BACKGROUND: Private equity (PE) ownership in the healthcare sector has increased, raising concerns about its impact on care quality and patient outcomes. In the U.S., private equity-owned home health agencies (HHAs) make up a growing share of the market. This study aims to compare the performance of PE-owned HHAs with non-PE-owned agencies across several quality measures. OBJECTIVE: To assess the impact of PE ownership on care quality, patient outcomes, and operational efficiency in HHAs by comparing PE-owned and non-PE-owned agencies using data from Medicare-certified HHAs. METHODS: The study utilized data from the Centers for Medicare & Medicaid Services (CMS) Home Health Compare dataset, spanning 2017 to 2023. Fourteen quality and outcome measures were analyzed. Non-parametric tests, including the Mann-Whitney U test and Cliff's Delta, were used to identify significant differences between PE-owned and non-PE-owned HHAs. RESULTS: PE-owned HHAs generally outperformed non-PE-owned agencies in metrics such as timely care initiation and patient improvement in mobility and self-care. However, they underperformed in areas related to long-term outcomes, such as timely physician-recommended medication actions, preventable readmission rates, and discharge to the community. CONCLUSIONS: PE-owned HHAs demonstrate greater efficiency and improvement in certain areas of patient care, but underperformance in critical long-term care outcomes raises concerns about the sustainability of care quality. Policymakers must carefully monitor the influence of PE ownership to ensure that improvements do not come at the expense of patient well-being.