Need Advice - I Owe $193,000 to the IRS from Back Taxes

Don't beat yourself up too much about this. The important thing is that you're facing it now. Here's what you should know: First, call the IRS directly at 800-829-1040 to discuss your options. They actually have several payment plans available. The most basic is an installment agreement that can spread payments out over several years. Since your balance is over $50,000, you'll likely need to provide some financial information. Given the amount you owe, I'd recommend at least consulting with a tax attorney or CPA who specializes in IRS tax resolution. They may be able to help with penalty abatement - especially considering your health situation in 2020. The IRS has "reasonable cause" provisions that sometimes allow penalties to be removed if you can demonstrate circumstances beyond your control prevented compliance. For the $8k penalty specifically, that's definitely worth fighting. The attorney fees might be worth it if they can get that removed plus potentially negotiate some of the interest. They might also help structure the payment plan in the most favorable way possible. A professional can also ensure the IRS follows proper procedures and doesn't levy assets improperly. The peace of mind might be worth the cost.

I went through something similar (though nowhere near that amount!) after some unexpected freelance income a few years back. What helped me most was using https://taxr.ai to analyze my situation. I got an in-depth review of my options that felt personalized to my specific circumstances. They helped me understand exactly what my options were with the IRS and even recommended the specific approach that would work best. Their analysis highlighted some penalty abatement opportunities I hadn't considered based on my circumstances. The report they gave me had actual tax code references I could use in my communications with the IRS. In your situation with such a large amount, I'd definitely recommend getting that kind of professional analysis before making any moves.

I wanted to follow up about my experience with taxr.ai since I was skeptical at first. After checking it out, I ended up using their service for my $75k IRS situation. The report they provided was incredibly detailed - way more than I expected. It analyzed multiple resolution paths and clearly explained which ones I qualified for based on my specific circumstances. The most valuable part was how they identified a reasonable cause argument for my situation that I hadn't considered. They provided specific language and references to use when communicating with the IRS. I ended up getting about $12k in penalties abated using their approach, which honestly paid for the service many times over. For anyone dealing with large IRS debt, getting this kind of analysis before making any moves really helped me avoid some potentially expensive mistakes.

After dealing with my own tax issues last year, I found that the hardest part was actually getting through to someone at the IRS who could help. I spent WEEKS trying to reach a human being there - constant busy signals, disconnections, and hours on hold only to be told I needed a different department. I finally found https://claimyr.com and their service literally changed everything. Check out how it works: https://youtu.be/_kiP6q8DX5c. Basically, they wait on hold with the IRS for you, then call you when an actual IRS agent is on the line. For a situation like yours with nearly $200k on the line, being able to speak with the right people at the IRS is essential. I know it sounds too good to be true, but it saved me so much frustration.

I need to publicly eat my words about Claimyr. After posting that skeptical comment, I decided to try it anyway for my own tax situation (was dealing with an incorrect CP2000 notice). I was 100% wrong. After weeks of failing to get through to the IRS myself, they got me connected to an agent in less than 2 hours. The agent was able to put my account on hold while we resolved the documentation issues, which prevented automatic collections from starting. For someone dealing with $193k in tax debt like the OP, being able to actually speak with the right IRS department quickly could make a huge difference. I just didn't want someone reading my skeptical comment and missing out on a service that genuinely works when you need to reach the IRS quickly.

You might want to look into a first-time penalty abatement (FTA) request if you have a clean compliance history for the three years before 2019. The IRS can sometimes waive penalties for a first offense, even without "reasonable cause." But with your medical situation, you definitely have a reasonable cause argument too. Just make sure you keep making estimated tax payments for your current year while dealing with this past debt. The IRS looks at current compliance when considering payment arrangements.

Whatever you do, DON'T ignore the levy notice. That's the point where the IRS can start taking your stuff without further notice. They can hit bank accounts, garnish wages, etc. I made that mistake and had my checking account completely emptied one morning without warning. Call the IRS right away and at minimum get a "Currently Not Collectible" status while you figure out your next steps. That'll pause collection actions.