Auna's Q2: Billing Penalties Sting as Mexico Recovery Accelerates
Peru's receivables reconciliation and temporary margin pressures mask a stronger underlying demand story across all three markets
AUNA · Earnings Call · 2026-08-19
Two stories, one quarter
Auna's second quarter 2026 is a tale of two forces running in opposite directions. Consolidated revenue rose 9% on an FX-neutral basis, driven by volume growth and a richer mix of high-complexity services across Mexico, Peru, and Colombia. Yet adjusted EBITDA fell 9% on the same basis, dragged by temporary margin pressures and — most notably — billing penalties in Peru. The penalties relate to the reconciliation of prior-year receivables, a sector-wide phenomenon as Peruvian payers tighten enforcement of billing deadlines. “This decline was attributed to temporary margin pressures in Mexico and Colombia as well as the impacts of accepted penalties related to billing matters primarily in the reconciliation of prior year's receivables in Peru.” — Jesús Zamora Leon, Chief Executive Officer · 2026-08-19
Management is adamant that this is a one-time repricing of how the sector does business, not a structural deterioration. Gisele Ferrero, CFO, explained on the call:
We are actively compressing our internal billing cycle to minimize these impacts going forward and also expect to close all open negotiations related to reconciliations of previous years during 2026.
The company expects the entire overhang to be cleared by year-end, and is deliberately excluding the impact from its adjusted EBITDA guidance. CEO Suso Zamora reinforced the point: “I think this is not going to be a situation that is going to pass 2026.” — Jesús Zamora Leon, Chief Executive Officer · 2026-08-19
Mexico: the recovery is real
While Peru's penalties grabbed the headline, Mexico showed the most encouraging operational momentum. Surgeries rose 7% sequentially, and oncology volume (chemotherapy + radiotherapy) surged 20% versus Q1 2026. The improved tier classifications with major insurers and the new ISSSTELEON contract are fueling high-complexity growth. “In Mexico, the recovery in volumes accelerated during the quarter, with surgeries increasing 7% and oncology chemotherapies and radiotherapies increasing by 20% compared to the first quarter of 2026.” — Jesús Zamora Leon, Chief Executive Officer · 2026-08-19 The company is also investing in capacity — a new Elekta EVO linear accelerator in Monterrey and a 30-bed expansion in Lima Sur — while keeping cost discipline front-of-mind. Mexico's improved tier classifications and a ramp in oncology are expected to drive margin recovery in the second half, echoing the confidence expressed in prior calls. “I see Mexico adjusted EBITDA increase 19% versus 4Q 2025.” — Jesús Zamora Leon, Chief Executive Officer · 2026-05-20
Cash, Colombia, and the path forward
Beyond the noise, cash generation remains a standout. Free cash flow increased 181% year-over-year, and cash on hand jumped 43% since year-end 2025. Net leverage fell to 3.6x from 3.8x at the end of Q1, with management targeting below 3x. The improvement is anchored not only in higher EBITDA but also in a deliberate working-capital program: cash conversion has improved via supplier financing initiatives and tighter receivables management. In Colombia, risk sharing agreements now represent 24% of revenue, up from 14% a year ago, and capacity utilization reached 79.2%, above pre-intervention levels. Adjusted EBITDA in Colombia rose 18% sequentially. Management reaffirmed the full-year revenue guidance of ~12% FX-neutral growth, while guiding adjusted EBITDA growth to the low end of the 10–14% range, excluding the Peru penalty impact. “During the second half of this year, we expect adjusted EBITDA to continue improving sequentially.” — Gisele Ferrero, Chief Financial Officer · 2026-08-19
The quarter's real message is that Auna can absorb a one-time sector shock without derailing its long-term growth story — and that Mexico, the largest source of upside, is finally turning the corner. The billing penalties will pass; the demand for high-complexity care is not.