The Oncology Institute, Inc. — Earnings Quality Grade F
TOI · Healthcare
Major red flags
Screening Summary
Management Signals
Financial Trends
Revenue & Net Income ($B)
Margins (%)
18-Point Screening
Revenue Quality
DSO 43 days, change -2 days YoY
AR growth 22.1% vs revenue growth 27.8%
Revenue grew 27.8% but CFFO only 7.4%
Expense Quality
Inventory growth 68.1% exceeds COGS 25.6%
CapEx growth -15.5% vs revenue 27.8%. Normal
SG&A/Gross Profit = 138.1%, exceeds 70%
Gross margin 15.2%, change +1.5pp. Stable
Cash Flow Quality
CFFO < Net Income for 3 consecutive years
Small-cap context: Small-cap CFFO/NI often diverges from working-capital swings, not necessarily manipulation.
FCF is negative ($-0.0B)
Accruals ratio = -21.9%. Low accruals
Cash $0.0B covers only 32% of debt $0.1B
Balance Sheet Health
Goodwill+Intangibles $0.0B = -116% of equity. Manageable
Interest coverage = -3.2x (<2x). Financial stress
Other assets 2.9% vs revenue 27.8%. Normal
No write-off data
Acquisition Risk
FCF after acquisitions negative for 3 years
Small-cap context: A single acquisition on a small balance sheet can trip serial-acquirer logic.
Goodwill+Intangibles change -17% YoY. Normal
Manipulation Score
M-Score = -3.40 (< -2.22). Unlikely manipulator
Portfolio monitoring
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Beneish M-Score
Altman Z-Score
Generated from public financial data using forensic accounting frameworks. Not investment advice. Data: Yahoo Finance · 2026-04-25