Healthcare
Visiting professionals, HIPAA-compliant logs, accountable plans and per-role reimbursement tables.
Home care is the fastest-growing healthcare category in all three regions. Visiting professionals — nurses, PTs, aides, doulas — spend 60 to 80 hours per month traveling between patients. Without rigorous tracking, that becomes invisible expense: in the US, a 1099 visiting nurse logging 1,500 mi/month at the IRS US$ 0.67/mi rate recovers US$ 12,060/year in deductions. In Brazil, the same profile with R$ 1.00/km and 1,200 km/month recovers R$ 14,400/year. The healthcare wrinkle is that every visit carries protected health information (PHI), so the mileage log itself must be HIPAA-compliant in the US and LGPD-compliant in Brazil.
Most home-care agencies do not publish detailed policies, and the boundary between per-visit pay and separate reimbursement confuses professionals migrating from hospital to in-home work. This guide separates the three classifications (W-2 with accountable plan, 1099, staffing agency contractor) and maps the tax treatment of each.
In the US, W-2 home-care professionals only receive non-taxable reimbursement when the employer runs a formal accountable plan under 26 CFR 1.62-2 — contemporaneous substantiation, return of excess, business connection. Without one, the reimbursement is W-2 income. 1099 professionals deduct on Schedule C line 9, choosing between the IRS standard rate (US$ 0.67/mi in 2025) or actual-expense method. Caregivers via staffing agencies can fall into a third category where the agency receives a per-visit total and passes part to the caregiver — treatment is contractual.
In Brazil, COREN-registered nurses and CREFITO-registered PTs operating as autônomos log mileage in the livro caixa. CLT (employed by a hospital with home-care wings) receive reimbursement via standardized receipt, non-taxable, when documented inside the operator's policy. CRESS regulates social workers with similar treatment.
In Mexico, professionals under honorarios deduct fuel and maintenance with CFDI issued to the counterparty. Under nómina, treatment depends on the employer (hospital or agency); RESICO simplifies for revenue up to MXN 3.5M.
Two structures dominate: per-visit compensation (the per-visit payment includes transport, with no separate allocation — the professional deducts on Schedule C or livro caixa) and additional per-km rate on top of the per-visit (non-taxable when documented). The first is more common in low-margin agencies; the second in integrated health systems with rigorous governance. In both cases, documentation via standardized receipt is what separates an audit-ready log from a vulnerable tax estimate.
Common mistakes in healthcare:
Home-care professionals who document every visit recover up to 18% of base salary annually as reimbursement or tax deduction — without changing the clinical routine.