RSM Expands Healthcare Team Amid Surge in ABA Transactions

The Firm

CHICAGO, ILLINOIS — RSM US LLP traces back to a one-office accounting practice founded by Ira B. McGladrey in Cedar Rapids, Iowa, in 1926. The firm rebranded from McGladrey LLP to RSM US in October 2015 to align with the global RSM International network. It marks its 100th year in 2026.

RSM US generated roughly $4 billion in revenue in fiscal year 2024, up about 8% from $3.7 billion the year before, according to its FY2024 impact report and trade-press coverage. It employs more than 16,000 professionals across 81 cities in the United States and Canada, with additional offices in India and El Salvador. Accounting Today ranked RSM as the fifth-largest U.S. accounting firm in its 2025 Top 100 list, the 19th consecutive year the firm has held that position.

In October 2025, RSM US, RSM UK, RSM Canada, and RSM Ireland approved a transatlantic partnership effective January 1, 2026. The structure stops short of the full financial merger initially proposed in October 2024, leaving each member firm a separate legal entity. What it adds is a centralized governance vehicle, a common approach to partner compensation, and shared investment in growth and technology. Combined, the partnership encompasses about 23,000 professionals and roughly $5 billion in aggregate annual revenue. Brian Becker, who became RSM US managing partner and CEO in 2022, leads the new transatlantic structure.

RSM stayed partner-owned in the process. In a January 2024 Financial Times interview, Becker said the firm had no need to bring in private capital to fund expansion or to allow partners to cash out early, citing the firm’s history under H&R Block ownership from 1999 to 2011 as a cautionary precedent. That decision now sets RSM apart from a growing share of the U.S. middle-market accounting industry, where private equity has bought into firms including EisnerAmper, Citrin Cooperman, Grant Thornton, and Baker Tilly.

Transaction Advisory Practice

RSM’s Transaction Advisory Services group provides buy-side and sell-side financial due diligence, due diligence for lenders, tax due diligence, HR due diligence, and post-close accounting support. Quality of earnings (QofE) reports are the practice’s core deliverable. The team also handles working capital calculations, purchase price mechanics, and earnout measurement.

Buy-side engagements run for both corporate acquirers and PE sponsors. The team evaluates quality of earnings, working capital needs, cash flow dynamics, and the underlying trends that drive value, with output framed around what RSM calls sustainable performance and upside opportunity. Sell-side engagements help practice owners and PE portfolio companies prepare for exit by surfacing diligence issues before a buyer’s advisor surfaces them.

A separate due-diligence-for-lenders track produces QofE reports for the banks and credit funds providing acquisition financing. In leveraged middle-market transactions, accepted reports from a recognized provider can shorten the financing path. RSM has long-standing relationships with healthcare-focused lenders that finance PE-backed provider platform deals.

In ABA M&A, the diligence question is rarely the headline EBITDA number. It is whether reported earnings reflect authorized hours, paid claims, and a defensible authorization renewal pipeline.

The Healthcare Hiring Build-Out

RSM has been hiring healthcare-specific TAS professionals across multiple levels and offices through 2025 and into 2026. Postings reviewed in April 2026 included senior associate, supervisor, manager, and director openings in financial due diligence with a healthcare focus, in cities including New York, San Francisco, Nashville, Philadelphia, Fort Lauderdale, Houston, Baltimore, and Columbus. Compensation ranges run from roughly $101,000 for managers to $304,000 at the director level, before bonuses.

The healthcare TAS team works across physician practices, ambulatory services, home health, behavioral health, and post-acute care. For ABA targets, the work concentrates on revenue sustainability across payer types, including Medicaid fee-for-service, Medicaid managed care, commercial insurance, and out-of-pocket. State-by-state reimbursement variance feeds directly into the model.

Hiring this kind of specialist talent is not speculative. Firms staff up against expected deal flow, and the open roles imply RSM expects continued ABA-adjacent work into 2026 and 2027. That is a useful read-through for sponsors and operators trying to gauge sector pacing.

Where RSM Fits in the ABA Math

Most ABA transactions land in the middle market. PE sponsors in the lower middle market or growth equity segment acquire platforms with EBITDA between roughly $5 million and $50 million. Established platforms then execute add-on deals on smaller practices with EBITDA under $10 million. Enterprise values on platform deals span a wide band, typically $50 million to $500 million depending on multiple, with add-ons usually below $50 million. RSM’s fee structure, partner-to-staff ratios, and bench availability are calibrated for this range.

ABA-specific diligence questions push the work past a generic healthcare QofE template. Authorization-based service delivery means revenue capacity is capped by approved therapy hours, while realized revenue depends on hours actually delivered and documented. The gap between authorized and delivered hours, the authorization renewal rate, the claims submission-to-payment timeline, and the denial and recoupment patterns each affect whether a target’s reported EBITDA is sustainable. RSM’s materials describe these as the inputs its healthcare TAS work pressure-tests on ABA engagements.

Tax structure is a parallel concern. Many roll-up platforms operate dozens of subsidiary entities across states with different treatment of pass-through income, sales tax applicability to healthcare services, and state employer tax obligations. RSM’s tax practice runs alongside the financial diligence work, identifying restructuring opportunities and assessing state and local tax exposure across the target’s footprint. HR due diligence fills in BCBA supervision ratios, RBT (registered behavior technician) retention, and clinical leadership continuity, all of which affect realizable platform value.

Competitive Set

RSM competes with BDO USA, Grant Thornton, Baker Tilly, and CohnReznick for healthcare middle-market diligence mandates. Each is moving in a different direction. BDO USA, with roughly 10,000 to 11,000 U.S. professionals, converted to an employee stock ownership plan in 2023 and ranked eighth-largest in the United States as of 2025. Grant Thornton US took private equity investment from New Mountain Capital in 2024. Baker Tilly closed its merger with Moss Adams in June 2025 to become the sixth-largest U.S. CPA firm at roughly 11,500 people and over $3 billion in revenue, with majority backing from Hellman & Friedman and Valeas Capital Partners. CohnReznick took on Apax Partners as a majority owner in early 2025.

RSM is now the largest U.S. middle-market accounting firm without private equity ownership. That stance is a positioning argument with PE clients who care about advisor independence on portfolio engagements, and a recruiting argument with partners who would rather not work for a sponsor. It is also an argument that has to be remade every year as competitors reach new scale through PE-funded combinations.

Relative to the Big Four, RSM offers a cost-effective alternative for transactions that need institutional-quality diligence but do not justify Big Four pricing. The analytical methodology and reporting standards run close to Big Four norms, while the fee structure aligns with middle-market deal economics. For ABA sponsors, where deal sizes sit well below hospital and health-system M&A, that pricing differential often decides advisor selection.

What RSM Does Not Position Itself As

RSM does not market itself as a clinical advisor on ABA, a healthcare strategy consultancy, or a regulatory specialist on Medicaid program integrity. The firm’s ABA touchpoints sit on the financial, tax, and operational diligence side of a transaction. The firm publishes broad insights on private equity, M&A trends, and middle-market dynamics. It does not publish proprietary research on BCBA workforce data, autism prevalence, payer rate-setting, or state Medicaid policy. Sponsors and operators looking for those inputs go elsewhere.

The firm also stops well short of the operational consulting positioning of larger advisors. Post-close performance improvement, clinical operating model design, and revenue cycle remediation in ABA are usually handled by sector specialists or by in-house teams at the sponsor. RSM’s value proposition is upstream: tell the sponsor whether the EBITDA is real and what risks ride with it.

What ABA Stakeholders Should Know

For large practice owners preparing for sale, the firm running diligence on the transaction will most often be either RSM, Baker Tilly, or one of the Big Four. Understanding the diligence methodology before going to market matters. Owners with clean working capital schedules, an authorization tracker that ties to revenue, and documented BCBA supervision ratios shorten the diligence timeline and reduce the risk of post-LOI repricing.

For PE sponsors, the bench depth and geographic reach support the relationship-based engagement model that bolt-on programs require. A consistent diligence provider across multiple add-ons compresses the integration runway and reduces fee leakage. Sponsors using leveraged structures benefit from RSM’s lender relationships, where accepted reports without additional verification requests shave days off the financing close.

For the ABA industry overall, the most useful signal is the hiring itself. RSM does not staff up healthcare-specific TAS roles speculatively. The pattern is a leading indicator of expected sector deal flow, alongside continued PE capital availability and exit pipeline activity. Whether that signal holds through the back half of 2026 is the question every middle-market ABA sponsor is now watching, with three earnout-driven exits scheduled to close before year-end and the 2026 Top 100 cycle already moving the competitive set again.

AT A GLANCE

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