare a meal, or assist with bathing. It begins the moment you walk through the door — with your attitude, your awareness, and the way you choose to show up.

A caregiver’s mindset is the foundation of every caregiving activity that follows. Yes, skills matter. Sure, training matters. But the mindset you bring into someone’s home determines whether your presence feels calming or stressful, respectful or intrusive, steady or unpredictable.

This chapter helps you understand what it means to “show up” as a professional caregiver — not just in what you do, but in how you think, how you observe, and how you treat the person and their home.

Enter with Humility and Respect

Professional caregivers enter with humility by:

looking before touching
asking before moving anything
treating every object as meaningful
remembering that routines exist for reasons you may not yet understand

Even something as simple as moving a chair or adjusting a blanket can feel like an intrusion if you do it without asking. Respect for the home is the first sign of respect for the client.

Your Job is Stability, Not Control

Many older adults feel vulnerable when someone new enters their home. They may worry about losing independence, privacy, or dignity. They may fear being judged. They may feel embarrassed about needing help.

Your role is not to take over.
Your role is to create stability.

Stability comes from:

predictable routines
calm communication
steady follow‑through
respecting the client’s pace and preferences

Caregiving is not about being fast. It’s about being reliable. When you move calmly and consistently, the client feels safer — and safety leads to cooperation.

Entering Someone Else’s World

A client’s home is not your workplace.
It is their private space — the place where they feel most themselves.

When you enter that space, you are stepping into someone’s history, habits, routines, and memories. You may see clutter, unusual décor, or ways of doing things that don’t match your own. None of that is your business (though it may suggest you send your agency’s Occupational Therapist to professionally assess safety issues). Your job is not to judge the home. Your job is to respect it.

You Are A Guest, Not A Manager

Even when a client needs significant help, the home remains theirs. You are there to support, not to run the household.

Professional caregivers avoid the trap of “fixing” everything. Instead, they:

collaborate rather than dictate
offer choices rather than instructions
adapt to the client’s rhythms rather than imposing their own

For example:
Instead of saying,
“Let’s get you dressed now.”
You might say,
“Would you like to get dressed before breakfast or after?”
Choices restore control.
Control restores dignity.
Dignity builds trust.

Your Work is Emotional First, Before Physical

Caregiving is not just a list of tasks. It is a relationship.

Many clients are grieving — not always the loss of a person, but the loss of abilities, independence, or identity. They be frustrated by what their body can no longer do. They may be embarrassed to need help. They may be afraid of what comes next.

Your presence can either increase that fear or reduce it.

Emotional safety is the foundation of physical care. Caregivers support emotional safety by:

listening without judgment
acknowledging feelings without trying to “fix” them
offering reassurance through tone and patience
giving people time to process and respond

You are not just helping with daily activities.
You are helping someone navigate a changing life.

Professionalism is A Daily Practice

Professional caregivers represent their agency, their training, and the caregiving profession itself. Clients notice everything — and they should. They are trusting you with their home, their health, and their dignity.

Professionalism shows up in:

punctuality
appearance
communication
boundaries
documentation
confidentiality

It also shows up in the small things:

put your phone away
stay focused on the client
avoid prying, personal conversations
maintain a calm presence even when the day is difficult

Professionalism is not about being perfect. It is about being consistent.

Understanding the Client's Reality

Before you ever walk through the door, the client is already living with pressures, fears, and adjustments to dependence that you may not see.

Loss of Control Is the Central Theme

Most clients do not ask for help because they want it. They ask because they no longer have a choice. That loss of control can feel humiliating, frightening, or deeply unfair.

Even small tasks — tying shoes, opening containers, getting out of a chair — may require assistance for the first time since childhood. Every request for help carries some emotional weight. Feeling like a helpless child carries more.

The Home Is Their Last Stronghold

For many clients, the home represents independence, identity, and safety. When a caregiver enters that space, the client may worry that:

their privacy will disappear
their routines will be disrupted
their preferences will be ignored
their home will no longer feel like their own

Respect for a person’s home environment is not optional — it is foundational.

Judge Not...

A caregiver may simply be observing the environment to understand needs, but the client may interpret that as criticism.

They may think:

“My home is a mess.”
“I’m not doing enough.”
“They must think I’m failing.”

Neutral language and gentle pacing reduce this fear.

Fear of Decline Is Always Present

Even when clients don’t say it, they are often thinking:

“What happens when I get worse?”
“Will I lose my home?”
“Will I become a burden?”

You cannot remove these fears, but you can avoid triggering them. Predictability and calmness go a long way.

The First Visit Sets the Tone

A caregiver’s first visit is more than an introduction — it defines the entire relationship. Clients quickly determine whether you will make them feel safe, respected, and understood.

Arrive Calm, Prepared, and Unhurried

Your arrival should feel like relief, not disruption.

Introduce Yourself Clearly

Clients should never have to guess who you are or why you’re there.

Observe Before You Act

The first visit is not the time to reorganize or “improve” anything. It is the time to learn.

Ask Permission for Everything

Even small actions require permission. Asking restores control.

Match the Client’s Pace

Your pace should never exceed theirs.

Keep the First Visit Simple

The goal is rapport, understanding, and emotional safety — not efficiency.

Heart of the Chapter

Caregiving begins with a mindset, not a task.
Caregiving begins with humility, awareness, and respect.
Caregiving begins with the attitude that you are entering someone else’s world — and your presence can either bring calm or create stress.

When you show up with steadiness, patience, and professionalism, you create the foundation for everything that follows.

# # #

Roger McManus is the author of several books on entrepreneurship, including “Entrepreneurial Insanity in the Home Care Business,” which he co-wrote with Tim Rowan. He advises Home Care owners and HR professionals on techniques for recruiting, retaining, and rewarding caregivers.

VA Cuts Harm Another Provider

by Kristin Rowan | Jul 24, 2026 | Advocacy, Veterans Affairs

by Kristin Rowan, Editor

Veterans Losing Access to Care

The 90-year-old veteran clutched tightly to his medal, a Purple Heart, as he made his way to a VA health center to apply for care. That was nine months ago.

He is still waiting.

Franchise Executive Speaks Out

We spoke with Heidi Maddocks, VP of Health Care Strategies and National Alliance for Amada Senior Care, a national franchise system with franchisees in Texas and New Mexico. She describes herself as a “self-appointed veteran advocate.”

“The rate cuts for Texas and New Mexico don’t make any sense,” she told us. “The community care network was created for veterans to access care outside of VA facilities. The parts they cut hit hardest where it is already hard to get care, such as rural areas in both states.”

She added...

“This is only one of many issues we have with the VA, but that is a story for another day.”

“Who decided this? What data did they use? Why did they keep rates steady in every other state?” She has a lot of questions, but found that the VA does not answer such questions. Perhaps that would change if more agency owners spoke up.

Veterans Experience Office

Maddocks works closely with the Veterans Experience Office in DC but is disappointed to find that most veterans do not know it exists. “Personnel in their regional offices are trying to do better,” she said. “They are not responsible for the cuts but must try to increase awareness and enrollment in spite of them. 48% of veterans are not enrolled in VA healthcare, often because they are elderly do don’t know it is available to them.”

A mission of awareness

Enrolling veterans is one of her missions. “It is one of three pain points for veterans,” she continued. “Suicide and homelessness are the other two. All three accompany loneliness.” Even veterans who receive other benefits don’t know about healthcare benefits they may be entitled to because the VA Health Administration and the benefits side are siloed. “They don’t talk to each other,” she asserted.

Veterans' Needs Come First

Ms. Maddocks understands that the VA Administration is trying to manage their budget. She does not know why Secretary Doug Collins can not understand that cutting home care will not achieve that goal. Limiting in-home services has always led to higher total expenditures when patients and clients are forced into institutional care.

“We have to put the veterans first,” she emphasized. “That is why we have kept our Waco office open, for example, even though it is operating at a loss. We have to have caregivers drive in from Dallas, which means higher hourly rates and drive time reimbursement.

Peer Advocates

She has also compiled a list of zip codes where veterans are impacted, in order to facilitate planning for resource allocation.

Final Thoughts

As we quoted in the first of these reports, VA Secretary Doug Collins believes his cuts will merely bring these two states in line with national market rates. He said they will not impact veteran care. The experience of Amada and other agencies to which we have spoken proves him wrong.

The thought of veterans, especially rural veterans, losing their in home care is devastating. For some, this is the only human contact they have. For others, it is the only contact they can have. The consistency and familiarity that comes from having the same caregiver visit at the same time in a familiar setting is vital for veterans with PTSD or dementia. Disturbing that care and then claiming the rate change will not impact veteran care is ignorant and irresponsible. Whether you are operating in Texas and New Mexico or not, please consider writing to Secretary Collins and your local officials to ensure someone with decision-making authority is looking at the reality they have created.

# # #

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

Medicaid Reform

by Kristin Rowan | Apr 17, 2026 | Home Health, Medicaid, Regulatory, Waste Fraud and Abuse

by Kristin Rowan, Editor

Medicaid Reform

New Efforts to Stop Fraud Before it Happens

As auditors continue to investigate fraudulent activity, new initiatives through Medicare reform aim to stop fraud before it happens. The new initiative, the Combating Deceptive Practices in Assistance Programs Act adds oversight to the Medicaid program.

Preserve Medicaid through Reform

Chairman of the Joint Economic Committee and Chairman of the House Ways and Means Oversight Subcommittee, Rep. David Schweikert, announced the legislation that would tighten eligibility requirements for home health services through Medicaid. The bill requires Medicaid recipients to prove they are unable to perform three or more ADL’s without assistance.

If we seriously want to preserve Medicaid, and provide for the people most in need, we must crack down on fraud. Reaching people that need these services the most should be the top priority of these programs, not growing one of the largest jobs corps in the state. With the U.S. adding almost $87,000 per second to our national debt, making commonsense reforms can save tens of billions of dollars while protecting the truly vulnerable.”

Rep. David Schweikert

Chairman, Joint Economic Committee and House Ways and Means Oversight Subcommittee

Medicaid Waiver Programs

According to the statement from the Joint Economic Committee, the federal waiver programs that allow states to provide at home care for Medicaid beneficiaries are lacking guardrails and oversight. The state policies are “egregious” and lead to waste, fraud, and abuse.

For example, the New York State Medicaid program includes the Consumer Directed Personal Assistance Program (CDPAP) which allows beneficiaries to choose their caregiver. This broad eligibility program allows enrollees to choose friends or family members with no caregiving experience. New York’s Medicaid spending jumped from $2.5 billion in 2019 to more than $9 billion in 2023 with estimates of $12 billion in 2025.

More Information

Read H. R. 7713

Read the accompanying brief from the Joint Economic Committee: From Care to Cash: Correting Misaligned Incentives in Home Health

# # #

The Home Care Show: A Review

by Kristin Rowan | Feb 26, 2026 | Editorial, Product Review

by Kristin Rowan, Editor

The Home Care Show

We attend a lot of events. As care at home professionals, nurses, agency owners, regulatory bodies, advocacy groups, and software solutions providers, we travel sometimes more than we are at home. As a general rule, these events comprise networking opportunities, vendor displays, educational panels, and activities. Most of the events are of good quality, well organized, and informative. After a while, they all seem to blend together and we can’t remember which event we attended last or who met at each one. Every now and again, something new comes along.

Local Event Goes National

The Home Care Show started as a regional event in New York, hosted by GlattHealth. After a few years of tri-state success, the group added The Home Care National in Miami in 2025. The Rowan Report became aware of the event through some trusted colleagues who are now on the board of the national event.

Education

After a morning networking block with several options to connect with attendees, The Home Care Show kicked off with an impressive “State of the Industry” panel. The panel included Denise Bellville, Executive Director of the Home Care Association of Florida, Damon Terzaghi, Vice President of Medicaid Advocacy & Programs for the National Alliance for Care at Home, and Eric Reinarman, Vice President of Government Relations for the Home Care Association of America.

Breakout sessions ranging from marketing to IT, led by some of the brightest minds in the industry, followed the state of the industry address. Additional panel topics included AI, payer diversification, navigating risk, optimizaing growth, and mergers & acquisitions.

Growing Pains

Any event that changes its structure, location, or size will have some growing pains. The hiccups at The Home Care Show were minor and easily overcome. There was some overlap in the schedule that disrupted the flow on Tuesday. Navigating the website on a mobile device was tricky. The registration booths were strategically placed in front of the vendor hall and panel room, seemingly to keep attendees out of those rooms before they opened. But drinks and snacks were also behind registration and not obviously available to attendees. The vendor area was heavily leaning to the insurance/financial investment/consultant/advisor variety with few exceptions. Seating in the vendor hall was limited, which made lunch on Wednesday tricky.

Nailed It!

Much of this two-day conference could be considered a home run. In fact, most of it was pretty fantastic.

The education was timely, relevant, professionally moderated, well-planned, and had a mix of representation from home care agencies, consultants, software solutions partners, and investors. One attendee said, “I learned more in that session that I did in three days at the last event.”

The networking events were varied enough to appeal to everyone. After registering, attendees had the option to play pickleball at the host hotel, enjoy the beautiful pool, or relax at the coffee shop. Tuesday evening, GlattHealth and other sponsors hosted a rooftop dinner with live music.

The vendor room kept all sponsors in the same size booth, requiring them to use their product and service to woo attendees rather than the cost of their setup. The layout allowed for movement through the hall, and lunch and cocktail hours were inside the hall, giving vendors more face-time with attendees.

Final Thoughts

As Care at Home events go, this one ranks near the top. The education is well-worth the trip. The opportunities to get concrete information from industry experts to launch your agency no matter the direction you’re taking makes this event stand apart. Whether you’re near Miami or have to travel, put The Home Care Show National on your calendar for 2027.

# # #

Purpose-Built AI for Care at Home

by Rowan Report | Jan 15, 2026 | Artificial Intelligence, Home Health, Hospice, Outcomes

by Isaac Greszes, Eleos

Purpose-Built AI for Care at Home

How Care at Home leaders can move beyond AI pilots

Care at Home is increasingly turning to AI to address documentation burden, clinician burnout, and regulatory pressure. While AI has the potential to address these issues and more, practical results remain uneven, leaving agencies with a lot of experimentation, but little clarity on actual value.

Evaluating AI solutions should focus on real-world outcomes, how the solution fits into your existing workflow, whether the software is scalable, and how it handles changing regulations. You should also look for AI solutions that are built for care at home (purpose-built). This series of articles will help you make informed, risk-aware decisions about AI adoption.

AI is Coming Fast

Home health and hospice leaders are navigating a difficult balance: persistent workforce shortages, rising provider burnout, expanding documentation requirements, and increasing regulatory scrutiny — all within thin operating margins.

At the same time, AI has moved quickly from experimental to strategic. Many organizations are now evaluating AI not just for productivity, but for operational and administrative efficiency, clinician experience, compliance readiness, and financial performance.

And the stakes are high

Early results across the market have been inconsistent. Some organizations report meaningful reductions in administrative burden and a clear return on investment. However, others struggle to find value after adoption. The difference often lies not in whether AI was adopted, but how it was designed, supported, and governed.

The pilot problem

As AI adoption accelerates, many organizations find themselves caught in extended pilot cycles — testing multiple tools without committing to the operational changes required for scale. While pilots can validate technical feasibility, they rarely provide the consistency or measurement discipline needed to demonstrate sustained ROI in regulated care at home environments.

Quality over Quantity

Why the right evidence matters

In today’s AI market, product demonstrations are easy to produce. Documented outcomes are not.

Executive leaders should expect vendors to demonstrate real-world impact, supported by customer data, third-party validation, or peer-reviewed research. Credible AI partners should be able to explain how their results translate to care at home — and where limitations exist. The challenge is not the lack of information from pilots, but the lack of evidence those pilots results can be reproduced, measured, and sustained, in a care at home setting.

Objective Evidence that Matters

When evaluating AI platforms, leaders should look for evidence related to:

Documentation efficiency, such as reduced time per visit or faster note completion
Operational ROI, including quicker billing readiness or reduced rework
Compliance support, such as documentation completeness or audit preparedness
Provider experience, including reduced perceived administrative burden
Care outcomes, including patient engagement and satisfaction

AI solutions can impact efficiency and burnout. But, these outcomes are highly dependent on whether the solution was built for care at home, the quality of implementation, how easily it will integrate into your workflow, and governance. If a vendor cannot explain how results were achieved and whether they are reliable and repeatable outside the pilot, the vendor and the solution should be evaluated carefully.

General Purpose AI

And inconsistent results

Many AI tools marketed to healthcare organizations rely on general-purpose language models designed for tasks like summarization, chat, or content generation — not for producing structured clinical notes aligned to regulatory and reimbursement requirements.

Home health and hospice documentation often includes:

Clinical observations made in non-clinical environments
Structured requirements tied to reimbursement and regulation
Risk-sensitive language related to safety, decline, or end-of-life care
Significant variation across disciplines, visit types, and patient contexts

Where generic AI breaks down

In these settings, AI tools based on general-purpose language models introduce risks related to accuracy, hallucinations, bias, privacy, and workflow fit — because they were not designed to operate within structured clinical, regulatory, and reimbursement frameworks.

In practice, organizations report that the additional oversight required to validate or correct AI-generated output can reduce — or even negate — anticipated efficiency gains, limiting adoption and ROI. As a result, organizations often remain stuck in pilot mode — investing time and effort in validation without achieving the scale or consistency required for meaningful return.

The right question

When evaluating an AI solution, the right question is not whether the AI tool can record a conversation and translate it into notes or whether the tool can reduce documentation, but whether it can consistently support high-quality clinical documentation at scale without increading burden or creating compliance risks.

Purpose-Built AI

What it means and why it drives operational impact

In care at home environments, purpose-built AI should be evaluated less as a point solution and more as foundational infrastructure — one designed to support regulated clinical workflows consistently over time.

Many AI platforms label themselves as “purpose-built,” but leaders must look past marketing language to truly scrutinize the way the technology is designed and deployed. In regulated clinical environments, purpose-built AI typically incorporates:

Domain-specific clinical intelligence, informed by real documentation patterns
Provider involvement in defining structure, logic, and validation criteria
Structured outputs aligned to required note components, in addition to free-text summaries
Grounding mechanisms that reduce fabricated or misattributed content
Privacy-conscious data handling, with explicit limits on data retention and reuse

Research consistently shows that providers prefer AI systems that function as collaborative tools — preserving human oversight while reducing administrative load — rather than fully automated systems that completely bypass clinical judgment. These characteristics directly affect whether AI improves documentation time, supports compliance workflows, and earns provider trust — all prerequisites for driving ROI.
These design choices are what allow AI systems to move beyond experimentation and begin delivering durable efficiency, compliance support, and clinician adoption at scale.

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This article is part 1 in a 4-part series. Come back next week for “Scalability, Security, and Governance.”

About Eleos

At Eleos, we believe the path to better healthcare is paved with provider-focused technology. Our purpose-built AI platform streamlines documentation, simplifies compliance and surfaces deep care insights to drive better client outcomes. Created using real-world care sessions and fine-tuned by our in-house clinical experts, our AI tools are scientifically proven to reduce documentation time by more than 70% and boost client engagement by 2x. With Eleos, providers are free to focus less on administrative tasks and more on what got them into this field in the first place: caring for their clients.

©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

BREAKING NEWS: Home Health Final Rule

by Kristin Rowan | Nov 29, 2025 | Breaking News, CMS, Home Health, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

BREAKING NEWS

Home Health Final Rule

While most of us were still recovering from our Thanksgiving feast overload, CMS quietly released the CY 2026 Home Health Prospective Payment System Final Rule (HH Final Rule). In past years, CMS published the HH Final Rule on or about November 1. The HH Final Rule was delayed this year due to the government shutdown.

Payment & Policy Updates

The payment rate for 2026 will change based on multiple factors:

HH payment update of +2.4%
The final permanent rate adjustment of -0.9%
The final temporary adjustment of -2.7%
Fixed-dollar loss ratio for outlier payments update of -0.1%

The aggregated payment update for 2026 is a net decrease of 1.3%

Read the CMS Fact Sheet

Face-to-Face

The CARES Act allows Nurse Practitioners, Certified Nurse Specialists, and Physicians Assistants to order and certify eligibility for Medicare HH and establish a plan of care. CMS has updated face-to-face encounters to now allow NPs, CNSs, PAs and physicians to perform face-to-face encounters whether or not they were the certifying practitioner or one who cared for the patient prior to home health care.

Home Health VBPM

Effective in April 2026, the HHCAHPS survey will undergo changes. CMS is removing these three survey-based measures:

Care of Patients
Communications between Providers and Patients
Specific Care Issues

CMS is adding four measures to them measure set. These include three measures related to bathing and dressing and the Medicare Spending per Beneficiary setting measure. These changes also prompted alterations to the weights of each measure and measure category.

The expanded model has built-in criteria for the removal of any quality measure. CMS is adding an additional criteria to the list of factors. Factor 9 reads that CMS may remove a quality measure if it is not feasible to implement the measure specificiations.

Medicare Provider Enrollment Revocation

Currently, any provider must enroll and be approved to become a Medicare provider. CMS has the authority to both approve and revoke provider Medicare enrollment. When CMS revokes a provider’s Medicare enrollment, the revocation is effective 30 days after CMS mails notification to the provider. In certain circumstances, CMS can revoke enrollment retroactively to the first date of non-compliance and consequently collect any money paid to that provider back to the retroactive date. CMS is adding to the allowable grounds for retroactive revocation.

If an enrolled physician or practitioner has not ordered or certified services for 12 consective months
If a beneficiary attests that a provider did not actually perform the services they billed

Additional Changes

CMS is recalibrating case-mix weights under PDGM and LUPA thresholds.

DMEPOS accreditation regulations will now require suppliers to be resurveyed and reaccredited annually. Additionally, CMS is increasing the amount and frequency of data accrediting organizations (AOs) submit, expanding their ability to monitor AOs, and strengthening their ability to address poorly performing AOs.

The DMEPOS Competitive Bidding Program will change, but we are still waiting for the finalized improvements. CMS will begin paying for all continuous glucose monitors and insulin infusion pumps.

Read the Final Rule and additional Documents

Final Thoughts

A decrease in pay of any amount is unfortunate. However, we applaud CMS for listening to the feedback. CMS stated, “…commenters raised concers that behavior change after CY 2022 might [attribute] to factors unrelated to…PDGM.” Changes since 2020 include the introduction of OASIS-E, the expansion of value-based purchasing, and the large increase in the percentage of Medicare Advantage enrollees.

Whatever the reason, The Rowan Report joins the National Alliance for Care at Home in commending CMS for adjusting its payment calculations. The permanent pay adjustment for 2026 is listed as the final adjustment, a positive for HH moving forward. The proposed rule issued mid-year had a net -6.4% decrease in payments for a net decrease of more than $1 billion dollars. The final rule payment adjustment has a net decrease of $220 million. Still a decrease, but much more palatable.

CMS will continue to assess the need for temporary payment adjustments for several more years. Additional adjustments (read decreases) to the payment rate will impact patient access to care. The Alliance will continue to advocate and educate members of Congress and HHS to lower or eliminate they reductions. Your advocacy and support is needed to ensure the future of Care at Home. The Rowan Report will continue to support the Alliance and other advocacy groups and share with you opportunities for advovacy.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

OASIS, OASIS Everywhere!

by Tim Rowan | Nov 13, 2025 | Artificial Intelligence, Clinical, New Tech

by Tim Rowan, Editor Emeritus

OASIS, OASIS, Everywhere

At this year’s annual meeting of The National Alliance for Care at Home, one could not attend a general or breakout session or walk an aisle in the exhibit hall without hearing about artificial intelligence. After 27 years covering Home Health, Home Care, and Hospice technology, I have seen buzzwords come and go. Declared game-changers have evolved from Windows to the iPad, to smartphones, to telehealth, to Big Data, to the Internet itself.

Interestingly enough, the “game” never changed. Patients/clients, nurses/CNAs, claims, payroll, and A/R have always, and will always, keep owners, administrators, and managers sprinting. AI will bring massive changes, but not to these constants.

AI is a Supplement, not a Replacement

There is much concern, and a plethora of articles, about how easily AI can be abused, even with the most noble intentions. We have detected serious concern about a movement to allow AI to make clinical decisions. We concur that this is inappropriate. Advising clinical decisions, providing background on previous patients with similar symptoms, or quickly accumulating data on the history of a chronic condition, can benefit our patients and clients in ways no other technology has been able to do. Making clinical decisions is different in both kind and degree.

This is why we were impressed with the focus on supplementing over replacing that we witnessed in New Orleans.

Ambient Listening for OASIS

When WellSky acquired Kinnser, everyone wondered whether the Home Health EMR would improve or merely be maintained for its customer base. Longtime friend of The Rowan Report, and WellSky and former Fazzi consultant Cindy Campbell, RN, convinced us with her uncharacteristic effusiveness to take another look at the latest WellSky feature.

How it works

During the OASIS visit, the nurse in the home logs into an app and places it between him/her and the patient. As the normal OASIS conversation takes place, the AI-enabled app not only hears but interprets every nuance of the chat. By the time the OASIS visit is over, the agency’s EMR has been fully populated. Every OASIS question has been answered, and every numerical rating field has been accurately completed.

Human touch

Wisely, WellSky allows no AI OASIS assessment to be saved or signed without review by a human. This is going to become standard practice as AI evolves, or at least it should be, the WellSky rep told us. Machine assistance is far removed from machine perfection. Nevertheless, she asserted, few changes are required by the reviewer, usually a QA nurse.

Beyond OASIS

In addition to streamlining the OASIS assessment visit, the new app gives voice reminders to each nurse of their daily and weekly schedule, and background information about each patient’s visit history, current condition, and goals.

But Wait, There's More

Our AI tour did not end at the WellSky booth. We lost count of the number of smaller companies that were demonstrating the exact same AI-assisted OASIS assessment. It was as though some unknown force ordered, “OK, everyone. It’s 2025. Roll out your Home Health AI functions.”

One of many

Roger is the name of one of the more evolved such apps, from the aptly named Roger Healthcare. We had interviewed co-founder Yunus Ansari several months ago and were impressed by the product’s progress since then. Like WellSky and the others, Roger claims 15-minute OASIS visits, 5-minutes routine visit notes, 2-minutes EMR syncing, and larger per-nurse patient caseloads without additional work time.

Where Do We Go From Here?

Clearly, AI is not a fad. It has already permeated Amazon, Facebook, and most gas and electric vehicles. In Home Health, Home Care, and Hospice, it promises to accelerate research, education, paperwork, and revenue cycle management. Here is the red line in the sand. When used to enhance the efficiency and working knowledge of a nurse, CNA, or non-medical caregiver, it will go a long way toward helping in-home care to keep up with budget cuts, reimbursement reductions, inflation, and nurse/caregiver shortages.

When used to replace the clinical expertise of physicians, nurses, CNAs, and even personal care assistants, it smacks of HAL, the renegade computer of 2001: A Space Odyssey. What we need to do as AI infiltrates more and more aspects of our lives, is constantly remind ourselves that it is only a tool, not a master.

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Tim Rowan is a 30-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