Florida Pediatric PPEC & Therapy Operator, Two-Location Medicaid Provider

$1.5M

SDE

15.0x

Multiple

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Full Editorial Writeup

This is a Florida-based pediatric healthcare operation running two custom-built Prescribed Pediatric Extended Care (PPEC) centers that serve medically fragile infants and children. The business delivers skilled nursing, physical, occupational, speech, behavioral, and respiratory therapies, plus integrated educational programming, transportation, meals, and family care coordination. It is Medicaid-reimbursed, which means its demand is largely non-discretionary and tied to a population of children with serious ongoing medical needs that families cannot manage alone at home.

Founded in 2014, the operation has reached scale with a multidisciplinary clinical team that is reportedly willing to stay on under new ownership. The seller cites relocation as the reason for sale and is offering transitional support. The two facilities sit on major thoroughfares with strong parking, and the associated real estate is valued at roughly $13 million but is explicitly NOT included in the $22.5 million asking price.

The headline math deserves scrutiny: $1.5 million in EBITDA against a $22.5 million ask is a 15x multiple on earnings alone, which is aggressive for a two-site clinical services business. The listing leans heavily on a large and growing Florida PPEC market ($200 million-plus, 8 to 12 percent annual growth), but the value here depends entirely on reimbursement stability, census, and whether the price is really pricing the operation or quietly bundling real estate expectations that are stated as separate.

Why we like it

Earnings quality is anchored in Medicaid reimbursement for medically fragile children, which is recurring, census-driven revenue that does not evaporate in a downturn. PPEC services are prescribed by physicians and renewed as long as the child qualifies, so revenue persists by default rather than requiring each sale to be re-won. That said, $1.5 million EBITDA against a $22.5 million ask is the central tension of this deal.
The moat is regulatory and operational, not marketing-driven. PPEC licensure in Florida is specialized, facilities are purpose-built, and the clinical staffing of nurses and multidisciplinary therapists is hard to replicate quickly. An existing two-site operation with a trained team willing to stay is a genuine barrier to a would-be new entrant.
Market tailwinds are real and demographic. Advances in neonatal and pediatric critical care mean more medically complex children survive and need ongoing skilled support, and Florida's population growth amplifies demand in underserved communities. The stated 8 to 12 percent annual market growth, if accurate, supports census expansion without heroic effort.
Operator advantage is meaningful for a buyer who understands Medicaid billing and multi-site clinical management. Census utilization, therapy mix, and payer contract optimization are all levers an experienced healthcare operator can pull to grow EBITDA well beyond the current $1.5 million base.

How to improve it

Attack census utilization at both facilities in the first 90 days. PPEC economics live and die on how many prescribed slots are filled daily; map current capacity versus actual daily census and build referral pipelines with NICUs, pediatricians, and discharge planners to close the gap.
Audit and optimize the Medicaid billing and coding function. In PPEC and skilled nursing, under-coding and denied claims silently erode margin; a clean revenue-cycle review often recovers meaningful EBITDA without adding a single patient.
Formalize physician and hospital referral relationships into repeatable processes. Relationships that currently live in the departing owner's head should be documented, with named liaisons and tracked referral volume, so the pipeline survives the ownership transition.
Expand the therapy service mix within existing facilities. Adding or deepening physical, occupational, speech, and behavioral therapy hours leverages real estate and overhead you already pay for, improving contribution margin per child served.
Evaluate a de novo third location using the proven two-site playbook. With an 8 to 12 percent growth market and a working model, controlled geographic expansion is the clearest path to justifying the price over a hold period.
Lock in the clinical team with retention agreements before close. The listing's value rests on staff staying; stay bonuses and clear career paths for key nurses and therapists protect the asset you are buying.
Renegotiate the real estate structure explicitly. Since the $13 million property is excluded, model a sale-leaseback or long-term lease at market rent to understand the true operating EBITDA after real occupancy cost, which changes the effective multiple.

Diligence notes

Demand the actual revenue figure immediately. The listing discloses $1.5 million EBITDA but hides gross revenue, which makes margin, census, and reimbursement analysis impossible; a $22.5 million ask on an undisclosed top line is a hard stop until the full P&L is produced.
Scrutinize the 15x multiple and the real estate exclusion. The $13 million property is NOT in the asking price, so you are paying 15x EBITDA for operations alone plus facing a separate real estate decision; model the total capital outlay and the implied rent before taking the price seriously.
Verify Medicaid payer concentration and reimbursement risk. Revenue appears heavily Medicaid-dependent, so examine rate schedules, recent or pending rate changes, claim denial rates, and any audit or recoupment history, since a single reimbursement shift can swing EBITDA materially.
Confirm licensure, survey history, and regulatory standing for both PPEC sites. Request state inspection reports, any deficiencies or corrective action plans, and census caps per license, because regulatory problems can cap growth or threaten operations outright.
Validate staff retention claims with documentation. The thesis depends on nurses and therapists staying; review current staffing ratios, turnover, open positions, and whether retention is contractually secured or merely hoped for.
Pressure-test the relocation reason and transition commitment. Get specificity on the seller's post-close involvement, duration, and whether key referral and payer relationships transfer, since vague transitional support is thin for a clinical business of this size and price.

Source

Originally listed on BizBuySell. View original listing →