Carlyle merges Knack, Equalize into AI healthcare RCM platform
MUMBAI, INDIA and NEW JERSEY and TEXAS, UNITED STATES — Global investment firm Carlyle acquired majority stakes in Knack RCM and EqualizeRCM combining two United States healthcare revenue cycle management (RCM) specialists into a single AI-native, multi-specialty platform backed by its Carlyle Asia Partners VI and Carlyle Asia Partners Growth II funds.
According to a company press release, the dual acquisition creates a delivery network spanning the United States, India, and the Philippines, serving physician groups, durable medical equipment providers, rural hospitals, and specialty care segments. Financial terms were not disclosed.
Carlyle targets specialty RCM with dual acquisition
Knack RCM contributes global delivery infrastructure anchored by Workmate, a proprietary orchestration platform managing end-to-end revenue cycle workflows across DME, anesthesia, eyecare, behavioral health, and rural hospital segments.
EqualizeRCM adds a payer enrollment platform, a denial prediction tool called Bill Smart, and an AI stack built on large language models and agentic AI — capabilities that have displaced established vendor contracts at major DME manufacturers.
“The U.S. healthcare revenue cycle market is growing rapidly, driven by margin compression, workforce shortages, and the shift to value-based care,” said Kapil Modi, partner at Carlyle India Advisors.
Carlyle frames the fragmented specialty RCM landscape as a consolidation opportunity, citing prior investments in Indegene, Visionary RCM, and CorroHealth as the execution template for the combined platform’s growth.
Combined platform targets rural hospitals and specialty physicians
Knack founder Rajiv Sharma and EqualizeRCM founder Nagi Rao will remain invested in the platform through a reinvestment of a portion of their proceeds, preserving client continuity through the integration.
The combined entity targets the revenue cycle’s highest-complexity workflows — rural cost reports, DME intake, and anesthesia billing — rather than high-volume, low-complexity automation.
“Healthcare providers measure success by their ability to meet payroll, preserve services, and support their communities — not by the amount of automation deployed,” said Gautam Barai, CEO of Knack RCM.
The platform’s differentiation rests on addressing the most financially consequential claims categories, where reimbursement errors carry the steepest cost to providers.
Private equity-backed consolidation in the U.S. healthcare RCM sector has intensified sharply over the past three years. TowerBrook Capital Partners and Clayton Dubilier & Rice took R1 RCM private in 2024 in a deal valued at approximately $8.9 billion, while Waystar completed an initial public offering in 2024 after years of private equity ownership.
Carlyle’s dual-close structure — building scale through simultaneous acquisitions rather than sequential bolt-ons — fits a broader pattern of PE sponsors deploying platform-aggregation strategies in RCM, where specialty fragmentation, AI-driven efficiency gains, and persistent provider margin pressure continue to attract capital.
