Why You Might Be Headed For 6-Figure Fines (And How to Avoid Them)

Many home care agencies don't realize they've crossed the Affordable Care Act threshold until the IRS comes knocking. Brendan Mullins, CRO of Vitable Health, explains why agencies with as early as $1–2M in annual revenue can already qualify as Applicable Large Employers, how 30 hours per week (not 40) triggers eligibility, and why variable caregiver schedules make ACA compliance especially difficult. We break down how the 50 Full-Time Equivalent (FTE) threshold is calculated, the misconceptions that lead agencies into trouble, and why penalties can quickly climb into the six figures. Brendan also walks through how ACA audits typically unfold, why compliance issues often surface years later, and the common mistakes agencies make along the way.

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min

Jun 30, 2026

Why You Might Be Headed For 6-Figure Fines (And How to Avoid Them)

Miriam Allred (00:11)
Hey everyone, welcome back to the Home Care Strategy Lab. It's your host, Miriam Allred. It's great to be back with you. I hope everyone's having a great week. Today in the lab, I am joined by Brendan Mullins, the CRO of Vitable Health. Brendan, welcome to the show.

Brendan Mullins (00:25)
Thank you for having me. It's great to be here.

Miriam Allred (00:27)
It's great to have you. I'm excited for this conversation. I told you I interviewed Joe last year, but it's been a while, and this topic is super important. And it's one of those things that I don't think enough people are thinking about, let alone talking about. And in this AI world, I wanna, I guess, just praise you guys in building something really tangible, meaningful, kind of basic or essential in the best way. And so like to kind of surface these conversations when I think everyone's kind of tapped out of AI. Not saying you're not using AI, you probably are, but

Something a little more like hands on and tangible. So excited to have this conversation.

Brendan Mullins (00:59)
Me too. Thank you.

Miriam Allred (01:01)
let's start with your background. Tell everyone a little bit about yourself and then do kind of a quick intro of Vitable as well.

Brendan Mullins (01:06)
Yeah, sure. So I'm Brendan Mullins. like you said, I ⁓ am the CRO at Vitable Health. I've been here just about two years. ⁓ I have been in the health and benefits industry for the last 20 working for a lot of probably the big brand names that you've heard and came to Vitable because I really I just got kind of got tired of like selling a thing and really wanted to do something different and actually help people.

And for me, you know, knowing this industry as well as I do, it's very tough to negotiate. It's very tough to navigate. ⁓ and often you don't feel like you're actually helping people, even though you might have set out to do that. So for me, Vitable was a really strong choice because I I think we have the best mission and I think we are really focused on, you know, actually doing something good for people. ⁓ personally, grew up in New York, live in San Francisco. I always say I have that, you know, cold, dark heart of a New Yorker inside that I present in a very fluffy and warm exterior. ⁓ but I've been very fortunate to have almost about twenty five years in both. So it really I think ⁓ big part of me but love living in the Bay Area now, which is where I'm at. So yeah.

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Miriam Allred (02:10)
Amazing. And two years at Vitable. Give everyone just kind of a teaser of Vitable and then we'll talk more about it at the end.

Brendan Mullins (02:16)
Yeah, so Vitable helps employers offer affordable health care benefits, ⁓ especially to hourly workers where they might have trouble, you know, affording the company health plan and maybe they're stuck in this limbo where they almost make a little too much to go get government assistance. And so we offer a wide variety of different health care benefits that are tapered to that sect of people. ⁓ and we combine primary care with preventative care ⁓ and offer ACA compliant health plans.

Miriam Allred (02:45)
Amazing. Let's start by talking about ACA compliance. I hope us talking about this, it's not anything new to anyone listening to this, but I want to just kinda like set the record straight and give everyone just like a quick refresher. give us a kind of a brief background of the ACA Affordable Care Act in a nutshell.

Brendan Mullins (02:48)
For sure. Yeah,

you know, my favorite topic. And it's it's so funny. I'll start Miriam by saying that I was on ⁓ a call with a customer yesterday and I said, we can go as deep as you want to go, right? We could start off here, but with the ACA, there is always another but or another and or another thing that we can talk about and add on because it can get very complicated. ⁓ ACA, ⁓ you know, you said hey, most most people are aware of this. Shockingly a lot are not.
So we work with you hundreds and hundreds of home care agencies, and often a lot of people don't understand ACA and what they have to do to be compliant, or you know, are required to provide health care and don't. So, broad overview, ⁓ the Affordable Care Act, or as many people know it as Obamacare, ⁓ was passed in 2010. And this was you know passed with the goal of expanding health care to really everybody. And at the time that came out, there was an employer mandate where it said, hey,

If you have over a certain amount of ⁓ full-time equivalents, you will have to provide health insurance. And at the time, which is no longer active, it said if you are an individual and you don't have health insurance, you are going to be fined at the end of the year. That piece eventually was repealed, except in a few states, I think like Vermont and one or two others, maybe DC. ⁓ but today, as it stands, there is now only that employer mandate where if you are an employer,

And you have more than fifty full time equivalent employees, we can talk about what that definition means, you have to supply healthcare. That's that's the very base level. We can go deeper from there, but that's where we are today.

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