Case Studies

Restructuring of In-Home Healthcare Services Company

J.S. Held Acquires Clark Seif Clark, Strengthening West Coast Capabilities for Environmental Claims, Disputes, and Catastrophe Response

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The Situation

4,000 patient provider of in-home healthcare services. $46 million annual revenue. $4 million debt.

  • Billing errors resulted in significant payback adjustments to cost reports and diminished credibility with the State's Medicaid
  • The State’s pending recoupment actions would likely result in the business being shut down.
  • The Company was presented with alleged claims for billing errors; the State’s recoupment procedures were to withhold A/R.
  • How to deal with the State’s procedure to unilaterally stop or reduce reimbursements in the case of fraud allegations?
    • Medicaid comprised 80% of the Company’s billings, and therefore, it would soon run out of cash.
  • Needed to rapidly develop a feasible plan to repay the State and continue to service bank debt.
  • For timely repayment, the Plan had to generate a cash flow that was greater than four times the EBITDA run rate of the previous year.

How We Advised

  • Performance improvement initiatives were identified, developed, and staged for implementation.
  • Pre-sold credibility with extensive due diligence.
  • Gained understanding of each party’s motivations and objectives; solved creditors’ problems for them.
  • Developed performance improvement initiatives and timeline/impact on EBITDA and cash flow.
  • The process included correcting billing procedures, installing new billing software, and implementing new accounting software.
  • Our experts continued to manage the Plan’s process until completion.
  • State and lenders accepted the restructuring and repayment plan developed by our team.
  • Stipulations provided that we remain involved until the state is paid in full.
  • Lenders agreed to several concessions:
    • Restructured four loan agreements, including amortization
    • Waived covenants on the line of credit
  • Ultimately, the initiatives to grow the Company resulted in an over $10M increase in revenue, most of which came from higher-margin sales.
  • The combination of revenue and efficiency initiatives increased EBITDA from $600k to $4.5 million in two years.
  • The Company is on a positive pathway to satisfy its repayment obligations according to plan.

Key Contact

Dan F. Dooley, CTP 
Senior Managing Director 
Strategic Advisory Practice 
+1 603 660 8952 
[email protected] 

Related Practice Areas

> Turnaround and Restructuring Services 
Navigating the many challenges confronting a company in transition requires an operationally focused approach that looks beyond the balance sheet to minimize further degradation and build a path to sustainable growth. Drawing upon decades of experience in the turnaround space, we help companies in transition identify practical strategies to improve profitability and liquidity for immediate relief, while concurrently developing and executing a comprehensive turnaround plan for long-term, sustainable value creation. 

 

> Solutions for Distressed Situations 
We deliver integrated solutions for distressed and insolvent businesses that maximize recovery, mitigate risk, and restore enterprise value. Our experts are retained to help distressed organizations stabilize operations, protect stakeholder interests, and execute turnaround strategies. We take an operationally-focused approach that looks beyond the balance sheet to minimize further degradation and build a path to sustainable growth. 

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J.S. Held

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50 Jericho Quadrangle
Suite 117
Jericho, N.Y. 11753
+1 516 621 2900
[email protected]

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© 2025 J.S. Held LLC.  

All Rights Reserved.

J.S. Held, its affiliates and subsidiaries are not certified public accounting firm(s) and do not provide audit, attest, or any other public accounting services. J.S. Held is not a law firm and does not provide legal advice. Securities offered through PM Securities, LLC, d/b/a Phoenix IB or Ocean Tomo Investments, a part of J.S. Held, member FINRA/SIPC. All rights reserved.
J.S. Held

Headquarters

50 Jericho Quadrangle
Suite 117
Jericho, N.Y. 11753
+1 516 621 2900
[email protected]

J.S. Held, its affiliates and subsidiaries are not certified public accounting firm(s) and do not provide audit, attest, or any other public accounting services. J.S. Held is not a law firm and does not provide legal advice. Securities offered through PM Securities, LLC, d/b/a Phoenix IB or Ocean Tomo Investments, a part of J.S. Held, member FINRA/SIPC. All rights reserved.
Markets Served

Geographies

Industries

Media Relations

[email protected]

 

© 2025 J.S. Held LLC.  

All Rights Reserved.

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