Buying a home care agency in Tampa Bay

• Referrals from many hospitals, doctors' offices, senior communities and case managers, not one or two relationships the owner holds personally.
• A core group of caregivers who have stayed for years, and steady hiring that keeps shifts filled without constant overtime.
• A director of nursing and an office team who run intake, scheduling and billing without the owner.
• For Medicare-certified agencies, clean recent surveys (inspections) and solid ratings on Medicare's Care Compare website.
• For private-pay agencies, long client relationships and a mix of payers, so no single Medicaid plan or insurer controls the business.
• Files that would survive an audit: background screening, training records, visit notes and physician orders, all current.
• Scheduling and visit verification that run smoothly. Florida's Medicaid plans require electronic verification of home health and personal care visits.

• Payers. Medicare rates change yearly, Medicare Advantage plans often pay less and require approvals, and Medicaid plan contracts can end. Florida is part of Medicare's Review Choice Demonstration, which reviews traditional Medicare home health claims before or after payment. Ask for the agency's results.
• Audit history. Records requests, denied claims and repayment demands. The seller stays liable for AHCA penalties from before the sale (section 408.807), but Florida Medicaid can also hold the buyer liable for overpayments identified by closing (section 409.907(6)). Ask AHCA, and cover the rest in the contract.
• How caregivers are paid. Treating aides as contractors outside a licensed nurse registry, or skipping overtime, can leave the business owing back wages. Federal overtime rules for agency caregivers are being revisited, so have an employment attorney look.
• The service area. A home health agency license lists the counties it may serve, all in one state health planning district. Adding counties takes an AHCA filing, and going beyond the district takes a separate license (rule 59A-8.003).
• People. Caregiver turnover, pay compared with local competitors, and any liability claims involving falls or missing property.

• Where do most new patients or clients come from, and which referral sources know you personally?
• Who pays for most of your clients' care, and has any payer changed rates or terms lately?
• How long do your caregivers usually stay, and how do you find new ones?
• When were your last AHCA survey and accreditation visit, and what came up?
• How have your claims fared under Medicare's Review Choice Demonstration? Any audits or repayment requests?
• Who handles intake, scheduling and nursing oversight day to day, and do you think they'll stay?
• Do you turn away any areas or kinds of clients because you can't staff them?

Tampa Bay, as we draw it, runs from Citrus County south through Hernando, Pasco, Pinellas and Hillsborough, and east into Polk: Tampa, St. Petersburg, Clearwater, Brandon, Wesley Chapel, Brooksville, Inverness, Lakeland and Winter Haven. Tampa is the business center, with Port Tampa Bay, Tampa International Airport, the University of South Florida and MacDill Air Force Base, home to the headquarters of U.S. Central Command and U.S. Special Operations Command. Financial services, insurance and health care employ many people, and the Gulf beaches of Pinellas bring tourists and seasonal residents.

Polk County sits on Interstate 4 between Tampa and Orlando and has become a center for warehouses and distribution, alongside its older citrus and phosphate industries. To the north, Pasco, Hernando and Citrus are more suburban and rural, with many retirees. Home service companies, the building trades, medical practices and auto businesses all have a deep customer base across the region.

Hurricane Helene's storm surge in September 2024 and Hurricane Milton two weeks later both hit the region hard. Flood zones and insurance costs now matter in any deal near the water. Ask how the business came through those storms, what it claimed, and whether its building sits in a flood zone.

The labor market is deep by Florida standards, though skilled tradespeople can still be hard to find. New homes have pushed north and east into Pasco and eastern Hillsborough, and along Interstate 4 in Polk, bringing demand for services with them. Coastal Pinellas is more seasonal than inland Tampa or Lakeland. The bay itself shapes a service company's territory: crossing a bridge at rush hour can turn a short distance into a long drive, so look at where the customers actually are.