This study aims to examine the effects of profitability, capital structure, firm size, and deferred tax expense on earnings management in PT Sido Muncul Tbk (SIDO), a healthcare industry company listed on the Indonesia Stock Exchange, over the 2018–2025 period. Earnings management refers to managerial intervention in financial reporting that may reduce earnings quality and mislead stakeholders. This study employs a quantitative approach using time-series regression analysis. Secondary data were obtained from the company’s audited annual financial statements. Earnings management is measured using discretionary accruals based on the Modified Jones Model, while the independent variables consist of profitability, measured by Return on Assets (ROA); capital structure, measured by Debt-to-Equity Ratio (DER); firm size (SIZE); and deferred tax expense (DTE). The results indicate that profitability, capital structure, firm size, and deferred tax expense have no significant partial or simultaneous effects on earnings management, as all hypotheses are rejected (p > 0.05). The regression model produces an R² of 80.5%, with an F-statistic of 3.09 and a significance level of 0.178. These findings suggest that SIDO’s high profitability, conservative capital structure, stable firm size, and consistent deferred tax expense are associated with relatively low earnings management practices and strong accounting conservatism.