California’s home-health boom is wrapped in mystery. Firms are billing Medicare billions, with some growing 800x. Meanwhile, the state’s patient population has barely grown, the home-health sector has declined nationwide, and many top billers have almost no online traffic. 1

California’s Outsized Home-Health Agency Growth

Change since 2019

+68%
+7%
−17%
−23%
CaliforniaOtherAgenciesPatients

Home-health providers need little to no certification, training, or technology. This made it one of the easiest ways for California’s unions, such as the SEIU-UHW, to recruit and deploy entry-level members. The politically connected union is the largest spender on many political issues while one of its major sources of revenue growth remains hidden from the public.

Agencies who first appeared after 2019 billed Medicare $1.07 billion in 2024. That was 33% of payments published for California that year. Nearly 40% of those payments went to addresses in Glendale, Burbank and Van Nuys. 2

Extreme Home-Health Billing Growth3

Sea Coast

$5.35M
+8,762%
+4,786%

BLC / Careway

$9.43M
+8,388%
+7,482%

Preferred Choice

$6.54M
+4,088%
+3,060%

Archer / Optimal

$11.90M
+2,324%
+2,304%
PaymentsPatients

At Therapeutic Home Healthcare in Fresno, annual Medicare payments stayed below $400,000 for six years. In 2022, they jumped to $3.35 million, reaching nearly $5 million by 2024. Therapeutic was one of seventeen California providers whose published Medicare payments increased by more than 1,000% between 2019 and 2024. Their combined payments rose from $2.8 million to $75 million. 3

Therapeutic Home Healthcare’s Medicare payments3

BLC Homehealth’s Medicare patient count rose from 17 to 1,289 during that same time interval. Payment per patient rose about 12%. 3

At Sea Coast, patient revenue rose 8% from 2023 to 2024, while operating expenses fell 36%. That lifted patient service income from $412,000 to $2.56 million. Sea Coast’s reported patient-service margin went from 8% to 46%. 4

Sea Coast’s patient service income rose sixfold4

2023
2024

Operating expenses

2023
2024

Patient service income

In October 2017, CDPH announced a major change to its state licensing program. If home-health agencies passed a private survey, CDPH would issue a six-month provisional state license. 5

CDPH reported waits of three months to two years for initial home-health licensing surveys in October 2017. Its alternative allowed applicants to hire an approved organization to conduct the state-licensing survey and send the findings to CDPH. 6

One accreditor warned CDPH that a prospective hospice used a fabricated address, but CDPH issued a license anyway. 7 California does not disclose which agencies were initially approved using private auditors.

Los Angeles County described two obstacles to following a complaint through the system: inspectors needed CMS authorization to conduct a complaint-validation survey at those agencies and received no information about case outcomes once federal fraud investigators took over. 5

L.A. County’s complaint process

  1. CMS

    Approves survey

  2. County inspectors

    Conduct survey

  3. Federal investigators

    Take over fraud case

  4. County follow-up

    No outcome shared

The county letter states that no further information is provided to HFID about the outcome of a case.

Federal regulators are starting to act. In May 2026, CMS announced a six-month nationwide freeze on new home-health and hospice enrollments and certain changes in majority ownership. CMS said it had suspended payments to approximately 800 Los Angeles home-health and hospice providers on suspicion of fraud.

In July 2026, a jury convicted HealthNow’s Simon Katz of a health-care-fraud conspiracy. The Justice Department described claims for services never provided and clinical work performed by unqualified personnel.

Screenshot of the Justice Department’s July 23, 2026 release announcing Simon Katz’s jury conviction for a health-care-fraud conspiracy involving false Medicare claims and falsified medical records.

In April 2026, the California attorney general announced charges against 21 suspects in an alleged $267 million Medi-Cal billing scheme involving 14 hospice companies. Prosecutors said the operation used stolen identities and straw owners to bill for services never provided.

In June, federal prosecutors announced a separate conspiracy case against Oren David Shachar, Jeannie Choi and Abraham Shin. The indictment alleges that four hospice businesses submitted $27.7 million in claims, receiving $26.9 million, through a scheme involving kickbacks and patients who were ineligible for hospice care or already dead.

In August, Lynn Galbraith, who operated Azure Hospice Care in Garden Grove, pleaded guilty to health-care fraud. The Justice Department said she submitted more than $2.2 million in false hospice claims and received about $2.1 million for services involving patients who were ineligible for the benefit.

DOJ Health Care Fraud Unit trials, calendar years 2018–20258

20182019202020212022202320242025172191538361917

California’s home-health industry is a representative example of how California became structurally vulnerable to fraud. Verification is delegated. Transparency is limited. It’s a staggering pattern that does not replicate across the country. Authorities often do not have the information to detect fraud to begin with, instead relying on retroactively demanding records which may not be preserved. The State of California has not shown any interest in policies which prevent fraud and has frequently changed policies to make fraud easier.

Footnotes

  1. Agency and patient growth. CMS 2019 and 2024 files; annual series and calculations. Agency counts use published provider IDs; patient counts use state totals. Outside California includes D.C. and Puerto Rico. California added 906 agencies, including 480 in 2022–24. These fee-for-service files exclude Medicare Advantage.

  2. Newer providers. Provider cohort, CMS source and calculation: $1.068 billion ÷ $3.255 billion in published California provider payments = 32.8%. Glendale, Burbank and Van Nuys account for 39.1% of cohort payments. “Newer” means first observed in the 2016–24 files; identifiers can change independently of business formation.
    Online presence and traffic analysis. September 14, 2026 business-presence analysis, audience-evidence column. The sample comprises the twenty largest recorded absolute billing increases across Medicare payments, submitted charges and selected Medicaid company codes, 2019–24.

    Providers in the online-presence analysis
    Data
    Healthflex Home Health Servicespayment27,642,984228.7%
    Best Home Health Providers, Inc.payment21,566,962692.9%
    Hoag Home Healthpayment15,748,3452,285.6%
    NATHAN O OGBATUE / California Home Health AgencyMedicaid company codes12,626,434.21,947.7%
    Archer Health Incpayment11,405,5162,323.9%
    Homebridge Inc., San FranciscoSF city paid vouchers9,962,814.238%
    BLC Homehealth Incpayment9,319,9118,388.2%
    Central Coast Home Health Inc., San Luis Obispopayment8,901,11941.8%
    Lorian Health, San Diegopayment8,120,122144.7%
    Sutter Care at Home, Modesto / Salidapayment7,948,666130.3%
    ASAP HOME HEALTH, INCMedicaid selected care codes7,826,624.4132.9%
    Bridge Home Health, East Bay / Walnut Creekpayment7,512,3511,353.6%
    MAXIM HEALTHCARE SERVICES, INC.Medicaid company codes7,455,139.21,105%
    AMERICAN CAREQUEST, INCMedicaid company codes7,308,602.33,215.4%
    Ace Home Health Care & Hospice, Incpayment7,189,106269.4%
    Sutter Care at Home, San Mateopayment6,955,64159.2%
    MAXIM HEALTHCARE SERVICES, INC.Medicaid company codes6,853,465.9315%
    Amedisys Home Health Carecharges6,533,311120.6%
    COASTAL KIDS HOME CAREMedicaid company codes6,455,392.41,694%
    Elegance Healthcare, Incpayment6,446,505346.4%

  3. Therapeutic and agency comparisons. Annual payment and patient records; comparison ranking. The series follows provider 059426 through nine CMS files, including 2016 and 2017. Payments rose from $316,201 to $3,352,094 in 2021–22 as patients rose from 65 to 807; payment per patient fell 14.6%. Agency comparison.

    Agency comparisons
    Data
    Sea Coast Home Health Care Inc$60,318$5,345,5588,762.3%
    Blc Homehealth Inc$111,107$9,431,0188,388.2%
    Preferred Choice Home Health Care, Inc$156,219$6,543,0264,088.4%
    Bay Nation Home Health Services Inc$114,967$3,435,7482,888.5%
    Blessed Heart Home Care, Inc$101,393$2,739,6462,602%
    Archer Health Inc$490,801$11,896,3172,323.9%
    Hoag Home Health$689,020$16,437,3652,285.6%
    Healing Touch Home Health Care Inc$135,425$3,205,2962,266.8%
    Therapeutic Home Healthcare$218,529$4,992,1982,184.5%
    Nobilis Home Health Care$70,617$1,417,0261,906.6%
    Dedicated Home Health Services, Inc$102,228$1,996,6361,853.1%
    Bliss Home Health Care, Inc$96,063$1,526,3901,488.9%
    New Dimension H C$76,687$988,3141,188.8%
    Joy Health Care Services$82,449$1,041,0341,162.6%
    Medco Home Health Care Inc$150,252$1,868,0071,143.2%
    Constellation Home Health Services, Llc$102,834$1,238,4811,104.3%
    Amberkare Home Health, Inc$76,493$851,4891,013.2%

  4. Agency finances. CMS cost-report archives for 2023 and 2024; selected financial cells and agency comparison. Patient service income equals patient revenue minus operating expenses. Figures are agency-reported across payers; Sea Coast’s selected reports cover calendar years and were settled without audit.

  5. California licensing and county oversight. CDPH All Facilities Letter 17-20 (October 6, 2017; option effective October 1). CDPH describes a private-survey option for initial California licensure, an application-approval step, submission of survey findings to CDPH and a six-month provisional state license after a passing survey. It reports district-office survey waits of three months to two years. Los Angeles County’s April 7, 2026 letters, pages 1–2, describe coordination concerns, survey authorization and missing case-outcome information.

  6. California initial-licensing survey process. CDPH’s October 2017 licensing procedure documents the licensing stages and reported waiting period. Process records and source links; CSV. Annual use of each California survey route requires applicant-level CDPH records: facility and license identifiers, application and approval dates, initial licensing-survey date and organization, result and license-issuance date. These records are required to calculate a state-licensing usage rate.

    California licensing process and sources
    Data
    ApplicationApplicantSubmit the application to CDPH; identify the selected organization if using the private-survey option.
    Application approvalCDPHReview and approve the application before the applicant schedules the private licensing survey.
    State survey routeCDPH district officeConduct the initial state-licensing survey. CDPH reported waits of three months to two years in October 2017.
    Private survey routeACHC, CHAP or The Joint CommissionConduct the initial survey for California licensure and send findings to the applicant and CDPH.
    Provisional licenseCDPHAfter a passing private initial survey, issue a six-month provisional state license.

  7. Warning to California licensing officials. California State Auditor, report 2021-123 (March 29, 2022), section on verifying hospice applications. A private survey organization reported a fabricated-address concern; CDPH issued the hospice license without resolving it. The finding concerns the state’s handling of a licensing warning.

  8. California Medicaid fraud enforcement. HHS Office of Inspector General, annual MFCU statistical charts: 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. California row, fraud-indictment and fraud-conviction columns (F7 and I7). Fiscal years; fraud category. Reporting definitions define charges by persons and entities and count convictions at sentencing. Abuse and neglect categories are separate. Percentage changes are calculated from the annual counts. Download all annual values and source locators. Federal health-care-fraud trials and outcomes. DOJ Fraud Section / White Collar Section annual reviews: 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. Health Care Fraud Unit, calendar years, including opioid-related prosecutions. Historical trial counts for 2018–23 appear on PDF page 22 of the 2023 review; 2024 and 2025 statistics appear on PDF page 6 of their respective reviews. Convictions here combine guilty pleas and individuals convicted at trial. The reports may include previously sealed matters when they are unsealed. The downloadable dataset in note 8 provides page locators for each year.