The Weekly Checkup · August 4, 2026
The Weekly Checkup: Week of July 27-31, 2026
The Pulse
I tracked 54 announced transactions this week, with platform deals jumping to 8 (roughly 15% of volume), against 3 last week and 6 the week before. The deals broke down into 28 for services, 26 for technology.
The winner for most interesting deal is definitely Advantage Behavioral Health, where a private equity firm is exiting a behavioral health platform to a nonprofit funded by $653 million of unrated municipal bonds while keeping the for-profit management company. There is no public offering statement. I found the sources and uses of funds in a New Jersey board book instead, and the figures are slightly different from what’s being reported.
Also this week: Curium is in advanced talks to buy Lantheus for about $7 billion, which is roughly what Curium itself is worth. MiMedx paid a 46% premium for Sanara MedTech four months after its own wound revenue fell 61%. Apax carved $1.71 billion of plastic packaging out of Gerresheimer. And lenders took the keys at Dental Care Alliance, one week after I wrote that private credit was wide open for dental.
Listings are in five different categories this week.
🤝 Announced Deals
Deal value: $7.0 billion | EV / Revenue: 4.5x | EV / EBITDA: 14.1x
Curium, backed by CapVest Partners, is in advanced talks to acquire Lantheus Holdings at roughly $102 per share in cash plus $12.50 per share in contingent value rights, which would take total consideration toward $8 billion. Lantheus generated FY2025 revenue of $1.54 billion and we’re calculating EBITDA of $496.7 million, a 32.2% margin. The upfront price sits below Lantheus's $108.03 close the day of the report, and the stock fell on the news.
My take: The cash number is below the market price, and about 11% of headline consideration is contingent, so technically shareholders are being asked to accept a discount to yesterday's close in exchange for a milestone. At a total EV similar to Curium’s market value, the scale is an interesting issue. CapVest recapitalized Curium in November 2025 through a continuation vehicle at roughly $7 billion, which was the largest transaction in nuclear medicine at the time. So a $7 billion company is bidding $7 billion for a competitor, so this is a merger of equals financed as an acquisition.
A finished radiopharmaceutical dose has a shelf life of a couple days and sometimes hours, so the valuable assets in this market are the production network and the distribution reach, rather than the compound. Combining two of the three largest isotope production footprints consolidates who can physically get a dose to a patient on time, so this is a candidate for antitrust review,
Purchase price: $550.9 million | Bond issue: $653.4 million | EV / Revenue: 3.24x | EV / EBITDA: 7.06x | EBITDA margin: 45.9%
Clearview Capital agreed to sell Advantage Behavioral Health, an outpatient behavioral health provider founded in 2017 with 48 New Jersey locations and leased sites in seven other states, to QCF Advantage, LLC, a Delaware entity wholly owned by QCF/I, Inc., a Georgia nonprofit organized in 1997 to own and operate hospitals and behavioral health facilities. The purchase is financed with tax-exempt and taxable revenue bonds issued through the New Jersey Economic Development Authority.
The NJEDA board book for June 10 includes the sources and uses of the bond financing:
Use | Amount | Share |
|---|---|---|
Acquisition of existing building | $550,941,476.88 | 84.3% |
Debt service reserve fund | $57,554,867.50 | 8.8% |
Capitalized interest | $23,259,655.62 | 3.6% |
Underwriter's discount | $8,368,000.00 | 1.3% |
Working capital | $7,000,000.00 | 1.1% |
Finance fees | $4,276,000.00 | 0.7% |
Other reserves | $2,000,000.00 | 0.3% |
Total | $653,400,000.00 |
According to the reporting:
“ABH, which serves privately insured patients through in-person and telehealth services, expects to treat more than 500,000 patients annually. Based on current projections, the business is expected to generate around $170 million in annual revenue and approximately $78 million of EBITDA this year. Forecasts prepared for the acquisition project EBITDA rising to about $90.8m in 2027 on revenue of approximately $192m, supported by continued expansion of the company’s Victory Bay addiction and mental health treatment centers.”
My take: 7x is low for a double digit grower of this size with margins over 40%, so there must be something else happening here. It could be the management fee accounting, since it’s unclear if the adjusted EBITDA figures presented in the press reports are before or after the management fee that will be paid to a Clearview affiliate post-close, and 45.9% margins are enormous for an after management fee figure. If that fee is incremental rather than a relabeling of salaries already in the P&L, it could change the picture quite a bit. We have 101 behavioral health transactions with derivable EBITDA multiples going back to 2010. This deal is priced well below pretty much anything of similar size, and I have to think there’s either something going on with the management fee or there are a lot of questions around the durability of the margins. Advantage doesn’t take Medicare nor Medicaid, and a 46% margin on a commercial and cash-pay book is a payer mix outcome rather than an operating achievement, and it could reset the day a large plan renegotiates.
Deal value: $350 million | EV / Revenue: 3.39x | EV / EBITDA: 20.59x
MiMedx agreed to acquire Sanara MedTech for $33.00 in cash plus 0.4735 MiMedx shares per Sanara share, $35.00 total, a 46% premium to Sanara's 30-day VWAP. Sanara generated FY2025 revenue of $103.1 million and EBITDA of $17.0 million, a 16.5% margin. MiMedx expects over $20 million of run-rate cost synergies and 2027 combined revenue above $400 million at a 20%-plus adjusted EBITDA margin, funded partly by a $300 million six-year term loan from Hayfin at SOFR plus 6.25%.
My take: MiMedx reported Q2 2026 net sales of $64.4 million, down 35% year over year, with wound revenue down 61% after Medicare reimbursement cuts to skin substitutes. So a company whose wound franchise just collapsed under a reimbursement change is paying a 46% premium, at 20.6x EBITDA, for a business that is 75% surgical, and levering up to do it. This is a mix repair deal as much as it is a synergy deal. Against our advanced materials and regenerative comp set, the price is defensible: 23 transactions back to 2010, median 3.46x revenue, and where EBITDA is derivable a 16.6x median with a range from 11.4x to 28.8x. So 3.39x revenue is right at the middle and 20.6x EBITDA is toward the top but inside the range that Osiris, Isto and Advanced BioHealing all cleared recently. The lesson for anyone valuing a wound care or regenerative asset is about which side of the reimbursement line the revenue sits on. MiMedx just demonstrated in one quarter that a wound book tied to a CMS payment policy can lose 61% of its revenue without anything happening to the product. Same company, same sales force, same technology. When you build a comp set in this category, splitting by call point matters more than splitting by product.
Deal value: €1.5 billion (about $1.71 billion) | EV / Revenue: 2.63x
Gerresheimer agreed to sell Centor US Holding and its global Primary Packaging Plastics business to Apax funds at a combined enterprise value of roughly €1.5 billion, covering 16 production sites across nine countries and about 2,400 employees generating €570 million ($649.8 million) of 2025 revenue. Centor is expected to close by the end of Gerresheimer's FY2026 and the plastics business in the first half of FY2027. Apax intends to run them as an independent healthcare packaging company.
My take: This is a distressed-seller carve-out dressed as a strategic refocus. Gerresheimer started the Centor process in February, delayed its financial reporting after an internal accounting review, got removed from the SDAX, and drew a BaFin audit. The CFO's stated use of proceeds is debt reduction and refinancing. When a seller launches a process to fix its capital structure and finishes it during a regulatory audit, it’s likely that the buyer set the price. Despite that, 2.63x revenue on a manufacturing carve-out is a reasonable outcome, and the structure is interesting: two units, two separate closings, roughly six months apart.
Dental Care Alliance completed a financial restructuring in which institutional lenders converted debt to equity and became majority owners of the DSO. This is the second dental platform I have covered this year where lenders ended up owning the business.
My take: One week after I wrote that private credit was wide open for dental at platform scale, a dental platform handed its equity to its lenders. Platforms financed in 2021 at low rates against 2021 multiples have spent three years absorbing wage inflation and higher debt service on the same EBITDA base. Lenders underwriting a new credit today are pricing current rates and current multiples against a business that has already been through it. So the same asset class can be simultaneously fundable and unfundable depending on vintage. For valuation work, the practical point is that a debt-for-equity conversion sets a valuation and almost nobody records it. When lenders take equity, they are marking the enterprise at roughly the debt they converted, which is often well below what the platform would have quoted you six months earlier.
Trivest-backed Optima Medical announced five simultaneous primary care acquisitions across Arizona and Nevada, including its first Nevada locations in Boulder City and Spring Valley.
My take: Fourth time this year I have flagged a platform batching announcements, after Bridge Dental, Southern Orthodontic and Pediatrics Plus. Five closings on one day means five sets of documents negotiated in parallel against one template, and a seller who tries to move meaningfully off that template becomes the reason the batch slips. That is meaningful negotiating leverage for the buyer and it is mostly invisible from the seller's side of the table. If you are the fifth practice in a five-practice batch, your ability to win a point on working capital or an indemnity cap is lower than it would be in a standalone deal, and your timeline is set by whichever of the other four is slowest. Ask early how many other closings are scheduled the same week. The answer changes how you negotiate.
I tracked 45 additional transactions this week. VSee Health signed a non-binding LOI for an undisclosed healthcare commerce platform at $42 million, 1.2x revenue and 6.0x EBITDA on a 20% margin, which is a nano-cap agreeing to buy something with more revenue than itself. argenx agreed to acquire Forte Biosciences for about $2.2 billion at $77.00 a share in cash for a Phase 1b anti-CD122 antibody. All Star Healthcare acquired Cross Country's locum tenens division in conjunction with the closing of Knox Lane's $437 million take-private, which I flagged when it was announced, so the carve-out and the close happened effectively together. Elsewhere: Included Health agreed to buy virtual-first plan Firefly Health, Standard BioTools sold its Mass Cytometry business as a condition of advancing its Treeline merger, Health Catalyst Capital bought a Midwest psychiatric platform serving long-term care facilities, and Kettering Health signed an LOI for 99-bed Knox Community Hospital in Ohio.
🏷️ Active Listings: Businesses You Can Actually Buy
After a couple weeks of deep dives into single segments, we’re spreading the love back out again with five deals in different niches.
Location: California | Asking Price: $44.0M | Revenue: $57.0M | Cash Flow: $3.7M | CF Margin: 6.5% | Price / Revenue: 0.77x | Price / Cash Flow: 11.9x
An independent multi-omics services provider offering sequencing, proteomics, metabolomics and epigenomics (hence “multi-omics”) to research and clinical customers across the Americas.
My take: 11.9x is the highest cash flow multiple in this week's group by a wide margin, on the thinnest margin in the group.
The case for paying it: this is a services CRO in a category growing in the mid-teens, and at $57 million of revenue it is one of the larger independent providers left. Consolidation in omics services has been steady, and a strategic with sequencing capacity or a pharma services platform can absorb this without the lab overhead. For that buyer, 0.77x revenue on $57 million of installed customer relationships is the number that matters most.
The case against: a 6.5% margin in a capital-intensive services business is thin, and instrument-heavy labs carry depreciation and service contracts that do not flex when volume drops. Two things I would want before anything else. First, the revenue split between academic and pharma customers, because academic demand moves with NIH funding cycles and pharma demand moves with R&D budgets, and they do not correlate. Second, the age and book value of the sequencers and mass specs, because a buyer inheriting a fleet due for replacement is funding a capital program on top of the purchase price. On comp: at $57 million of revenue there is a management team here and it is paid inside the number, so 6.5% is likely a true operating margin rather than an owner-comp artifact.
Location: Pittsburgh, PA | Asking Price: $27.2M | Revenue: $20.7M | Cash Flow: $5.5M | CF Margin: 26.6% | Price / Revenue: 1.32x | Price / Cash Flow: 4.95x
A senior care franchise resale doing most of its work through government contracts described as transferring with the corporation. The listing states a client base of 108 and EVV compliance of 96%, and says the business was "fully appraised (at Fair Market Value) by an accredited Wall Street level appraiser who works with over 250 US banks."
My take: I want to take the appraisal claim first, because I do this for a living and the sentence is doing more work than it should. An appraisal prepared for a bank's underwriting department answers a lender's question, which is whether the collateral supports the loan under that bank's standards. It is not a market clearing price and it is not a fairness opinion, and the appraiser was engaged by one side. "We did not come at this price willy-nilly" is in the listing copy. Fine, but an appraisal is an opinion with a stated purpose, and the purpose here was financing, not sale. Ask for the report, check the intended use and intended user on the cover page, and read the assumptions.
Then the arithmetic, which does not work. $20.7 million of revenue across 108 clients is $191,600 per client per year. Pennsylvania personal care reimbursement through Community HealthChoices runs in the low twenties per hour, so $191,600 implies somewhere around 9,000 billed hours per client per year. A year has 8,760 hours. Either the client count means something other than clients, or the revenue is aggregated across entities that are not all in the sale, or someone transposed a number. That is the first question, before price.
Third, the margin. Personal care is a direct labor business where caregiver wages and taxes consume 70% to 75% of revenue, and agency EBITDA lands in the 8% to 15% range. 26.6% is roughly double the top of that band. Franchise royalties alone, typically 5% of gross, are about $1.03 million a year here.
Two structural items. "Transfers with the corporation" signals a stock sale, which means inherited liabilities including any Medicaid overpayment exposure, and it makes the survey and billing history the most important diligence you do. And 96% EVV compliance sounds strong until you price the other 4%, since visits without compliant electronic verification are the ones that get denied or recouped on audit. On $20.7 million, 4% is $828,000 of revenue with a question mark on it.
Location: Chicago, IL | Asking Price: $22.3M | Revenue: $13.2M | Cash Flow: $3.13M | CF Margin: 23.7% | Price / Revenue: 1.69x | Price / Cash Flow: 7.1x
Four leased outpatient locations totaling about 35,700 square feet, offering primary care, HIV care, behavioral health, a long-acting injectable program, GLP-1 and medical weight loss, physical therapy, neuropsychological services, TMS and ancillary diagnostics. The full listing states approximately $14.7 million of 2025 revenue.
My take: Primary care plus HIV care plus a long-acting injectable program is a drug margin business wearing a clinic's clothes. Long-acting injectable antiretrovirals are high-cost buy-and-bill products, and HIV clinics are one of the categories where 340B pricing is available. If a meaningful share of that $3.13 million of cash flow is drug spread rather than professional services, the entire valuation rests on whether the spread survives the sale, and it usually does not. 340B eligibility flows from the entity's status, most relevantly here as a Ryan White grantee, not from the site or the patients. A grant does not transfer to a for-profit acquirer, covered entities must notify HRSA immediately when eligibility changes and stop purchasing at 340B prices, and no amount of deal structuring creates eligibility that the buyer does not independently qualify for. So the first question is blunt: is this entity a 340B covered entity, and if so, on what basis? If the answer is a grantee designation, a private buyer should model the drug margin going to zero at closing. If the answer is that the margin is ordinary buy-and-bill at ASP plus 6%, that is a much thinner and more durable number, and 7.1x is closer to fair.
Everything else is secondary but not trivial. Illinois corporate practice of medicine rules are among the strictest in the country, so a non-physician buyer structures through an MSO and the management fee needs standalone fair market value support. GLP-1 weight loss revenue is cash-pay and repricing fast as supply normalizes, so the diligence list on this one is long.
Location: Florida | Asking Price: $4.9M | Revenue: $1.96M | Cash Flow: $1.37M | CF Margin: 70.0% | Price / Revenue: 2.50x | Price / Cash Flow: 3.57x
Founded 2018. Robotic hair restoration systems combining AI, augmented reality and robotics for follicle extraction, implantation and procedure planning, sold to physicians, clinics and entrepreneurs entering the hair restoration market. The broker's own headline describes it as an "FDA Class I Device" with "22+ Granted Patent Claims" and a $110,000-plus average deal size.
My take: The Class I claim is where I would start, and it is not a small thing. The established competitor in robotic hair restoration, the ARTAS system, is 510(k) cleared as a computer-assisted hair harvesting system, which is Class II. A robotic system that extracts and implants follicles performing essentially the same function as a Class II predicate, marketed as Class I, raises an obvious question: is the classification correct, or has the company self-determined its way out of a 510(k)? Class I is largely exempt from premarket notification, which is exactly why misclassification is attractive and exactly why FDA notices it. Before anything else, get the classification rationale in writing, the product code, and any correspondence with the agency. If a 510(k) turns out to be required, the enterprise value is not 3.57x cash flow, it is whatever the IP is worth in a wind-down.
Second, "22+ granted patent claims" is not 22 patents. Claims are the numbered paragraphs at the end of a patent, and a single patent routinely has twenty. Ask how many issued patents there are, in which jurisdictions, and when they expire.
Third, the margin. 70% cash flow on a hardware business is not a manufacturing margin. Physical device companies carry component and assembly COGS that put gross margin in the 40% to 60% range before any operating expense. A 70% number means either the revenue is mostly licensing or software rather than systems, or R&D and owner compensation are being added back, or both. On a business this size with a founder-inventor, assume the founder's compensation and most of the engineering effort are in that add-back, and that a buyer replacing both pays for it twice over. Normalize those and the multiple is materially higher than 3.57x. The SBA pre-qualification is somewhat surprising, but it merely tells you a lender will finance it; it does not tell you the earnings are transferable.
Location: Westchester County, NY | Asking Price: $4.2M | Revenue: $4.6M | Cash Flow: $950K | CF Margin: 20.7% | Price / Revenue: 0.91x | Price / Cash Flow: 4.42x
Fourteen years in operation, providing wheelchair, stretcher and special needs transportation across Westchester, the Bronx and New York City. Includes 32 vehicles, hospital and nursing home contracts, an experienced management team, multiple TLC licenses, and Medicaid and private-pay revenue.
My take: This listing read honestly, tbh. The copy discloses fleet size, geography, license type, contract types and payer mix without a single superlative, and a 20.7% margin on NEMT is plausible rather than aspirational. At 4.42x with an existing management team, the number is defensible on its face.
The diligence is mostly about assets and access rather than earnings quality. Thirty-two vehicles at $4.2 million means a meaningful share of the price is rolling stock, so get the fleet list with age, mileage and title status, and figure out how much of the asking price is really a used vehicle portfolio with a replacement schedule attached. Wheelchair-accessible vans run $60,000 to $80,000 new and do not last forever. Then confirm which of the 32 are financed and whether that debt travels.
On access: New York routes Medicaid transportation through a single statewide broker, Medical Answering Services, which covers Westchester, the Bronx and the city. The provider relationship is with the broker, not the state, so confirm the contract is assignable or that the buyer can be credentialed promptly, and understand where this operator sits in the broker's assignment hierarchy, because trip volume is allocated rather than won. NYC TLC licenses matter for the same reason and have their own transfer process. Two things I would price separately: the hospital and nursing home contracts, which are the durable asset here and should be reviewed for change-of-control clauses, and the Medicaid rate exposure, which is a policy variable rather than a negotiated one. On comp, at $4.6 million with a stated management team, the $950,000 is probably close to a true operating number, but ask whether the owner is dispatching, because in NEMT that role is the business.
Sign-Off
That's it for Issue #17.
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.
See you next Tuesday.
Will Hamilton, CVA Founder, Scope Research
The Weekly Checkup is published every Tuesday morning. Written for general informational purposes. Engagements through Scope Research or HealthFMV require a separate agreement.