Navigating heightened scrutiny: billing compliance for home health agencies

Federal agencies are intensifying their focus on Medicaid home care billing following reports of significant expenditure growth between 2018 and 2024. As government oversight increases, home health, hospice, and home care providers in the Chicagoland area must proactively address the financial complexities within their operations to ensure they remain shielded from allegations of fraud or billing abuse.

Analyzing the rise in medicaid spending

• Medicaid home care spending more than doubled in the last six years, rising from $937 million to $2.15 billion monthly.

• Rapid growth in expenditures has triggered government-led investigations and data-driven audits.

• Administrative scrutiny is shifting from broad industry averages to granular checks of individual billing patterns.

• Small business owners face increased liability if their internal financial controls cannot substantiate rapid revenue growth.

The reality of billing irregularities

Recent industry data suggests that while high-level numbers may signal potential financial anomalies, the reality is rarely a case of systemic organizational fraud. Rather, billing errors often stem from individual actors within the system or poor coordination between scheduling and payroll. At Soriaga and Associates, we observe that these errors frequently arise from outdated administrative workflows that fail to catch discrepancies in real-time. For providers in Naperville, Lisle, and Westmont, maintaining a reactive stance is no longer sufficient; operators must transition to proactive financial oversight to distinguish genuine operational growth from red-flag billing variances.

Protecting your agency through financial diligence

For home health and hospice operators, the best defense is a robust accounting framework. Implementing rigorous bookkeeping and regular cost report preparation allows you to identify irregularities before government auditors do. Our team provides specialized fractional CFO services that go beyond basic tax preparation, acting as a safeguard for your business operations. By ensuring that every hour billed is verified against authorized care logs and compliant payroll data, providers can maintain transparency and integrity. We help owners focus on patient care while our professional accounting solutions serve as the foundation for audit-ready compliance in an increasingly restrictive regulatory climate.

Sources

• CMS says home care fraud is rampant. What do the data show?, STAT.