The Weekly Checkup · July 28, 2026
The Weekly Checkup: Week of July 20-24, 2026
The Pulse
62 announced transactions, and the composition flipped. Services 38, Technology 24, almost the inverse of last week. Platform formation fell again to 3, the thinnest count all summer, while SPACs and reverse mergers tripled to 6: when small-cap biotech can't raise, it merges into a listing instead.
Dental was relentless: nine transactions in five days, including Dentalcorp entering the U.S. with a 21-practice Florida group and Warburg Pincus backing a surgeon-led buyback at Paradigm Oral Health, Warburg's third and fourth healthcare deal in eight days after PANTHERx and Integrace.
Surgery Partners agreed to sell its Idaho Falls hospital interests to Intermountain Health at a $1.15 billion enterprise value. Second week running that a tax-exempt system has bought out for-profit ownership in surgical facilities.
Listings are all DME and home medical equipment.
🤝 Announced Deals
Deal value: $1.15 billion (100% EV) | EV / Revenue: 1.56x | EV / EBITDA: 9.50x
Surgery Partners agreed to sell its interests in Mountain View Hospital and Idaho Falls Community Hospital to Intermountain Health, its partner since 2023. Proceeds to Surgery Partners are roughly $795 million against a combined enterprise value of about $1.15 billion. Physician ownership of Mountain View is unchanged. We’re calculating FY2025 revenue of $736.0 million and EBITDA of $121.0 million, a 16.4% margin.
My take: About 31% of the equity sits with physicians and is staying put while control transfers around it. On the multiple itself: we have 25 specialty surgical hospital transactions with derivable EBITDA multiples going back to 2012, built mostly from cost reports and audited financials. Median 8.0x, middle half between 6.8x and 9.0x. 9.5x is the fourth highest in fourteen years and about a turn and a half above the median, so this is a strong outcome, not an outlier.
What's paying for that turn and a half is size. Deals above $100 million of revenue clear at a median of 8.85x against 7.90x below it, and this facility group is roughly seven times the median transaction in the set. The two largest deals we've ever captured in the category are Surgery Partners buying National Surgical Healthcare at $536 million of revenue and 9.9x, and now this one.
One theory the data kills: there's no tax-exempt premium. Nonprofit buyers in this set pay a 7.95x median, for-profits 7.90x. Whatever Intermountain is paying for, it isn't a mission discount running in reverse. That said, the buyer being tax-exempt does change the compliance work rather than the price. The remaining sellers are physicians who refer into the facility, so purchase price and future distributions both need contemporaneous fair market value support at the unit level.
Deal value: $235 million (diabetes) | EV / Revenue: 0.4x | EV / EBITDA: 9.0x
Cardinal agreed to buy AdaptHealth's Diabetes Health segment for $235 million cash and urology-focused Strive Medical separately, roughly $360 million combined. Per AdaptHealth’s FY2025 10-K, diabetes generated $592.4 million of revenue, down 3.6%, and adjusted EBITDA of $26.1 million, down 56.9% from $60.5 million. Margin fell to 4.4%. AdaptHealth also took a $128 million goodwill impairment against the unit in Q4.
My take: Perhaps the most instructive deal of the week, even though $235 million is a rounding error for Cardinal. Revenue fell 3.6%; EBITDA fell 57%. On the Q4 call, management said CGM census was flat at about 153,000 while payer mix shifted from commercial to government, lowering reimbursement per patient. So volume held, but price collapsed. Such is life in DME, amiright?
Stick with me here... revenue fell $22.0 million, while adjusted EBITDA fell a whopping $34.5 million. The earnings decline was larger in absolute dollars than the revenue decline, which only happens when the revenue you lost was worth more per dollar than the revenue you kept, and your cost base grew at the same time. The 10-K says exactly that: lower net revenue from a payer mix shift, plus higher product and supply costs from growth in insulin pump census, plus labor inflation. Pump growth was the good news in the release and it diluted margin, because pumps carry product cost that CGM resupply doesn't.
Now the part that isn't in the earnings call: That payer mix shift was likely a policy decision. In April 2023 the DME MACs revised LCD L33822 and dropped the frequent-insulin-adjustment requirement, extending CGM coverage to any insulin-treated beneficiary plus those with documented problematic hypoglycemia. Estimates at the time put newly eligible beneficiaries between 1.5 and 2 million. Medicare Part B spending on CGMs and supplies went from $109 million in 2018 to $1.3 billion in 2023. So the commercial-to-government drift wasn't drift. CMS enlarged the government-paid population, government pays less per patient than commercial, and every DME supplier with a CGM book absorbed the mix change on the same schedule.
Then read what came next, because this is why I'd be careful calling 9.0x cheap. In November 2025 the OIG published OEI-04-23-00430, finding that Medicare paid suppliers $377 million, or 69%, above acquisition cost for CGMs and supplies over a twelve-month period, and that supply payments exceeded retail pharmacy prices by $290 million. For a beneficiary on a year of Class 3 supplies, Medicare paid roughly $1,524 more than retail. OIG recommended CMS cut the rates, either through inherent reasonableness or competitive bidding. Both recommendations are still open and unimplemented, with a CMS update due in May.
Which means a reimbursement reset is on the horizon.
So the multiple. 9.0x on trailing segment EBITDA looks ordinary until you remember the denominator halved; against 2024 EBITDA the same price is 3.9x. Cardinal is paying 0.4x revenue for 225,000 patient relationships, betting its scale plus Advanced Diabetes Supply's 500,000 fixes the unit economics before the rates reset.
BioLife: $1.5B EV | 15.59x revenue | 60.0x EBITDA Personalis: $1.5B EV | 18.99x revenue | EBITDA negative
Repligen agreed to acquire BioLife at $31.00 per share, a 24% premium to the 90-day VWAP, against FY2025 revenue of $96.2 million and adjusted EBITDA near $25 million. CryoStor supports 18 approved cell therapies and 98% of revenue is recurring consumables. Tempus agreed to acquire Personalis at $16.25 per share, $1.5 billion net of the 12% stake it already held, against 2026 guidance near $79 million of revenue and negative EBITDA of roughly $105 million. The revenue multiple is literally meaningless on that one due to the technology value and four recent Medicare coverage announcements.
My take: Same price, opposite logic, which is why they're worth reading together.
BioLife at 60x isn't an EBITDA transaction. Once CryoStor is written into an approved cell therapy process, changing it means a comparability exercise and a regulatory conversation nobody wants. That is stickier than any supply agreement. Same argument I made on StatLab last week, one step further: consumables embedded in a validated process are the most defensible revenue in life sciences, and 15.6x on a business growing 29% is a function of switching cost, not growth.
Personalis is the opposite (and the stock actually tanked on the deal, which made me quite sad personalisly, lol). Tempus was already the commercial partner and already an owner, with visibility into the technology and the projected volumes and reimbursement from several recent Medicare coverage announcements. The release says an exhaustive process was run; but the existing partner won it at a 6% premium to the last close, and the stock tanked because it’s a mostly stock deal. Such is life in high-tech life sciences, amiright?
Deal value: $1.8 billion cash, plus up to $200 million contingent | 10.29x revenue | 21.18x EBITDA
Dassault agreed to acquire ArisGlobal from Nordic Capital for $1.8 billion cash plus $200 million tied to multi-year AI revenue targets. Founded 1989, based in Waltham, its LifeSphere platform serves 200-plus customers including half of the fifty largest biopharma companies and processes over 12 million safety reports a year. Reporting puts revenue near $175 million and EBITDA around $85 million, a 49% margin.
My take: The 49% margin explains the price. Software inside a regulated workflow charges like infrastructure, because the customer's alternative is building and validating the system themselves. Pharmacovigilance case processing is mandatory, volume-driven and audited, so the spend isn't discretionary the way most healthcare software spend is.
The structure deserves a note: roughly 10% of consideration rides on a metric the buyer controls after closing. If you're negotiating an earnout on a product line the acquirer will own, price, staff and cross-sell, you need definitions, minimum investment covenants and a dispute mechanism, or the milestone is decorative. This fails more often in software and services deals than anywhere else, and it fails quietly. Worth saying for sellers of vertical healthcare software: 10x revenue is available when the margin is there and the workflow is regulated. It isn't available for horizontal tools growing just as fast.
SkyKnight agreed to acquire a stake in Apex Infusion, a Signal Hill, California omnichannel provider founded in 2006 running roughly 40 ambulatory infusion suites plus a home infusion nursing network. Management retains significant ownership and FFL Partners, which invested in December 2025 when Apex had 11 California locations, stays on as a minority investor.
My take: One of three platform deals this week, and the growth math is the story: 11 locations in December, about 40 now. That isn't organic, and a sponsor selling control seven months after investing usually means the asset outgrew what the fund could carry.
Site-of-care economics drive the category. The same infusion in a hospital outpatient department costs a payer multiples of what it costs in an ambulatory suite, and payers have spent three years steering volume there. That arbitrage is the enterprise value, and the question is how durable it is, because the spread closes the day a payer decides ambulatory rates should come down. The assets are chairs, nurses and a pharmacy license.
Two structural items: the margin split between the pharmacy and the administration site is where the value sits and buyers routinely mis-allocate it, and if referring physicians hold economic interest in a suite, or the suite pays a physician for medical direction, that needs a defensible FMV opinion and an Anti-Kickback review before anyone asks for it.
I tracked 56 additional transactions this week. Samsung Biologics agreed to acquire Swiss peptide CDMO PolyPeptide Group at about $1.81 billion, 3.37x annualized revenue and 16.3x EBITDA on a 20.7% margin, and Eurofins agreed to buy Element Materials' North American testing business, 27 labs, for roughly $400 million. At the other end, Custom Health signed an LOI for Wisconsin's Evergreen Pharmacy at $3.5 million, or 5.8x EBITDA, with at least $1 million of that in prescription inventory and $450,000 in working capital: in pharmacy the balance sheet can be most of the price. Behavioral health consolidated hard (Mindoula bought two companies in one release, Beacon Behavioral added a 17-location psychiatric platform), and UMMC took Greenwood Leflore Hospital out of bankruptcy. The complete list, with the financial detail Scope is known for, will be available to premium subscribers when that tier launches.
🏷️ Active Listings: Businesses You Can Actually Buy
Everything this week was DME, home medical equipment, or orthotics and prosthetics. Three things apply to all of them and matter more than any multiple below.
Competitive bidding restarts, and the bid window opens this fall. CMS finalized the next round in the CY2026 home health rule: seven national Remote Item Delivery categories, including Class II CGMs and insulin pumps, urological and ostomy supplies, hydrophilic catheters, and off-the-shelf back, knee and upper extremity braces. If a target draws Medicare revenue from those categories, you're underwriting a book that may not exist in eighteen months.
Accreditation is now annual, up from every three years. That's a recurring cost and a recurring risk that didn't exist when most of these businesses were last valued.
And the 36-month rule bites harder in DMEPOS than buyers expect. Under 42 CFR 424.551, if majority ownership changes by sale, including asset sales and stock transfers, within 36 months of initial enrollment or of the last majority ownership change, billing privileges do not convey. The buyer enrolls as a new supplier and obtains new accreditation through a survey, plus a $50,000 surety bond per NPI. One of the five below sits right on that line.
Reported margins across the eight listings I reviewed ran from 4.4% to 36%, inside one category. I've said where I think owner compensation is hiding in each.
Location: Pennsylvania | Asking Price: $4.0M | Revenue: $10.0M | Cash Flow: $515K | CF Margin: 5.2% | Price / Revenue: 0.40x | Price / Cash Flow: 7.8x
DME and home respiratory therapy serving institutional and home-based patients. Founded in the early 1990s.
My take: Put this next to the Cardinal deal above. Cardinal paid 0.40x revenue for a $592 million business at a 4.4% margin. This asks 0.40x on a $10 million business at 5.2%. Identical revenue multiple. The difference is that Cardinal gets patient relationships it can drop onto an existing platform, and this buyer gets a standalone cost structure that produced $515,000 on $10 million.
On comp: at this revenue, with institutional contracts and a respiratory book, there's a management team and it's paid inside the number. So 5.2% is probably a true operating margin, not SDE with a big owner add-back. That's the problem. It isn't understated, it's thin. Respiratory HME should beat 5%, which points at fleet and service costs on rentals, hospital referral concentration, or payer mix drifting the way AdaptHealth's did.
7.8x is the wrong frame; nobody buys a 5% margin business on a cash flow multiple. This is a census purchase for a strategic with billing, a warehouse and a service fleet nearby that can strip the overhead, and for that buyer $4 million for a $10 million respiratory book with thirty years of history could work. For a first-time buyer it's a business with no margin of error. Ask for the rental-versus-sale split, oxygen and PAP census with equipment age, and three years of payer mix by dollar.
Location: New Mexico and Texas | Asking Price: $2.9M | Revenue: $1.6M | Adjusted EBITDA: $580K | Margin: 36% | Price / Revenue: 1.81x | Price / EBITDA: 5.0x
Founded by its owner in 2008, custom O&P care across two states, payers spanning Medicare, Medicaid and commercial contracts. The listing reports $1.5 million of revenue in 2023 and $1.3 million in 2024, with the current year expected to close at $1.6 million and $580,000 of adjusted EBITDA. Staff stays and the founder wants to keep treating patients. The price excludes cash, receivables and working capital.
My take: The 36% margin doesn't survive scrutiny, and the proof is on the same broker's website. Their Midwest O&P listing, one ID away, runs $10 million of revenue at a 19% adjusted EBITDA margin with an in-house fabrication lab. Industry net margins for O&P run 5% to 15%. This claims roughly double the margin of a business six times its size, same specialty, same broker. That gap is owner compensation.
Revenue per licensed practitioner in O&P runs $500,000 to $750,000, so $1.6 million supports two to three. The founder is one of them and wants to keep practicing. Replacing a certified prosthetist orthotist costs $110,000 to $140,000 loaded in that market, putting normalized EBITDA at $440,000 to $470,000 and the effective multiple at 6.2x to 6.6x rather than 5.0x. If he's also handling billing oversight and referral development, it drops further.
Location: Florida (national footprint) | Asking Price: $2.5M | Revenue: $16.2M | Cash Flow: $707K | CF Margin: 4.4% | Price / Revenue: 0.15x | Price / Cash Flow: 3.5x
Established 1999. Consumable supplies to home health agencies, patients and managed care plans nationally: wound care, incontinence, urology, ostomy, PPE, diabetic testing. Drop-ship model using supplier inventory rather than carrying stock. Full management and warehouse staff. Sellers are retiring and will stay through an extended transition.
My take: 0.15x revenue looks like a typo until you understand the model, and then it's about right. Drop-ship distribution means the revenue line tells you nothing about value. Same logic I applied to specialty pharmacy last week: enormous gross revenue, thin gross margin, and the asset is the customer list and supplier terms. Value it off earnings and working capital and ignore the 0.15x.
On comp: the listing says sellers, plural, staying post-closing. Two owner-managers at market salaries of $150,000 each is $300,000 of add-back, which against $707,000 leaves roughly $400,000 of true EBITDA and moves the multiple from 3.5x to about 6.2x. That's the first question and the answer is in the W-2s. The counterpoint is that the copy claims a full management staff, so part of that may already be paid. Get the org chart and payroll register, not the summary.
The regulatory exposure is why I'd move carefully. Urology, ostomy and hydrophilic catheters are three of the seven national bid categories, about eight contracts expected in each of the first two, and diabetic testing sits adjacent to CGMs. A 32-state drop-ship supplier with Medicare volume in those lines either wins a national contract or loses that book when single payment amounts take effect. Get Medicare revenue by HCPCS category before you value anything, then decide whether you're buying a business or an option on a bid you haven't submitted. The window opens within months, and the seller is retiring rather than bidding.
Location: Massachusetts | Asking Price: $1.5M | Revenue: $3.6M | Adjusted EBITDA: $523K | Margin: 14.5% | Price / Revenue: 0.42x | Price / EBITDA: 2.9x
Breast pumps, compression garments, post-mastectomy items and mobility equipment across four New England states, sold online and through a retail store. Two NPIs (DME and O&P), BOC accredited. Payer mix 65% Medicaid, 15% Medicare, 10% commercial, 10% cash. Product mix 65% breast pumps, 25% compression and O&P. Revenue has run $3.6 to $3.8 million for five years. Ownership exits, staff stays.
My take: 2.9x is the cheapest ask in the group by a distance, and the listing tells you why in two numbers: 65% Medicaid and 65% breast pumps. Concentration on both axes at once.
On comp: this broker labels its figures adjusted EBITDA rather than cash flow and says staff stays, so management is likely paid inside the number. But at $3.6 million with a retail location, somebody runs the day to day, and if that's the exiting owner, a $100,000 to $130,000 replacement takes the margin to roughly 11% and the multiple to about 3.8x. Still cheap. Ask for the add-back schedule and who holds the operational and compliance roles.
Medicaid concentration is the valuation question. MassHealth sets the rates, so two thirds of revenue carries no pricing power and no leverage, which is worth fewer turns than a commercial or cash-pay book. The flip side: breast pumps are covered without cost sharing as a preventive benefit, demand is demographic rather than discretionary, and five years at $3.6 to $3.8 million is a stable base. Fine business at 3x, bad one at 6x.
Diligence: confirm both NPIs transfer or that the buyer can enroll without a gap, since DME and O&P are separate paths, and pull MassHealth rate history on the top ten codes. Then map the breast pump manufacturer relationships, because supplier concentration sits underneath the payer concentration.
Location: Camarillo, CA | Asking Price: $1.4M | Revenue: $1.6M | Cash Flow: $333K | CF Margin: 20.8% | Price / Revenue: 0.88x | Price / Cash Flow: 4.2x
Established 28 years, licensed and accredited, with proprietary patented products. Contracted with Medicare, Medi-Cal, Anthem, Blue Shield of California and several IPAs. Six full-time and one part-time employee, monthly payroll $26,000. Lease $10,000 a month through March 2028. The listing reports monthly gross of $135,000, monthly net of $35,000, and TTM net income of $400,000. The current owner acquired the business in 2023 and runs it absentee. Seller open to carrying up to $400,000.
My take: Before the financials, the date. The current owner acquired this in 2023. Under 42 CFR 424.551, a majority ownership change within 36 months of the last one means billing privileges don't convey: the buyer enrolls as a new supplier and re-accredits through a survey, which means months without Medicare billing on a business where Medicare and Medi-Cal are the anchor contracts. If that 2023 closing was in the second half of the year, a deal signed this fall lands inside the window. Get the exact date before you spend a dollar on diligence. It's worth more than every multiple on the page.
The listing also gives three different earnings figures: $333,000 of cash flow, $35,000 monthly net that annualizes to $420,000, and $400,000 TTM. Those can't all be right, and the spread is a quarter of the earnings. Ask which one ties to a return.
Sign-Off
That's it for Issue #16.
If you're interested in our healthcare M&A research, or are exploring a healthcare transaction, a valuation engagement, or a services arrangement FMV opinion, reply directly. Scope Research tracks healthcare M&A in a unique way. HealthFMV works with healthcare business owners, health systems, physician groups, and their attorneys on independent valuations for regulatory compliance, M&A, buy-in/buyout, tax, and disputes.
See you next Tuesday.
Will Hamilton, CVA Founder, Scope Research and HealthFMV
The Weekly Checkup is published every Tuesday morning. Written for general informational purposes. Engagements through Scope Research or HealthFMV require a separate agreement.