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Philadelphia Home Health Agencies: 8 Restructuring Moves When Payroll Comes Before the Remittance

Bottom line: A Philadelphia home health, home care or behavioral health agency carries labor cost weekly and collects on a government claim monthly, and eight things decide what a restructuring here is worth: (1) 55 Pa. Code §1101.65, which forbids the provider from factoring or assigning Medical Assistance claims rather than merely forbidding the payer from paying a factor, (2) the 45 day clean claim duty at 40 P.S. §991.2166(a.1) and the contract that can move it, (3) 26 U.S.C. §7501(a) and §6672, which turn payroll order into personal liability, (4) 29 C.F.R. §552.109, which closes the companionship exemption to your agency, (5) back wage exposure carrying two multipliers and your own name, (6) Medical Assistance recoupment that shrinks the deposit before any debit posts, (7) three separate definitions of a change of ownership, and (8) an exclusion statute that does not list insolvency. Call (888) 559-0156.

What a Philadelphia Agency Is Actually Selling When It Sells Future Receipts

The cost side of a home health agency is almost entirely people, and the people get paid on a fixed calendar whether or not anyone has adjudicated a claim. Aides, LPNs, registered nurses, behavioral health staff and the schedulers who keep the visits covered draw wages weekly or every other week, and those wages carry withholding that is due to the government on a deposit schedule of its own. The revenue side looks nothing like that. What your billing staff produces is a claim submitted to a Community HealthChoices or HealthChoices plan, to a Medicare administrative contractor, or to a county behavioral health managed care entity, adjudicated against a contracted rate and paid on a calendar the plan controls. A funder that bought a percentage of your future receipts bought a position in that gap, and the gap is the whole business.

Start with the part of this that runs against the pitch, because a page that opens with the flattering half is not worth reading at eleven at night. Federal law does restrict who may be paid Medicaid and Medicare money, and owners who find that rule tend to call their funder announcing that the receivables cannot be sold. Pennsylvania has a second rule pointing the other direction, and almost nobody in this industry has read it: 55 Pa. Code §1101.65 prohibits the provider from factoring or assigning the rights to any claims or payments for services rendered under the Medical Assistance program, with two narrow exceptions, and the enforcement for breaking it lands on your enrollment rather than on the funder’s. The federal rule tells a payer what it may not do. The Pennsylvania regulation tells you what you may not do, and that is a materially worse place to be standing.

The eight items below run in the order a home health file actually gets worked, from what the collateral is and when the money is legally due, through the two payroll exposures that follow an owner personally out of a business failure, to recoupment, to the exits that licensure closes. Two of the answers are different in Pennsylvania than in the states these funding agreements are usually drafted in, one federal rule that everyone assumes is settled has a pending proposal to undo it, and one question that a lot of pages resolve confidently is genuinely open.

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1. Pennsylvania Tells You Not to Sell the Claim

Section 1101.65 of Title 55 opens by stating that the Department makes direct payments to enrolled providers for medically necessary compensable services furnished to eligible recipients. It then adds the sentence that matters to anybody carrying an advance: providers are prohibited from factoring, assigning, reassigning or executing a power of attorney for the rights to any claims or payments for services rendered under the program, except as provided in two listed paragraphs. Paragraph (1) permits a reassignment only to a government agency or by court order and states that the Department will not pay a collection agency or service bureau to which a provider has assigned his accounts receivable. Paragraph (2) shuts the billing company door by providing that the Department will not pay a provider through a billing service or accounting firm that receives payment in the name of the provider.

The word factor is defined a few pages earlier and the definition reads like a description of the product you were sold. Under 55 Pa. Code §1101.21 a factor is an individual or an organization, such as a service bureau, that advances money to a provider for accounts receivable that the provider has assigned, sold or transferred to it for an added fee or a deduction of a portion of the accounts receivable. Read that next to the recitals on the first page of your funding agreement, which almost certainly describe a purchase of a specified amount of future receipts at a discount, and the overlap is not subtle. The federal analogue at 42 C.F.R. §447.10(h) says payment may not be made to or through a factor, and Pennsylvania went one step further and put the prohibition on the provider’s side of the transaction.

What that changes is who carries the consequence. A rule that binds the payer produces, at worst, a funder that cannot collect at the source, which is a problem for the funder. A rule that binds you produces an enforcement question under 55 Pa. Code §1101.77(a)(1), which allows the Department to terminate a provider’s enrollment and direct and indirect participation and to seek restitution under §1101.83 where it determines that the provider failed to comply with the chapter. Nobody should read that as a prediction about any particular file, and no reported Pennsylvania decision applying §1101.65 to a merchant advance turned up in our search. It is a reason to have counsel read the assignment language and the U.C.C.-1 collateral description before a negotiation opens rather than after a funder has written to a plan.

One further question underneath all of it we are not going to resolve for you, because the primary text does not resolve it either. Most Pennsylvania home health revenue now arrives from a managed care plan rather than from the Department directly, and 42 C.F.R. §447.10(a) describes itself as implementing a prohibition on State payments, while §447.10(c) frames the whole section as a State plan requirement and 42 U.S.C. §1396a(a)(32) speaks of payment under the plan. The managed care regulations at 42 C.F.R. part 438 do not carry §447.10 across into the relationship between a plan and a network provider, and §438.230(c) reaches an organization’s subcontractors rather than the agencies in its network. Chapter 1101 of the Pennsylvania Code never uses the words managed care, capitation or HealthChoices anywhere, though §1101.65 is written around claims for services rendered under the program rather than around who pays them. We could not locate authority settling either question, and the honest posture is to treat both as open and to have the plan participation agreement read, since it carries its own assignment terms.

Section 1101.65 Points at You: 55 Pa. Code §1101.65 provides that providers are prohibited from factoring, assigning, reassigning or executing a power of attorney for the rights to any claims or payments for services rendered under the Medical Assistance program, subject only to a government or court-ordered reassignment. Section 1101.21 defines a factor as an organization that advances money to a provider for accounts receivable assigned, sold or transferred for an added fee or a deduction of a portion of the receivables. (55 Pa. Code Chapter 1101)

2. The Forty-Five Day Clock, and the Contract That Moves It

Pennsylvania put a payment deadline on managed care plans by statute, and it reaches Medicaid plans by name. Under 40 P.S. §991.2166(a) an insurer shall pay a clean claim submitted by a health care provider or covered person within forty-five days of receipt, and subsection (a.1) applies the same forty-five day duty to an MA or CHIP managed care plan. Subsection (b) attaches a consequence rather than leaving the deadline aspirational: interest at ten per centum per annum is added to the amount owed on a clean claim paid late, running from the day after the payment was required until the claim is paid, with a small minimum before interest is owed at all. That is a real number on a large aged receivable, and it is one of the few clocks in this industry that runs in the provider’s favor.

The federal standard sits alongside it and is drafted more loosely than most owners expect. Under 42 C.F.R. §447.46(c)(1) a State’s contract with an MCO must require the organization to meet §447.45(d)(2) and (d)(3), which are the familiar benchmarks of ninety percent of clean claims within thirty days and ninety-nine percent within ninety days. Then §447.46(c)(2) provides that the MCO and its providers may, by mutual agreement, establish an alternative payment schedule, and §447.46(c)(3) requires only that the alternative be stipulated in the contract. If your agency signed a plan participation agreement without anybody reading the payment article, the schedule you are actually entitled to may not be the one in the regulation.

The definition of a clean claim is where an agency in distress loses the protection at exactly the moment it needs the protection most. Under 42 C.F.R. §447.45(b) a clean claim is one that can be processed without obtaining additional information from the provider or from a third party, and the definition expressly excludes a claim from a provider who is under investigation for fraud or abuse and a claim under review for medical necessity. An agency that has drawn utilization review attention is therefore outside the forty-five day duty on the very claims the reviewer pulled, which is a compounding problem rather than a coincidence.

On the Medicare side the deadline that costs agencies real money runs the other way and is only five days long. Under 42 C.F.R. §484.205(j)(1) an HHA must submit a Notice of Admission to its Medicare contractor within five calendar days after the start of care date. Section 484.205(j)(3) sets out what happens when it does not. Medicare does not pay for the days from the start date to the date of filing, the wage and case-mix adjusted thirty day period payment is reduced by one thirtieth for each of those days, and no low-utilization payments are made that fall in the late window. The non-covered days are a provider liability the agency is barred from billing to the beneficiary. The waiver at §484.205(j)(4) exists for fires, floods, contractor system failures and similarly exceptional events, not for a week when the intake coordinator quit. None of this is visible from a funder’s side of the table, because a debit calibrated to deposit volume keeps posting at full size while the deposits shrink by a thirtieth a day.

Clean Claim Has a Definition: 40 P.S. §991.2166(a.1) requires an MA or CHIP managed care plan to pay a clean claim within forty-five days of receipt, and subsection (b) adds interest at ten per centum per annum on a late one. Read that against 42 C.F.R. §447.45(b), which excludes from the term clean claim any claim from a provider under investigation for fraud or abuse and any claim under review for medical necessity.

3. Every Payroll Is a Trust Before It Is an Expense

The money an agency withholds from a caregiver’s check never belongs to the agency at any point. Under 26 U.S.C. §7501(a), whenever any person is required to collect or withhold any internal revenue tax from any other person and to pay it over to the United States, the amount collected or withheld is held to be a special fund in trust for the United States, and that fund is assessed and collected subject to the same provisions and penalties as the tax it arose from. For a business whose entire cost structure is wages, that single sentence describes a very large share of every dollar moving through the operating account, and it is the reason payroll tax exposure behaves differently from every trade payable on the aging report.

The enforcement provision reaches individuals rather than the entity. Under 26 U.S.C. §6672(a) any person required to collect, truthfully account for, and pay over any tax who willfully fails to do so is liable for a penalty equal to the total amount of the tax not collected or not accounted for and paid over, which is why practitioners call it the hundred percent penalty. The Internal Revenue Service publishes its own working standard for both halves of that test, and both halves are the reason a struggling agency gets caught. On responsibility, the agency looks at whether the person exercised independent judgment with respect to the financial affairs of the business, and it states that an employee whose function was solely to pay the bills as directed by a superior is not a responsible person. On willfulness, the published sentence is that using available funds to pay other creditors when the business is unable to pay the employment taxes is an indication of willfulness.

Put those two sentences beside the week you are actually having and the exposure becomes obvious. An agency that cannot cover both the net wages and the federal deposit is choosing between them, and in home health the choice feels forced, because the caregivers are the deliverable and a roster that misses a payday scatters into the four other agencies hiring within a mile. Paying the aides and deferring the deposit keeps the census intact for another two weeks and creates a record of using available funds to pay someone other than the government. We are not telling you to reorder anything, and nobody should reorder anything on the strength of a web page. What belongs in front of counsel and a CPA, before the next cycle rather than after the third one, is the actual sequence of payments, who signed and who authorized them, and whether any payment can be designated.

The procedure has two dates worth knowing. Section 6672(b)(1) requires the Service to notify the taxpayer in writing or in person that an assessment is proposed, and §6672(b)(2) requires that notice to precede any notice and demand of the penalty by at least sixty days, which is the appeal window that arrives in the mail and gets treated as junk. Section 6672(c) allows a person to halt levy and collection of the remainder by paying the minimum amount required to commence a court proceeding, filing a refund claim and furnishing a bond, all within thirty days of notice and demand. The reason all of this outlives the business is 11 U.S.C. §523(a)(1)(A), which excepts from an individual’s discharge any tax of the kind specified in §507(a)(8), and §507(a)(8)(C), which covers a tax required to be collected or withheld and for which the debtor is liable in whatever capacity. Unlike the income and employment tax categories in §507(a)(8)(A) and (D), subparagraph (C) carries no lookback period at all.

Sixty Days, Then Thirty: 26 U.S.C. §6672(b)(2) requires the preliminary written notice of a proposed trust fund recovery penalty to precede any notice and demand by at least sixty days, and the IRS letter carrying it states the appeal period on its face. Section 6672(c) then gives thirty days after notice and demand to pay the divisible minimum, file a refund claim and post a bond in order to stop levy on the remainder. (26 U.S.C. §6672)

4. The Companionship Exemption Your Agency Cannot Use

Congress exempted companionship services from the minimum wage and overtime provisions in 1974, and for nearly forty years agencies claimed that exemption for their own employees. That ended with a regulation that is still on the books. Under 29 C.F.R. §552.109(a), third party employers of employees engaged in companionship services within the meaning of §552.6 may not avail themselves of the minimum wage and overtime exemption provided by section 13(a)(15) of the Act, even if the employee is jointly employed by the individual or member of the family or household using the services, though the household itself may still assert it. Subsection (c) does the same to the live-in overtime exemption under section 13(b)(21). Your agency is the third party employer in both sentences.

The definition that feeds those sentences is narrow in a way that matters for scheduling. Under 29 C.F.R. §552.6(a) companionship services means the provision of fellowship and protection for an elderly person or a person with an illness, injury or disability who requires assistance in caring for himself or herself. Subsection (b) allows care to count only if it is provided attendant to and in conjunction with fellowship and protection, and only if it does not exceed twenty percent of the total hours worked per person and per workweek. Subsection (d) removes medically related services entirely, and it measures that by whether the services typically require and are performed by trained personnel rather than by the title of the person who happened to perform them. A visit built around bathing, transferring and medication assistance is past the twenty percent line before anyone argues about it.

There is a live proposal to undo all of this and it has not been finalized. The Department of Labor published a proposed rule titled Application of the Fair Labor Standards Act to Domestic Service on July 2, 2025 under RIN 1235-AA51, with comments closing that September 2. It states that the Department is concerned the 2013 regulations might not reflect the best interpretation of the Act, and it proposes a return to the 1975 rules. As of the eCFR edition current through July 31, 2026, §552.109 still carries only the 2013 amendment at 78 FR 60557, and no final rule has issued under that RIN. Planning a Pennsylvania restructuring around a rescission that has not happened is a way to build a wage liability while waiting.

It also would not help you as much as it sounds, because Pennsylvania answers this question with its own statute and its own case. The Minimum Wage Act exempts domestic services in or about the private home of the employer at 43 P.S. §333.105(a)(2), and 34 Pa. Code §231.1(b) defines domestic services as work in or about a private dwelling for an employer in the capacity as a householder, as distinguished from work for that employer in the pursuit of a trade, occupation, profession, enterprise or vocation. In Bayada Nurses, Inc. v. Commonwealth, Department of Labor and Industry, 958 A.2d 1050 (Pa. Cmwlth. 2008), affirmed at 8 A.3d 866 (Pa. 2010), that reading was upheld: the state exemption runs to employees of a householder employer and not to employees of a third party agency, and it is not preempted by the federal scheme. Overtime under 34 Pa. Code §231.41 is one and one half times the regular rate for all hours over forty in a workweek, and a federal rescission would leave that untouched.

What a Rescission Would Not Reach Here: 29 C.F.R. §552.109(a) and (c) close both the companionship and the live-in exemptions to third party employers, and the July 2, 2025 proposal to restore the 1975 rules had not been finalized as of the eCFR edition current through July 31, 2026. Pennsylvania reached the same result independently: 34 Pa. Code §231.1(b) limits the state domestic services exemption to householder employment, as Bayada Nurses held. (29 C.F.R. §552.109)

5. Back Wages Carry Two Multipliers and Your Own Name

A wage claim behaves nothing like a trade payable in a workout, and the arithmetic is the reason. Under 29 U.S.C. §216(b) an employer who violates the overtime provisions is liable for the unpaid overtime compensation and an additional equal amount as liquidated damages, and the court in such an action shall allow a reasonable attorney’s fee to be paid by the defendant along with costs. Under 29 U.S.C. §255(a) the reach-back is two years, extended to three where the violation was willful. Two years of unpaid overtime across a roster of forty caregivers, doubled, with the other side’s fees on top, is frequently a larger number than the advance stack that brought the agency to a settlement desk in the first place.

Pennsylvania stacks a second remedy with a different multiplier and a different clock. The Wage Payment and Collection Law defines employer at 43 P.S. §260.2a to include every person, firm, partnership, association, corporation, receiver or other officer of a court of this Commonwealth and any agent or officer of any of those classes employing any person in this Commonwealth, which is how an administrator or an owner ends up named individually in a wage case that began with a scheduling error. Section 260.10 allows liquidated damages of twenty-five percent of the total amount of wages due or five hundred dollars, whichever is greater, where wages remain unpaid past the statutory windows and no good faith dispute exists. Section 260.9a(f) directs that the court shall allow costs for reasonable attorneys’ fees of any nature to be paid by the defendant, and §260.9a(g) sets three years from the day the wages were due.

The classification question underneath all of this is itself unsettled at the moment, which is a reason for caution rather than for optimism. Part 795 of Title 29, sourced at 89 FR 1741 and dated January 10, 2024, still states the economic reality analysis that governs whether a worker is an employee or an independent contractor. That part remains in the Code of Federal Regulations as of the July 31, 2026 edition, and a further proposed rule on the same subject was published on February 27, 2026. Agencies that moved caregivers onto 1099s to smooth a cash crunch built an exposure that is measured under a test currently in motion, and the exposure sits on the same balance sheet as the advances.

None of that is negotiable in the way an advance is negotiable, and that is the point a restructuring plan has to absorb early. A funder will discount a balance because the alternative to discounting is uncertain and expensive. A wage claimant with a statutory fee shift and a doubling provision has an alternative that is neither, and a plaintiff-side firm evaluating your roster is looking at a class of people who all worked the same schedule under the same policy. An agency that settles four advances and leaves an unremediated overtime practice in place has bought eighteen months and a larger creditor.

Two Multipliers, Two Clocks: 29 U.S.C. §216(b) doubles unpaid overtime through liquidated damages and shifts a reasonable attorney’s fee, with a two year window under §255(a) and three years for a willful violation. 43 P.S. §260.10 adds twenty-five percent of the wages due or five hundred dollars, whichever is greater, §260.9a(f) shifts fees again, and §260.9a(g) allows three years. Section 260.2a puts an agent or officer inside the definition of employer.

6. The Plan Takes Its Money Back Before Your Bank Sees It

Recoupment is the exposure no funding model leaves room for, because it never arrives as a bill. Under 55 Pa. Code §1101.83(a), where the Department determines that a provider has billed and been paid for a service for which payment should not have been made, it will review the provider’s paid and unpaid invoices and compute the overpayment, and the section expressly authorizes the use of statistical sampling methods in calculating the amount of restitution due. Extrapolation from a sample is how a review of thirty visits becomes a six figure demand covering three years of episodes. Section 1101.83(d) leaves the method of repayment to the Department, either directly or by offset of valid invoices not yet paid, and §1101.83(f) forbids the provider from billing the recipient for anything it must restore.

The timeline attached to a cost settlement is short and it does not pause for an appeal. Under 55 Pa. Code §1101.69(b)(1) the Office of the Comptroller issues a cost settlement letter stating the overpayment and asking the provider to make contact within fifteen days to establish a repayment schedule, with the date of the letter counting as day one. If no acceptable plan comes back, §1101.69(b)(2) has the Department offset the overpayment against the provider’s Medical Assistance payments until it is satisfied, and §1101.69(b)(3) limits an offset plan to a single lump sum or a maximum of four equal installments over the repayment period. Section 1101.69(b)(6) provides that an appeal of the offset does not stay it, and §1101.84(b)(5) states flatly that an appeal of an audit disallowance does not suspend the obligation to repay.

Managed care does not soften any of that, and in one respect it moves faster. Under 42 C.F.R. §438.608(a)(8) a State’s contract must require the plan to suspend payments to a network provider for which the State determines there is a credible allegation of fraud, and §438.608(a)(2) requires the plan to report all overpayments identified or recovered within thirty calendar days, specifying which are due to potential fraud. Section §438.608(d) then requires the contract to spell out the plan’s retention policies for recoveries of overpayments from providers. In practice an agency learns about a plan-side recovery when a remittance advice arrives lighter than the claims it covers, and reconciling that against the funder’s reconciliation clause is a records exercise nobody has staffed.

From a funder’s desk a recouped month is indistinguishable from a bad month. Deposit volume drops, the daily or weekly debit stays where the contract set it, and the file gets reclassified from performing to problem on a metric that had nothing to do with how many visits your nurses made. That is why a payer correspondence file belongs in the first substantive conversation with a funder rather than the fifth, and why an agency that discovers a cost settlement letter in an unopened envelope has usually lost the fifteen day window and the thirty day appeal window under §1101.84(c) at the same time. Where the Department believes a prohibited act under §1101.75(a) occurred, §1101.83(e) permits a civil action seeking twice the amount of excess benefits or payments plus legal interest from the date of the violation, which is a different order of problem and a reason for health care counsel rather than a negotiator.

Fifteen Days, Then Offset: 55 Pa. Code §1101.69(b)(1) gives fifteen days from the date of a cost settlement letter to establish a repayment schedule, with the letter’s own date counting as day one, and §1101.69(b)(2) directs offset against Medical Assistance payments if nothing acceptable is returned. Section 1101.84(b)(5) confirms that appealing the audit disallowance does not suspend the obligation to repay.

7. Three Definitions of a Change of Ownership, All Live

The exit most owners picture is selling equity to somebody with cash, and in this industry that transaction gets measured three separate times against three different definitions. Start with Pennsylvania licensure, because a home health care agency is a licensed health care facility under 28 Pa. Code §51.2(6), which puts it inside §51.4. Subsection (a) requires written notice to the Department at least thirty days prior to a transfer involving five percent or more of the stock or equity of the facility. Subsection (b) requires written notice at least thirty days prior to a change in ownership, a change in the form of ownership or a change of name, and defines a change in ownership as any transfer of the controlling interest. Subsection (c) requires notice within thirty days after a change of management, which occurs when the person responsible for day to day operation changes.

The home health chapter layers its own reporting on top of that. Under 28 Pa. Code §601.7(a)(3) an agency owned by an association or corporation must disclose the officers, directors and principal stockholders of the corporate owner and of any parent, with ownership interests of five percent or more, direct or indirect, disclosed, and §601.7(b) requires written notice to the Department within thirty days whenever the partners, officers, directors, principal stockholders or persons in charge change. A regular license runs one year from issue under §601.12(b), and where the Department finds numerous deficiencies or one serious deficiency it may issue a provisional license for not more than six months under §601.12(d), renewable three times, which any buyer’s counsel will pull. Behavioral health sits in a parallel scheme: an IBHS agency must hold a license from the Department before beginning operations under 55 Pa. Code §5240.3(a), and must notify it within thirty days of a change in organizational structure under §5240.4(b).

Medicare defines the same event differently, and the difference is the trap. Under 42 C.F.R. §489.18(a)(3), the merger of the provider corporation into another corporation or a consolidation creating a new corporation is a change of ownership, but a transfer of corporate stock, and the merger of another corporation into the provider corporation, is not. Where there is a change of ownership, §489.18(c) automatically assigns the existing provider agreement to the new owner, and §489.18(d) subjects the assigned agreement to all applicable statutes and regulations and to the terms and conditions under which it was originally issued, including any existing plan of correction. A buyer taking assignment is taking the survey history with it, which is the diligence point that reprices these deals late.

Then there is the rule written for this sector specifically. Under 42 C.F.R. §424.550(b)(1), a change in majority ownership of a home health agency or hospice by sale, including asset sales, stock transfers, mergers and consolidations, stops the provider agreement and the Medicare billing privileges from conveying to the buyer. The trigger is timing: within thirty-six months after initial enrollment, or within thirty-six months after the most recent change in majority ownership. The buyer must instead enroll as a new agency under §424.510 and obtain a state survey or accreditation. The four exceptions in §424.550(b)(2) are narrow: two consecutive years of full cost reports, an internal corporate restructuring of the parent, a change of business structure where the owners remain the same, or the death of an individual owner. Medical Assistance adds one more filing: 55 Pa. Code §1101.43(b)(1) requires a change in ownership or control interest of five percent or more to be reported within thirty days, and makes an incomplete report a deceptive practice under 62 P.S. §1407(a)(1).

Three Clocks on One Closing: 28 Pa. Code §51.4(a) requires thirty days advance written notice of a transfer of five percent or more of stock or equity. 42 C.F.R. §489.18(a)(3) says a stock transfer is not a Medicare change of ownership at all. 42 C.F.R. §424.550(b)(1) says a stock transfer that changes majority ownership inside thirty-six months stops the provider agreement from conveying. All three can describe the same signature page. (42 C.F.R. §424.550)

8. Being Short of Cash Is Not on the Exclusion List

Owners in distress ask whether an unpaid advance, a judgment or a bankruptcy filing can cost them their ability to bill, and the statute answers plainly. The mandatory grounds at 42 U.S.C. §1320a-7(a) are four convictions rather than four conditions. Two of them are a criminal offense related to the delivery of an item or service under Medicare or a State health care program and a criminal offense relating to neglect or abuse of patients. The other two are a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility or other financial misconduct connected to health care or a government program, and a felony relating to controlled substances. The permissive grounds at §1320a-7(b) run to sixteen paragraphs covering further convictions, license actions, program sanctions, excessive or unnecessary claims, kickbacks, disclosure failures and refusals of access. Insolvency is not among them. Neither is defaulting on a merchant advance, losing a judgment or filing a petition.

Where financial trouble converts into exclusion risk, it does so through a different door. Section 1320a-7(b)(4) reaches an entity whose license to provide health care has been revoked or suspended by a State licensing authority, or that surrendered one while a disciplinary proceeding was pending, for reasons bearing on professional competence, professional performance or financial integrity, and §1320a-7(b)(5) reaches suspension or sanction under a Federal or State health care program on those same grounds. Section 1320a-7(b)(8) reaches an entity in which a person with a direct or indirect ownership or control interest of five percent or more, or an officer, director, agent or managing employee, has been convicted of a listed offense, assessed a civil monetary penalty or excluded. That is the mechanism that carries an individual’s problem onto the agency’s enrollment, and it is a reason the disclosure filings described in the previous item get made on time.

The periods are long enough to be terminal for a going concern. Under §1320a-7(c)(3)(B) a mandatory exclusion runs not less than five years, and §1320a-7(c)(3)(G) raises that to not less than ten years where the individual has one prior qualifying conviction and makes it permanent on two. A permissive exclusion under paragraphs (b)(1), (2) or (3) is three years under §1320a-7(c)(3)(D) absent aggravating or mitigating circumstances, and an exclusion under (b)(4) or (b)(5) runs not less than the period the license or program sanction is in effect under §1320a-7(c)(3)(E). Pennsylvania tracks that on its own: 55 Pa. Code §1101.42(c) makes providers excluded from Medicare or another state’s Medicaid ineligible here during the termination period, §1101.77(a)(5) treats suspension or termination from Medicare as its own ground, and §1101.77(b)(3)(i) sets a five year termination on a Medicare or Medicaid related conviction.

One provision in the statute was written for this sector and it is worth knowing before anyone panics about continuity of care. Under 42 U.S.C. §1320a-7(c)(2)(B)(ii), unless the Secretary determines that the health and safety of individuals receiving services warrants an earlier effective date, an exclusion does not apply to payments for home health services and hospice care furnished to an individual under a plan of care established before the date of the exclusion until thirty days after the effective date. That is a thirty day runway on existing patients, not a reprieve, and it exists so that people in their own homes are not abandoned on a Tuesday. The honest summary of this item is that distress by itself does not put your enrollment at risk, and the way distress puts an enrollment at risk is through billing decisions made to cover a debit, which is exactly the pressure a stacked position creates.

What Being Broke Is Not: Nothing in 42 U.S.C. §1320a-7(a) or (b) makes insolvency, a defaulted advance, a civil judgment or a bankruptcy filing a ground for exclusion. What does appear is §1320a-7(b)(4), a license action for reasons bearing on financial integrity, and §1320a-7(b)(8), an entity controlled by a person holding five percent or more who has been convicted, penalized or excluded. (42 U.S.C. §1320a-7)

What a Confessed Judgment Does to a Philadelphia Payroll Week

Pennsylvania is one of a small number of states where a confession of judgment still works in a commercial deal, and funders drafting paper for this region know it. Rule 2950 of the Rules of Civil Procedure defines the action as a proceeding to enter judgment by confession for money pursuant to an instrument other than one executed by a natural person in connection with a consumer credit transaction, and the official note states that the action is abolished only insofar as it would apply to consumer credit paper. An agency signing as a corporation or a limited liability company is outside that carve-out, and so is a guaranty signed by an owner in connection with a commercial advance rather than a personal one. Under 42 Pa. C.S. §2737(3) the prothonotary is the officer who enters all civil judgments, including judgments by confession.

What Pennsylvania does not allow is the bare filing that other cognovit states permit. Rule 2951(a) requires the action to be commenced by filing a complaint with the prothonotary in substantially the form Rule 2952 prescribes, Rule 2952(a)(2) requires the original or a reproduction of the instrument showing the defendant’s signature to be attached, Rule 2951(b) requires leave of court where the instrument is more than twenty years old, and Rule 2951(c) requires leave of court where no signed copy is attached. Rule 2955(b) permits the plaintiff’s own attorney to sign the confession as attorney for the defendant unless an Act of Assembly or the instrument provides otherwise, and Rule 2956 directs the prothonotary to enter judgment in conformity with the confession. The practical effect is that a funder can hold an entered judgment against your agency in days, before anything has been argued.

The deadline that decides whether you can fight it is not the one owners assume. Rule 2956.1(c)(2) conditions execution on service of a notice under Rule 2958.1 at least thirty days before the praecipe for the writ is filed, or under Rule 2958.2 with a notice of sale of real property, or under Rule 2958.3 with the writ itself. Rule 2959(a)(3) then requires a petition for relief to be filed within thirty days after service of that notice, and provides that an untimely petition shall be denied unless the defendant demonstrates compelling reasons for the delay. Rule 2959(a)(1) requires every ground, to strike and to open, in a single petition, and Rule 2959(c) waives all defenses and objections not included in it. Rule 2959(e) sets the standard that matters: if evidence is produced which in a jury trial would require the issues to be submitted to the jury, the court shall open the judgment, though Rule 2959(f) preserves the lien of the judgment and of any levy while the proceeding runs.

Rule 2958.3 is the fast route and it is used far less than it should be. Where the funder serves the notice with the writ and levies on personal property, the defendant may file with the sheriff a petition to strike in the form prescribed by Rule 2967, limited to whether the defendant voluntarily, intelligently and knowingly waived the right to notice and hearing before entry. Execution is stayed under Rule 2958.3(d) from the moment the form is filed until the court rules, the sheriff must present the matter immediately and the court must hear it within three business days under Rule 2958.3(c), and the burden is on the plaintiff to show the waiver by a preponderance. If it fails to, Rule 2958.3(c)(2) directs the court to vacate the writ, strike the judgment and return anything seized. For an agency whose bank account has to clear a payroll on Friday, a three business day hearing is not an academic remedy. Two other Pennsylvania facts belong beside it: as of August 2026 the Commonwealth has enacted no commercial financing disclosure or provider registration statute, so there is no missing-disclosure defect to plead here, and 41 P.S. §201(b)(3) removes business loans of any principal amount from the six percent ceiling, so rate alone is not a claim either.

Thirty Days From the Notice, Not the Judgment: Pa. R.C.P. 2959(a)(3) runs the thirty day petition deadline from service of the execution notice required by Rule 2956.1(c)(2), not from entry of the judgment, and an untimely petition shall be denied absent compelling reasons for the delay. Rule 2959(a)(1) requires all grounds in one petition and Rule 2959(c) waives whatever is left out. Get the docket and the service return to Pennsylvania counsel the day the notice arrives.

The Order a Philadelphia Home Health File Gets Worked In

Sequence decides outcomes here more reliably than any single argument does, and the first pass is arithmetic rather than law. Build a two column view of a single ordinary month: on one side every dollar of gross payroll, the employer share, the withholding due and the deposit dates, and on the other side the claims submitted, the claims adjudicated, the denials outstanding and the dates the remittances actually landed. Most owners have never put those two columns next to each other, and the distance between them is the number that explains why four advances stacked up in eleven months. It is also the number a funder never modeled, because the underwriting was done off bank statements and bank statements show a deposit without showing what was recouped out of it.

The second pass sorts the positions. Separate a genuine purchase of receipts with a reconciliation provision the funder honors from a fixed daily debit whose reconciliation clause exists only on the page, and separate both from a term loan and from equipment paper on your vehicles or your electronic visit verification hardware. Pull a current U.C.C. search against the exact registered name of the entity, which in this industry is frequently not the name on the license, and read the collateral descriptions against 13 Pa. C.S. §9406(i), which provides that the redirect notice mechanism in §9406 does not apply to an assignment of a health-care-insurance receivable at all. Then check every agreement for a warrant of attorney, because whether one is present changes how much time the file has.

Some agencies do not need anybody, and a firm that will not say so is optimizing for its own enrollment. One advance, a reconciliation clause being honored, current payroll deposits and a stable census is a situation an owner can often resolve with a phone call and a written agreement signed before any money moves. Where the stack is three or four deep, where a cost settlement letter is in the file, or where the withholding has slipped even one quarter, the work is document analysis, negotiation and litigation posture running at the same time, and the payroll tax question goes to a tax professional first because it is the one exposure that follows a person out of a closed business. Delancey Street is a settlement company rather than a law firm, and attorneys within the Delancey Street network handle the filings, the confessed judgment petitions and the licensing exposure that sit alongside a home health restructuring. Owners weighing whether counsel belongs in the file can start with our overview of how MCA defense works in Philadelphia, and owners comparing providers can read our page on business debt settlement companies here.

Five Documents Before the First Call: Have these in one folder: every funding agreement with its addenda and signature pages, a current U.C.C. search on the entity’s exact registered name, a payer mix report showing what share of collections comes from each managed care plan and from Medicare, the last four quarters of federal payroll tax filings with proof of deposit, and every letter received from the Department, a plan integrity unit or a contractor. The fourth item is the one owners leave out and the one that changes the plan.

Who Should You Call? Our Top-Rated Business Debt Firms

One firm on this list works the entire lifecycle of a business debt file, from stopping the daily debits through attorney-led negotiation, UCC lien removal, and a signed release. The other two cover broader debt categories that often sit alongside the advances. Choose accordingly.

★ Our Top Pick
#1

Delancey Street

Attorney-Led MCA & Business Debt Settlement - $100M+ Resolved Nationwide

The only firm here that handles the full arc of a business debt file: attorney-led negotiation, ACH revocation, legal defense, UCC lien removal, and a settlement agreement with a real release attached. Over $100M settled, no upfront fees, all 50 states, settlements at 30-60% of the balance.

Best for: Business owners carrying one or more advances who want aggressive, attorney-led negotiation with no upfront cost
Total Settled: $100M+
Settlement Range: 30-60%
Attorney-Led: Yes
Upfront Fees: None
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#2

National Debt Relief

Largest U.S. Debt Settlement Firm - A+ BBB Rating - 550,000+ Clients

Not an MCA specialist. National Debt Relief does not negotiate advances, challenge confessions of judgment, or fight UCC liens. For the ordinary unsecured business debt sitting next to your advances, their scale and track record make them a reasonable option on that side of the ledger.

Best for: General unsecured business debt over $7,500 (not MCA-specific settlement)
Clients Served: 550,000+
MCA Settlement: No
Every Week You Wait, The File Gets More Expensive Stop the ACH debits, get the UCC lien addressed, and settle at 30-60%. Over $100M settled. Free consultation.
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#3

CuraDebt

25+ Years in Business Debt & Tax Resolution - IAPDA Certified

Not an MCA specialist either. CuraDebt handles business debt alongside IRS and state tax resolution, so if unpaid payroll taxes have stacked up behind the advances, they can work that front while the MCA side is negotiated.

Best for: Combined business debt and tax resolution (not MCA-specific settlement)
Tax Resolution: Yes (IRS & State)
MCA Settlement: No

Frequently Asked Questions

Can my funder tell Keystone First or UPMC to pay it instead of me?
No, and two separate rules get there. 13 Pa. C.S. §9406(i) provides that §9406 does not apply to an assignment of a health-care-insurance receivable, which removes the notification mechanism a funder uses in other industries to redirect a customer. On the government side, 42 C.F.R. §447.10(h) bars Medicaid payment to or through a factor. What that does not do is void your agreement, reduce the balance or stop an ACH debit once the money has settled in your operating account, and an owner who spends two weeks writing letters to a plan about it has gained nothing.
I signed a receivables purchase agreement. Did I break a Medical Assistance rule by doing that?
That is exactly the question to put to health care counsel, and it deserves a straight answer rather than reassurance. 55 Pa. Code §1101.65 prohibits providers from factoring, assigning, reassigning or executing a power of attorney for the rights to claims or payments for services rendered under the program, subject only to a government or court-ordered reassignment, and §1101.21 defines a factor in terms that describe a receivables advance closely. Section 1101.77(a)(1) makes failure to comply with the chapter a ground to terminate enrollment. We found no Pennsylvania decision applying the section to a merchant advance, so this is a live question and not a settled one.
The plan is sitting on sixty days of claims. Is there anything requiring it to pay?
Yes. 40 P.S. §991.2166(a.1) requires an MA or CHIP managed care plan to pay a clean claim submitted by a health care provider within forty-five days of receipt, and subsection (b) adds interest at ten per centum per annum on a claim paid late. Two limits matter before you rely on it. A claim under review for medical necessity, or from a provider under investigation for fraud or abuse, is not a clean claim under 42 C.F.R. §447.45(b). And 42 C.F.R. §447.46(c)(2) lets a plan and its providers agree by contract to an alternative payment schedule, so read the payment article of your participation agreement first.
I paid my aides and skipped the 941 deposit for one quarter. How bad is that?
Bad in a way that outlives the company, which is why it goes to a tax professional now rather than at year end. Withheld tax is a special fund held in trust for the United States under 26 U.S.C. §7501(a), and §6672(a) imposes a penalty equal to the full trust fund amount on any responsible person who willfully fails to pay it over. The IRS publishes the position that using available funds to pay other creditors when the business cannot pay the employment taxes is an indication of willfulness. Because 11 U.S.C. §523(a)(1)(A) incorporates §507(a)(8)(C), a personal bankruptcy does not discharge it.
Do I owe overtime to home care aides in Pennsylvania if the federal companionship rule gets rolled back?
On the state side the answer does not move. Pennsylvania exempts domestic services in or about the private home of the employer at 43 P.S. §333.105(a)(2), and 34 Pa. Code §231.1(b) defines that as work for an employer acting as a householder rather than in the employer’s pursuit of a trade or enterprise. Bayada Nurses, Inc. v. Commonwealth, Department of Labor and Industry, 958 A.2d 1050 (Pa. Cmwlth. 2008), affirmed at 8 A.3d 866 (Pa. 2010), upheld that reading against a preemption challenge. Agency employees therefore earn one and one half times the regular rate over forty hours under 34 Pa. Code §231.41 regardless of what happens to 29 C.F.R. §552.109.
Can I sell the agency to clear the stack and let the buyer take over the Medicare number?
Not in the form most owners picture. 42 C.F.R. §424.550(a) prohibits selling Medicare billing privileges outright, and §424.550(b)(1) provides that where a home health agency changes majority ownership by sale, including asset sales, stock transfers, mergers and consolidations, within thirty-six months of initial enrollment or of its last majority-ownership change, the provider agreement and billing privileges do not convey and the buyer must enroll as new and obtain a survey or accreditation. Pennsylvania separately requires thirty days advance written notice of a five percent equity transfer under 28 Pa. Code §51.4(a).
A cost settlement letter came in and I already appealed. Can I keep the money until the appeal is decided?
No, and this is the single most expensive misunderstanding in Pennsylvania Medical Assistance recoupment. 55 Pa. Code §1101.84(b)(5) states that an appeal of an audit disallowance does not suspend the provider’s obligation to repay, and §1101.69(b)(6) provides that appealing the Department’s offset does not stay it either. The fifteen day response window in §1101.69(b)(1) starts on the date of the letter, not the date you opened it, and if nothing acceptable comes back the Department offsets against your Medical Assistance payments until the overpayment is satisfied.
Four funders are debiting weekly and I cannot cover Friday. What do I do first?
Work the order rather than the phone log. Sort the positions by funding date, by whether the instrument is truly a purchase of receipts or a disguised fixed debit, and by whether any of them contains a warrant of attorney, because a confessed judgment in Pennsylvania moves faster than a lawsuit does. Do not revoke an ACH authorization or move the operating account before counsel has read the agreements and the guaranty, since each of those is a legal act with consequences under the contract. Put the payroll deposit question in front of a tax professional the same week. Call (888) 559-0156.

Have the Agency File Read Before the Next Payroll Clears

Send the funding agreements and guaranty pages, a U.C.C. search, a payer mix report and four quarters of payroll tax filings. Back comes a read on each position: which carry a warrant of attorney, where leverage actually sits, and what belongs with counsel. Nothing is charged for the review.

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