OPKO Health (OPK) 10-K 2 Mar 20 2019 FY Annual report Financial data

COVER PAGE

COVER PAGE - USD ($)	12 Months Ended
	Dec. 31, 2019	Feb. 15, 2020	Jun. 30, 2019
Cover page.
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2019
Document Transition Report	false
Entity File Number	001-33528
Entity Registrant Name	OPKO Health, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	75-2402409
Entity Address, Address Line One	4400 Biscayne Blvd.
Entity Address, City or Town	Miami,
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33137
City Area Code	(305)
Local Phone Number	575-4100
Title of 12(b) Security	Common Stock, $.01 par value per share
Trading Symbol	OPK
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 866,904,611
Entity Common Stock, Shares Outstanding		669,828,524
Entity Central Index Key	0000944809
Amendment Flag	false
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Current Fiscal Year End Date	--12-31
Documents Incorporated by Reference	Portions of the registrant’s definitive proxy statement for its 2020 Annual Meeting of Stockholders are incorporated by reference in Items 10, 11, 12, 13, and 14 of Part III of this Annual Report on Form 10-K.

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 85,452	$ 96,473
Accounts receivable, net	134,617	143,907
Inventory, net	53,434	42,299
Other current assets and prepaid expenses	50,542	35,052
Total current assets	324,045	317,731
Property, plant and equipment, net	127,111
Property, plant and equipment, net		144,674
Intangible assets, net	528,962	614,452
In-process research and development	590,200	635,572
Goodwill	671,940	700,193
Investments	20,746	31,228
Operating lease right-of-use assets	39,380
Other assets	6,888	7,222
Total assets	2,309,272	2,451,072
Current liabilities:
Accounts payable	62,537	47,395
Accrued expenses	164,925	203,513
Current maturities of operating leases	12,038
Current portion of convertible notes	0	31,562
Current portion of lines of credit and notes payable	9,619	5,851
Total current liabilities	249,119	288,321
Operating lease liabilities	27,665
Convertible notes	211,208	57,299
Deferred tax liabilities	118,717	115,193
Other long-term liabilities, principally contract liabilities, contingent consideration and lines of credit	87,804	198,968
Total long-term liabilities	445,394	371,460
Total liabilities	694,513	659,781
Equity:
Common Stock - $0.01 par value, 1,000,000,000 and 750,000,000 shares authorized at December 31, 2019 and 2018, respectively; 670,378,701 and 586,881,720 shares issued at December 31, 2019 and 2018, respectively	6,704	5,869
Treasury Stock, - 549,907 shares at December 31, 2019 and 2018, respectively	(1,791)	(1,791)
Additional paid-in capital	3,142,993	3,004,422
Accumulated other comprehensive income (loss)	(22,070)	(20,131)
Accumulated deficit	(1,511,077)	(1,197,078)
Total shareholders’ equity	1,614,759	1,791,291
Total liabilities and equity	$ 2,309,272	$ 2,451,072

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Common Stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	1,000,000,000	750,000,000
Common Stock, shares issued (in shares)	670,378,701	586,881,720
Treasury stock, shares (in shares)	549,907	549,907

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Revenues:
Total revenues	$ 901,935	$ 990,266	$ 966,006
Costs and expenses:
Selling, general and administrative	343,305	358,346	414,628
Research and development	117,870	125,586	126,435
Contingent consideration	(14,854)	(16,816)	(3,423)
Amortization of intangible assets	64,783	67,933	71,484
Asset impairment charges	92,399	21,778	13,194
Total costs and expenses	1,175,987	1,161,463	1,242,448
Operating loss	(274,052)	(171,197)	(276,442)
Other income and (expense), net:
Interest income	1,710	1,240	610
Interest expense	(21,516)	(11,890)	(6,601)
Fair value changes of derivative instruments, net	174	3,043	52
Other income (expense), net	(11,281)	1,535	10,457
Other income and (expense), net	(30,913)	(6,072)	4,518
Loss before income taxes and investment losses	(304,965)	(177,269)	(271,924)
Income tax benefit (provision)	(7,060)	38,726	(18,855)
Net loss before investment losses	(312,025)	(138,543)	(290,779)
Loss from investments in investees	(2,900)	(14,497)	(14,471)
Net loss	$ (314,925)	$ (153,040)	$ (305,250)
Loss per share basic and diluted:
Loss per share (in dollars per share)	$ (0.53)	$ (0.27)	$ (0.55)
Weighted average common shares outstanding, basic and diluted (in shares)	595,454,394	563,143,663	559,160,565
Revenue from services
Revenues:
Total revenues	$ 716,434	$ 813,248	$ 782,710
Costs and expenses:
Cost of service/product revenue	511,206	546,654	558,953
Product
Revenues:
Total revenues	112,184	107,112	107,759
Costs and expenses:
Cost of service/product revenue	61,278	57,982	61,177
Transfer of intellectual property and other
Revenues:
Total revenues	$ 73,317	$ 69,906	$ 75,537

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Statement of Comprehensive Income [Abstract]
Net loss	$ (314,925)	$ (153,040)	$ (305,250)
Other comprehensive income (loss), net of tax:
Change in foreign currency translation and other comprehensive income (loss)	(1,939)	(14,727)	22,724
Investments:
Change in unrealized gain (loss), net of tax	0	0	3,790
Reclassification adjustments due to adoption of ASU 2016-01	0	(4,876)	0
Reclassification adjustments for losses included in net loss, net of tax	0	0	(33)
Comprehensive loss	$ (316,864)	$ (172,643)	$ (278,769)

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($) $ in Thousands	Total	OPKO Health Europe	Common Stock	Treasury	TreasuryOPKO Health Europe	Additional Paid-In Capital	Additional Paid-In CapitalOPKO Health Europe	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit
Beginning balance, shares (in shares) at Dec. 31, 2016			558,576,051	(586,760)
Beginning balance at Dec. 31, 2016	$ 2,046,433		$ 5,586	$ (1,911)		$ 2,845,096		$ (27,009)	$ (775,329)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	28,307					28,307
Exercise of Common Stock options and warrants (in shares)			1,447,694
Exercise of Common Stock options and warrants	2,132		$ 14			2,118
Reclassification of embedded derivatives to equity	13,551					13,551
Issuance of Treasury Stock in connection with OPKO Health Europe's Contingent Consideration (in shares)					36,853
Issuance of Treasury Stock in connection with OPKO Health Europe's Contingent Consideration		$ 304			$ 120		$ 184
Net loss	(305,250)								(305,250)
Other comprehensive loss	26,481							26,481
Ending balance, shares (in shares) at Dec. 31, 2017			560,023,745	(549,907)
Ending balance at Dec. 31, 2017	1,843,623		$ 5,600	$ (1,791)		2,889,256		(528)	(1,048,914)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	21,761					21,761
Exercise of Common Stock options and warrants (in shares)			353,677
Exercise of Common Stock options and warrants	1,174		$ 4			1,170
Sale of common stock (in shares)			26,504,298
Sale of common stock	92,500		$ 265			92,235
Net loss	(153,040)								(153,040)
Other comprehensive loss	(14,727)							(14,727)
Ending balance, shares (in shares) at Dec. 31, 2018			586,881,720	(549,907)
Ending balance at Dec. 31, 2018	1,791,291		$ 5,869	$ (1,791)		3,004,422		(20,131)	(1,197,078)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	$ 13,421					13,421
Exercise of Common Stock options and warrants (in shares)	24,877		19,232
Exercise of Common Stock options and warrants	$ (3)					(3)
2025 convertible notes including share lending agreement (in shares)			29,250,000
2025 convertible notes including share lending agreement	50,852		$ 293			50,559
Sale of common stock (in shares)			54,227,749
Sale of common stock	76,062		$ 542			75,520
Net loss	(314,925)								(314,925)
Ending balance, shares (in shares) at Dec. 31, 2019			670,378,701	(549,907)
Ending balance at Dec. 31, 2019	$ 1,614,759		$ 6,704	$ (1,791)		$ 3,142,993		$ (22,070)	$ (1,511,077)

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net loss	$ (314,925)	$ (153,040)	$ (305,250)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Depreciation and amortization	93,807	97,344	102,093
Non-cash interest	8,731	4,903	2,575
Amortization of deferred financing costs	995	187	224
Losses from investments in investees	2,900	14,497	14,471
Equity-based compensation – employees and non-employees	13,421	21,761	28,307
Asset impairment charges	92,399	21,778	13,194
Realized loss (gain) on disposal of fixed assets and sales of equity securities and other	739	46	(8,663)
Change in fair value of equity securities and derivative instruments and other	8,748	(6,524)	(52)
Change in fair value of contingent consideration	(14,854)	(16,816)	(3,423)
Deferred income tax provision (benefit)	4,324	(35,133)	16,092
Changes in assets and liabilities, net of the effects of acquisitions:
Accounts receivable, net	7,376	20,397	58,011
Inventory, net	(12,133)	4,590	(3,539)
Other current assets and prepaid expenses	(11,486)	2,276	4,771
Other assets	409	(69)	(2,372)
Accounts payable	15,636	(26,083)	20,171
Foreign currency measurement	(71)	294	(255)
Contract liabilities	(69,302)	(61,264)	(58,876)
Accrued expenses and other liabilities	764	1,715	30,441
Net cash (used in) provided by operating activities	(172,522)	(109,141)	(92,080)
Cash flows from investing activities:
Investments in investees	(1,200)	(1,000)	(9,625)
Proceeds from sale of equity securities	0	1,516	2,211
Proceeds from the sale of property, plant and equipment	671	1,223	7,271
Capital expenditures	(12,741)	(27,858)	(46,524)
Net cash used in investing activities	(13,270)	(26,119)	(46,667)
Cash flows from financing activities:
Issuance of common stock	76,062	92,500	0
Issuance of 2023 Convertible Notes, including to related parties	200,293	55,000	0
Debt issuance costs	(7,762)	0	0
Proceeds from the exercise of Common Stock options and warrants	(3)	1,173	2,132
Borrowings on lines of credit	294,780	26,917	92,421
Repayments of lines of credit	(359,322)	(34,681)	(33,510)
Redemption of 2033 Senior Notes	(28,800)	0	0
Net cash provided by (used in) financing activities	175,248	140,909	61,043
Effect of exchange rate changes on cash and cash equivalents	(477)	(675)	470
Net increase (decrease) in cash and cash equivalents	(11,021)	4,974	(77,234)
Cash and cash equivalents at beginning of period	96,473	91,499	168,733
Cash and cash equivalents at end of period	85,452	96,473	91,499
SUPPLEMENTAL INFORMATION:
Interest paid	11,873	2,076	1,313
Income taxes paid, net of refunds	2,667	(1,410)	5,416
Operating lease right-of-use assets due to adoption of ASU No. 2016-02	39,380	0	0
Operating lease liabilities due to adoption of ASU No. 2016-02	39,703	0	0
Non-cash financing:
Shares issued upon the conversion of - Common Stock options and warrants, surrendered in net exercise	20	806	1,546
OPKO Health Europe
Issuance of capital stock to acquire or contingent consideration settlement:
Capital stock issued	$ 0	$ 0	$ 304

Consolidated Statements of Ca_2

Consolidated Statements of Cash Flows (Parenthetical)	Jan. 31, 2013
Notes | Notes Due February 1, 2033
Interest rate of notes payable	3.00%

Business and Organization

Business and Organization	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business and Organization	Business and Organization We are a diversified healthcare company that seeks to establish industry-leading positions in large and rapidly growing medical markets. Our diagnostics business includes BioReference Laboratories, Inc. (“BioReference”), one of the nation’s largest full service laboratories with a core genetic testing business and an almost 300 -person sales and marketing team focused on driving growth and leveraging new products, including the 4Kscore test. Our pharmaceutical business features Rayaldee , an FDA-approved treatment for secondary hyperparathyroidism (“SHPT”) in adults with stage 3 or 4 chronic kidney disease (“CKD”) and vitamin D insufficiency (launched in November 2016); OPK88004, a selective androgen receptor modulator which we are exploring for various potential indications; and OPK88003, a once weekly oxyntomodulin for type 2 diabetes and obesity which is a clinically advanced drug candidate among the new class of GLP-1 glucagon receptor dual agonists (phase 2b). Our pharmaceutical business also features hGH-CTP, a once-weekly human growth hormone that recently successfully completed a phase 3 trial and which is partnered with Pfizer Inc. (“Pfizer”). We are incorporated in Delaware, and our principal executive offices are located in leased offices in Miami, Florida. Through BioReference, we provide laboratory testing services, primarily to customers in the larger metropolitan areas across New York, New Jersey, Maryland, Pennsylvania, Delaware, Washington, DC, Florida, California, Texas, Illinois and Massachusetts, as well as to customers in a number of other states. We offer a comprehensive test menu of clinical diagnostics for blood, urine and tissue analysis. This includes hematology, clinical chemistry, immunoassay, infectious diseases, serology, hormones, and toxicology assays, as well as Pap smear, anatomic pathology (biopsies) and other types of tissue analysis. We market our laboratory testing services directly to physicians, geneticists, hospitals, clinics, correctional and other health facilities. We operate established pharmaceutical platforms in Ireland, Chile, Spain, and Mexico, which are generating revenue and from which we expect to generate positive cash flow and facilitate future market entry for our products currently in development. In addition, we have a development and commercial supply pharmaceutical company and a global supply chain operation and holding company in Ireland. We own a specialty active pharmaceutical ingredients (“APIs”) manufacturer in Israel, which we expect will facilitate the development of our pipeline of molecules and compounds for our proprietary molecular diagnostic and therapeutic products. Our research and development activities are primarily performed at facilities in Miramar, FL, Woburn, MA, Waterford, Ireland, Kiryat Gat, Israel, and Barcelona, Spain.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of presentation. The accompanying Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the U.S. and with the instructions to Form 10-K and of Regulation S-X. Principles of consolidation. The accompanying Consolidated Financial Statements include the accounts of OPKO Health, Inc. and of our wholly-owned subsidiaries. All intercompany accounts and transactions are eliminated in consolidation. Use of estimates. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ significantly from these estimates. Cash and cash equivalents. Cash and cash equivalents include short-term, interest-bearing instruments with original maturities of 90 days or less at the date of purchase. We also consider all highly liquid investments with original maturities at the date of purchase of 90 days or less as cash equivalents. These investments include money markets, bank deposits, certificates of deposit and U.S. treasury securities. Inventories. Inventories are valued at the lower of cost and net realizable value. Cost is determined by the first-in, first-out method. We consider such factors as the amount of inventory on hand, estimated time required to sell such inventories, remaining shelf-life, and current market conditions to determine whether inventories are stated at the lower of cost and net realizable value. Inventories at our diagnostics segment consist primarily of purchased laboratory supplies, which is used in our testing laboratories. Inventory obsolescence expense for the years ended December 31, 2019 and 2018 was $2.3 million and $1.9 million , respectively. Pre-launch inventories. We may accumulate commercial quantities of certain product candidates prior to the date we anticipate that such products will receive final U.S. FDA approval. The accumulation of such pre-launch inventories involves the risk that such products may not be approved for marketing by the FDA on a timely basis, or ever. This risk notwithstanding, we may accumulate pre-launch inventories of certain products when such action is appropriate in relation to the commercial value of the product launch opportunity. In accordance with our policy, this pre-launch inventory is expensed. Goodwill and intangible assets. Goodwill represents the difference between the purchase price and the estimated fair value of the net assets acquired accounted for by the acquisition method of accounting. Refer to Note 5. Goodwill, in-process research and development (“IPR&D”) and other intangible assets acquired in business combinations, licensing and other transactions at December 31, 2019 and 2018 , was $1.8 billion and $2.0 billion , respectively. Assets acquired and liabilities assumed in business combinations, licensing and other transactions are generally recognized at the date of acquisition at their respective fair values. Any excess of the purchase price over the estimated fair values of the net assets acquired is recognized as goodwill. At acquisition, we generally determine the fair value of intangible assets, including IPR&D, using the “income method.” Subsequent to acquisition, goodwill and indefinite lived intangible assets are tested at least annually as of October 1 for impairment, or when events or changes in circumstances indicate it is more likely than not that the carrying amount of such assets may not be recoverable. Goodwill was $671.9 million and $700.2 million , respectively, at December 31, 2019 and 2018 . Estimating the fair value of a reporting unit for goodwill impairment is highly sensitive to changes in projections and assumptions and changes in assumptions could potentially lead to impairment. We perform sensitivity analyses around our assumptions in order to assess the reasonableness of the assumptions and the results of our testing. Ultimately, potential changes in these assumptions may impact the estimated fair value of a reporting unit and result in an impairment if the fair value of such reporting unit is less than its carrying value. Net intangible assets other than goodwill were $1.1 billion and $1.3 billion , including IPR&D of $590.2 million and $635.6 million , respectively, at December 31, 2019 and 2018 . Intangible assets are highly vulnerable to impairment charges, particularly newly acquired assets for recently launched products and IPR&D. Considering the high risk nature of research and development and the industry’s success rate of bringing developmental compounds to market, IPR&D impairment charges are likely to occur in future periods. Estimating the fair value of IPR&D for potential impairment is highly sensitive to changes in projections and assumptions and changes in assumptions could potentially lead to impairment. Upon obtaining regulatory approval, IPR&D assets are then accounted for as a finite-lived intangible asset and amortized on a straight-line basis over its estimated useful life. If the project is abandoned, the IPR&D asset is charged to expense. Finite lived intangible assets are tested for impairment when events or changes in circumstances indicate it is more likely than not that the carrying amount of such assets may not be recoverable. The testing includes a comparison of the carrying amount of the asset to its estimated undiscounted future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated undiscounted future cash flows, then an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset. Impairment charges for the year ended December 31, 2019 were $92.4 million and consist of a goodwill impairment charge of $26.2 million to write the carrying amount of the OPKO Diagnostics, CURNA and Transition Therapeutics reporting units down to their estimated fair value, an impairment charge of $44.8 million to write our IPR&D assets for OPK88003 and CURNA’s platform technology for oligonucleotide therapeutics down to their estimated fair value, and an impairment charge of $20.7 million to write our intangible asset for the Claros Analyzer down to its estimated fair value as a result of our testing. These impairment charges for the year ended December 31, 2019 , resulted from liquidity constraints, longer than expected development timelines and changes in the competitive landscape, which resulted in changes to our estimates and assumptions of the expected future cash flows of the reporting units focused on the development of the Claros Analyzer, OPK88003 and CURNA’s platform technology. We believe that our estimates and assumptions are reasonable and otherwise consistent with assumptions that marketplace participants would use in their estimates of fair value. However, if future results are not consistent with our estimates and assumptions, then we may be exposed to an impairment charge, which could be material. For the year ended December 31, 2019, the results of operations of our BioReference reporting unit were below management’s long-term forecast of expected cash flows for the year ending December 31, 2019 due to a change in reimbursement coverage for our 4Kscore test and other market factors. Our 2019 impairment test of the BioReference reporting unit indicated an excess of estimated fair value over the carrying amount of approximately 11% . If we are unable to obtain appropriate reimbursement for our services and experience future declines in operating results versus forecast, then our estimates of the fair value of the BioReference reporting unit may decrease, and the resulting impairment could be significant. We recorded a goodwill impairment charge of $11.7 million in Asset impairment charges in our Consolidated Statement of Operations for the year ended December 31, 2018 to write the carrying amount of the FineTech reporting unit down to its estimated fair value. No goodwill impairment was recorded for the year ended December 31, 2017. We recorded an impairment charge of $10.1 million in Asset impairment charges in our Consolidated Statement of Operations for the year ended December 31, 2018 to write our IPR&D assets for Alpharen and OPK88004 down to their estimated fair value as a result of our testing and we recorded an impairment charge of $13.2 million for the year ended December 31, 2017 to write our intangible asset for VARUBI™ down to its estimated fair value as a result of our testing. We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives, ranging from 3 to 20 years. We use the straight-line method of amortization as there is no reliably determinable pattern in which the economic benefits of our intangible assets are consumed or otherwise used up. Amortization expense was $64.8 million , $67.9 million and $71.5 million for the years ended December 31, 2019 , 2018 and 2017 , respectively. Amortization expense from operations for our intangible assets is expected to be $56.3 million, $50.3 million, $50.0 million, $47.2 million and $44.2 million for the years ended December 31, 2020 , 2021 , 2022 , 2023 and 2024 , respectively. Fair value measurements . The carrying amounts of our cash and cash equivalents, accounts receivable, accounts payable and short-term debt approximate their fair value due to the short-term maturities of these instruments. Investments that are considered equity securities as of December 31, 2019 and 2018 are predominately carried at fair value. Our debt under the credit agreement with JPMorgan Chase Bank, N.A. approximates fair value due to the variable rate of interest. In evaluating the fair value information, considerable judgment is required to interpret the market data used to develop the estimates. The use of different market assumptions and/or different valuation techniques may have a material effect on the estimated fair value amounts. Accordingly, the estimates of fair value presented herein may not be indicative of the amounts that could be realized in a current market exchange. Refer to Note 18. Contingent consideration . Each period we revalue the contingent consideration obligations associated with certain prior acquisitions to their fair value and record increases in the fair value as contingent consideration expense and decreases in the fair value as a reduction in contingent consideration expense. Changes in contingent consideration result from changes in the assumptions regarding probabilities of successful achievement of related milestones, the estimated timing in which the milestones are achieved and the discount rate used to estimate the fair value of the liability. Contingent consideration may change significantly as our development programs progress, revenue estimates evolve and additional data is obtained, impacting our assumptions. The assumptions used in estimating fair value require significant judgment. The use of different assumptions and judgments could result in a materially different estimate of fair value which may have a material impact on our results from operations and financial position. Derivative financial instruments. We record derivative financial instruments on our Consolidated Balance Sheet at their fair value and recognize the changes in the fair value in our Consolidated Statement of Operations when they occur, the only exception being derivatives that qualify as hedges. For the derivative instrument to qualify as a hedge, we are required to meet strict hedge effectiveness and contemporaneous documentation requirements at the initiation of the hedge and assess the hedge effectiveness on an ongoing basis over the life of the hedge. At December 31, 2019 and 2018 , our foreign currency forward contracts held to economically hedge inventory purchases did not meet the documentation requirements to be designated as hedges. Accordingly, we recognize all changes in the fair values of our derivatives instruments, net, in our Consolidated Statement of Operations. Refer to Note 19. Property, plant and equipment. Property, plant and equipment are recorded at cost. Depreciation is provided using the straight-line method over the estimated useful lives of the assets and includes amortization expense for assets capitalized under finance leases. The estimated useful lives by asset class are as follows: software - 3 years , machinery, medical and other equipment - 5 - 8 years , furniture and fixtures - 5 - 12 years , leasehold improvements - the lesser of their useful life or the lease term, buildings and improvements - 10 - 40 years , and automobiles - 3 - 5 years . Expenditures for repairs and maintenance are charged to expense as incurred. Depreciation expense was $29.0 million , $29.4 million and $30.6 million for the years ended December 31, 2019 , 2018 and 2017 , respectively. Assets held under finance leases are included within Property, plant and equipment, net in our Consolidated Balance Sheets and are amortized over the shorter of their useful lives or the expected term of their related leases. Impairment of long-lived assets. Long-lived assets, such as property and equipment, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to estimated undiscounted future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future cash flows, then an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset. Income taxes. Income taxes are accounted for under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and the respective tax bases and for operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in operations in the period that includes the enactment date. We periodically evaluate the realizability of our net deferred tax assets. Our tax accruals are analyzed periodically and adjustments are made as events occur to warrant such adjustment. Valuation allowances on certain U.S. deferred tax assets and non-U.S. deferred tax assets are established, because realization of these tax benefits through future taxable income does not meet the more-likely-than-not threshold. On December 22, 2017, the Tax Act was enacted into law and the new legislation contains several key tax provisions, including a reduction of the corporate income tax rate from 35% to 21% effective January 1, 2018 and a one-time mandatory transition tax on accumulated foreign earnings, among others. We were required to recognize the effect of the tax law changes in the period of enactment, such as remeasuring our U.S. deferred tax assets and liabilities, as well as reassessing the net realizability of our deferred tax assets and liabilities. Effective January 1, 2018, the Tax Act provides for a new GILTI provision. Under the GILTI provision, certain foreign subsidiary earnings in excess of an allowable return on the foreign subsidiary’s tangible assets are included in U.S. taxable income. The Company currently estimates GILTI will be immaterial for the years ended December 31, 2019 and 2018, although interpretive guidance continues to be issued and future guidance may impact this analysis. The Company has not recorded any deferred taxes for future GILTI inclusions as any future inclusions are expected to be treated as a period expense and offset by net operating loss carryforwards in the U.S. We operate in various countries and tax jurisdictions globally. For the year ended December 31, 2019, the tax rate differed from the U.S. federal statutory rate of 21% primarily due to the valuation allowance against certain U.S. and non-U.S. deferred tax assets, the relative mix in earnings and losses in the U.S. versus foreign tax jurisdictions, and the impact of certain discrete tax events and operating results in tax jurisdictions which do not result in a tax benefit. Included in Other long-term liabilities is an accrual of $2.9 million related to uncertain tax positions involving income recognition. We recognize that local tax law is inherently complex and the local taxing authorities may not agree with certain tax positions taken. In connection with an examination of a 2014 and 2015 tax return in a foreign jurisdiction, the taxing authority has issued an initial income tax assessment of approximately $66 million (including interest). We are protesting it as we believe that the proposed adjustment is without technical merit. We expect to exhaust all administrative and judicial remedies necessary to resolve the matter, which could be a lengthy process. There can be no assurance that this matter will be resolved in our favor, and an adverse outcome, or any future tax examinations involving similar assertions, could have a material effect on our financial condition, results of operations and cash flows. Revenue recognition . We recognize revenue when a customer obtains control of promised goods or services in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers (“Topic 606”). The amount of revenue that is recorded reflects the consideration that we expect to receive in exchange for those goods or services. We apply the following five-step model in order to determine this amount: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) we satisfy a performance obligation. We apply the five-step model to contracts when it is probable that we will collect the consideration we are entitled to in exchange for the goods or services we transfer to the customer. At contract inception, once the contract is determined to be within the scope of Topic 606, we review the contract to determine which performance obligations we must deliver and which of these performance obligations are distinct. We recognize as revenue the amount of the transaction price that is allocated to the respective performance obligation when the performance obligation is satisfied or as it is satisfied. For a complete discussion of accounting for Revenues from services, Revenues from products and Revenue from transfer of intellectual property and other, refer to Note 14. Concentration of credit risk and allowance for doubtful accounts . Financial instruments that potentially subject us to concentrations of credit risk consist primarily of accounts receivable. Substantially all of our accounts receivable are with either companies in the health care industry or patients. However, credit risk is limited due to the number of our clients as well as their dispersion across many different geographic regions. While we have receivables due from federal and state governmental agencies, we do not believe that such receivables represent a credit risk since the related healthcare programs are funded by federal and state governments, and payment is primarily dependent upon submitting appropriate documentation. At December 31, 2019 and 2018 , receivable balances (net of contractual adjustments) from Medicare and Medicaid were 6% and 7% , respectively, of our consolidated Accounts receivable, net. The portion of our accounts receivable due from individual patients comprises the largest portion of credit risk. At December 31, 2019 and 2018 , receivables due from patients represent approximately 2.5% and 2.9% , respectively, of our consolidated Accounts receivable, net. We assess the collectability of accounts receivable balances by considering factors such as historical collection experience, customer credit worthiness, the age of accounts receivable balances, regulatory changes and current economic conditions and trends that may affect a customer’s ability to pay. Actual results could differ from those estimates. The allowance for doubtful accounts was $1.9 million and $1.8 million at December 31, 2019 and 2018 , respectively. The provision for bad debts for the years ended December 31, 2019 and 2018 was $0.5 million and $0.7 million , respectively. Equity-based compensation. We measure the cost of services received in exchange for an award of equity instruments based on the grant-date fair value of the award. That cost is recognized in the Consolidated Statement of Operations over the period during which an employee is required to provide service in exchange for the award. We record excess tax benefits realized from the exercise of stock options as cash flows from operations. During the years ended December 31, 2019 , 2018 and 2017 , we recorded $13.4 million , $21.8 million and $28.3 million , respectively, of equity-based compensation expense. Research and development expenses. Research and development expenses include external and internal expenses. External expenses include clinical and non-clinical activities performed by contract research organizations, lab services, purchases of drug and diagnostic product materials and manufacturing development costs. Research and development employee-related expenses include salaries, benefits and equity-based compensation expense. Other internal research and development expenses are incurred to support overall research and development activities and include expenses related to general overhead and facilities. We expense these costs in the period in which they are incurred. We estimate our liabilities for research and development expenses in order to match the recognition of expenses to the period in which the actual services are received. As such, accrued liabilities related to third party research and development activities are recognized based upon our estimate of services received and degree of completion of the services in accordance with the specific third party contract. Research and development expense includes costs for in-process research and development projects acquired in asset acquisitions which have not reached technological feasibility and which have no alternative future use. For in-process research and development projects acquired in business combinations, the in-process research and development project is capitalized and evaluated for impairment until the development process has been completed. Once the development process has been completed the asset will be amortized over its remaining useful life. Segment reporting. Our chief operating decision-maker (“CODM”) is Phillip Frost, M.D., our Chairman and Chief Executive Officer. Our CODM reviews our operating results and operating plans and makes resource allocation decisions on a Company-wide or aggregate basis. We manage our operations in two reportable segments, pharmaceutical and diagnostics. The pharmaceutical segment consists of our pharmaceutical operations in Chile, Mexico, Ireland, Israel and Spain, Rayaldee product sales and our pharmaceutical research and development. The diagnostics segment primarily consists of clinical laboratory operations through BioReference and point-of-care operations. There are no significant inter-segment sales. We evaluate the performance of each segment based on operating profit or loss. There is no inter-segment allocation of interest expense or income taxes. Refer to Note 17. Shipping and handling costs. We do not charge customers for shipping and handling costs. Shipping and handling costs are classified as Cost of revenues in the Consolidated Statement of Operations. Foreign currency translation . The financial statements of certain of our foreign operations are measured using the local currency as the functional currency. The local currency assets and liabilities are generally translated at the rate of exchange to the U.S. dollar on the balance sheet date and the local currency revenues and expenses are translated at average rates of exchange to the U.S. dollar during the reporting periods. Foreign currency transaction gains (losses) have been reflected as a component of Other income (expense), net within the Consolidated Statement of Operations and foreign currency translation gains (losses) have been included as a component of the Consolidated Statement of Comprehensive Loss. During the years ended December 31, 2019 , 2018 and 2017, we recorded $0.4 million , $1.9 million and $1.4 million , respectively of transaction gains (losses). Variable interest entities. The consolidation of a variable interest entity (“VIE”) is required when an enterprise has a controlling financial interest. A controlling financial interest in a VIE will have both of the following characteristics: (a) the power to direct the activities of a VIE that most significantly impact the VIE’s economic performance and (b) the obligation to absorb losses of the VIE that could potentially be significant to the VIE. Refer to Note 4. Investments. We have made strategic investments in development stage and emerging companies. We record these investments as equity method investments or as equity securities based on our percentage of ownership and whether we have significant influence over the operations of the investees. For investments classified under the equity method of accounting, we record our proportionate share of their losses in Losses from investments in investees in our Consolidated Statement of Operations. Refer to Note 4. For investments classified as equity securities, we record changes in their fair value as Other income (expense) in our Consolidated Statement of Operations based on their closing price per share at the end of each reporting period, unless the equity security does not have a readily determinable fair value. Refer to Note 4. Recently adopted accounting pronouncements . In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, “Leases (Topic 842),” which requires organizations that lease assets with lease terms of more than 12 months to recognize assets and liabilities for the rights and obligations created by those leases on their balance sheets. ASU 2016-02, as amended and codified under Topic 842, requires new qualitative and quantitative disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. As required, we adopted Topic 842 on January 1, 2019 and used the modified retrospective approach for all lease arrangements at the beginning or the period of adoption. Results for reporting periods beginning January 1, 2019 are presented under Topic 842, while prior period amounts were not adjusted and continue to be reported in accordance our historic accounting under ASC 840. For leases that commenced before the effective date of Topic 842, we elected the use of permitted practical expedients and did not reassess the following: (i) whether any expired or existing contracts contain leases; (ii) the lease classification for any expired or existing leases; and (iii) initial direct costs for any existing leases. We also elected the policy of not recording leases on our Consolidated Balance Sheet when the leases have terms of 12 months or less, and we elected not to separate nonlease components from lease components and instead account for each separate lease component and the nonlease components associated with that lease component as a single lease component. The adoption of Topic 842 resulted in the recognition of operating lease liabilities of approximately $33.7 million and operating lease right-to-use assets of approximately $33.3 million as of March 31, 2019, primarily related to operating leases for our diagnostic facilities, based on the present value of lease payments over the lease term. There was no cumulative-effect adjustment to beginning Accumulated deficit on the Consolidated Balance Sheet. The accounting for our finance leases remains substantially unchanged, as finance lease liabilities and their corresponding right-to-use assets were already recorded on the Consolidated Balance Sheet under the previous guidance. The adoption of Topic 842 did not have a significant effect on our results of operations or cash flows. Refer to Note 16 for additional disclosures required by Topic 842. In February 2018, the FASB issued ASU No. 2018-02, "Income Statement-Reporting Comprehensive Income (Topic 220)." This standard provides an option to reclassify stranded tax effects within accumulated other comprehensive loss to retained earnings due to the U.S. federal corporate income tax rate change in the Tax Cuts and Jobs Act of 2017. This standard is effective for interim and annual reporting periods beginning after December 15, 2018. We adopted this standard effective January 1, 2019 with the election not to reclassify immaterial amounts of stranded tax effects from accumulated other comprehensive loss to retained earnings. In June 2018, the FASB issued ASU No. 2018-07, “Compensation - Stock Compensation (Topic 718),” which expands the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from non-employees. The adoption of ASU 2018-07 on January 1, 2019, did not have a significant impact on our Consolidated Financial Statements. Pending accounting pronouncements . In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments,” which amends the impairment model by requiring entities to use a forward-looking approach based on expected losses rather than incurred losses to estimate credit losses on certain types of financial instruments, including trade receivables. This may result in the earlier recognition of allowances for losses. The ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. We are currently evaluating the impact of this new guidance on our Consolidated Financial Statements.

Loss Per Share

Loss Per Share	12 Months Ended
	Dec. 31, 2019
Earnings Per Share [Abstract]
Loss Per Share	Loss Per Share Basic loss per share is computed by dividing our net loss by the weighted average number of shares of our common stock par value $0.01 per share (“Common Stock”) outstanding during the period. Shares of Common Stock outstanding under the share lending arrangement entered into in conjunction with the 2025 Notes (as defined in Note 6) are excluded from the calculation of basic and diluted earnings per share because the borrower of the shares is required under the share lending arrangement to refund any dividends paid on the shares lent. Refer to Note 6. For diluted earnings per share, the dilutive impact of stock options and warrants is determined by applying the “treasury stock” method. The dilutive impact of the 2033 Senior Notes, the 2023 Convertible Notes and the 2025 Notes (each, as defined herein and as discussed in Note 6) has been considered using the “if converted” method. For periods in which their effect would be antidilutive, no effect is given to outstanding options, warrants or the potentially dilutive shares issuable pursuant to the 2033 Senior Notes, the 2023 Convertible Notes and the 2025 Notes in the dilutive computation. A total of 67,765,380 , 16,568,520 and 6,255,624 potential shares of Common Stock have been excluded from the calculation of diluted net loss per share for the years ended December 31, 2019 , 2018 and 2017, respectively, because their inclusion would be antidilutive. A full presentation of diluted earnings per share has not been provided because the required adjustments to the numerator and denominator resulted in diluted earnings per share equivalent to basic earnings per share. During the year ended December 31, 2019 , an aggregate of 24,877 options and warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 19,232 shares of Common Stock. Of the 24,877 Common Stock options and Common Stock warrants exercised, 5,645 shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the applicable option and warrant agreements. During the year ended December 31, 2018 , an aggregate of 540,000 options and warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 353,677 shares of Common Stock. Of the 540,000 Common Stock options and Common Stock warrants exercised, 186,323 shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the applicable option and warrant agreements. During the year ended December 31, 2017, an aggregate of 1,720,649 options and warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 1,447,792 shares of Common Stock. Of the 1,720,649 Common Stock options and Common Stock warrants exercised, 272,857

Investments

Investments	12 Months Ended
	Dec. 31, 2019
Business Combinations [Abstract]
Investments	Investments Investments The following table reflects the accounting method, carrying value and underlying equity in net assets of our unconsolidated investments as of December 31, 2019 : (in thousands) Investment type Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ 826 $ 9,931 Variable interest entity, equity method 894 — Equity securities 18,870 Equity securities with no readily determinable fair value 36 Warrants and options 120 Total carrying value of investments $ 20,746 Equity method investments Our equity method investments consist of investments in Pharmsynthez (ownership 9% ), Cocrystal Pharma, Inc. (“COCP”) ( 7% ), Non-Invasive Monitoring Systems, Inc. (“NIMS”) ( 1% ), Neovasc Inc. (“Neovasc”)( 4% ), InCellDx, Inc. (“InCellDx”) ( 29% ), BioCardia, Inc. (“BioCardia”) ( 3% ), and Xenetic Biosciences, Inc. (“Xenetic”) ( 3% ). The total assets, liabilities, and net losses of our equity method investees as of and for the year ended December 31, 2019 were $191.5 million , $58.4 million , and $62.9 million , respectively. We have determined that we or our related parties can significantly influence the operations of our equity method investees through our board representation and/or voting power. Accordingly, we account for our investment in these entities under the equity method and record our proportionate share of their respective losses in Loss from investments in investees in our Consolidated Statement of Operations. Included in Loss from investments in investees for the year ended December 31, 2018 is a charge of $2.9 million to write our investment in InCellDx, Inc. down to its fair value as of December 31, 2018. The aggregate value of our equity method investments based on the quoted market price of their respective shares of common stock and the number of shares held by us as of December 31, 2019 was $6.0 million . Equity securities Our equity securities consist of investments in Phio Pharmaceuticals (“Phio”) (ownership 0.1% ), VBI Vaccines Inc. (“VBI”) ( 4% ), ChromaDex Corporation ( 0.1% ), MabVax Therapeutics Holdings, Inc. (“MabVax”) ( 1% ), and Eloxx Pharmaceuticals, Inc. (“Eloxx”)( 3% ). We have determined that our ownership, along with that of our related parties, does not provide us with significant influence over the operations of these investments. Accordingly, we account for our investment in these entities as equity securities, and we record changes in the fair value of these investments in Other income (expense) each reporting period when they have readily determinable fair value. Equity securities without a readily determinable fair value are adjusted to fair value when an observable price change can be identified. Net gains and losses on our equity securities for the year ended December 31, 2019 are as follows: (in thousands) Equity Securities For the year ended December 31, 2019 Net gains and losses recognized during the period on equity securities $ (7,443 ) Less: Net gains and losses realized during the period on equity securities — Unrealized net gains recognized during the period on equity securities still held at the reporting date $ (7,443 ) Sales of investments Gains (losses) included in earnings from sales of our investments are recorded in Other income (expense), net in our Consolidated Statement of Operations. We did not have significant sales activity during the years ended December 31, 2019 and 2018 . Gains (losses) from sale of our investments for the year ended December 31, 2017 was $1.5 million . The cost of securities sold is based on the specific identification method. Warrants and options In addition to our equity method investments and equity securities, we hold options to purchase 47 thousand additional shares of BioCardia, 31 thousand of which were vested as of December 31, 2019 , and 33 thousand , 0.7 million , 40 thousand and 22 thousand of warrants to purchase additional shares of COCP, InCellDx, Inc., Xenetic and Phio, respectively. We recorded the changes in the fair value of the options and warrants in Fair value changes of derivative instruments, net in our Consolidated Statement of Operations. We also recorded the fair value of the options and warrants in Investments, net in our Consolidated Balance Sheet. See further discussion of the Company’s options and warrants in Note 18 and Note 19. Investments in variable interest entities We have determined that we hold variable interests in Zebra Biologics, Inc. (“Zebra”). We made this determination as a result of our assessment that Zebra does not have sufficient resources to carry out its principal activities without additional financial support. We own 1,260,000 shares of Zebra Series A-2 Preferred Stock and 900,000 shares of Zebra restricted common stock (ownership 29% at December 31, 2019 ). Zebra is a privately held biotechnology company focused on the discovery and development of biosuperior antibody therapeutics and complex drugs. Dr. Richard Lerner, M.D., a member of our Board of Directors, is a founder of Zebra and, along with Dr. Frost, serves as a member of Zebra’s Board of Directors. In order to determine the primary beneficiary of Zebra, we evaluated our investment and our related parties’ investment, as well as our investment combined with the related parties’ investment to identify if we had the power to direct the activities that most significantly impact the economic performance of Zebra. Based on the capital structure, governing documents and overall business operations of Zebra, we determined that, while a VIE, we do not have the power to direct the activities that most significantly impact Zebra’s economic performance and have no obligation to fund expected losses. We did determine, however, that we can significantly influence the success of Zebra through our board representation and voting power. Therefore, we have the ability to exercise significant influence over Zebra’s operations and account for our investment in Zebra under the equity method. Other We recorded $8.8 million of expense in Selling, general and administrative expenses in our Consolidated Statement of Operations for the year ended December 31, 2017 to write certain Other current assets from our investees down to their estimated fair value.

Composition of Certain Financia

Composition of Certain Financial Statement Captions	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Composition of Certain Financial Statement Captions	Composition of Certain Financial Statement Captions For the years ended December 31, (In thousands) 2019 2018 Accounts receivable, net Accounts receivable $ 136,551 $ 145,665 Less: allowance for doubtful accounts (1,934 ) (1,758 ) $ 134,617 $ 143,907 Inventories, net Consumable supplies $ 23,005 $ 23,264 Finished products 25,142 15,259 Work in-process 3,238 2,473 Raw materials 4,586 4,259 Less: inventory reserve (2,537 ) (2,956 ) $ 53,434 $ 42,299 Other current assets and prepaid expenses Taxes recoverable $ 19,808 $ 15,708 Other receivables $ 3,262 $ 2,368 Prepaid supplies 8,147 9,693 Prepaid insurance 3,486 3,436 Other 15,839 3,847 $ 50,542 $ 35,052 Property, plant and equipment, net: Machinery, medical and other equipment $ 165,501 $ 147,757 Leasehold improvements 33,606 34,607 Furniture and fixtures 12,631 12,737 Automobiles and aircraft 10,029 10,133 Software 13,861 13,425 Building 18,462 18,554 Land 2,422 2,453 Construction in process 7,044 16,670 Less: accumulated depreciation (136,445 ) (111,662 ) $ 127,111 $ 144,674 Intangible assets, net: Customer relationships $ 445,408 $ 446,296 Technologies 296,246 340,729 Trade names 49,786 50,404 Covenants not to compete 16,318 16,322 Licenses 5,766 5,766 Product registrations 7,578 7,861 Other 6,094 5,613 Less: accumulated amortization (298,234 ) (258,539 ) $ 528,962 $ 614,452 For the years ended December 31, (In thousands) 2019 2018 Accrued expenses: Contract liabilities $ 19,196 $ 63,503 Employee benefits 33,671 45,621 Commitments and Contingencies 38,635 15,327 Clinical trials 8,122 10,401 Professional fees 1,333 2,952 Finance leases short-term 2,743 3,280 Milestone payment — 4,871 Contingent consideration 2,375 2,375 Other 58,850 55,183 $ 164,925 $ 203,513 Other long-term liabilities: Line of credit $ 44,749 $ 105,198 Contract liabilities 2,571 27,566 Contingent consideration 7,308 22,162 Finance leases long-term 4,046 5,620 Mortgages and other debts payable 3,906 4,654 Other 25,224 33,768 $ 87,804 $ 198,968 Our intangible assets and goodwill relate principally to our completed acquisitions of OPKO Renal, OPKO Biologics, EirGen and BioReference. We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives. The estimated useful lives by asset class are as follows: technologies - 7 - 17 years , customer relationships - 7 - 20 years , product registrations - 7 - 10 years , covenants not to compete - 5 years , trade names - 5 - 10 years , other 9 - 13 years . We do not anticipate capitalizing the cost of product registration renewals, rather we expect to expense these costs, as incurred. Our goodwill is not tax deductible for income tax purposes in any jurisdiction in which we operate. The changes in value of the intangible assets and goodwill during the year ended December 31, 2019 are primarily due to an impairment charge of $44.8 million to write our IPR&D assets for OPK88003 and CURNA’s platform technology for oligonucleotide therapeutics down to their estimated fair value, a goodwill impairment charge of $26.2 million to write the carrying amount of the OPKO Diagnostics, CURNA and Transition Therapeutics reporting units down to their estimated fair value, and an impairment charge of $20.7 million to write our intangible asset for the Claros Analyzer down to its estimated fair value. The changes in value of the intangible assets during the year ended December 31, 2018 are primarily due to an impairment charge of $10.1 million to write our IPR&D assets for Alpharen and OPK88004 down to their estimated fair value. The value of our intangible assets and goodwill for the years ended December 31, 2019 and 2018 were also affected by foreign currency fluctuations between the Chilean Peso, the Euro and the Shekel against the U.S. dollar. The following table reflects the changes in the allowance for doubtful accounts, provision for inventory reserve and tax valuation allowance accounts: (In thousands) Beginning balance Charged to expense Written-off Ending balance 2019 Allowance for doubtful accounts $ (1,758 ) (469 ) 293 $ (1,934 ) Inventory reserve $ (2,956 ) (2,349 ) 2,768 $ (2,537 ) Tax valuation allowance $ (154,916 ) (38,340 ) — $ (193,256 ) 2018 Allowance for doubtful accounts $ (1,446 ) (665 ) 353 $ (1,758 ) Inventory reserve $ (6,565 ) (1,915 ) 5,524 $ (2,956 ) Tax valuation allowance $ (142,062 ) (12,854 ) — $ (154,916 ) The following table summarizes the changes in Goodwill by reporting unit during the years ended December 31, 2019 and 2018 . 2019 2018 (In thousands) Balance at January 1 Goodwill impairment Foreign exchange and other Balance at December 31st Balance at January 1 Goodwill impairment Foreign exchange and other Balance at December 31 Pharmaceuticals CURNA $ 4,827 $ (4,827 ) $ — $ — $ 4,827 $ — $ — $ 4,827 Rayaldee 87,314 — (1,709 ) 85,605 91,295 — (3,981 ) 87,314 FineTech — — — — 11,698 (11,698 ) — — OPKO Biologics 139,784 — 139,784 139,784 — — 139,784 OPKO Chile 4,614 (266 ) 4,348 5,203 — (589 ) 4,614 OPKO Health Europe 7,546 (152 ) 7,394 7,898 — (352 ) 7,546 Transition Therapeutics 3,322 (3,421 ) 99 — 3,608 — (286 ) 3,322 Diagnostics BioReference 434,809 — — 434,809 434,809 — — 434,809 OPKO Diagnostics 17,977 (17,977 ) — — 17,977 — — 17,977 $ 700,193 $ (26,225 ) $ (2,028 ) $ 671,940 $ 717,099 $ (11,698 ) $ (5,208 ) $ 700,193

Debt

Debt	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Debt	Debt In February 2019, we issued $200.0 million aggregate principal amount of Senior Convertible Notes due 2025 (the “2025 Notes”) in an underwritten public offering. The 2025 Notes bear interest at a rate of 4.50% per year, payable semiannually in arrears on February 15 and August 15 of each year. The 2025 Notes mature on February 15, 2025, unless earlier repurchased, redeemed or converted. Holders may convert their 2025 Notes into shares of Common Stock at their option at any time prior to the close of business on the business day immediately preceding November 15, 2024 only under the following circumstances: (1) during any calendar quarter commencing after the calendar quarter ended March 31, 2019 (and only during such calendar quarter), if the last reported sale price of our Common Stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any five consecutive trading day period (the “measurement period”) in which the trading price per $1,000 principal amount of 2025 Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of our Common Stock and the conversion rate on each such trading day; (3) if we call any or all of the 2025 Notes for redemption, at any time prior to the close of business on the scheduled trading day immediately preceding the redemption date; or (4) upon the occurrence of specified corporate events set forth in the indenture governing the 2025 Notes. On or after November 15, 2024, until the close of business on the business day immediately preceding the maturity date, holders of the 2025 Notes may convert their notes at any time, regardless of the foregoing conditions. Upon conversion, we will pay or deliver, as the case may be, cash, shares of our Common Stock, or a combination of cash and shares of our Common Stock, at our election. The initial and current conversion rate for the 2025 Notes is 236.7424 shares of Common Stock per $1,000 principal amount of 2025 Notes (equivalent to a conversion price of approximately $4.22 per share of Common Stock). The conversion rate for the 2025 Notes is subject to adjustment in certain events, but will not be adjusted for any accrued and unpaid interest. In addition, following certain corporate events that occur prior to the maturity date of the 2025 Notes or if we deliver a notice of redemption, in certain circumstances the indenture governing the 2025 Notes would require an increase in the conversion rate of the 2025 Notes for a holder who elects to convert its notes in connection with such a corporate event or notice of redemption, as the case may be. We may not redeem the 2025 Notes prior to February 15, 2022. We may redeem for cash any or all of the notes, at our option, on or after February 15, 2022, if the last reported sale price of our Common Stock has been at least 130% of the then current conversion price for the notes for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which we provide notice of redemption at a redemption price equal to 100% of the principal amount of the notes to be redeemed, plus accrued and unpaid interest to, but excluding, the redemption date. No sinking fund is provided for the 2025 Notes. If we undergo a fundamental change, as defined in the indenture governing the 2025 Notes, prior to the maturity date of the 2025 Notes, holders may require us to repurchase for cash all or any portion of their notes at a repurchase price equal to 100% of the principal amount of the notes to be repurchased, plus accrued and unpaid interest to, but excluding, the fundamental change repurchase date. The 2025 Notes are our senior unsecured obligations and rank senior in right of payment to any of our indebtedness that is expressly subordinated in right of payment to the 2025 Notes; equal in right of payment to any of our existing and future liabilities that are not so subordinated; effectively junior in right of payment to any of our secured indebtedness to the extent of the value of the assets securing such indebtedness; and structurally junior to all indebtedness and other liabilities (including trade payables) of our current or future subsidiaries. In conjunction with the issuance of the 2025 Notes, we agreed to loan up to 30,000,000 shares of our Common Stock to affiliates of the underwriter in order to assist investors in the 2025 Notes to hedge their position. As of December 31, 2019 , a total of 29,250,000 shares were issued under the share lending arrangement. We will not receive any of the proceeds from the sale of the borrowed shares, but we received a one-time nominal fee of $0.3 million for the newly issued shares. Shares of our Common Stock outstanding under the share lending arrangement are excluded from the calculation of basic and diluted earnings per share. See Note 3. As required by ASC 470-20, “Debt with Conversion and Other Options,” we calculated the equity component of the 2025 Notes, taking into account both the fair value of the conversion option and the fair value of the share lending arrangement. The equity component was valued at $52.6 million at issue date and this amount was recorded as Additional paid-in capital, which resulted in a discount on the 2025 Notes. The discount is being amortized to Interest expense over the term of the 2025 Notes, which results in an effective interest rate on the 2025 Notes of 11.2% . The following table sets forth information related to the 2025 Notes which is included in our Consolidated Balance Sheet as of December 31, 2019 : (In thousands) 2025 Senior Notes Discount Debt Issuance Cost Total Balance at December 31, 2018 $ — $ — $ — $ — Issuance of 4.50% convertible notes 200,000 (52,600 ) (5,720 ) 141,680 Amortization of debt discount and debt issuance costs — 5,826 634 6,460 Balance at December 31, 2019 $ 200,000 $ (46,774 ) $ (5,086 ) $ 148,140 On November 8, 2018, we entered into a credit agreement with an affiliate of Dr. Frost, pursuant to which the lender committed to provide us with an unsecured line of credit in the aggregate principal amount of $60 million . The credit agreement was terminated on or around February 20, 2019 and we repaid the $28.8 million outstanding thereunder from the proceeds of the 2025 Notes offering. In February 2018, we issued a series of 5% Convertible Promissory Notes (the “2023 Convertible Notes”) in the aggregate principal amount of $55.0 million . The 2023 Convertible Notes mature 5 years from the date of issuance. Each holder of a 2023 Convertible Note has the option, from time to time, to convert all or any portion of the outstanding principal balance of such 2023 Convertible Note, together with accrued and unpaid interest thereon, into shares of our Common Stock at a conversion price of $5.00 per share of Common Stock. We may redeem all or any part of the then issued and outstanding 2023 Convertible Notes, together with accrued and unpaid interest thereon, pro rata among the holders, upon no fewer than 30 days, and no more than 60 days, notice to the holders. The 2023 Convertible Notes contain customary events of default and representations and warranties of OPKO. The issuance of the 2023 Convertible Notes and the issuance of the shares of Common Stock, if any, upon conversion thereof was not, and will not be, respectively, registered under the Securities Act, pursuant to the exemption provided by Section 4(a)(2) thereof, and we have not agreed to register the of Common Stock if or when such shares are issued. Purchasers of the 2023 Convertible Notes include an affiliate of Dr. Phillip Frost, M.D., our Chairman and Chief Executive Officer, and Dr. Jane H. Hsiao, Ph.D., MBA, our Vice-Chairman and Chief Technical Officer. In January 2013, we entered into note purchase agreements with respect to the issuance and sale of our 3.0% Senior Notes due 2033 (the “2033 Senior Notes”) in a private placement exempt from registration under the Securities Act. We issued the 2033 Senior Notes on January 30, 2013 . The 2033 Senior Notes, which totaled $175.0 million in original principal amount, bear interest at the rate of 3.0% per year, payable semiannually on February 1 and August 1 of each year. The 2033 Senior Notes will mature on February 1, 2033 , unless earlier repurchased, redeemed or converted. Upon a fundamental change as defined in the indenture, governing the 2033 Senior Notes, subject to certain exceptions, the holders may require us to repurchase all or any portion of their 2033 Senior Notes for cash at a repurchase price equal to 100% of the principal amount of the 2033 Senior Notes being repurchased, plus any accrued and unpaid interest to but not including the related fundamental change repurchase date. From 2013 to 2016, holders of the 2033 Senior Notes converted $143.2 million in aggregate principal amount into an aggregate of 21,539,873 shares of Common Stock. On February 1, 2019, approximately $28.8 million aggregate principal amount of 2033 Senior Notes were tendered by holders pursuant to such holders’ option to require us to repurchase the 2033 Senior Notes as set forth in the indenture, following which repurchase only $3.0 million aggregate principal amount of the 2033 Senior Notes remained outstanding. Holders of the remaining $3.0 million principal amount of the 2033 Senior Notes may require us to repurchase such notes for 100% of their principal amount, plus accrued and unpaid interest, on February 1, 2023, on February 1, 2028, or following the occurrence of a fundamental change as defined in the indenture governing the 2033 Senior Notes. The terms of the 2033 Senior Notes, include, among others: (i) rights to convert the notes into shares of our Common Stock, including upon a fundamental change; and (ii) a coupon make-whole payment in the event of a conversion by the holders of the 2033 Senior Notes on or after February 1, 2017 but prior to February 1, 2019. We determined that these specific terms were embedded derivatives. Embedded derivatives are required to be separated from the host contract, the 2033 Senior Notes, and carried at fair value when: (a) the embedded derivative possesses economic characteristics that are not clearly and closely related to the economic characteristics of the host contract; and (b) a separate, stand-alone instrument with the same terms would qualify as a derivative instrument. We concluded that the embedded derivatives within the 2033 Senior Notes met these criteria and, as such, were valued separate and apart from the 2033 Senior Notes and recorded at fair value each reporting period. For accounting and financial reporting purposes, we combined these embedded derivatives and valued them together as one unit of accounting. In 2017, certain terms of the embedded derivatives expired pursuant to the original agreement and the embedded derivatives no longer met the criteria to be separated from the host contract and, as a result, the embedded derivatives were no longer required to be valued separate and apart from the 2033 Senior Notes and were reclassified to additional paid in capital. In November 5, 2015, BioReference and certain of its subsidiaries entered into the Credit Agreement, as amended from time to time, with CB, as lender and administrative agent. The Credit Agreement provides for a $75.0 million secured revolving credit facility and includes a $20.0 million sub-facility for swingline loans and a $20.0 million sub-facility for the issuance of letters of credit. The Credit Agreement matures on November 5, 2021 and is guaranteed by all of BioReference’s domestic subsidiaries. The Credit Agreement is also secured by substantially all assets of BioReference and its domestic subsidiaries, as well as a non-recourse pledge by us of our equity interest in BioReference. Availability under the Credit Agreement is based on a borrowing base comprised of eligible accounts receivables of BioReference and certain of its subsidiaries, as specified therein. As of December 31, 2019 , $6.2 million additional funds were available to be borrowed under the Credit Agreement. Principal under the Credit Agreement is due upon maturity on November 5, 2021. At BioReference’s option, borrowings under the Credit Agreement (other than swingline loans) will bear interest at (i) the CB floating rate (defined as the higher of (a) the prime rate and (b) the LIBOR rate (adjusted for statutory reserve requirements for Eurocurrency liabilities) for an interest period of one month plus 2.50% ) plus an applicable margin of 0.35% for the first 12 months and 0.50% thereafter or (ii) the LIBOR rate (adjusted for statutory reserve requirements for Eurocurrency liabilities) plus an applicable margin of 1.35% for the first 12 months and 1.50% thereafter. Swingline loans will bear interest at the CB floating rate plus the applicable margin. The Credit Agreement also calls for other customary fees and charges, including an unused commitment fee of 0.25% of the lending commitments. On March 17, 2017, BioReference and certain of its subsidiaries entered into Amendment No. 3 to Credit Agreement, which amended the Credit Agreement to permit BioReference and its subsidiaries to dividend cash to the Company in the form of an intercompany loan, in an aggregate amount not to exceed $55.0 million . On August 7, 2017, BioReference and certain of its subsidiaries entered into Amendment No. 4 to Credit Agreement, which amended the Credit Agreement to permit BioReference and its subsidiaries to dividend cash to the Company in the form of an additional intercompany loan, in an aggregate amount not to exceed $35.0 million . On November 8, 2017, BioReference and certain of its subsidiaries entered into Amendment No. 5 to Credit Agreement, which amended the Credit Agreement to, among other things, ease certain thresholds that require increased reporting by BioReference and reduce the pro forma availability condition for BioReference to make certain cash dividends to the Company. On December 22, 2017, BioReference and certain of its subsidiaries entered into Amendment No. 6 to Credit Agreement, which amended the Credit Agreement to, among other things, permit BioReference and its subsidiaries to dividend cash to the Company in the form of intercompany loans, in an aggregate amount not to exceed $45.0 million . The other terms of the Credit Agreement remain unchanged. In February 2018, BioReference and certain of its subsidiaries entered into Amendment No. 7 to the Credit Agreement, which amended the Credit Agreement to permit BioReference and its subsidiaries to use cash on hand, up to a maximum amount set forth in the amendment, to meet the availability requirements that otherwise would trigger (i) covenants that would require BioReference to maintain a minimum fixed charge coverage ratio and provide certain increased reporting under the Credit Agreement and (ii) CB’s right, as agent for the lenders under the Credit Agreement, to exercise sole dominion over funds held in certain accounts of BioReference. The other terms of the Credit Agreement remain unchanged. On February 26, 2019, BioReference and certain of its subsidiaries entered into Amendment No. 8 to the Credit Agreement, which amended the Credit Agreement to add back certain cost savings resulting from work force reductions in the 2018 fiscal year to the calculation of EBITDA for purposes of complying with the minimum fixed charge coverage ratio covenant. The other terms of the Credit Agreement remain unchanged. On August 6, 2019, BioReference and certain of its subsidiaries entered into Amendment No. 9 to the Credit Agreement, which amended certain definitions in the Credit Agreement and further amended the Credit Agreement to provide that the fixed charge coverage ratio requirement set forth in the Credit Agreement would not be tested for the second quarter and would not be tested for the quarter ending September 30, 2019, subject, in the case of testing for the quarter ending September 30, 2019, to (i) there having been no event of default occurring and (ii) availability under the revolving facility exceeding 10% of the total revolving commitment, subject to certain adjustments, for at least 30 consecutive days ending on September 30, 2019. The other terms of the Credit Agreement remain unchanged. On November 4, 2019, BioReference and certain of its subsidiaries entered into Amendment No. 10 to the Credit Agreement, which amended certain definitions in the Credit Agreement, extended the maturity date to 2021 and reduced the lenders’ aggregate commitment from $100 million to $75 million . The other terms of the Credit Agreement remained unchanged. On February 25, 2020, BioReference and certain of its subsidiaries entered into Amendment No. 11 to the Credit Agreement, which amended the Credit Agreement to provide that the fixed charge coverage ratio requirement set forth in the Credit Agreement would not be tested for the quarter ended December 31, 2019, with respect to availability calculated on January 29, 2020 and January 30, 2020, subject, in the case of testing for the quarter ended December 31, 2019, to (i) there having been no event of default occurring and (ii) availability under the revolving facility exceeding 10% of the total revolving commitment, for at least 30 consecutive days for the period ended on December 31, 2019, excluding December 18, 2019. The other terms of the Credit Agreement remain unchanged. As of December 31, 2019 , $44.7 million outstanding under the Credit Agreement was included within Other long-term liabilities. The Credit Agreement contains customary covenants and restrictions, including, without limitation, covenants that require BioReference and its subsidiaries to maintain a minimum fixed charge coverage ratio if availability under the new credit facility falls below a specified amount and to comply with laws and restrictions on the ability of BioReference and its subsidiaries to incur additional indebtedness or to pay dividends and make certain other distributions to the Company, subject to certain exceptions as specified therein. Failure to comply with these covenants would constitute an event of default under the Credit Agreement, notwithstanding the ability of BioReference to meet its debt service obligations. The Credit Agreement also includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Credit Agreement and execution upon the collateral securing obligations under the Credit Agreement. Substantially all the assets of BioReference and its subsidiaries are restricted from sale, transfer, lease, disposal or distributions to the Company, subject to certain exceptions. BioReference and its subsidiaries net assets as of December 31, 2019 were approximately $885.2 million , which includes goodwill of $434.8 million and intangible assets of $365.7 million . In addition to the Credit Agreement with CB, we have lines of credit with eleven other financial institutions as of December 31, 2019 and 2018 in the U.S., Chile and Spain. These lines of credit are used primarily as a source of working capital for inventory purchases. The following table summarizes the amounts outstanding under the BioReference, Chilean and Spanish lines of credit: (Dollars in thousands) Balance Outstanding Lender Interest rate on borrowings at December 31, 2019 Credit line capacity December 31, December 31, 2018 JP Morgan Chase 3.69% $ 75,000 $ 44,750 $ 105,198 Itau Bank 5.50% 1,810 472 232 Bank of Chile 6.60% 3,800 851 432 BICE Bank 5.50% 2,500 1,429 818 BBVA Bank 5.50% 3,250 11 858 Security Bank 5.50% 588 588 — Estado Bank 5.50% 3,500 1,365 308 Santander Bank 5.50% 4,500 1,943 852 Scotiabank 5.00% 1,800 668 2 Banco De Sabadell 1.45% 336 — — Banco Bilbao Vizcaya 2.45% 336 — — Santander Bank 1.40% 336 — 10 Total $ 97,756 $ 52,077 $ 108,710 At December 31, 2019 and 2018 , the weighted average interest rate on our lines of credit was approximately 4.0% and 4.7% , respectively. At December 31, 2019 and 2018 , we had notes payable and other debt (excluding the 2033 Senior Notes, the 2023 Convertible Notes, the 2025 Notes, the Credit Agreement and amounts outstanding under lines of credit described above) as follows: (In thousands) December 31, December 31, Current portion of notes payable $ 2,494 $ 2,560 Other long-term liabilities 4,723 5,693 Total $ 7,217 $ 8,253 The notes and other debt mature at various dates ranging from 2019 through 2024 bearing variable interest rates from 1.0% up to 3.8% . The weighted average interest rate on the notes and other debt at December 31, 2019 and 2018 , was 2.7% and 2.1%

Shareholders' Equity

Shareholders' Equity	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Shareholders' Equity	Shareholders’ Equity Our authorized capital stock consists of 1,000,000,000 shares of Common Stock, par value $0.01 per share, and 10,000,000 shares of Preferred Stock, par value $0.01 per share. Sales of Common Stock On October 29, 2019, we issued 50 million shares of our Common Stock at a price of $1.50 per share in an underwritten public offering (the “Offering”), resulting in net proceeds to the Company of approximately $70 million , after deducting underwriting commissions and offering expenses. In November 2019, pursuant to an option the Company granted the underwriters, we issued an additional 4,227,749 shares at $1.50 per share, less underwriting discounts and commissions, resulting in net proceeds of approximately $6 million . The Company intends to use the net proceeds received from the Offering to fund research and development, to further develop and commercialize its portfolio of proprietary pharmaceutical and diagnostic products and for working capital, capital expenditures, acquisitions and other general corporate purposes. Drs. Frost and Hsiao and Mr. Steven Rubin, members of OPKO’s senior management purchased an aggregate of 2,415,000 shares in the Offering. On November 8, 2018, we entered into stock purchase agreements with certain investors pursuant to which we agreed to sell to such investors in private placements exempt from registration under the Securities Act an aggregate of approximately 26.5 million shares of Common Stock at a purchase price of $3.49 per share, which was the closing bid price per share of Common Stock on the NASDAQ Global Select Market (“NASDAQ”) on such date, for an aggregate purchase price of $92.5 million . Investors in the offering included an affiliate of Dr. Phillip Frost, our Chairman and Chief Executive Officer ( $70 million ), and Dr. Jane Hsiao, our Vice Chairman and Chief Technical Officer ( $2 million ). Common Stock Subject to the rights of the holders of any shares of Preferred Stock currently outstanding or which may be issued in the future, the holders of the Common Stock are entitled to receive dividends from our funds legally available when, as and if declared by our Board of Directors, and are entitled to share ratably in all of our assets available for distribution to holders of Common Stock upon the liquidation, dissolution or winding-up of our affairs subject to the liquidation preference, if any, of any then outstanding shares of Preferred Stock. Holders of our Common Stock do not have any preemptive, subscription, redemption or conversion rights. Holders of our Common Stock are entitled to one vote per share on all matters which they are entitled to vote upon at meetings of stockholders or upon actions taken by written consent pursuant to Delaware corporate law. The holders of our Common Stock do not have cumulative voting rights, which means that the holders of a plurality of the outstanding shares can elect all of our directors. All of the shares of our Common Stock currently issued and outstanding are fully-paid and nonassessable. No dividends have been paid to holders of our Common Stock since our incorporation, and no cash dividends are anticipated to be declared or paid on our Common Stock in the reasonably foreseeable future. Preferred Stock Under our certificate of incorporation, our Board of Directors has the authority, without further action by stockholders, to designate up to 10 million shares of Preferred Stock in one or more series and to fix or alter, from time to time, the designations, powers and rights of each series of Preferred Stock and the qualifications, limitations or restrictions of any series of Preferred Stock, including dividend rights, dividend rate, conversion rights, voting rights, rights and terms of redemption (including sinking fund provisions), redemption price or prices, and the liquidation preference of any wholly issued series of Preferred Stock, any or all of which may be greater than the rights of the Common Stock, and to establish the number of shares constituting any such series. Of the authorized Preferred Stock, 4,000,000 shares, 500,000 shares and 2,000,000 shares were designated Series A Preferred Stock, Series C Preferred Stock and Series D Preferred Stock, respectively. As of December 31, 2019 and 2018, there were no shares of Series A Preferred Stock, Series C Preferred Stock or Series D Preferred Stock issued or outstanding.

Accumulated Other Comprehensive

Accumulated Other Comprehensive Income (Loss)	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Accumulated Other Comprehensive Income (Loss)	Accumulated Other Comprehensive Income (Loss) For the year ended December 31, 2019 , changes in Accumulated other comprehensive income (loss), net of tax, were as follows: (In thousands) Foreign Balance at December 31, 2018 $ (20,131 ) Other comprehensive income (loss) before reclassifications (1,939 ) Net other comprehensive income (loss) (1,939 ) Balance at December 31, 2019 $ (22,070 ) For the year ended December 31, 2018 , changes in Accumulated other comprehensive income, net of tax, were as follows: (In thousands) Foreign Unrealized Total Balance at December 31, 2017 $ (5,404 ) $ 4,876 $ (528 ) Other comprehensive income (loss) before reclassifications (14,727 ) — (14,727 ) Reclassification adjustment due to adoption of ASU 2016-01 — (4,876 ) (4,876 ) Net other comprehensive income (loss) (14,727 ) (4,876 ) (19,603 ) Balance at December 31, 2018 $ (20,131 ) $ — $ (20,131 )

Equity-Based Compensation

Equity-Based Compensation	12 Months Ended
	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Equity-Based Compensation	Equity-Based Compensation We maintain six equity-based incentive compensation plans, the 2016 Equity Incentive Plan, the Acuity Pharmaceuticals, Inc. 2003 Equity Incentive Plan, the 2007 Equity Incentive Plan, the 2000 Stock Option Plan, the Modigene Inc. 2005 Stock Incentive Plan and the Modigene Inc. 2007 Equity Incentive Plan that provide for grants of stock options and restricted stock to our directors, officers, key employees and certain outside consultants. Equity awards granted under our 2016 Equity Incentive Plan are exercisable for a period of up to 10 years from the date of grant. Equity awards granted under our 2007 Equity Incentive Plan are exercisable for a period of either 7 years or 10 years from the date of grant. Equity awards granted under our 2000 Stock Option Plan, 2003 Equity Incentive Plan and the two Modigene Plans are exercisable for a period of up to 10 years from date of grant. Vesting periods range from immediate to 5 years. We classify the cash flows resulting from the tax benefit that arises when the tax deductions exceed the compensation cost recognized for those equity awards (excess tax benefits) as cash flows from operations. There were no excess tax benefits for the years ended December 31, 2019 , 2018 , and 2017 . Valuation and Expense Information We recorded equity-based compensation expense of $13.4 million , $21.8 million and $28.3 million for the years ended December 31, 2019 , 2018 , and 2017 , respectively, all of which were reflected as operating expenses. Of the $13.4 million of equity based compensation expense recorded in the year ended December 31, 2019 , $9.7 million was recorded as selling, general and administrative expenses, $2.0 million was recorded as research and development expenses and $1.6 million was recorded as a cost of revenue. Of the $21.8 million of equity based compensation expense recorded in the year ended December 31, 2018 , $14.7 million was recorded as selling, general and administrative expense, $4.2 million was recorded as research and development expenses and $2.8 million was recorded as a cost of revenue. Of the $28.3 million of equity based compensation expense recorded in the year ended December 31, 2017 , $21.2 million was recorded as selling, general and administrative expense, $5.1 million was recorded as research and development expenses and 2.0 million was recorded as cost of revenue. As of December 31, 2019 , there was $15.4 million of unrecognized compensation cost related to the stock options granted under our equity-based incentive compensation plans. Such cost is expected to be recognized over a weighted-average period of approximately 1.71 years . Stock Options We estimate the fair value of each stock option on the date of grant using the Black-Scholes-Merton Model option-pricing formula and amortize the fair value to expense over the stock option’s vesting period using the straight-line attribution approach. We account for forfeitures as they occur and apply the following assumptions in our Black-Scholes-Merton Model option-pricing formula: Year Ended December 31, 2019 Year Ended December 31, 2018 Year Ended December 31, 2017 Expected term (in years) 3.0 - 10.0 3.0 - 10.0 3.0 - 10.0 Risk-free interest rate 1.35% - 2.63% 2.32% - 3.09% 1.32% - 2.41% Expected volatility 54% - 63% 40% - 54% 38% - 55% Expected dividend yield 0% 0% 0% Expected Term: For the expected term of options grants, we used an estimate of the expected option life based on historical experience. Risk-Free Interest Rate: The risk-free interest rate is based on the rates paid on securities issued by the U.S. Treasury with a term approximating the expected life of the option. Expected Volatility: The expected volatility for stock options was based on the historical volatility of our Common Stock. Expected Dividend Yield: We do not intend to pay dividends on Common Stock for the foreseeable future. Accordingly, we used a dividend yield of zero in the assumptions. We maintain incentive stock plans that provide for the grants of stock options to our directors, officers, employees and non-employee consultants. As of December 31, 2019 , there were 22,304,368 shares of Common Stock reserved for issuance under our 2016 Equity Incentive Plan and our 2007 Equity Incentive Plan. We intend to issue new shares upon the exercise of stock options. Stock options granted under these plans have been granted at an option price equal to the closing market value of the stock on the date of the grant. Stock options granted under these plans to employees typically become exercisable over four years in equal annual installments after the date of grant, and stock options granted to non-employee directors become exercisable in full one -year after the grant date, subject to, in each case, continuous service with us during the applicable vesting period. We assumed stock options to grant Common Stock as part of the mergers with Acuity Pharmaceuticals, Inc., Froptix, Inc., OPKO Biologics and BioReference, which reflected various vesting schedules, including monthly vesting to employees and non-employee consultants. A summary of option activity under our stock option plans as of December 31, 2019 , and the changes during the year is presented below: Options Number of options Weighted average exercise price Weighted average remaining contractual term (years) Aggregate intrinsic value (in thousands) Outstanding at December 31, 2018 33,031,298 $ 9.31 5.93 $ 232 Granted 8,066,000 $ 2.47 Exercised (24,877 ) $ 0.66 Forfeited (1,443,575 ) $ 7.32 Expired (2,258,425 ) $ 7.74 Outstanding at December 31, 2019 37,370,421 $ 8.01 6.00 $ — Vested and expected to vest at December 31, 2019 37,370,421 $ 8.01 6.00 $ — Exercisable at December 31, 2019 24,448,521 $ 10.18 4.49 $ — The total intrinsic value of stock options exercised for the years ended December 31, 2019 , 2018 , and 2017 was $0.1 million , $0.5 million and $6.4 million , respectively. The weighted average grant date fair value of stock options granted for the years ended December 31, 2019 , 2018 , and 2017 was $1.15 , $2.08 , and $4.50 , respectively. The total fair value of stock options vested during the years ended December 31, 2019 , 2018 , and 2017 was $18.6 million , $25.8 million and $34 million , respectively.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes We operate and are required to file tax returns in the U.S. and various foreign jurisdictions. The benefit (provision) for incomes taxes consists of the following: For the years ended December 31, (In thousands) 2019 2018 2017 Current Federal $ — $ — $ 2,398 State (89 ) 6,318 (1,737 ) Foreign (2,647 ) (2,738 ) (3,424 ) (2,736 ) 3,580 (2,763 ) Deferred Federal 333 2,045 (10,759 ) State 125 5,673 (2,738 ) Foreign (4,782 ) 27,428 (2,595 ) (4,324 ) 35,146 (16,092 ) Total, net $ (7,060 ) $ 38,726 $ (18,855 ) Deferred income tax assets and liabilities as of December 31, 2019 and 2018 are comprised of the following: (In thousands) December 31, 2019 December 31, 2018 Deferred income tax assets: Federal net operating loss $ 121,125 $ 101,662 State net operating loss 64,648 59,126 Foreign net operating loss 32,162 34,407 Research and development expense 1,560 2,893 Tax credits 22,989 21,669 Stock options 30,640 30,430 Accruals 17,215 6,294 Equity investments 13,495 12,904 Bad debts 445 414 Lease liability 1,064 1,370 Foreign credits 9,909 10,837 Available-for-sale securities 2,478 2,447 Operating lease asset 10,204 — Other 8,395 11,668 Deferred income tax assets 336,329 296,121 Deferred income tax liabilities: Intangible assets (230,662 ) (250,640 ) Convertible Debt (12,219 ) — Operating lease liability (10,204 ) — Fixed assets (3,976 ) (3,486 ) Other (2,130 ) (2,272 ) Deferred income tax liabilities (259,191 ) (256,398 ) Net deferred income tax assets (liabilities) 77,138 39,723 Valuation allowance (194,869 ) (154,916 ) Net deferred income tax liabilities* $ (117,731 ) $ (115,193 ) Note: Net deferred income tax liability balance includes $986 thousand recorded to Other Assets on the Consolidated Balance Sheet. As of December 31, 2019 , we have federal, state and foreign net operating loss carryforwards of approximately $698.3 million , $873.3 million and $139.6 million , respectively, that expire at various dates through 2039 unless indefinite in nature. As of December 31, 2019 , we have research and development tax credit carryforwards of approximately $23.0 million that expire in varying amounts through 2039. As of each reporting date, management considers new evidence, both positive and negative, that could affect its view of the future realization of deferred tax assets. We have determined a valuation allowance is required against all of our net deferred tax assets that we do not expect to be utilized by the reversing of deferred income tax liabilities. Under Section 382 of the Internal Revenue Code of 1986, as amended, certain significant changes in ownership may restrict the future utilization of our income tax loss carryforwards and income tax credit carryforwards in the U.S. The annual limitation is equal to the value of our stock immediately before the ownership change, multiplied by the long-term tax-exempt rate (i.e., the highest of the adjusted federal long-term rates in effect for any month in the three-calendar-month period ending with the calendar month in which the change date occurs). This limitation may be increased under the IRC Section 338 Approach (IRS approved methodology for determining recognized Built-In Gain). As a result, federal net operating losses and tax credits may expire before we are able to fully utilize them. During 2008, we conducted a study to determine the impact of the various ownership changes that occurred during 2007 and 2008. As a result, we have concluded that the annual utilization of our net operating loss carryforwards (“NOLs”) and tax credits is subject to a limitation pursuant to Internal Revenue Code Section 382. Under the tax law, such NOLs and tax credits are subject to expiration from 15 to 20 years after they were generated. As a result of the annual limitation that may be imposed on such tax attributes and the statutory expiration period, some of these tax attributes may expire prior to our being able to use them. There is no current impact on these financial statements as a result of the annual limitation. This study did not conclude whether OPKO’s predecessor, eXegenics, pre-merger NOLs were limited under Section 382. As such, of the $698.3 million of federal net operating loss carryforwards, at least approximately $47.4 million may not be able to be utilized. We file federal income tax returns in the U.S. and various foreign jurisdictions, as well as with various U.S. states and the Ontario and Nova Scotia provinces in Canada. We are subject to routine tax audits in all jurisdictions for which we file tax returns. Tax audits by their very nature are often complex and can require several years to complete. It is reasonably possible that some audits will close within the next twelve months, which we do not believe would result in a material change to our accrued uncertain tax positions. U.S. Federal: Under the tax statute of limitations applicable to the Internal Revenue Code, we are no longer subject to U.S. federal income tax examinations by the Internal Revenue Service for years before 2016. However, because we are carrying forward income tax attributes, such as net operating losses and tax credits from 2016 and earlier tax years, these attributes can still be audited when utilized on returns filed in the future. State: Under the statute of limitations applicable to most state income tax laws, we are no longer subject to state income tax examinations by tax authorities for years before 2015 in states in which we have filed income tax returns. Certain states may take the position that we are subject to income tax in such states even though we have not filed income tax returns in such states and, depending on the varying state income tax statutes and administrative practices, the statute of limitations in such states may extend to years before 2015. Foreign: Under the statute of limitations applicable to our foreign operations, we are generally no longer subject to tax examination for years before 2014 in jurisdictions where we have filed income tax returns. Tax Cuts and Jobs Act On December 22, 2017, the 2017 Tax Act was enacted into law and the new legislation contains several key tax provisions, including a reduction of the corporate income tax rate from 35% to 21% effective January 1, 2018 and a one-time mandatory transition tax on accumulated foreign earnings, among others. We were required to recognize the effect of the tax law changes in the period of enactment, such as remeasuring our U.S. deferred tax assets and liabilities, as well as reassessing the net realizability of our deferred tax assets and liabilities. Effective January 1, 2018, the Tax Act provides for a new GILTI provision. Under the GILTI provision, certain foreign subsidiary earnings in excess of an allowable return on the foreign subsidiary’s tangible assets are included in U.S. taxable income. The Company currently estimates GILTI will be immaterial for the year ended December 31, 2019, although interpretive guidance continues to be issued and future guidance may impact this analysis. The Company has not recorded any deferred taxes for future GILTI inclusions as any future inclusions are expected to be treated as a period expense and offset by net operating loss carryforwards in the U.S. Unrecognized Tax Benefits As of December 31, 2019 , 2018 , and 2017 , the total amount of gross unrecognized tax benefits was approximately $17.2 million , $17.5 million , and $21.3 million , respectively. As of December 31, 2019 , the total amount of unrecognized tax benefits that, if recognized, would affect our effective income tax rate was $(13.2) million . We account for any applicable interest and penalties on uncertain tax positions as a component of income tax expense and we recognized $(0.1) million and $(1.9) million of interest expense for the years ended December 31, 2019 and 2018 , respectively. As of December 31, 2018 and 2017 , $(14.2) million and $(12.4) million of the unrecognized tax benefits, if recognized, would have affected our effective income tax rate. We believe it is reasonably possible that approximately $0.5 million of unrecognized tax benefits may be recognized within the next twelve months, mainly due to anticipated statute of limitations lapses in various jurisdictions. The following summarizes the changes in our gross unrecognized income tax benefits. For the years ended December 31, (In thousands) 2019 2018 2017 Unrecognized tax benefits at beginning of period $ 17,513 $ 21,347 $ 27,545 Gross increases – tax positions in prior period — — 44 Gross increases – tax positions in current period 884 8,384 — Gross decreases – tax positions in prior period (298 ) (7,597 ) (1,724 ) Lapse of Statute of Limitations (939 ) (4,621 ) (4,518 ) Unrecognized tax benefits at end of period $ 17,160 $ 17,513 $ 21,347 Other Income Tax Disclosures The significant elements contributing to the difference between the federal statutory tax rate and the effective tax rate are as follows: For the years ended December 31, 2019 2018 2017 Federal statutory rate 21.0 % 21.0 % 35.0 % State income taxes, net of federal benefit 2.8 % 4.3 % 5.1 % Foreign income tax (6.6 )% (6.0 )% (5.3 )% Income Tax Refunds — % 3.6 % — % Research and development tax credits 0.3 % 1.9 % 0.6 % Non-Deductible components of Convertible Debt — % (0.2 )% 0.1 % Valuation allowance (17.9 )% (7.1 )% (28.4 )% Rate change effect 0.4 % 8.1 % (10.8 )% Non-deductible items (0.7 )% (2.9 )% (1.9 )% Unrecognized tax benefits — % (1.8 )% (0.7 )% Impairments (1.6 )% — % — % Other — % (0.7 )% (0.4 )% Total (2.3 )% 20.2 % (6.7 )% The following table reconciles our losses before income taxes between U.S. and foreign jurisdictions: For the years ended December 31, (In thousands) 2019 2018 2017 Pre-tax income (loss): U.S. $ (236,544 ) $ (132,102 ) $ (247,938 ) Foreign (71,321 ) (59,664 ) (38,457 ) Total $ (307,865 ) $ (191,766 ) $ (286,395 )

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2019
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions On October 29, 2019, we issued 50 million shares of our Common Stock at a price of $1.50 per share in the Offering, resulting in net proceeds to the Company of approximately $70 million , after deducting underwriting commissions and offering expenses. In November 2019, pursuant to an option the Company granted the underwriters, we issued an additional 4,227,749 shares at the public offering price, less underwriting discounts and commissions, resulting in net proceeds to the Company of approximately $6 million . The Company intends to use the net proceeds received from the Offering to fund research and development, to further develop and commercialize its portfolio of proprietary pharmaceutical and diagnostic products and for working capital, capital expenditures, acquisitions and other general corporate purposes. Drs. Frost and Hsiao and Mr. Steven Rubin, members of OPKO’s senior management purchased an aggregate of 2,415,000 shares of Common Stock in the Offering. On March 1, 2019, OPKO Pharmaceuticals, LLC entered into an assignment agreement with Xenetic Biosciences, Inc., as amended from time to time (the “Assignment Agreement”), pursuant to which Xenetic acquired all of OPKO Pharmaceuticals’ right, title and interest in and to that certain Intellectual Property License Agreement (the “IP License Agreement”), entered into between The Scripps Research Institute and OPKO Pharmaceuticals, regarding certain patents for novel CAR T platform technology and through which the Institute granted an exclusive royalty-bearing license in exchange for royalties, subject to the terms of the IP License Agreement. Under the Assignment Agreement and the IP License Agreement, Xenetic issued to OPKO Pharmaceuticals 164,062 shares of Xenetic common stock (the “OPKO Transaction Shares”). In connection with the Assignment Agreement, OPKO Pharmaceuticals entered into a voting agreement pursuant to which OPKO Pharmaceuticals agreed, among other things, to vote its shares in Xenetic in favor of the transactions contemplated by the Assignment Agreement, and a lock-up agreement with Xenetic which restricts OPKO Pharmaceuticals’ sale or transfer of any of the OPKO Transaction Shares as provided therein and as otherwise required by law. The Assignment Agreement and the obligations thereunder took effect on July 19, 2019, after Xenetic satisfied certain closing conditions, including obtaining stockholder approval and securing certain financing. The Company owns approximately 9% of Pharmsynthez, and Pharmsynthez is Xenetic’s largest and controlling stockholder. Dr. Richard Lerner, a director of the Company, is a co-inventor of Xenetic’s technology and received 31,240 shares of Xenetic upon the closing of the Xenetic transactions described above. Adam Logal, our Senior Vice President and Chief Financial Officer, is a director of Xenetic. In March 2019, we paid the $125,000 filing fee to the Federal Trade Commission (the “FTC”) in connection with filings made by us and Dr. Jane Hsiao, our Vice Chairman and Chief Technical Officer, under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 (“HSR Act”) relating to her purchases of Common Stock. In February 2019, Dr. Phillip Frost, our Chairman and Chief Executive Officer, paid a filing fee of $280,000 to the FTC under the HSR Act in connection with filings made by us and Dr. Frost, relating to his purchases of Common Stock. We reimbursed Dr. Frost for the HSR filing fee. On November 8, 2018, we entered into stock purchase agreements with certain investors pursuant to which we agreed to sell to such investors in private placements an aggregate of approximately 26.5 million shares of our Common Stock at a purchase price of $3.49 per share, which was the closing bid price of our Common Stock on the NASDAQ on such date, for an aggregate purchase price of $92.5 million . The investors in the private placements included an affiliate of Dr. Frost ( $70 million ), and Dr. Hsiao ( $2 million ). On November 8, 2018, we entered into a credit agreement with an affiliate of Dr. Frost, pursuant to which the lender committed to provide us with an unsecured line of credit in the amount of $60 million . Borrowings under the line of credit bore interest at a rate of 10% per annum and could have been repaid and reborrowed at any time. The credit agreement included various customary remedies for the lender following an event of default, including the acceleration of repayment of outstanding amounts under line of credit. The line of credit would have matured on November 8, 2023. We repaid approximately $28.8 million that was borrowed in 2019 and terminated the line of credit on or around February 20, 2019. In February 2018, we issued the 2023 Convertible Notes in the aggregate principal amount of $55.0 million . Refer to Note 6. Purchasers of the 2023 Convertible Notes included Dr. Hsiao and an affiliate of Dr. Frost. We hold investments in Zebra (ownership 29% ), Neovasc ( 4% ), ChromaDex Corporation ( 0% ), MabVax ( 1% ), COCP ( 7% ), NIMS ( 1% ), Eloxx ( 3% ) and BioCardia ( 3% ). These investments were considered related party transactions as a result of our executive management’s ownership interests and/or board representation in these entities. See further discussion of our investments in Note 4. In February 2018, we invested an additional $1.0 million in COCP for a convertible note, which was converted into 538,544 shares of its common stock in May 2018. In April 2017, we invested an additional $1.0 million in COCP for 138,889 shares of its common stock. In November 2017, we invested an additional $3.0 million in Neovasc for 20,547 shares of its common stock, 20,547 Series A warrants, 20,547 Series B warrants and 8,221 Series C warrants, after adjusting for a 1-for-100 reverse stock split in 2018. In April 2018, we exercised our Series B warrants in a cashless exercise and received 10,690 shares of Neovasc common stock. In the first quarter of 2019, we exercised the Series C warrants for $1.2 million and exchanged the Series A warrants and received a total of 22,660 additional shares of Neovasc common stock. In July 2017, we invested an additional $0.1 million in MabVax for 50,714 shares of common stock and in May 2017, we invested an additional $0.5 million in MabVax for 1,667 shares of Series L Preferred Stock and 107,607 shares of Series I Preferred Stock. In November 2016, we entered into a Pledge Agreement with the Museum of Science, Inc. and the Museum of Science Endowment Fund, Inc. pursuant to which we will contribute an aggregate of $1.0 million over a four-year period for constructing, equipping and the general operation of the Frost Science Museum. Dr. Frost and Mr. Richard Pfenniger serve on the Board of Trustees of the Frost Science Museum and Mr. Pfenniger is the Vice Chairman of the Board of Trustees. We lease office space from Frost Real Estate Holdings, LLC in Miami, Florida, where our principal executive offices are located. Effective August 1, 2019, we entered into an amendment to our lease agreement with Frost Holdings. The lease, as amended, is for approximately 29,500 square feet of space. The lease provides for payments of approximately $89 thousand per month in the first year increasing annually to $101 thousand per month in the fifth year, plus applicable sales tax. The rent is inclusive of operating expenses, property taxes and parking. BioReference purchases and uses certain products acquired from InCellDx, a company in which we hold a 29% minority interest. We reimburse Dr. Frost for Company-related use by Dr. Frost and our other executives of an airplane owned by a company that is beneficially owned by Dr. Frost. We reimburse Dr. Frost for out-of-pocket operating costs for the use of the airplane by Dr. Frost or Company executives for Company-related business. We do not reimburse Dr. Frost for personal use of the airplane by Dr. Frost or any other executive. For the years ended December 31, 2019 , 2018 , and 2017 , we recognized approximately $328 thousand , $238 thousand , and $361 thousand

Employee Benefit Plans

Employee Benefit Plans	12 Months Ended
	Dec. 31, 2019
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee Benefit Plans Effective January 1, 2007, the OPKO Health Savings and Retirement Plan (the “Plan”) permits employees to contribute up to 100% of qualified pre-tax annual compensation up to annual statutory limitations. The discretionary company match for employee contributions to the Plan is 100% up to the first 4% of the participant’s earnings contributed to the Plan. Effective January 1, 2017, employees of BioReference and its subsidiaries are eligible for participation in the Plan. Our matching contributions to our plans, including predecessor plans for BioReference, were approximately $8.3 million , $8.3 million and $8.4 million for the years ended December 31, 2019 , 2018 , and 2017 respectively.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies In connection with our acquisitions of CURNA, OPKO Diagnostics and OPKO Renal, we agreed to pay future consideration to the sellers upon the achievement of certain events. As a result, as of December 31, 2019 , we recorded $9.7 million as contingent consideration, with $2.4 million recorded within Accrued expenses and $7.3 million recorded within Other long-term liabilities in the accompanying Consolidated Balance Sheets. Refer to Note 5. On June 3, 2019, BioReference reported that Retrieval-Masters Creditors Bureau, Inc. d/b/a American Medical Collection Agency (“AMCA”), had notified BioReference about a data security incident involving AMCA (the “AMCA Incident”). AMCA informed BioReference that an unauthorized user had access to AMCA’s system between August 1, 2018 and March 30, 2019. AMCA advised that AMCA’s affected system may have included patient name, date of birth, address, phone, date of service, provider, and balance information, as well as credit card information, bank account information (but no passwords or security questions) and email addresses that were provided by the consumer to AMCA. AMCA has advised BioReference that no Social Security Numbers were compromised, and BioReference provided no laboratory results or diagnostic information to AMCA. BioReference has notified patients and provided notice to the Office of Civil Rights of the AMCA Incident. To date, BioReference has been named in at least two class action lawsuits against AMCA and other defendants in connection with the AMCA Incident. In addition, the Office of Inspector General and Office for Civil Rights (“OCR”) of the Department of Health and Human Services, as well as the attorney generals’ offices from certain states have contacted BioReference to request additional information relating to the AMCA Incident. It is not possible at this time to estimate the amount of loss or range of loss, if any, that might result from adverse judgments, settlements, fines, penalties, or other resolution of these proceedings and investigations based on the stage of these proceedings and investigations, the absence of specific allegations as to alleged damages, the uncertainty as to the certification of a class or classes and the size of any certified class, if applicable, and/or the lack of resolution of significant factual and legal issues. As previously disclosed, on September 7, 2018, the Securities and Exchange Commission (“SEC”) filed a lawsuit in the Southern District of New York (the “SEC Complaint”) against a number of individuals and entities (the “Defendants”), including the Company and its CEO and Chairman, Dr. Phillip Frost. The SEC alleged, among other things, that the Company (i) aided and abetted an illegal “pump and dump” scheme perpetrated by a number of the Defendants, and (ii) failed to file required Schedules 13D or 13G with the SEC. On December 27, 2018, the Company announced that the Company and Dr. Frost entered into settlement agreements with the SEC, which upon approval of the court would resolve the SEC Complaint against each of them. The settlement was approved by the court in January 2019. Pursuant to the settlement, and without admitting or denying any of the allegations of the Complaint, the Company is enjoined from violating Section 13(d) of the Exchange Act and paid a $100,000 penalty. Liability under Section 13(d) can be established without any showing of wrongful intent or negligence. Following the SEC’s announcement of the SEC Complaint, we were named in several class action lawsuits, more than a dozen derivative suits, and other litigation relating to the allegations in the SEC Complaint among other matters. The Company intends to vigorously defend itself against the claims. For a more detailed discussion of pending matters, please see Part I, Item 3, “Legal Proceedings”. In April 2017, the Civil Division of the United States Attorney’s Office for the Southern District of New York (the “SDNY”) informed BioReference that it believes that, from 2006 to the present, BioReference had, in violation of the False Claims Act, improperly billed Medicare and TRICARE (both are federal government healthcare programs) for clinical laboratory services provided to hospital inpatient beneficiaries at certain hospitals. In April 2019, the SDNY also informed BioReference that it believes that BioReference provided physicians subsidies for electronic health record systems prior to 2012 that violated regulations adopted by HHS in 2006 which allowed laboratories to provide these donations under certain conditions. BioReference is assessing the allegations made by the SDNY and continues to discuss the matter with the SDNY. On October 11, 2019, GeneDx received a letter from the Centers for Medicare and Medicaid Services (“CMS”), notifying GeneDx of CMS’ determination to suspend Medicare payments to GeneDx, which suspension became effective on September 27, 2019 (the “CMS Letter”). The CMS Letter specifically stated that the foregoing suspension may last for up to 180 days from the effective date and may be extended under certain circumstances. CMS advised that it suspended payments due to possible overpayments to GeneDx in connection with reimbursement claims for genetic testing services based on a diagnosis of family history of cancer, which testing CMS has alleged is not covered by Medicare under the applicable provisions of the Social Security Act on the basis that such testing is not reasonable and necessary for the diagnosis or treatment of illness or injury. On or around February 3, 2020, we were notified that CMS was lifting the payment suspension. CMS noted, however, that the decision to lift the payment suspension should not be construed as a positive determination regarding our Medicare billing. CMS also notified us of results of a payment audit concluding that the Company had been overpaid by Medicare for genetic testing services based on a diagnosis of a family history of cancer. The Company is currently evaluating the audit findings. There can be no assurance that CMS and other governmental payor programs will not seek to recoup payments from us, suspend reimbursement or seek overpayment damages from GeneDx. From time to time, we may receive inquiries, document requests, Civil Investigative Demands (“CIDs”) or subpoenas from the Department of Justice, OCR, CMS, various payors and fiscal intermediaries, and other state and federal regulators regarding investigations, audits and reviews. In addition to the matters discussed in this note, we are currently responding to CIDs, subpoenas, payor audits, and document requests for various matters relating to our laboratory operations. Some pending or threatened proceedings against us may involve potentially substantial amounts as well as the possibility of civil, criminal, or administrative fines, penalties, or other sanctions, which could be material. Settlements of suits involving the types of issues that we routinely confront may require monetary payments as well as corporate integrity agreements. Additionally, qui tam or “whistleblower” actions initiated under the civil False Claims Act may be pending but placed under seal by the court to comply with the False Claims Act’s requirements for filing such suits. Also, from time to time, we may detect issues of non-compliance with federal healthcare laws pertaining to claims submission and reimbursement practices and/or financial relationships with physicians, among other things. We may avail ourselves of various mechanisms to address these issues, including participation in voluntary disclosure protocols. Participating in voluntary disclosure protocols can have the potential for significant settlement obligations or even enforcement action. The Company generally has cooperated, and intends to continue to cooperate, with appropriate regulatory authorities as and when investigations, audits and inquiries arise. We are a party to other litigation in the ordinary course of business. While we cannot predict the ultimate outcome of legal matters, we accrue a liability for legal contingencies when we believe that it is both probable that a liability has been incurred and that we can reasonably estimate the amount of the loss. It’s reasonably possible the ultimate liability could exceed amounts currently estimated and we review established accruals and adjust them to reflect ongoing negotiations, settlements, rulings, advice of legal counsel and other relevant information. To the extent new information is obtained and our views on the probable outcomes of claims, suits, assessments, investigations or legal proceedings change, changes in our accrued liabilities would be recorded in the period in which such determination is made. Because of the high degree of judgment involved in establishing loss estimates, the ultimate outcome of such matters will differ from our estimates and such differences may be material to our business, financial condition, results of operations, and cash flows. We expect to continue to incur substantial research and development expenses, including expenses related to the hiring of personnel and additional clinical trials. We expect that selling, general and administrative expenses will also increase as we expand our sales, marketing and administrative staff and add infrastructure, particularly as it relates to Rayaldee. We do not anticipate that we will generate substantial revenue from the sale of proprietary pharmaceutical products or certain of our diagnostic products for some time and we have generated only limited revenue from our pharmaceutical operations in Chile, Mexico, Israel, Spain, and Ireland, and from sale of the 4Kscore test. If we acquire additional assets or companies, fail to generate expected cash flow from BioReference, accelerate our product development programs or initiate additional clinical trials, we will need additional funds. If we are not able to secure additional funding when needed, we may have to delay, reduce the scope of, or eliminate one or more of our clinical trials or research and development programs or possible acquisitions. We have employment agreements with certain employees of BioReference which provide for compensation and certain other benefits and for severance payments under certain circumstances. During the years ended December 31, 2019 , 2018 and 2017, we recognized $3.0 million , $4.9 million and $5.8 million , respectively, of severance costs pursuant to these employment agreements as a component of Selling, general and administrative expense. At December 31, 2019 , we were committed to make future purchases for inventory and other items in 2020 that occur in the ordinary course of business under various purchase arrangements with fixed purchase provisions aggregating approximately $89.2 million

Revenue Recognition

Revenue Recognition	12 Months Ended
	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition We generate revenues from services, products and intellectual property as follows: Revenue from services Revenue for laboratory services is recognized at the time test results are reported, which approximates when services are provided and the performance obligations are satisfied. Services are provided to patients covered by various third-party payor programs including various managed care organizations, as well as the Medicare and Medicaid programs. Billings for services are included in revenue net of allowances for contractual discounts, allowances for differences between the amounts billed and estimated program payment amounts, and implicit price concessions provided to uninsured patients which are all elements of variable consideration. The following are descriptions of our payors for laboratory services: Healthcare Insurers. Reimbursements from healthcare insurers are based on negotiated fee-for-service schedules. Revenues consist of amounts billed, net of contractual allowances for differences between amounts billed and the estimated consideration we expect to receive from such payors, which considers historical denial and collection experience and the terms of our contractual arrangements. Adjustments to the allowances, based on actual receipts from the third-party payors, are recorded upon settlement. Government Payors. Reimbursements from government payors are based on fee-for-service schedules set by governmental authorities, including traditional Medicare and Medicaid. Revenues consist of amounts billed, net of contractual allowances for differences between amounts billed and the estimated consideration we expect to receive from such payors, which considers historical denial and collection experience and the terms of our contractual arrangements. Adjustments to the allowances, based on actual receipts from the government payors, are recorded upon settlement. Client Payors. Client payors include physicians, hospitals, employers, and other institutions for which services are performed on a wholesale basis, and are billed and recognized as revenue based on negotiated fee schedules. Patients. Uninsured patients are billed based on established patient fee schedules or fees negotiated with physicians on behalf of their patients. Insured patients (including amounts for coinsurance and deductible responsibilities) are billed based on fees negotiated with healthcare insurers. Collection of billings from patients is subject to credit risk and ability of the patients to pay. Revenues consist of amounts billed net of discounts provided to uninsured patients in accordance with our policies and implicit price concessions. Implicit price concessions represent differences between amounts billed and the estimated consideration that we expect to receive from patients, which considers historical collection experience and other factors including current market conditions. Adjustments to the estimated allowances, based on actual receipts from the patients, are recorded upon settlement. The complexities and ambiguities of billing, reimbursement regulations and claims processing, as well as considerations unique to Medicare and Medicaid programs, require us to estimate the potential for retroactive adjustments as an element of variable consideration in the recognition of revenue in the period the related services are rendered. Actual amounts are adjusted in the period those adjustments become known. For the years ended December 31, 2019 , 2018 and 2017, revenue reductions due to changes in estimates of implicit price concessions for performance obligations satisfied in prior periods of $24.8 million , $22.8 million and $66.0 million , respectively, were recognized. Third-party payors, including government programs, may decide to deny payment or recoup payments for testing they contend were improperly billed or not medically necessary, against their coverage determinations, or for which they believe they have otherwise overpaid (including as a result of their own error), and we may be required to refund payments already received. Our revenues may be subject to retroactive adjustment as a result of these factors among others, including without limitation, differing interpretations of billing and coding guidance and changes by government agencies and payors in interpretations, requirements, and “conditions of participation” in various programs. We have processed requests for recoupment from third-party payors in the ordinary course of our business, and it is likely that we will continue to do so in the future. If a third-party payer denies payment for testing or recoups money from us in a later period, reimbursement for our testing could decline. As an integral part of our billing compliance program, we periodically assess our billing and coding practices, respond to payor audits on a routine basis, and investigate reported failures or suspected failures to comply with federal and state healthcare reimbursement requirements, as well as overpayment claims which may arise from time to time without fault on the part of the Company. We may have an obligation to reimburse Medicare, Medicaid, and third-party payors for overpayments regardless of fault. We have periodically identified and reported overpayments, reimbursed payors for overpayments and taken appropriate corrective action. Settlements with third-party payors for retroactive adjustments due to audits, reviews or investigations are also considered variable consideration and are included in the determination of the estimated transaction price for providing services. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and our historical settlement activity, including an assessment of the probability a significant reversal of cumulative revenue recognized will occur when the uncertainty is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews, and investigations. As of December 31, 2019 and 2018 , we have liabilities of approximately $27.3 million and $35.9 million within Accrued expenses and Other long-term liabilities related to reimbursements for payor overpayments. The composition of Revenue from services by payor for the years ended December 31, 2019 , 2018 and 2017 is as follows: For the years ended December 31, (In thousands) 2019 2018 2017 Healthcare insurers $ 419,101 $ 492,995 $ 495,209 Government payors 116,662 150,851 140,195 Client payors 159,972 148,070 126,264 Patients 20,699 21,332 21,042 Total $ 716,434 $ 813,248 $ 782,710 Revenue from products We recognize revenue from product sales when a customer obtains control of promised goods or services. The amount of revenue that is recorded reflects the consideration that we expect to receive in exchange for those goods or services. Our estimates for sales returns and allowances are based upon the historical patterns of product returns and allowances taken, matched against the sales from which they originated, and our evaluation of specific factors that may increase or decrease the risk of product returns. Product revenues are recorded net of estimated rebates, chargebacks, discounts, co-pay assistance and other deductions (collectively, “Sales Deductions”) as well as estimated product returns which are all elements of variable consideration. Allowances are recorded as a reduction of revenue at the time product revenues are recognized. The actual amounts of consideration ultimately received may differ from our estimates. If actual results in the future vary from our estimates, we will adjust these estimates, which would affect Revenue from products in the period such variances become known. Rayaldee is distributed in the U.S. principally through the retail pharmacy channel, which initiates with the largest wholesalers in the U.S. (collectively, “ Rayaldee Customers”). In addition to distribution agreements with Rayaldee Customers, we have entered into arrangements with many healthcare providers and payors that provide for government-mandated and/or privately-negotiated rebates, chargebacks and discounts with respect to the purchase of Rayaldee . We recognize revenue for shipments of Rayaldee at the time of delivery to customers after estimating Sales Deductions and product returns as elements of variable consideration utilizing historical information and market research projections. For the years ended December 31, 2019 , and 2018 , we recognized $31.4 million and $20.3 million in net product revenue from sales of Rayaldee . The following table presents an analysis of product sales allowances and accruals as contract liabilities for the years ended December 31, 2019 and 2018: (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2018 $ 1,316 $ 2,090 $ 637 $ 4,043 Provision related to current period sales 13,723 25,106 3,699 42,528 Credits or payments made (11,845 ) (21,355 ) (1,585 ) (34,785 ) Balance at December 31, 2019 $ 3,194 $ 5,841 $ 2,751 $ 11,786 Total gross Rayaldee sales $ 73,965 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 57 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2017 $ 233 $ 348 $ 437 $ 1,018 Provision related to current period sales 5,704 10,061 680 16,445 Credits or payments made (4,621 ) (8,319 ) (480 ) (13,420 ) Balance at December 31, 2018 $ 1,316 $ 2,090 $ 637 $ 4,043 Total gross Rayaldee sales $ 36,715 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 45 % Taxes collected from customers related to revenues from services and revenues from products are excluded from revenues. Revenue from intellectual property We recognize revenues from the transfer of intellectual property generated through license, development, collaboration and/or commercialization agreements. The terms of these agreements typically include payment to us for one or more of the following: non-refundable, up-front license fees; development and commercialization milestone payments; funding of research and/or development activities; and royalties on sales of licensed products. Revenue is recognized upon satisfaction of a performance obligation by transferring control of a good or service to the customer. For research, development and/or commercialization agreements that result in revenues, we identify all material performance obligations, which may include a license to intellectual property and know-how, and research and development activities. In order to determine the transaction price, in addition to any upfront payment, we estimate the amount of variable consideration at the outset of the contract either utilizing the expected value or most likely amount method, depending on the facts and circumstances relative to the contract. We constrain (reduce) our estimates of variable consideration such that it is probable that a significant reversal of previously recognized revenue will not occur throughout the life of the contract. When determining if variable consideration should be constrained, we consider whether there are factors outside of our control that could result in a significant reversal of revenue. In making these assessments, we consider the likelihood and magnitude of a potential reversal of revenue. These estimates are re-assessed each reporting period as required. Upfront License Fees: If a license to our intellectual property is determined to be functional intellectual property distinct from the other performance obligations identified in the arrangement, we recognize revenue from nonrefundable, upfront license fees based on the relative value prescribed to the license compared to the total value of the arrangement. The revenue is recognized when the license is transferred to the customer and the customer is able to use and benefit from the license. For licenses that are not distinct from other obligations identified in the arrangement, we utilize judgment to assess the nature of the combined performance obligation to determine whether the combined performance obligation is satisfied over time or at a point in time. If the combined performance obligation is satisfied over time, we apply an appropriate method of measuring progress for purposes of recognizing revenue from nonrefundable, upfront license fees. We evaluate the measure of progress each reporting period and, if necessary, adjust the measure of performance and related revenue recognition. Development and Regulatory Milestone Payments: Depending on facts and circumstances, we may conclude that it is appropriate to include the milestone in the estimated transaction price or that it is appropriate to fully constrain the milestone. A milestone payment is included in the transaction price in the reporting period that we conclude that it is probable that recording revenue in the period will not result in a significant reversal in amounts recognized in future periods. We may record revenues from certain milestones in a reporting period before the milestone is achieved if we conclude that achievement of the milestone is probable and that recognition of revenue related to the milestone will not result in a significant reversal in amounts recognized in future periods. We record a corresponding contract asset when this conclusion is reached. Milestone payments that have been fully constrained are not included in the transaction price to date. These milestones remain fully constrained until we conclude that achievement of the milestone is probable and that recognition of revenue related to the milestone will not result in a significant reversal in amounts recognized in future periods. We re-evaluate the probability of achievement of such development milestones and any related constraint each reporting period. We adjust our estimate of the overall transaction price, including the amount of revenue recorded, if necessary. Research and Development Activities: If we are entitled to reimbursement from our customers for specified research and development expenses, we account for them as separate performance obligations if distinct. We also determine whether the research and development funding would result in revenues or an offset to research and development expenses in accordance with provisions of gross or net revenue presentation. The corresponding revenues or offset to research and development expenses are recognized as the related performance obligations are satisfied. Sales-based Milestone and Royalty Payments: Our customers may be required to pay us sales-based milestone payments or royalties on future sales of commercial products. We recognize revenues related to sales-based milestone and royalty payments upon the later to occur of (i) achievement of the customer’s underlying sales or (ii) satisfaction of any performance obligation(s) related to these sales, in each case assuming the license to our intellectual property is deemed to be the predominant item to which the sales-based milestones and/or royalties relate. Other Potential Products and Services: Arrangements may include an option for license rights, future supply of drug substance or drug product for either clinical development or commercial supply at the licensee’s election. We assess if these options provide a material right to the licensee and if so, they are accounted for as separate performance obligations at the inception of the contract and revenue is recognized only if the option is exercised and products or services are subsequently delivered or when the rights expire. If the promise is based on market terms and not considered a material right, the option is accounted for if and when exercised. If we are entitled to additional payments when the licensee exercises these options, any additional payments are generally recorded in license or other revenues when the licensee obtains control of the goods, which is upon delivery. For the years ended December 31, 2019 , 2018 and 2017 we recorded $73.3 million , $69.9 million and $75.5 million of revenue from the transfer of intellectual property, respectively. For the year ended December 31, 2019, revenue from the transfer of intellectual property included $66.8 million related to the Pfizer Transaction. For the year ended December 31, 2018, revenue from the transfer of intellectual property included $60.0 million related to the Pfizer Transaction and $2.0 million related to a milestone payment from our licensee, Vifor Fresenius Medical Care Renal Pharma Ltd (“VFMCRP”). For the year ended December 31, 2017, revenue from the transfer of intellectual property included $61.2 million related to the Pfizer Transaction and $10.0 million related to a milestone payment from our licensee, TESARO. Refer to Note 15. Total contract liabilities included in Accrued expenses and Other long-term liabilities was $21.8 million and $91.1 million at December 31, 2019 and December 31, 2018 , respectively. The contract liability balance at December 31, 2019 and 2018

Strategic Alliances

Strategic Alliances	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Strategic Alliances	Strategic Alliances Japan Tobacco Inc. On October 12, 2017, EirGen, our wholly-owned subsidiary, and Japan Tobacco Inc. (“JT”) entered into a Development and License Agreement (the “JT Agreement”) granting JT the exclusive rights for the development and commercialization of Rayaldee in Japan (the “JT Territory”). The license grant to JT covers the therapeutic and preventative use of the product for (i) SHPT in non-dialysis and dialysis patients with CKD, (ii) rickets, and (iii) osteomalacia (the “JT Initial Indications”), as well as such additional indications as may be added to the scope of the license subject to the terms of the JT Agreement (the JT Additional Indications” and together with the JT Initial Indications, the “JT Field”). In connection with the license, OPKO received an initial upfront payment of $6 million and received another $6 million upon the initiation of OPKO’s phase 2 study for Rayaldee in dialysis patients in the U.S. in September 2018 (the “Initial Consideration”). OPKO is also eligible to receive up to an additional aggregate amount of $31 million upon the achievement of certain regulatory and development milestones by JT for Rayaldee in the JT Territory, and $75 million upon the achievement of certain sales based milestones by JT in the JT Territory. OPKO is also entitled to receive tiered, double digit royalty payments at percentages ranging from low double digits to mid-teens on net sales of Rayaldee within the JT Territory. JT will, at its sole cost and expense, be responsible for performing all development activities necessary to obtain all regulatory approvals for Rayaldee in Japan and for all commercial activities pertaining to Rayaldee in Japan. The JT Agreement provides for the following: (1) an exclusive license in the JT Territory in the JT Field for the development and commercialization of Rayaldee ; and (2) at JT’s option, EirGen will supply products to support the development, sale and commercialization of the products to JT in the JT Territory. The Initial Consideration will be recognized over the performance period through 2021, when we anticipate completing the transfer of license materials specified in the JT Agreement and our performance obligation is complete. Payments received for regulatory, development and sales milestones are non-refundable. The milestones are payable if and when the associated milestone is achieved and will be recognized as revenue in the period in which the associated milestone is achieved, assuming all other revenue recognition criteria are met. . To date, no revenue has been recognized related to these milestones. Vifor Fresenius Medical Care Renal Pharma Ltd In May 2016, EirGen, our wholly-owned subsidiary, and Vifor Fresenius Medical Care Renal Pharma Ltd (“VFMCRP”), entered into a Development and License Agreement (the “VFMCRP Agreement”) for the development and commercialization of Rayaldee (the “Product”) worldwide, except for (i) the U.S., (ii) any country in Central America or South America (excluding Mexico), (iii) Russia, (iv) China, (v) Japan, (vi) Ukraine, (vii) Belorussia, (viii) Azerbaijan, (ix) Kazakhstan, and (x) Taiwan (the “VFMCRP Territory”). The license to VFMCRP potentially covers all therapeutic and prophylactic uses of the Product in human patients (the “VFMCRP Field”), provided that initially the license is for the use of the Product for the treatment or prevention of SHPT related to patients with CKD and vitamin D insufficiency/deficiency (the “VFMCRP Initial Indication”). Under the terms of the VFMCRP Agreement, EirGen granted to VFMCRP an exclusive license in the VFMCRP Territory in the VFMCRP Field to use certain EirGen patents and technology to make, have made, use, sell, offer for sale, and import Products and to develop, commercialize, have commercialized, and otherwise exploit the Product. EirGen received a non-refundable and non-creditable initial payment of $50 million , which was recognized in Revenue from the transfer of intellectual property and other in our Consolidated Statement of Operations in 2016. EirGen also received a $2.0 million payment triggered by the approval of Rayaldee in Canada for the treatment of SHPT in adults with stage 3 or 4 CKD and vitamin D insufficiency in July 2018. EirGen is also eligible to receive up to an additional $35 million in regulatory milestones (“Regulatory Milestones”) and $195 million in launch and sales-based milestones (“Sales Milestones”), and will receive tiered royalties on sales of the product at percentage rates that range from the mid-teens to the mid-twenties or a minimum royalty, whichever is greater, upon the commencement of sales of the Product within the VFMCRP Territory and in the VFMCRP Field. We plan to share responsibility with VFMCRP for the conduct of trials specified within an agreed-upon development plan, with each company leading certain activities within the plan. EirGen will lead the manufacturing activities within and outside the VFMCRP Territory and the commercialization activities outside the VFMCRP Territory and outside the VFMCRP Field in the VFMCRP Territory and VFMCRP will lead the commercialization activities in the VFMCRP Territory and the VFMCRP Field. For the initial development plan, the companies have agreed to certain cost sharing arrangements. VFMCRP will be responsible for all other development costs that VFMCRP considers necessary to develop the Product for the use of the Product for the VFMCRP Initial Indication in the VFMCRP Territory in the VFMCRP Field except as otherwise provided in the VFMCRP Agreement. The first of the clinical studies provided for in the development activities commenced in September 2018. In connection with the VFMCRP Agreement, the parties entered into a letter agreement pursuant to which EirGen granted to VFMCRP an exclusive option (the “Option”) to acquire an exclusive license under certain EirGen patents and technology to use, import, offer for sale, sell, distribute and commercialize the Product in the U.S. solely for the treatment of SHPT in dialysis patients with CKD and vitamin D insufficiency (the “Dialysis Indication”). Upon exercise of the Option, VFMCRP will reimburse EirGen for all of the development costs incurred by EirGen with respect to the Product for the Dialysis Indication in the U.S. VFMCRP would also pay EirGen up to an additional aggregate amount of $555 million of sales-based milestones upon the achievement of certain milestones and would be obligated to pay royalties at percentage rates that range from the mid-teens to the mid-twenties on sales of the Product in the U.S. for the Dialysis Indication. To date, VFMCRP has not exercised its option. Payments received for Regulatory Milestones and Sales Milestones are non-refundable. The Regulatory Milestones are payable if and when VFMCRP obtains approval from certain regulatory authorities and will be recognized as revenue in the period in which the associated milestone is achieved, assuming all other revenue recognition criteria are met. We account for the Sales Milestones as royalties and Sales Milestones payments will be recognized as revenue in the period in which the associated milestone is achieved or sales occur, assuming all other revenue recognition criteria are met. Pfizer Inc. In December 2014, we entered into an exclusive worldwide agreement (the “Pfizer Agreement”) with Pfizer for the development and commercialization of our long-acting hGH-CTP (Somatrogon) for the treatment of growth hormone deficiency (“GHD”) in adults and children, as well as for the treatment of growth failure in children born small for gestational age (the “Pfizer Transaction”). On October 21, 2019, we and Pfizer announced that the global Phase 3 trial evaluating Somatrogon (hGH-CTP) dosed once-weekly in prepubertal children with GHD met its primary endpoint of non-inferiority to daily Genotropin® (somatropin) for injection, as measured by annual height velocity at 12 months. The Pfizer Transaction closed in January 2015. Under the terms of the Pfizer Transaction, we received non-refundable and non-creditable upfront payments of $295.0 million and are eligible to receive up to an additional $275.0 million upon the achievement of certain regulatory milestones. Pfizer received the exclusive license to commercialize hGH-CTP worldwide. In addition, we are eligible to receive initial tiered royalty payments associated with the commercialization of hGH-CTP for adult GHD with percentage rates ranging from the high teens to mid-twenties. Upon the launch of hGH-CTP for pediatric GHD in certain major markets, the royalties will transition to regional, tiered gross profit sharing for both hGH-CTP and Pfizer’s Genotropin®. The agreement with Pfizer will remain in effect until the last sale of the licensed product, unless earlier terminated as permitted under the Pfizer Agreement. In addition to termination rights for material breach and bankruptcy, Pfizer is permitted to terminate the Pfizer Agreement in its entirety, or with respect to one or more world regions, without cause after a specified notice period. If the Pfizer Agreement is terminated by us for Pfizer’s uncured material breach, or by Pfizer without cause, provision has been made for transition of product and product responsibilities to us for the terminated regions, as well as continued supply of product by Pfizer or transfer of supply to us in order to support the terminated regions. We are recognizing the non-refundable $295.0 million upfront payments as revenue as the research and development services are completed and had contract liabilities related to the Pfizer Transactions of $16.3 million at December 31, 2019 , of which were classified in Accrued expenses. The Pfizer Transaction includes milestone payments of $275.0 million upon the achievement of certain milestones. The milestones range from $20.0 million to $90.0 million each and are based on achievement of regulatory approval in the U.S. and regulatory approval and price approval in other major markets. The milestone payments will be recognized as revenue in the period in which the associated milestone is achieved, assuming all other revenue recognition criteria are met. To date, no revenue has been recognized related to the achievement of the milestones. TESARO In November 2009, we entered into an asset purchase agreement (the “NK-1 Agreement”) under which we acquired VARUBI™ (rolapitant) and other neurokinin-1 (“NK-1”) assets from Merck. In December 2010, we entered into an exclusive license agreement with TESARO, Inc. (“TESARO”), in which we out-licensed the development, manufacture, commercialization and distribution of our lead NK-1 candidate, VARUBI™ (the “TESARO License”). Under the terms of the license, we received a $6.0 million upfront payment from TESARO and we received $30.0 million of milestone payments from TESARO upon achievement of certain regulatory and commercial sale milestones and we are eligible to receive additional commercial milestone payments of up to $85.0 million if specified levels of annual net sales are achieved. The sales based milestone payments will be recognized as revenue in full in the period in which the associated sales occur. During the years ended December 31, 2019 and 2018 , no revenue was recognized related to the achievement of the milestones under the TESARO License. During year ended December 31, 2017, $10.0 million of revenue was recognized related to the achievement of the milestones under the TESARO License. Under the TESARO License, TESARO was also obligated to pay us tiered royalties on annual net sales achieved in the U.S. and Europe at percentage rates that range from the low double digits to the low twenties, and outside of the U.S. and Europe at low double-digit percentage rates until the later of the date that all of the patent rights licensed from us and covering VARUBI™ expire, are invalidated or are not enforceable and 12 years from the first commercial sale of the product. TESARO announced in 2018 that it has elected to suspend further distribution of Varubi IV. In June 2018, TESARO assigned its rights and obligations under the agreement to TerSera Therapeutics LLC (“TerSera”) pursuant to an asset purchase agreement. Under the asset purchase agreement, TerSera is responsible for VARUBI in the U.S. and Canada and TESARO was permitted to continue to commercialize VARUBY® in Europe and the rest of the world though a sublicense with TerSera. In September 2019, TESARO informed us and TerSera that it intends to stop selling VARUBY ® in the TESARO Territory and that it intends to withdraw its marketing authorization for VARUBY ® in Europe. The term of the license with TerSera will remain in force until the expiration of the royalty term in each country, unless we terminate the license earlier for material breach of the license or bankruptcy. TerSera has a right to terminate the license at any time during the term for any reason on three months’ written notice. Pharmsynthez In April 2013, we entered into a series of concurrent transactions with Pharmsynthez, a Russian pharmaceutical company traded on the Moscow Stock Exchange pursuant to which we acquired an equity method investment in Pharmsynthez (ownership 9% ). We also granted rights to certain technologies in the Russian Federation, Ukraine, Belarus, Azerbaijan and Kazakhstan (the “Pharmsynthez Territories”) to Pharmsynthez and agreed to perform certain development activities. We will receive from Pharmsynthez royalties on net sales of products incorporating the technologies in the Pharmsynthez Territories, as well as a percentage of any sublicense income from third parties for the technologies in the Pharmsynthez Territories. Phio Pharmaceuticals Corp. In March 2013, we completed the sale to RXi Pharmaceuticals Corporation (now known as Phio Pharmaceuticals Corp.) of substantially all of our assets in the field of RNA interference (the “RNAi Assets”) (collectively, the “Asset Purchase Agreement”). Pursuant to the Asset Purchase Agreement, Phio will be required to pay us up to $50.0 million in milestone payments upon the successful development and commercialization of each drug developed by Phio, certain of its affiliates or any of its or their licensees or sublicensees utilizing patents included within the RNAi Assets (each, a “Qualified Drug”). In addition, Phio will also be required to pay us royalties equal to: (a) a mid single-digit percentage of “Net Sales” (as defined in the Asset Purchase Agreement) with respect to each Qualified Drug sold for an ophthalmologic use during the applicable “Royalty Period” (as defined in the Asset Purchase Agreement); and (b) a low single-digit percentage of net sales with respect to each Qualified Drug sold for a non-ophthalmologic use during the applicable Royalty Period. Other We have completed strategic deals with numerous institutions and commercial partners. In connection with these agreements, upon the achievement of certain milestones we are obligated to make certain payments and have royalty obligations upon sales of products developed under the license agreements. At this time, we are unable to estimate the timing and amounts of payments as the obligations are based on future development of the licensed products.

Leases

Leases	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Leases	Leases We have operating leases for office space, laboratory operations, research and development facilities, manufacturing locations, warehouses and certain equipment. We determine if a contract contains a lease at inception or modification of a contract. Our leases generally do not provide an implicit interest rate, and we therefore use our incremental borrowing rate as the discount rate when measuring operating lease liabilities. The incremental borrowing rate represents an estimate of the interest rate we would incur at lease commencement to borrow an amount equal to the lease payments on a collateralized basis over the term of the lease within a particular currency environment. We used the incremental borrowing rates as of January 1, 2019 for operating leases that commenced prior to that date. Many of our leases contain rental escalation, renewal options and/or termination options that are factored into our determination of lease payments as appropriate. Variable lease payment amounts that cannot be determined at the commencement of the lease are not included in the right-to-use assets or liabilities. The following table presents the lease balances within the Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Classification on the Balance Sheet December 31, 2019 Assets Operating lease assets Operating lease right-of-use assets $ 39,380 Finance lease assets Property, plant and equipment, net 6,789 Liabilities Current Operating lease liabilities Current maturities of operating leases 12,038 Accrued expenses Current maturities of finance leases 2,743 Long-term Operating lease liabilities Operating lease liabilities 27,665 Other long-term liabilities Finance lease liabilities $ 4,046 Weighted average remaining lease term Operating leases 5.6 years Finance leases 2.6 years Weighted average discount rate Operating leases 6.3 % Finance leases 3.0 % The following table reconciles the undiscounted future minimum lease payments (displayed by year and in the aggregate) under noncancelable operating leases with terms of more than one year to the total operating lease liabilities recognized on our Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Operating Finance 2020 $ 12,750 $ 2,871 2021 6,526 2,186 2022 5,777 1,155 2023 5,450 563 2024 4,297 233 Thereafter 17,186 — Total undiscounted future minimum lease payments 51,986 7,008 Less: Difference between lease payments and discounted lease liabilities 12,283 219 Total lease liabilities $ 39,703 $ 6,789 Expense under operating leases and finance leases was $20.2 million and $3.1 million , respectively, for the year ended December 31, 2019 , and includes $3.4 million of variable lease costs. Operating lease costs and finance lease costs are included within Operating loss in the Consolidated Statement of Operations. Short-term lease costs were not material. Supplemental cash flow information is as follows: (in thousands) For the year ended December 31, 2019 Operating cash out flows from operating leases $ 20,712 Operating cash out flows from finance leases 374 Financing cash out flows from finance leases 2,833 Total $ 23,919
Leases	Leases We have operating leases for office space, laboratory operations, research and development facilities, manufacturing locations, warehouses and certain equipment. We determine if a contract contains a lease at inception or modification of a contract. Our leases generally do not provide an implicit interest rate, and we therefore use our incremental borrowing rate as the discount rate when measuring operating lease liabilities. The incremental borrowing rate represents an estimate of the interest rate we would incur at lease commencement to borrow an amount equal to the lease payments on a collateralized basis over the term of the lease within a particular currency environment. We used the incremental borrowing rates as of January 1, 2019 for operating leases that commenced prior to that date. Many of our leases contain rental escalation, renewal options and/or termination options that are factored into our determination of lease payments as appropriate. Variable lease payment amounts that cannot be determined at the commencement of the lease are not included in the right-to-use assets or liabilities. The following table presents the lease balances within the Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Classification on the Balance Sheet December 31, 2019 Assets Operating lease assets Operating lease right-of-use assets $ 39,380 Finance lease assets Property, plant and equipment, net 6,789 Liabilities Current Operating lease liabilities Current maturities of operating leases 12,038 Accrued expenses Current maturities of finance leases 2,743 Long-term Operating lease liabilities Operating lease liabilities 27,665 Other long-term liabilities Finance lease liabilities $ 4,046 Weighted average remaining lease term Operating leases 5.6 years Finance leases 2.6 years Weighted average discount rate Operating leases 6.3 % Finance leases 3.0 % The following table reconciles the undiscounted future minimum lease payments (displayed by year and in the aggregate) under noncancelable operating leases with terms of more than one year to the total operating lease liabilities recognized on our Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Operating Finance 2020 $ 12,750 $ 2,871 2021 6,526 2,186 2022 5,777 1,155 2023 5,450 563 2024 4,297 233 Thereafter 17,186 — Total undiscounted future minimum lease payments 51,986 7,008 Less: Difference between lease payments and discounted lease liabilities 12,283 219 Total lease liabilities $ 39,703 $ 6,789 Expense under operating leases and finance leases was $20.2 million and $3.1 million , respectively, for the year ended December 31, 2019 , and includes $3.4 million of variable lease costs. Operating lease costs and finance lease costs are included within Operating loss in the Consolidated Statement of Operations. Short-term lease costs were not material. Supplemental cash flow information is as follows: (in thousands) For the year ended December 31, 2019 Operating cash out flows from operating leases $ 20,712 Operating cash out flows from finance leases 374 Financing cash out flows from finance leases 2,833 Total $ 23,919

Segments

Segments	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Segments	Segments We manage our operations in two reportable segments, pharmaceuticals and diagnostics. The pharmaceuticals segment consists of our pharmaceutical operations in Chile, Mexico, Ireland, Israel and Spain, Rayaldee product sales and our pharmaceutical research and development. The diagnostics segment primarily consists of our clinical laboratory operations through BioReference and our point-of-care operations. There are no significant inter-segment sales. We evaluate the performance of each segment based on operating profit or loss. There is no inter-segment allocation of interest expense and income taxes. Information regarding our operations and assets for our operating segments and the unallocated corporate operations as well as geographic information are as follows: For the years ended December 31, (In thousands) 2019 2018 2017 Revenue from services: Pharmaceutical $ — $ — $ — Diagnostics 716,434 813,248 782,710 Corporate — — $ 716,434 $ 813,248 $ 782,710 Revenue from products: Pharmaceutical $ 112,184 $ 107,112 $ 107,759 Diagnostics — — Corporate — — $ 112,184 $ 107,112 $ 107,759 Revenue from transfer of intellectual property and other: Pharmaceutical $ 73,317 $ 69,906 $ 75,537 Diagnostics — — Corporate — — $ 73,317 $ 69,906 $ 75,537 Operating loss: Pharmaceutical $ (109,062 ) $ (82,641 ) $ (84,287 ) Diagnostics (123,359 ) (44,942 ) (136,540 ) Corporate (41,631 ) (43,614 ) (55,615 ) $ (274,052 ) $ (171,197 ) $ (276,442 ) Depreciation and amortization: Pharmaceutical $ 30,073 $ 28,007 $ 27,513 Diagnostics 63,675 69,246 74,442 Corporate 59 91 138 $ 93,807 $ 97,344 $ 102,093 Loss from investment in investees: Pharmaceutical $ (2,900 ) $ (10,822 ) $ (12,646 ) Diagnostics — (3,675 ) (1,825 ) Corporate — — — $ (2,900 ) $ (14,497 ) $ (14,471 ) Revenues: U.S. $ 751,099 $ 837,509 $ 803,853 Ireland 81,170 78,102 80,905 Chile 33,642 41,216 44,286 Spain 18,747 18,195 18,285 Israel 8,769 9,479 13,951 Mexico 8,032 5,598 4,605 Other 476 167 121 $ 901,935 $ 990,266 $ 966,006 (In thousands) December 31, December 31, Assets: Pharmaceutical $ 1,174,639 $ 1,236,499 Diagnostics 1,035,112 1,162,160 Corporate 99,521 52,413 $ 2,309,272 $ 2,451,072 Goodwill: Pharmaceutical $ 237,131 $ 247,407 Diagnostics 434,809 452,786 Corporate — — $ 671,940 $ 700,193 No customer represented more than 10% of our total consolidated revenue during the years ended December 31, 2019 , 2018 and 2017. As of December 31, 2019 and 2018, no customer represented more than 10% of our accounts receivable balance. The following table reconciles our Property, plant and equipment, net between U.S. and foreign jurisdictions: (In thousands) December 31, 2019 December 31, 2018 PP&E: U.S. $ 62,158 $ 76,907 Foreign 64,953 67,767 Total $ 127,111 $ 144,674

Fair Value Measurements

Fair Value Measurements	12 Months Ended
	Dec. 31, 2019
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements We record fair values at an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement determined based on assumptions that market participants would use in pricing an asset or liability. We utilize a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value. These tiers include: Level 1, defined as observable inputs such as quoted prices in active markets; Level 2, defined as inputs other than quoted prices in active markets that are either directly or indirectly observable; and Level 3, defined as unobservable inputs in which little or no market data exists, therefore requiring an entity to develop its own assumptions. As of December 31, 2019 , we have equity securities (refer to Note 4), forward foreign currency exchange contracts for inventory purchases (refer to Note 19) and contingent consideration related to the acquisitions of CURNA, OPKO Diagnostics and OPKO Renal that are required to be measured at fair value on a recurring basis. In addition, in connection with our investment and our consulting agreement with BioCardia, we record the related BioCardia options at fair value as well as the warrants from COCP, InCellDx, Inc., Xenetic and Phio. Our financial assets and liabilities measured at fair value on a recurring basis are as follows: Fair value measurements as of December 31, 2019 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities $ 18,870 $ — $ — $ 18,870 Common stock options/warrants — 120 — 120 Forward contracts — 133 — 133 Total assets $ 18,870 $ 253 $ — $ 19,123 Liabilities: Contingent consideration: $ — $ — $ 9,683 9,683 Total liabilities $ — $ — $ 9,683 $ 9,683 Fair value measurements as of December 31, 2018 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities $ 26,313 $ — $ — $ 26,313 Common stock options/warrants — 855 — 855 Forward contracts — 21 — 21 Total assets $ 26,313 $ 876 $ — $ 27,189 Liabilities: Contingent consideration: $ — $ — $ 24,537 $ 24,537 Total liabilities $ — $ — $ 24,537 $ 24,537 The carrying amount and estimated fair value of our 2025 Notes, as well as the applicable fair value hierarchy tiers, are contained in the table below. The fair value of the 2025 Notes is determined using quoted prices in active markets. December 31, 2019 (In thousands) Carrying Value Total Fair Value Level 1 Level 2 Level 3 2025 Notes $ 148,140 $ 158,174 $ 158,174 $ — $ — There have been no transfers between Level 1 and Level 2 and no transfers to or from Level 3 of the fair value hierarchy. As of December 31, 2019 and 2018 , the carrying value of our other significant financial instrument assets and liabilities approximates their fair value due to their short-term nature or variable rate of interest. The following tables reconcile the beginning and ending balances of our Level 3 assets and liabilities as of December 31, 2019 and 2018 : December 31, 2019 (In thousands) Contingent consideration Balance at December 31, 2018 $ 24,537 Total losses (gains) for the period: Included in results of operations (14,854 ) Balance at December 31, 2019 $ 9,683 December 31, 2018 (In thousands) Contingent Balance at December 31, 2017 $ 41,353 Total losses (gains) for the period: Included in results of operations (16,816 ) Balance at December 31, 2018 $ 24,537 The estimated fair values of our financial instruments have been determined by using available market information and what we believe to be appropriate valuation methodologies. We use the following methods and assumptions in estimating fair value: Contingent consideration – We estimate the fair value of the contingent consideration utilizing a discounted cash flow model for the expected payments based on estimated timing and expected revenues. We use several discount rates depending on each type of contingent consideration related to OPKO Diagnostics, CURNA and OPKO Renal transactions. If estimated future sales were to decrease by 10% , the contingent consideration related to OPKO Renal, which accounts for the majority of the change in our contingent consideration liability, would decrease by $0.8 million . As of December 31, 2019 , of the $9.7 million of contingent consideration, $2.4 million is recorded in Accrued expenses and $7.3 million is recorded in Other long-term liabilities. As of December 31, 2018 , of the $24.6 million of contingent consideration, $2.4 million is recorded in Accrued expenses and $22.2 million is recorded in Other long-term liabilities.

Derivative Contracts

Derivative Contracts	12 Months Ended
	Dec. 31, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Contracts	Derivative Contracts The following table summarizes the fair values and the presentation of our derivative financial instruments in the Consolidated Balance Sheets: (In thousands) Balance Sheet Component December 31, 2019 December 31, Derivative financial instruments: Common stock options/warrants Investments, net $ 120 $ 855 Forward contracts Unrealized gains on forward contracts are recorded in Other current assets and prepaid expenses. Unrealized (losses) on forward contracts are recorded in Accrued expenses. $ 133 $ 21 We enter into foreign currency forward exchange contracts with respect to the risk of exposure to exchange rate differences arising from inventory purchases on letters of credit. Under these forward contracts, for any rate above or below the fixed rate, we receive or pay the difference between the spot rate and the fixed rate for the given amount at the settlement date. To qualify the derivative instrument as a hedge, we are required to meet strict hedge effectiveness and contemporaneous documentation requirements at the initiation of the hedge and assess the hedge effectiveness on an ongoing basis over the life of the hedge. At December 31, 2019 and 2018 , our derivative financial instruments do not meet the documentation requirements to be designated as hedges. Accordingly, we recognize the changes in Fair value of derivative instruments, net in our Consolidated Statement of Operations. The following table summarizes the losses and gains recorded for the years ended December 31, 2019 , 2018 and 2017 : For the years ended December 31, (In thousands) 2019 2018 2017 Derivative gain (loss): Common stock options/warrants $ (601 ) $ 2,643 $ (2,533 ) 2033 Senior Notes — — 3,185 Forward contracts $ 775 $ 400 $ (600 ) Total $ 174 $ 3,043 $ 52

Selected Quarterly Financial Da

Selected Quarterly Financial Data (Unaudited)	12 Months Ended
	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Selected Quarterly Financial Data (Unaudited)	Selected Quarterly Financial Data (Unaudited) For the 2019 Quarters Ended (In thousands, except per share data) March 31 June 30 September 30 December 31 Total revenues $ 222,451 $ 226,368 $ 228,772 $ 224,344 Total costs and expenses 297,769 273,628 267,783 336,807 Net income (loss) (80,762 ) (59,806 ) (62,007 ) (112,350 ) Earnings (loss) per share, basic and diluted $ (0.14 ) $ (0.10 ) $ (0.11 ) $ (0.18 ) For the 2018 Quarters Ended (In thousands, except per share data) March 31 June 30 September 30 December 31 Total revenues $ 254,914 $ 263,685 $ 249,815 $ 221,852 Total costs and expenses 297,525 268,793 283,279 311,866 Net income (loss) (43,114 ) (6,201 ) (27,655 ) (76,070 ) Earnings (loss) per share, basic and diluted $ (0.08 ) $ (0.01 ) $ (0.05 ) $ (0.13 )

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2019
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On February 25, 2020, we entered into a credit agreement with an affiliate of Dr. Frost, pursuant to which the lender committed to provide us with an unsecured line of credit in the amount of $100 million . Borrowings under the line of credit will bear interest at a rate of 11% per annum and may be repaid and reborrowed at any time. The credit agreement includes various customary remedies for the lender following an event of default, including the acceleration of repayment of outstanding amounts under line of credit. The line of credit matures on February 25, 2025. The line of credit also calls for a commitment fee equal to 0.25% per annum of the unused portion of the line. On February 25, 2020, BioReference and certain of its subsidiaries entered into Amendment No. 11 to the Credit Agreement, which amended the Credit Agreement to provide that the fixed charge coverage ratio requirement set forth in the Credit Agreement would not be tested for the quarter ended December 31, 2019, with respect to availability calculated on January 29, 2020 and January 30, 2020, subject, in the case of testing for the quarter ended December 31, 2019, to (i) there having been no event of default occurring and (ii) availability under the revolving facility exceeding 10% of the total revolving commitment, for at least 30 consecutive days for the period ended on December 31, 2019, excluding December 18, 2019. The other terms of the Credit Agreement remain unchanged. We have reviewed all subsequent events and transactions that occurred after the date of our December 31, 2019

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Basis of presentation	Basis of presentation.
Principles of consolidation	Principles of consolidation. The accompanying Consolidated Financial Statements include the accounts of OPKO Health, Inc. and of our wholly-owned subsidiaries. All intercompany accounts and transactions are eliminated in consolidation.
Use of estimates	Use of estimates. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ significantly from these estimates.
Cash and cash equivalents	Cash and cash equivalents. Cash and cash equivalents include short-term, interest-bearing instruments with original maturities of 90 days or less at the date of purchase. We also consider all highly liquid investments with original maturities at the date of purchase of 90 days
Inventories	Inventories. Inventories are valued at the lower of cost and net realizable value. Cost is determined by the first-in, first-out method. We consider such factors as the amount of inventory on hand, estimated time required to sell such inventories, remaining shelf-life, and current market conditions to determine whether inventories are stated at the lower of cost and net realizable value. Inventories at our diagnostics segment consist primarily of purchased laboratory supplies, which is used in our testing laboratories. Inventory obsolescence expense for the years ended December 31, 2019 and 2018 was $2.3 million and $1.9 million , respectively. Pre-launch inventories. We may accumulate commercial quantities of certain product candidates prior to the date we anticipate that such products will receive final U.S. FDA approval. The accumulation of such pre-launch inventories involves the risk that such products may not be approved for marketing by the FDA on a timely basis, or ever. This risk notwithstanding, we may accumulate pre-launch inventories of certain products when such action is appropriate in relation to the commercial value of the product launch opportunity. In accordance with our policy, this pre-launch inventory is expensed.
Goodwill and intangible assets	Goodwill and intangible assets. Goodwill represents the difference between the purchase price and the estimated fair value of the net assets acquired accounted for by the acquisition method of accounting. Refer to Note 5. Goodwill, in-process research and development (“IPR&D”) and other intangible assets acquired in business combinations, licensing and other transactions at December 31, 2019 and 2018 , was $1.8 billion and $2.0 billion , respectively. Assets acquired and liabilities assumed in business combinations, licensing and other transactions are generally recognized at the date of acquisition at their respective fair values. Any excess of the purchase price over the estimated fair values of the net assets acquired is recognized as goodwill. At acquisition, we generally determine the fair value of intangible assets, including IPR&D, using the “income method.” Subsequent to acquisition, goodwill and indefinite lived intangible assets are tested at least annually as of October 1 for impairment, or when events or changes in circumstances indicate it is more likely than not that the carrying amount of such assets may not be recoverable. Goodwill was $671.9 million and $700.2 million , respectively, at December 31, 2019 and 2018 . Estimating the fair value of a reporting unit for goodwill impairment is highly sensitive to changes in projections and assumptions and changes in assumptions could potentially lead to impairment. We perform sensitivity analyses around our assumptions in order to assess the reasonableness of the assumptions and the results of our testing. Ultimately, potential changes in these assumptions may impact the estimated fair value of a reporting unit and result in an impairment if the fair value of such reporting unit is less than its carrying value. Net intangible assets other than goodwill were $1.1 billion and $1.3 billion , including IPR&D of $590.2 million and $635.6 million , respectively, at December 31, 2019 and 2018 . Intangible assets are highly vulnerable to impairment charges, particularly newly acquired assets for recently launched products and IPR&D. Considering the high risk nature of research and development and the industry’s success rate of bringing developmental compounds to market, IPR&D impairment charges are likely to occur in future periods. Estimating the fair value of IPR&D for potential impairment is highly sensitive to changes in projections and assumptions and changes in assumptions could potentially lead to impairment. Upon obtaining regulatory approval, IPR&D assets are then accounted for as a finite-lived intangible asset and amortized on a straight-line basis over its estimated useful life. If the project is abandoned, the IPR&D asset is charged to expense. Finite lived intangible assets are tested for impairment when events or changes in circumstances indicate it is more likely than not that the carrying amount of such assets may not be recoverable. The testing includes a comparison of the carrying amount of the asset to its estimated undiscounted future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated undiscounted future cash flows, then an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset. Impairment charges for the year ended December 31, 2019 were $92.4 million and consist of a goodwill impairment charge of $26.2 million to write the carrying amount of the OPKO Diagnostics, CURNA and Transition Therapeutics reporting units down to their estimated fair value, an impairment charge of $44.8 million to write our IPR&D assets for OPK88003 and CURNA’s platform technology for oligonucleotide therapeutics down to their estimated fair value, and an impairment charge of $20.7 million to write our intangible asset for the Claros Analyzer down to its estimated fair value as a result of our testing. These impairment charges for the year ended December 31, 2019 , resulted from liquidity constraints, longer than expected development timelines and changes in the competitive landscape, which resulted in changes to our estimates and assumptions of the expected future cash flows of the reporting units focused on the development of the Claros Analyzer, OPK88003 and CURNA’s platform technology. We believe that our estimates and assumptions are reasonable and otherwise consistent with assumptions that marketplace participants would use in their estimates of fair value. However, if future results are not consistent with our estimates and assumptions, then we may be exposed to an impairment charge, which could be material. For the year ended December 31, 2019, the results of operations of our BioReference reporting unit were below management’s long-term forecast of expected cash flows for the year ending December 31, 2019 due to a change in reimbursement coverage for our 4Kscore test and other market factors. Our 2019 impairment test of the BioReference reporting unit indicated an excess of estimated fair value over the carrying amount of approximately 11% . If we are unable to obtain appropriate reimbursement for our services and experience future declines in operating results versus forecast, then our estimates of the fair value of the BioReference reporting unit may decrease, and the resulting impairment could be significant. We recorded a goodwill impairment charge of $11.7 million in Asset impairment charges in our Consolidated Statement of Operations for the year ended December 31, 2018 to write the carrying amount of the FineTech reporting unit down to its estimated fair value. No goodwill impairment was recorded for the year ended December 31, 2017. We recorded an impairment charge of $10.1 million in Asset impairment charges in our Consolidated Statement of Operations for the year ended December 31, 2018 to write our IPR&D assets for Alpharen and OPK88004 down to their estimated fair value as a result of our testing and we recorded an impairment charge of $13.2 million for the year ended December 31, 2017 to write our intangible asset for VARUBI™ down to its estimated fair value as a result of our testing. We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives, ranging from 3 to 20
Fair value measurements	Fair value measurements . The carrying amounts of our cash and cash equivalents, accounts receivable, accounts payable and short-term debt approximate their fair value due to the short-term maturities of these instruments. Investments that are considered equity securities as of December 31, 2019 and 2018 are predominately carried at fair value. Our debt under the credit agreement with JPMorgan Chase Bank, N.A. approximates fair value due to the variable rate of interest.
Contingent consideration	Contingent consideration . Each period we revalue the contingent consideration obligations associated with certain prior acquisitions to their fair value and record increases in the fair value as contingent consideration expense and decreases in the fair value as a reduction in contingent consideration expense. Changes in contingent consideration result from changes in the assumptions regarding probabilities of successful achievement of related milestones, the estimated timing in which the milestones are achieved and the discount rate used to estimate the fair value of the liability. Contingent consideration may change significantly as our development programs progress, revenue estimates evolve and additional data is obtained, impacting our assumptions. The assumptions used in estimating fair value require significant judgment. The use of different assumptions and judgments could result in a materially different estimate of fair value which may have a material impact on our results from operations and financial position.
Derivative financial instruments	Derivative financial instruments. We record derivative financial instruments on our Consolidated Balance Sheet at their fair value and recognize the changes in the fair value in our Consolidated Statement of Operations when they occur, the only exception being derivatives that qualify as hedges. For the derivative instrument to qualify as a hedge, we are required to meet strict hedge effectiveness and contemporaneous documentation requirements at the initiation of the hedge and assess the hedge effectiveness on an ongoing basis over the life of the hedge. At December 31, 2019 and 2018
Property, plant, equipment	Property, plant and equipment. Property, plant and equipment are recorded at cost. Depreciation is provided using the straight-line method over the estimated useful lives of the assets and includes amortization expense for assets capitalized under finance leases. The estimated useful lives by asset class are as follows: software - 3 years , machinery, medical and other equipment - 5 - 8 years , furniture and fixtures - 5 - 12 years , leasehold improvements - the lesser of their useful life or the lease term, buildings and improvements - 10 - 40 years , and automobiles - 3 - 5 years . Expenditures for repairs and maintenance are charged to expense as incurred. Depreciation expense was $29.0 million , $29.4 million and $30.6 million for the years ended December 31, 2019 , 2018 and 2017 , respectively. Assets held under finance leases are included within Property, plant and equipment, net in our Consolidated Balance Sheets and are amortized over the shorter of their useful lives or the expected term of their related leases.
Impairment of long-lived assets	Impairment of long-lived assets. Long-lived assets, such as property and equipment, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to estimated undiscounted future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future cash flows, then an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset.
Income taxes	Income taxes. Income taxes are accounted for under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and the respective tax bases and for operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in operations in the period that includes the enactment date. We periodically evaluate the realizability of our net deferred tax assets. Our tax accruals are analyzed periodically and adjustments are made as events occur to warrant such adjustment. Valuation allowances on certain U.S. deferred tax assets and non-U.S. deferred tax assets are established, because realization of these tax benefits through future taxable income does not meet the more-likely-than-not threshold. On December 22, 2017, the Tax Act was enacted into law and the new legislation contains several key tax provisions, including a reduction of the corporate income tax rate from 35% to 21% effective January 1, 2018 and a one-time mandatory transition tax on accumulated foreign earnings, among others. We were required to recognize the effect of the tax law changes in the period of enactment, such as remeasuring our U.S. deferred tax assets and liabilities, as well as reassessing the net realizability of our deferred tax assets and liabilities. Effective January 1, 2018, the Tax Act provides for a new GILTI provision. Under the GILTI provision, certain foreign subsidiary earnings in excess of an allowable return on the foreign subsidiary’s tangible assets are included in U.S. taxable income. The Company currently estimates GILTI will be immaterial for the years ended December 31, 2019 and 2018, although interpretive guidance continues to be issued and future guidance may impact this analysis. The Company has not recorded any deferred taxes for future GILTI inclusions as any future inclusions are expected to be treated as a period expense and offset by net operating loss carryforwards in the U.S. We operate in various countries and tax jurisdictions globally. For the year ended December 31, 2019, the tax rate differed from the U.S. federal statutory rate of 21% primarily due to the valuation allowance against certain U.S. and non-U.S. deferred tax assets, the relative mix in earnings and losses in the U.S. versus foreign tax jurisdictions, and the impact of certain discrete tax events and operating results in tax jurisdictions which do not result in a tax benefit. Included in Other long-term liabilities is an accrual of $2.9 million related to uncertain tax positions involving income recognition. We recognize that local tax law is inherently complex and the local taxing authorities may not agree with certain tax positions taken. In connection with an examination of a 2014 and 2015 tax return in a foreign jurisdiction, the taxing authority has issued an initial income tax assessment of approximately $66 million (including interest). We are protesting it as we believe that the proposed adjustment is without technical merit. We expect to exhaust all administrative and judicial remedies necessary to resolve the matter, which could be a lengthy process. There can be no assurance that this matter will be resolved in our favor, and an adverse outcome, or any future tax examinations involving similar assertions, could have a material effect on our financial condition, results of operations and cash flows.
Revenue recognition	Shipping and handling costs. We do not charge customers for shipping and handling costs. Shipping and handling costs are classified as Cost of revenues in the Consolidated Statement of Operations. Revenue recognition . We recognize revenue when a customer obtains control of promised goods or services in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers (“Topic 606”). The amount of revenue that is recorded reflects the consideration that we expect to receive in exchange for those goods or services. We apply the following five-step model in order to determine this amount: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) we satisfy a performance obligation.
Concentrations of credit risk and allowance for doubtful accounts	Concentration of credit risk and allowance for doubtful accounts . Financial instruments that potentially subject us to concentrations of credit risk consist primarily of accounts receivable. Substantially all of our accounts receivable are with either companies in the health care industry or patients. However, credit risk is limited due to the number of our clients as well as their dispersion across many different geographic regions. While we have receivables due from federal and state governmental agencies, we do not believe that such receivables represent a credit risk since the related healthcare programs are funded by federal and state governments, and payment is primarily dependent upon submitting appropriate documentation. At December 31, 2019 and 2018 , receivable balances (net of contractual adjustments) from Medicare and Medicaid were 6% and 7% , respectively, of our consolidated Accounts receivable, net. The portion of our accounts receivable due from individual patients comprises the largest portion of credit risk. At December 31, 2019 and 2018 , receivables due from patients represent approximately 2.5% and 2.9% , respectively, of our consolidated Accounts receivable, net.
Equity-based compensation	Equity-based compensation.
Research and development expenses	Research and development expenses. Research and development expenses include external and internal expenses. External expenses include clinical and non-clinical activities performed by contract research organizations, lab services, purchases of drug and diagnostic product materials and manufacturing development costs. Research and development employee-related expenses include salaries, benefits and equity-based compensation expense. Other internal research and development expenses are incurred to support overall research and development activities and include expenses related to general overhead and facilities. We expense these costs in the period in which they are incurred. We estimate our liabilities for research and development expenses in order to match the recognition of expenses to the period in which the actual services are received. As such, accrued liabilities related to third party research and development activities are recognized based upon our estimate of services received and degree of completion of the services in accordance with the specific third party contract. Research and development expense includes costs for in-process research and development projects acquired in asset acquisitions which have not reached technological feasibility and which have no alternative future use. For in-process research and development projects acquired in business combinations, the in-process research and development project is capitalized and evaluated for impairment until the development process has been completed. Once the development process has been completed the asset will be amortized over its remaining useful life.
Segment reporting	Segment reporting. Our chief operating decision-maker (“CODM”) is Phillip Frost, M.D., our Chairman and Chief Executive Officer. Our CODM reviews our operating results and operating plans and makes resource allocation decisions on a Company-wide or aggregate basis. We manage our operations in two reportable segments, pharmaceutical and diagnostics. The pharmaceutical segment consists of our pharmaceutical operations in Chile, Mexico, Ireland, Israel and Spain, Rayaldee
Foreign currency translations	Foreign currency translation
Variable interest entities	Variable interest entities.
Investments	Investments. We have made strategic investments in development stage and emerging companies. We record these investments as equity method investments or as equity securities based on our percentage of ownership and whether we have significant influence over the operations of the investees. For investments classified under the equity method of accounting, we record our proportionate share of their losses in Losses from investments in investees in our Consolidated Statement of Operations. Refer to Note 4. For investments classified as equity securities, we record changes in their fair value as Other income (expense) in our Consolidated Statement of Operations based on their closing price per share at the end of each reporting period, unless the equity security does not have a readily determinable fair value. Refer to Note 4.
Recent accounting pronouncements	Recently adopted accounting pronouncements . In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, “Leases (Topic 842),” which requires organizations that lease assets with lease terms of more than 12 months to recognize assets and liabilities for the rights and obligations created by those leases on their balance sheets. ASU 2016-02, as amended and codified under Topic 842, requires new qualitative and quantitative disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. As required, we adopted Topic 842 on January 1, 2019 and used the modified retrospective approach for all lease arrangements at the beginning or the period of adoption. Results for reporting periods beginning January 1, 2019 are presented under Topic 842, while prior period amounts were not adjusted and continue to be reported in accordance our historic accounting under ASC 840. For leases that commenced before the effective date of Topic 842, we elected the use of permitted practical expedients and did not reassess the following: (i) whether any expired or existing contracts contain leases; (ii) the lease classification for any expired or existing leases; and (iii) initial direct costs for any existing leases. We also elected the policy of not recording leases on our Consolidated Balance Sheet when the leases have terms of 12 months or less, and we elected not to separate nonlease components from lease components and instead account for each separate lease component and the nonlease components associated with that lease component as a single lease component. The adoption of Topic 842 resulted in the recognition of operating lease liabilities of approximately $33.7 million and operating lease right-to-use assets of approximately $33.3 million as of March 31, 2019, primarily related to operating leases for our diagnostic facilities, based on the present value of lease payments over the lease term. There was no cumulative-effect adjustment to beginning Accumulated deficit on the Consolidated Balance Sheet. The accounting for our finance leases remains substantially unchanged, as finance lease liabilities and their corresponding right-to-use assets were already recorded on the Consolidated Balance Sheet under the previous guidance. The adoption of Topic 842 did not have a significant effect on our results of operations or cash flows. Refer to Note 16 for additional disclosures required by Topic 842. In February 2018, the FASB issued ASU No. 2018-02, "Income Statement-Reporting Comprehensive Income (Topic 220)." This standard provides an option to reclassify stranded tax effects within accumulated other comprehensive loss to retained earnings due to the U.S. federal corporate income tax rate change in the Tax Cuts and Jobs Act of 2017. This standard is effective for interim and annual reporting periods beginning after December 15, 2018. We adopted this standard effective January 1, 2019 with the election not to reclassify immaterial amounts of stranded tax effects from accumulated other comprehensive loss to retained earnings. In June 2018, the FASB issued ASU No. 2018-07, “Compensation - Stock Compensation (Topic 718),” which expands the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from non-employees. The adoption of ASU 2018-07 on January 1, 2019, did not have a significant impact on our Consolidated Financial Statements. Pending accounting pronouncements . In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments,” which amends the impairment model by requiring entities to use a forward-looking approach based on expected losses rather than incurred losses to estimate credit losses on certain types of financial instruments, including trade receivables. This may result in the earlier recognition of allowances for losses. The ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. We are currently evaluating the impact of this new guidance on our Consolidated Financial Statements.

Investments (Tables)

Investments (Tables)	12 Months Ended
	Dec. 31, 2019
Business Combinations [Abstract]
Accounting Method, Carrying Value and Underlying Equity in Net Assets of Unconsolidated Investments	The following table reflects the accounting method, carrying value and underlying equity in net assets of our unconsolidated investments as of December 31, 2019 : (in thousands) Investment type Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ 826 $ 9,931 Variable interest entity, equity method 894 — Equity securities 18,870 Equity securities with no readily determinable fair value 36 Warrants and options 120 Total carrying value of investments $ 20,746
Schedule of Net Gains and Losses on Equity Securities	(in thousands) Equity Securities For the year ended December 31, 2019 Net gains and losses recognized during the period on equity securities $ (7,443 ) Less: Net gains and losses realized during the period on equity securities — Unrealized net gains recognized during the period on equity securities still held at the reporting date $ (7,443 )

Composition of Certain Financ_2

Composition of Certain Financial Statement Captions (Tables)	12 Months Ended
	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Composition of Certain Financial Statement Captions	For the years ended December 31, (In thousands) 2019 2018 Accounts receivable, net Accounts receivable $ 136,551 $ 145,665 Less: allowance for doubtful accounts (1,934 ) (1,758 ) $ 134,617 $ 143,907 Inventories, net Consumable supplies $ 23,005 $ 23,264 Finished products 25,142 15,259 Work in-process 3,238 2,473 Raw materials 4,586 4,259 Less: inventory reserve (2,537 ) (2,956 ) $ 53,434 $ 42,299 Other current assets and prepaid expenses Taxes recoverable $ 19,808 $ 15,708 Other receivables $ 3,262 $ 2,368 Prepaid supplies 8,147 9,693 Prepaid insurance 3,486 3,436 Other 15,839 3,847 $ 50,542 $ 35,052 Property, plant and equipment, net: Machinery, medical and other equipment $ 165,501 $ 147,757 Leasehold improvements 33,606 34,607 Furniture and fixtures 12,631 12,737 Automobiles and aircraft 10,029 10,133 Software 13,861 13,425 Building 18,462 18,554 Land 2,422 2,453 Construction in process 7,044 16,670 Less: accumulated depreciation (136,445 ) (111,662 ) $ 127,111 $ 144,674 Intangible assets, net: Customer relationships $ 445,408 $ 446,296 Technologies 296,246 340,729 Trade names 49,786 50,404 Covenants not to compete 16,318 16,322 Licenses 5,766 5,766 Product registrations 7,578 7,861 Other 6,094 5,613 Less: accumulated amortization (298,234 ) (258,539 ) $ 528,962 $ 614,452 For the years ended December 31, (In thousands) 2019 2018 Accrued expenses: Contract liabilities $ 19,196 $ 63,503 Employee benefits 33,671 45,621 Commitments and Contingencies 38,635 15,327 Clinical trials 8,122 10,401 Professional fees 1,333 2,952 Finance leases short-term 2,743 3,280 Milestone payment — 4,871 Contingent consideration 2,375 2,375 Other 58,850 55,183 $ 164,925 $ 203,513 Other long-term liabilities: Line of credit $ 44,749 $ 105,198 Contract liabilities 2,571 27,566 Contingent consideration 7,308 22,162 Finance leases long-term 4,046 5,620 Mortgages and other debts payable 3,906 4,654 Other 25,224 33,768 $ 87,804 $ 198,968
Summary of Valuation Allowance	The following table reflects the changes in the allowance for doubtful accounts, provision for inventory reserve and tax valuation allowance accounts: (In thousands) Beginning balance Charged to expense Written-off Ending balance 2019 Allowance for doubtful accounts $ (1,758 ) (469 ) 293 $ (1,934 ) Inventory reserve $ (2,956 ) (2,349 ) 2,768 $ (2,537 ) Tax valuation allowance $ (154,916 ) (38,340 ) — $ (193,256 ) 2018 Allowance for doubtful accounts $ (1,446 ) (665 ) 353 $ (1,758 ) Inventory reserve $ (6,565 ) (1,915 ) 5,524 $ (2,956 ) Tax valuation allowance $ (142,062 ) (12,854 ) — $ (154,916 )
Schedule of Goodwill	The following table summarizes the changes in Goodwill by reporting unit during the years ended December 31, 2019 and 2018 . 2019 2018 (In thousands) Balance at January 1 Goodwill impairment Foreign exchange and other Balance at December 31st Balance at January 1 Goodwill impairment Foreign exchange and other Balance at December 31 Pharmaceuticals CURNA $ 4,827 $ (4,827 ) $ — $ — $ 4,827 $ — $ — $ 4,827 Rayaldee 87,314 — (1,709 ) 85,605 91,295 — (3,981 ) 87,314 FineTech — — — — 11,698 (11,698 ) — — OPKO Biologics 139,784 — 139,784 139,784 — — 139,784 OPKO Chile 4,614 (266 ) 4,348 5,203 — (589 ) 4,614 OPKO Health Europe 7,546 (152 ) 7,394 7,898 — (352 ) 7,546 Transition Therapeutics 3,322 (3,421 ) 99 — 3,608 — (286 ) 3,322 Diagnostics BioReference 434,809 — — 434,809 434,809 — — 434,809 OPKO Diagnostics 17,977 (17,977 ) — — 17,977 — — 17,977 $ 700,193 $ (26,225 ) $ (2,028 ) $ 671,940 $ 717,099 $ (11,698 ) $ (5,208 ) $ 700,193

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2019
Debt Disclosure [Abstract]
Schedule of Principal Amounts, Unamortized Discount and Net Carrying Amounts	The following table sets forth information related to the 2025 Notes which is included in our Consolidated Balance Sheet as of December 31, 2019 : (In thousands) 2025 Senior Notes Discount Debt Issuance Cost Total Balance at December 31, 2018 $ — $ — $ — $ — Issuance of 4.50% convertible notes 200,000 (52,600 ) (5,720 ) 141,680 Amortization of debt discount and debt issuance costs — 5,826 634 6,460 Balance at December 31, 2019 $ 200,000 $ (46,774 ) $ (5,086 ) $ 148,140 At December 31, 2019 and 2018 , we had notes payable and other debt (excluding the 2033 Senior Notes, the 2023 Convertible Notes, the 2025 Notes, the Credit Agreement and amounts outstanding under lines of credit described above) as follows: (In thousands) December 31, December 31, Current portion of notes payable $ 2,494 $ 2,560 Other long-term liabilities 4,723 5,693 Total $ 7,217 $ 8,253
Summary of Lines of Credit	The following table summarizes the amounts outstanding under the BioReference, Chilean and Spanish lines of credit: (Dollars in thousands) Balance Outstanding Lender Interest rate on borrowings at December 31, 2019 Credit line capacity December 31, December 31, 2018 JP Morgan Chase 3.69% $ 75,000 $ 44,750 $ 105,198 Itau Bank 5.50% 1,810 472 232 Bank of Chile 6.60% 3,800 851 432 BICE Bank 5.50% 2,500 1,429 818 BBVA Bank 5.50% 3,250 11 858 Security Bank 5.50% 588 588 — Estado Bank 5.50% 3,500 1,365 308 Santander Bank 5.50% 4,500 1,943 852 Scotiabank 5.00% 1,800 668 2 Banco De Sabadell 1.45% 336 — — Banco Bilbao Vizcaya 2.45% 336 — — Santander Bank 1.40% 336 — 10 Total $ 97,756 $ 52,077 $ 108,710

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Income (Loss) (Tables)	12 Months Ended
	Dec. 31, 2019
Equity [Abstract]
Changes in Accumulated Other Comprehensive Income, Net of Tax	For the year ended December 31, 2019 , changes in Accumulated other comprehensive income (loss), net of tax, were as follows: (In thousands) Foreign Balance at December 31, 2018 $ (20,131 ) Other comprehensive income (loss) before reclassifications (1,939 ) Net other comprehensive income (loss) (1,939 ) Balance at December 31, 2019 $ (22,070 ) For the year ended December 31, 2018 , changes in Accumulated other comprehensive income, net of tax, were as follows: (In thousands) Foreign Unrealized Total Balance at December 31, 2017 $ (5,404 ) $ 4,876 $ (528 ) Other comprehensive income (loss) before reclassifications (14,727 ) — (14,727 ) Reclassification adjustment due to adoption of ASU 2016-01 — (4,876 ) (4,876 ) Net other comprehensive income (loss) (14,727 ) (4,876 ) (19,603 ) Balance at December 31, 2018 $ (20,131 ) $ — $ (20,131 )

Equity-Based Compensation (Tabl

Equity-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Schedule of Stock Options	apply the following assumptions in our Black-Scholes-Merton Model option-pricing formula: Year Ended December 31, 2019 Year Ended December 31, 2018 Year Ended December 31, 2017 Expected term (in years) 3.0 - 10.0 3.0 - 10.0 3.0 - 10.0 Risk-free interest rate 1.35% - 2.63% 2.32% - 3.09% 1.32% - 2.41% Expected volatility 54% - 63% 40% - 54% 38% - 55% Expected dividend yield 0% 0% 0%
Summary of Option Activity Under Stock Plans	A summary of option activity under our stock option plans as of December 31, 2019 , and the changes during the year is presented below: Options Number of options Weighted average exercise price Weighted average remaining contractual term (years) Aggregate intrinsic value (in thousands) Outstanding at December 31, 2018 33,031,298 $ 9.31 5.93 $ 232 Granted 8,066,000 $ 2.47 Exercised (24,877 ) $ 0.66 Forfeited (1,443,575 ) $ 7.32 Expired (2,258,425 ) $ 7.74 Outstanding at December 31, 2019 37,370,421 $ 8.01 6.00 $ — Vested and expected to vest at December 31, 2019 37,370,421 $ 8.01 6.00 $ — Exercisable at December 31, 2019 24,448,521 $ 10.18 4.49 $ —

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Components of Income Tax Benefit (Provision)	The benefit (provision) for incomes taxes consists of the following: For the years ended December 31, (In thousands) 2019 2018 2017 Current Federal $ — $ — $ 2,398 State (89 ) 6,318 (1,737 ) Foreign (2,647 ) (2,738 ) (3,424 ) (2,736 ) 3,580 (2,763 ) Deferred Federal 333 2,045 (10,759 ) State 125 5,673 (2,738 ) Foreign (4,782 ) 27,428 (2,595 ) (4,324 ) 35,146 (16,092 ) Total, net $ (7,060 ) $ 38,726 $ (18,855 )
Components of Deferred Income Tax Assets and Liabilities	Deferred income tax assets and liabilities as of December 31, 2019 and 2018 are comprised of the following: (In thousands) December 31, 2019 December 31, 2018 Deferred income tax assets: Federal net operating loss $ 121,125 $ 101,662 State net operating loss 64,648 59,126 Foreign net operating loss 32,162 34,407 Research and development expense 1,560 2,893 Tax credits 22,989 21,669 Stock options 30,640 30,430 Accruals 17,215 6,294 Equity investments 13,495 12,904 Bad debts 445 414 Lease liability 1,064 1,370 Foreign credits 9,909 10,837 Available-for-sale securities 2,478 2,447 Operating lease asset 10,204 — Other 8,395 11,668 Deferred income tax assets 336,329 296,121 Deferred income tax liabilities: Intangible assets (230,662 ) (250,640 ) Convertible Debt (12,219 ) — Operating lease liability (10,204 ) — Fixed assets (3,976 ) (3,486 ) Other (2,130 ) (2,272 ) Deferred income tax liabilities (259,191 ) (256,398 ) Net deferred income tax assets (liabilities) 77,138 39,723 Valuation allowance (194,869 ) (154,916 ) Net deferred income tax liabilities* $ (117,731 ) $ (115,193 ) Note: Net deferred income tax liability balance includes $986 thousand recorded to Other Assets on the Consolidated Balance Sheet.
Summary of Changes in Gross Unrecognized Income Tax Benefits	The following summarizes the changes in our gross unrecognized income tax benefits. For the years ended December 31, (In thousands) 2019 2018 2017 Unrecognized tax benefits at beginning of period $ 17,513 $ 21,347 $ 27,545 Gross increases – tax positions in prior period — — 44 Gross increases – tax positions in current period 884 8,384 — Gross decreases – tax positions in prior period (298 ) (7,597 ) (1,724 ) Lapse of Statute of Limitations (939 ) (4,621 ) (4,518 ) Unrecognized tax benefits at end of period $ 17,160 $ 17,513 $ 21,347
Summary of Significant Elements Contributing to the Difference Between the Federal Statutory Rate and the Effective Tax Rate	The significant elements contributing to the difference between the federal statutory tax rate and the effective tax rate are as follows: For the years ended December 31, 2019 2018 2017 Federal statutory rate 21.0 % 21.0 % 35.0 % State income taxes, net of federal benefit 2.8 % 4.3 % 5.1 % Foreign income tax (6.6 )% (6.0 )% (5.3 )% Income Tax Refunds — % 3.6 % — % Research and development tax credits 0.3 % 1.9 % 0.6 % Non-Deductible components of Convertible Debt — % (0.2 )% 0.1 % Valuation allowance (17.9 )% (7.1 )% (28.4 )% Rate change effect 0.4 % 8.1 % (10.8 )% Non-deductible items (0.7 )% (2.9 )% (1.9 )% Unrecognized tax benefits — % (1.8 )% (0.7 )% Impairments (1.6 )% — % — % Other — % (0.7 )% (0.4 )% Total (2.3 )% 20.2 % (6.7 )%
Reconciliation of Losses Before Income Taxes Between U.S. and Foreign Jurisdictions	The following table reconciles our losses before income taxes between U.S. and foreign jurisdictions: For the years ended December 31, (In thousands) 2019 2018 2017 Pre-tax income (loss): U.S. $ (236,544 ) $ (132,102 ) $ (247,938 ) Foreign (71,321 ) (59,664 ) (38,457 ) Total $ (307,865 ) $ (191,766 ) $ (286,395 )

Revenue Recognition (Tables)

Revenue Recognition (Tables)	12 Months Ended
	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The composition of Revenue from services by payor for the years ended December 31, 2019 , 2018 and 2017 is as follows: For the years ended December 31, (In thousands) 2019 2018 2017 Healthcare insurers $ 419,101 $ 492,995 $ 495,209 Government payors 116,662 150,851 140,195 Client payors 159,972 148,070 126,264 Patients 20,699 21,332 21,042 Total $ 716,434 $ 813,248 $ 782,710
Schedule of Product Sales Allowances and Accruals	The following table presents an analysis of product sales allowances and accruals as contract liabilities for the years ended December 31, 2019 and 2018: (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2018 $ 1,316 $ 2,090 $ 637 $ 4,043 Provision related to current period sales 13,723 25,106 3,699 42,528 Credits or payments made (11,845 ) (21,355 ) (1,585 ) (34,785 ) Balance at December 31, 2019 $ 3,194 $ 5,841 $ 2,751 $ 11,786 Total gross Rayaldee sales $ 73,965 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 57 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2017 $ 233 $ 348 $ 437 $ 1,018 Provision related to current period sales 5,704 10,061 680 16,445 Credits or payments made (4,621 ) (8,319 ) (480 ) (13,420 ) Balance at December 31, 2018 $ 1,316 $ 2,090 $ 637 $ 4,043 Total gross Rayaldee sales $ 36,715 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 45 %

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2019
Leases [Abstract]
Lease Assets and Liabilities	The following table presents the lease balances within the Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Classification on the Balance Sheet December 31, 2019 Assets Operating lease assets Operating lease right-of-use assets $ 39,380 Finance lease assets Property, plant and equipment, net 6,789 Liabilities Current Operating lease liabilities Current maturities of operating leases 12,038 Accrued expenses Current maturities of finance leases 2,743 Long-term Operating lease liabilities Operating lease liabilities 27,665 Other long-term liabilities Finance lease liabilities $ 4,046 Weighted average remaining lease term Operating leases 5.6 years Finance leases 2.6 years Weighted average discount rate Operating leases 6.3 % Finance leases 3.0 %
Lease Liability Maturity	(in thousands) Classification on the Balance Sheet December 31, 2019 Assets Operating lease assets Operating lease right-of-use assets $ 39,380 Finance lease assets Property, plant and equipment, net 6,789 Liabilities Current Operating lease liabilities Current maturities of operating leases 12,038 Accrued expenses Current maturities of finance leases 2,743 Long-term Operating lease liabilities Operating lease liabilities 27,665 Other long-term liabilities Finance lease liabilities $ 4,046 Weighted average remaining lease term Operating leases 5.6 years Finance leases 2.6 years Weighted average discount rate Operating leases 6.3 % Finance leases 3.0 % The following table reconciles the undiscounted future minimum lease payments (displayed by year and in the aggregate) under noncancelable operating leases with terms of more than one year to the total operating lease liabilities recognized on our Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Operating Finance 2020 $ 12,750 $ 2,871 2021 6,526 2,186 2022 5,777 1,155 2023 5,450 563 2024 4,297 233 Thereafter 17,186 — Total undiscounted future minimum lease payments 51,986 7,008 Less: Difference between lease payments and discounted lease liabilities 12,283 219 Total lease liabilities $ 39,703 $ 6,789
Lease Liability Maturity	The following table reconciles the undiscounted future minimum lease payments (displayed by year and in the aggregate) under noncancelable operating leases with terms of more than one year to the total operating lease liabilities recognized on our Consolidated Balance Sheet as of December 31, 2019 : (in thousands) Operating Finance 2020 $ 12,750 $ 2,871 2021 6,526 2,186 2022 5,777 1,155 2023 5,450 563 2024 4,297 233 Thereafter 17,186 — Total undiscounted future minimum lease payments 51,986 7,008 Less: Difference between lease payments and discounted lease liabilities 12,283 219 Total lease liabilities $ 39,703 $ 6,789
Supplemental Cash Flow Information	Supplemental cash flow information is as follows: (in thousands) For the year ended December 31, 2019 Operating cash out flows from operating leases $ 20,712 Operating cash out flows from finance leases 374 Financing cash out flows from finance leases 2,833 Total $ 23,919

Segments (Tables)

Segments (Tables)	12 Months Ended
	Dec. 31, 2019
Segment Reporting [Abstract]
Operations and Assets for Operating Segments and Geographic Information	Information regarding our operations and assets for our operating segments and the unallocated corporate operations as well as geographic information are as follows: For the years ended December 31, (In thousands) 2019 2018 2017 Revenue from services: Pharmaceutical $ — $ — $ — Diagnostics 716,434 813,248 782,710 Corporate — — $ 716,434 $ 813,248 $ 782,710 Revenue from products: Pharmaceutical $ 112,184 $ 107,112 $ 107,759 Diagnostics — — Corporate — — $ 112,184 $ 107,112 $ 107,759 Revenue from transfer of intellectual property and other: Pharmaceutical $ 73,317 $ 69,906 $ 75,537 Diagnostics — — Corporate — — $ 73,317 $ 69,906 $ 75,537 Operating loss: Pharmaceutical $ (109,062 ) $ (82,641 ) $ (84,287 ) Diagnostics (123,359 ) (44,942 ) (136,540 ) Corporate (41,631 ) (43,614 ) (55,615 ) $ (274,052 ) $ (171,197 ) $ (276,442 ) Depreciation and amortization: Pharmaceutical $ 30,073 $ 28,007 $ 27,513 Diagnostics 63,675 69,246 74,442 Corporate 59 91 138 $ 93,807 $ 97,344 $ 102,093 Loss from investment in investees: Pharmaceutical $ (2,900 ) $ (10,822 ) $ (12,646 ) Diagnostics — (3,675 ) (1,825 ) Corporate — — — $ (2,900 ) $ (14,497 ) $ (14,471 ) Revenues: U.S. $ 751,099 $ 837,509 $ 803,853 Ireland 81,170 78,102 80,905 Chile 33,642 41,216 44,286 Spain 18,747 18,195 18,285 Israel 8,769 9,479 13,951 Mexico 8,032 5,598 4,605 Other 476 167 121 $ 901,935 $ 990,266 $ 966,006 (In thousands) December 31, December 31, Assets: Pharmaceutical $ 1,174,639 $ 1,236,499 Diagnostics 1,035,112 1,162,160 Corporate 99,521 52,413 $ 2,309,272 $ 2,451,072 Goodwill: Pharmaceutical $ 237,131 $ 247,407 Diagnostics 434,809 452,786 Corporate — — $ 671,940 $ 700,193
Property, Plant and Equipment, Net by Jurisdiction	The following table reconciles our Property, plant and equipment, net between U.S. and foreign jurisdictions: (In thousands) December 31, 2019 December 31, 2018 PP&E: U.S. $ 62,158 $ 76,907 Foreign 64,953 67,767 Total $ 127,111 $ 144,674

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2019
Fair Value Disclosures [Abstract]
Financial Assets and Liabilities Measured at Fair Value on a Recurring Basis	Our financial assets and liabilities measured at fair value on a recurring basis are as follows: Fair value measurements as of December 31, 2019 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities $ 18,870 $ — $ — $ 18,870 Common stock options/warrants — 120 — 120 Forward contracts — 133 — 133 Total assets $ 18,870 $ 253 $ — $ 19,123 Liabilities: Contingent consideration: $ — $ — $ 9,683 9,683 Total liabilities $ — $ — $ 9,683 $ 9,683 Fair value measurements as of December 31, 2018 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities $ 26,313 $ — $ — $ 26,313 Common stock options/warrants — 855 — 855 Forward contracts — 21 — 21 Total assets $ 26,313 $ 876 $ — $ 27,189 Liabilities: Contingent consideration: $ — $ — $ 24,537 $ 24,537 Total liabilities $ — $ — $ 24,537 $ 24,537
Carrying Amount and Estimated Fair Value of Long-Term Debt	The carrying amount and estimated fair value of our 2025 Notes, as well as the applicable fair value hierarchy tiers, are contained in the table below. The fair value of the 2025 Notes is determined using quoted prices in active markets. December 31, 2019 (In thousands) Carrying Value Total Fair Value Level 1 Level 2 Level 3 2025 Notes $ 148,140 $ 158,174 $ 158,174 $ — $ —
Reconciliation of Beginning and Ending Balances of Level 3 Assets and Liabilities	The following tables reconcile the beginning and ending balances of our Level 3 assets and liabilities as of December 31, 2019 and 2018 : December 31, 2019 (In thousands) Contingent consideration Balance at December 31, 2018 $ 24,537 Total losses (gains) for the period: Included in results of operations (14,854 ) Balance at December 31, 2019 $ 9,683 December 31, 2018 (In thousands) Contingent Balance at December 31, 2017 $ 41,353 Total losses (gains) for the period: Included in results of operations (16,816 ) Balance at December 31, 2018 $ 24,537

Derivative Contracts (Tables)

Derivative Contracts (Tables)	12 Months Ended
	Dec. 31, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Summary of Fair Values and Presentation of Derivative Financial Instruments	The following table summarizes the fair values and the presentation of our derivative financial instruments in the Consolidated Balance Sheets: (In thousands) Balance Sheet Component December 31, 2019 December 31, Derivative financial instruments: Common stock options/warrants Investments, net $ 120 $ 855 Forward contracts Unrealized gains on forward contracts are recorded in Other current assets and prepaid expenses. Unrealized (losses) on forward contracts are recorded in Accrued expenses. $ 133 $ 21
Summary of the Losses and Gains Recorded for the Changes in Fair Values of Derivative Instruments	The following table summarizes the losses and gains recorded for the years ended December 31, 2019 , 2018 and 2017 : For the years ended December 31, (In thousands) 2019 2018 2017 Derivative gain (loss): Common stock options/warrants $ (601 ) $ 2,643 $ (2,533 ) 2033 Senior Notes — — 3,185 Forward contracts $ 775 $ 400 $ (600 ) Total $ 174 $ 3,043 $ 52

Selected Quarterly Financial _2

Selected Quarterly Financial Data (Unaudited) (Tables)	12 Months Ended
	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Summary of Selected Quarterly Financial Data (Unaudited)	For the 2019 Quarters Ended (In thousands, except per share data) March 31 June 30 September 30 December 31 Total revenues $ 222,451 $ 226,368 $ 228,772 $ 224,344 Total costs and expenses 297,769 273,628 267,783 336,807 Net income (loss) (80,762 ) (59,806 ) (62,007 ) (112,350 ) Earnings (loss) per share, basic and diluted $ (0.14 ) $ (0.10 ) $ (0.11 ) $ (0.18 ) For the 2018 Quarters Ended (In thousands, except per share data) March 31 June 30 September 30 December 31 Total revenues $ 254,914 $ 263,685 $ 249,815 $ 221,852 Total costs and expenses 297,525 268,793 283,279 311,866 Net income (loss) (43,114 ) (6,201 ) (27,655 ) (76,070 ) Earnings (loss) per share, basic and diluted $ (0.08 ) $ (0.01 ) $ (0.05 ) $ (0.13 )

Business and Organization (Deta

Business and Organization (Details)	12 Months Ended
	Dec. 31, 2019person
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of sales employees	300

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Details)	12 Months Ended
	Dec. 31, 2019USD ($)segment	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Mar. 31, 2019USD ($)
Summary of Significant Accounting Policies [Line Items]
Inventory write-down	$ 2,300,000	$ 1,900,000
Goodwill and intangible assets	1,800,000,000	2,000,000,000
Goodwill	671,940,000	700,193,000	$ 717,099,000
Net intangible assets other than goodwill	1,100,000,000	1,300,000,000
Asset impairment charges	92,399,000	21,778,000	13,194,000
Goodwill impairment loss	26,225,000	11,698,000	0
Amortization of intangible assets	64,783,000	67,933,000	71,484,000
Amortization expense in 2020	56,300,000
Amortization expense in 2021	50,300,000
Amortization expense in 2022	50,000,000
Amortization expense in 2023	47,200,000
Amortization expense in 2024	44,200,000
Depreciation	29,000,000	29,400,000	30,600,000
Accrual related to uncertain tax positions included in income tax benefit	2,900,000
Estimated tax exposure range	66,000,000
Allowance for doubtful accounts	1,934,000	1,758,000
Provision for doubtful accounts	500,000	700,000
Equity-based compensation expense for continuing operations	$ 13,421,000	21,761,000	28,307,000
Number of reportable segments | segment	2
Foreign currency transaction gains	$ 400,000	$ 1,900,000	1,400,000
Operating lease liability	39,703,000
Operating lease right-of-use assets	$ 39,380,000
Minimum
Summary of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives	3 years
Maximum
Summary of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives	20 years
Computer Software, Intangible Asset
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	3 years
Machinery, Medical and Other Equipment | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	5 years
Machinery, Medical and Other Equipment | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	8 years
Furniture and Fixtures | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	5 years
Furniture and Fixtures | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	12 years
Land, Buildings and Improvements | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	10 years
Land, Buildings and Improvements | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	40 years
Automobiles and Aircraft | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	3 years
Automobiles and Aircraft | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, useful life	5 years
Accounts Receivable | Government Contracts Concentration Risk
Summary of Significant Accounting Policies [Line Items]
Percentage of revenue contributed by customer	6.00%	7.00%
Accounts Receivable | Customer Concentration Risk
Summary of Significant Accounting Policies [Line Items]
Percentage of revenue contributed by customer	2.50%	2.90%
Accounting Standards Update 2016-02
Summary of Significant Accounting Policies [Line Items]
Operating lease liability				$ 33,700,000
Operating lease right-of-use assets				$ 33,300,000
In Process Research and Development
Summary of Significant Accounting Policies [Line Items]
Net intangible assets other than goodwill	$ 590,200,000	$ 635,600,000
Impairment of assets		10,100,000	$ 13,200,000
VARUBI
Summary of Significant Accounting Policies [Line Items]
Impairment of assets	20,700,000
BioReference
Summary of Significant Accounting Policies [Line Items]
Goodwill	$ 434,800,000
Excess of estimated fair value over carrying amount (as a percent)	11.00%
In Process Research and Development
Summary of Significant Accounting Policies [Line Items]
Impairment of assets		$ 10,100,000

Loss Per Share - Narrative (Det

Loss Per Share - Narrative (Details) - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Number of common stock warrant and common stock options exercised (in shares)	24,877	540,000	1,720,649
Number of common stock issued for stock warrant and stock options exercised (in shares)	19,232	353,677	1,447,792
Shares surrendered in lieu of cash payment (in shares)	5,645	186,323	272,857
Equity securities
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares excluded from diluted net loss per share calculation (in shares)	67,765,380	16,568,520	6,255,624

Investments - Accounting Metho

Investments - Accounting Method, Carrying Value and Underlying Equity in Net Assets of Unconsolidated Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Long-term Investments [Abstract]
Equity method investments, carrying value	$ 826
Variable interest entity, equity method, carrying value	894
Available for sale investments, carrying value	18,870
Cost method investment	36
Warrants and options	120
Total carrying value of investments	20,746	$ 31,228
Equity method Investments, underlying equity in net assets	9,931
Variable interest entity, equity method, underlying equity in net assets	$ 0

Investments - Narrative (Detai

Investments - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Total assets of equity method investees	$ 191,500
Total liabilities of equity method investees	58,400
Net losses of equity method investees	(62,900)
Market value of equity method investees	6,000
Gain (loss) on sale of investments	$ 0
Write down to other assets			$ 8,800
Pharmsynthez
Business Acquisition [Line Items]
Ownership percentage	9.00%
Cocrystal Pharma
Business Acquisition [Line Items]
Ownership percentage	7.00%
NIMS
Business Acquisition [Line Items]
Ownership percentage	1.00%
Neovasc
Business Acquisition [Line Items]
Ownership percentage	4.00%
InCellDx, Inc
Business Acquisition [Line Items]
Ownership percentage	29.00%
BioCardia, Inc.
Business Acquisition [Line Items]
Ownership percentage	3.00%
Warrants to purchase common shares (in shares)	47,000
Vested warrants (in shares)	31,000
Xenetic Biosciences, Inc.
Business Acquisition [Line Items]
Ownership percentage	3.00%
Warrants to purchase common shares (in shares)	40,000
Phio Pharmaceuticals
Business Acquisition [Line Items]
Equity security investments, ownership percentage	0.10%
Warrants to purchase common shares (in shares)	22,000
VBI Vaccines Inc
Business Acquisition [Line Items]
Equity security investments, ownership percentage	4.00%
ChromaDex Corporation
Business Acquisition [Line Items]
Equity security investments, ownership percentage	0.10%
MabVax
Business Acquisition [Line Items]
Equity security investments, ownership percentage	1.00%
Eloxx Pharmaceuticals
Business Acquisition [Line Items]
Equity security investments, ownership percentage	3.00%
Cocrystal
Business Acquisition [Line Items]
Warrants to purchase common shares (in shares)	33,000
InCellDx Inc.
Business Acquisition [Line Items]
Write down of investment		$ 2,900
Warrants to purchase common shares (in shares)	700,000
Zebra
Business Acquisition [Line Items]
Ownership percentage	29.00%
Zebra | Series A Preferred Stock
Business Acquisition [Line Items]
Investment owned, shares (in shares)	1,260,000
Zebra | Restricted Stock
Business Acquisition [Line Items]
Investment owned, shares (in shares)	900,000
Other Income (Expense), Net
Business Acquisition [Line Items]
Gain (loss) on sale of investments			$ 1,500
Variable Interest Entity, Not Primary Beneficiary | Zebra
Business Acquisition [Line Items]
Ownership percentage	29.00%

Investments - Schedule of Net G

Investments - Schedule of Net Gains and Losses on Equity Securities (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Business Combinations [Abstract]
Net gains and losses recognized during the period on equity securities	$ (7,443)
Less: Net gains and losses realized during the period on equity securities	0
Unrealized net gains recognized during the period on equity securities still held at the reporting date	$ (7,443)

Composition of Certain Financ_3

Composition of Certain Financial Statement Captions (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Accounts receivable, net
Accounts receivable	$ 136,551	$ 145,665
Less: allowance for doubtful accounts	(1,934)	(1,758)
Accounts receivable, net	134,617	143,907
Inventories, net
Consumable supplies	23,005	23,264
Finished products	25,142	15,259
Work in-process	3,238	2,473
Raw materials	4,586	4,259
Less: inventory reserve	(2,537)	(2,956)
Inventory, net	53,434	42,299
Other current assets and prepaid expenses
Taxes recoverable	19,808	15,708
Other receivables	3,262	2,368
Prepaid supplies	8,147	9,693
Prepaid insurance	3,486	3,436
Other	15,839	3,847
Prepaid expenses and other current assets	50,542	35,052
Property, plant and equipment, net:
Less: accumulated depreciation	(136,445)
Less: accumulated depreciation		(111,662)
Property, plant and equipment, net	127,111
Property, plant and equipment, net		144,674
Intangible assets, net:
Less: accumulated amortization	(298,234)	(258,539)
Intangible assets, net	528,962	614,452
Accrued expenses:
Contract liabilities	19,196	63,503
Employee benefits	33,671	45,621
Commitments and Contingencies	38,635	15,327
Clinical trials	8,122	10,401
Professional fees	1,333	2,952
Finance leases short-term	2,743
Finance leases short-term		3,280
Milestone payment	0	4,871
Contingent consideration	2,375	2,375
Other	58,850	55,183
Accrued expenses	164,925	203,513
Other long-term liabilities:
Line of credit	44,749	105,198
Contract liabilities	2,571	27,566
Contingent consideration	7,308	22,162
Finance leases long-term	4,046
Finance leases long-term		5,620
Mortgages and other debts payable	3,906	4,654
Other	25,224	33,768
Other long-term liabilities	87,804	198,968
Customer relationships
Intangible assets, net:
Intangible assets	445,408	446,296
Technologies
Intangible assets, net:
Intangible assets	296,246	340,729
Trade names
Intangible assets, net:
Intangible assets	49,786	50,404
Covenants not to compete
Intangible assets, net:
Intangible assets	16,318	16,322
Licenses
Intangible assets, net:
Intangible assets	5,766	5,766
Product registrations
Intangible assets, net:
Intangible assets	7,578	7,861
Other
Intangible assets, net:
Intangible assets	6,094	5,613
Machinery, medical and other equipment
Property, plant and equipment, net:
Property, plant and equipment, gross	165,501
Property, plant and equipment, gross		147,757
Leasehold improvements
Property, plant and equipment, net:
Property, plant and equipment, gross	33,606
Property, plant and equipment, gross		34,607
Furniture and fixtures
Property, plant and equipment, net:
Property, plant and equipment, gross	12,631
Property, plant and equipment, gross		12,737
Automobiles and aircraft
Property, plant and equipment, net:
Property, plant and equipment, gross	10,029
Property, plant and equipment, gross		10,133
Software
Property, plant and equipment, net:
Property, plant and equipment, gross	13,861
Property, plant and equipment, gross		13,425
Building
Property, plant and equipment, net:
Property, plant and equipment, gross	18,462
Property, plant and equipment, gross		18,554
Land
Property, plant and equipment, net:
Property, plant and equipment, gross	2,422
Property, plant and equipment, gross		2,453
Construction in process
Property, plant and equipment, net:
Property, plant and equipment, gross	$ 7,044
Property, plant and equipment, gross		$ 16,670

Composition of Certain Financ_4

Composition of Certain Financial Statement Captions - Narrative (Details) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Summary of Significant Accounting Policies [Line Items]
Goodwill impairment loss	$ 26,225,000	$ 11,698,000	$ 0
In Process Research and Development
Summary of Significant Accounting Policies [Line Items]
Impairment of assets		$ 10,100,000
Covenants not to compete
Summary of Significant Accounting Policies [Line Items]
Useful life	5 years
Minimum | Technology
Summary of Significant Accounting Policies [Line Items]
Useful life	7 years
Minimum | Customer relationships
Summary of Significant Accounting Policies [Line Items]
Useful life	7 years
Minimum | Product registrations
Summary of Significant Accounting Policies [Line Items]
Useful life	7 years
Minimum | Trade names
Summary of Significant Accounting Policies [Line Items]
Useful life	5 years
Minimum | Other
Summary of Significant Accounting Policies [Line Items]
Useful life	9 years
Maximum | Technology
Summary of Significant Accounting Policies [Line Items]
Useful life	17 years
Maximum | Customer relationships
Summary of Significant Accounting Policies [Line Items]
Useful life	20 years
Maximum | Product registrations
Summary of Significant Accounting Policies [Line Items]
Useful life	10 years
Maximum | Trade names
Summary of Significant Accounting Policies [Line Items]
Useful life	10 years
Maximum | Other
Summary of Significant Accounting Policies [Line Items]
Useful life	13 years
Trademarks
Summary of Significant Accounting Policies [Line Items]
Impairment of assets	$ 20,700,000

Composition of Certain Financ_5

Composition of Certain Financial Statement Captions - Changes in Allowance for Doubtful Accounts, Provision for Inventory Reserve and Tax Valuation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Allowance for doubtful accounts
Allowance for doubtful accounts for inventory reserve and tax valuation
Beginning balance	$ (1,758)	$ (1,446)
Charged to expense	(469)	(665)
Written-off	293	353
Ending balance	(1,934)	(1,758)
Inventory reserve
Allowance for doubtful accounts for inventory reserve and tax valuation
Beginning balance	(2,956)	(6,565)
Charged to expense	(2,349)	(1,915)
Written-off	2,768	5,524
Ending balance	(2,537)	(2,956)
Tax valuation allowance
Allowance for doubtful accounts for inventory reserve and tax valuation
Beginning balance	(154,916)	(142,062)
Charged to expense	(38,340)	(12,854)
Written-off	0	0
Ending balance	$ (193,256)	$ (154,916)

Composition of Certain Financ_6

Composition of Certain Financial Statement Captions - Changes in Goodwill (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill [Roll Forward]
Beginning balance	$ 700,193,000	$ 717,099,000
Foreign exchange and other	(2,028,000)	(5,208,000)
Goodwill impairment	(26,225,000)	(11,698,000)	$ 0
Ending balance	671,940,000	700,193,000	717,099,000
BioReference
Goodwill [Roll Forward]
Ending balance	434,800,000
Pharmaceutical | CURNA
Goodwill [Roll Forward]
Beginning balance	4,827,000	4,827,000
Foreign exchange and other	0	0
Goodwill impairment	(4,827,000)	0
Ending balance	0	4,827,000	4,827,000
Pharmaceutical | Rayaldee
Goodwill [Roll Forward]
Beginning balance	87,314,000	91,295,000
Foreign exchange and other	(1,709,000)	(3,981,000)
Goodwill impairment	0	0
Ending balance	85,605,000	87,314,000	91,295,000
Pharmaceutical | FineTech
Goodwill [Roll Forward]
Beginning balance	0	11,698,000
Foreign exchange and other	0	0
Goodwill impairment	0	(11,698,000)
Ending balance	0	0	11,698,000
Pharmaceutical | OPKO Biologics
Goodwill [Roll Forward]
Beginning balance	139,784,000	139,784,000
Foreign exchange and other	0	0
Goodwill impairment		0
Ending balance	139,784,000	139,784,000	139,784,000
Pharmaceutical | OPKO Chile
Goodwill [Roll Forward]
Beginning balance	4,614,000	5,203,000
Foreign exchange and other	(266,000)	(589,000)
Goodwill impairment		0
Ending balance	4,348,000	4,614,000	5,203,000
Pharmaceutical | OPKO Health Europe
Goodwill [Roll Forward]
Beginning balance	7,546,000	7,898,000
Foreign exchange and other	(152,000)	(352,000)
Goodwill impairment		0
Ending balance	7,394,000	7,546,000	7,898,000
Pharmaceutical | Transition Therapeutics
Goodwill [Roll Forward]
Beginning balance	3,322,000	3,608,000
Foreign exchange and other	99,000	(286,000)
Goodwill impairment	(3,421,000)	0
Ending balance	0	3,322,000	3,608,000
Diagnostics | BioReference
Goodwill [Roll Forward]
Beginning balance	434,809,000	434,809,000
Foreign exchange and other	0	0
Goodwill impairment	0	0
Ending balance	434,809,000	434,809,000	434,809,000
Diagnostics | OPKO Diagnostics
Goodwill [Roll Forward]
Beginning balance	17,977,000	17,977,000
Foreign exchange and other	0	0
Goodwill impairment	(17,977,000)	0
Ending balance	$ 0	$ 17,977,000	$ 17,977,000

Debt - Narrative (Details)

Debt - Narrative (Details)

Feb. 20, 2019USD ($)

Dec. 22, 2017USD ($)

Aug. 07, 2017USD ($)

Mar. 17, 2017USD ($)

Nov. 05, 2015USD ($)

Feb. 28, 2019USD ($)

Feb. 28, 2018USD ($)$ / shares

Jan. 31, 2013USD ($)

Sep. 30, 2019

Dec. 31, 2019USD ($)dayinstitution$ / sharesshares

Dec. 31, 2018USD ($)

Dec. 31, 2017USD ($)

Dec. 31, 2016USD ($)shares

Nov. 04, 2019USD ($)

Feb. 01, 2019USD ($)

Nov. 08, 2018USD ($)

Nov. 30, 2015USD ($)

Debt Instrument [Line Items]

Credit line capacity

$ 97,756,000

Repayments of line of credit

359,322,000

$ 34,681,000

$ 33,510,000

Line of credit

44,749,000

105,198,000

Net assets

1,614,759,000

1,791,291,000

1,843,623,000

$ 2,046,433,000

Goodwill

$ 671,940,000

$ 700,193,000

$ 717,099,000

Number of financial institutions | institution

11

BioReference Laboratories, Inc.

Debt Instrument [Line Items]

Net assets

$ 885,200,000

Goodwill

434,800,000

Intangible assets

$ 365,700,000

OPKO Health Europe

Debt Instrument [Line Items]

Weighted average interest rate (as a percent)

2.70%

2.10%

Minimum

Debt Instrument [Line Items]

Total revolving commitment, minimum consecutive days

30 days

30 days

Minimum | OPKO Health Europe

Debt Instrument [Line Items]

Variable interest rates (as a percent)

1.00%

Maximum

Debt Instrument [Line Items]

Total revolving commitment (as a percent)

10.00%

10.00%

Maximum | OPKO Health Europe

Debt Instrument [Line Items]

Variable interest rates (as a percent)

3.80%

Notes | Notes Due February 1, 2033

Debt Instrument [Line Items]

Debt face amount

$ 175,000,000

Interest rate of notes payable

3.00%

Equivalent redemption price

100.00%

Debt repurchase amount

$ 28,800,000

Long term debt

$ 3,000,000

Convertible Debt

Debt Instrument [Line Items]

Interest rate of notes payable

4.50%

Convertible Debt | Convertible Senior Notes Due 2025

Debt Instrument [Line Items]

Debt face amount

$ 200,000,000

Conversion ratio

0.2367

Conversion price (in dollars per share) | $ / shares

$ 4.22

Maximum shares of common stock to be loaned to affiliates | shares

30,000,000

Convertible debt, stock issued from conversion (in shares) | shares

29,250,000

One-time nominal fee for newly issued shares

$ 300,000

Valuation of equity component at issue date

$ 52,600,000

Effective interest rate (as a percent)

11.20%

Convertible Debt | Convertible Senior Notes Due 2025 | On or after February 1, 2017 and before February 1, 2019

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

130.00%

Equivalent redemption price

100.00%

Convertible Debt | Convertible Senior Notes Due 2025 | On or after February 1, 2017 and before February 1, 2019 | Minimum

Debt Instrument [Line Items]

Threshold trading days | day

20

Convertible Debt | Convertible Senior Notes Due 2025 | On or after February 1, 2017 and before February 1, 2019 | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

30

Convertible Debt | Convertible Senior Notes Due 2025 | Prior to November 15, 2024

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

98.00%

Convertible Debt | Convertible Senior Notes Due 2025 | Prior to November 15, 2024 | Minimum

Debt Instrument [Line Items]

Threshold trading days | day

5

Convertible Debt | Convertible Senior Notes Due 2025 | Prior to November 15, 2024 | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

5

Convertible Debt | Convertible Senior Notes Due 2025 | On Or After February 15, 2022

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

130.00%

Equivalent redemption price

100.00%

Convertible Debt | Convertible Senior Notes Due 2025 | On Or After February 15, 2022 | Minimum

Debt Instrument [Line Items]

Threshold trading days | day

20

Convertible Debt | Convertible Senior Notes Due 2025 | On Or After February 15, 2022 | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

30

Convertible Debt | 5% Convertible Notes

Debt Instrument [Line Items]

Debt face amount

$ 55,000,000

Interest rate of notes payable

5.00%

Conversion price (in dollars per share) | $ / shares

$ 5

Note maturity term (in years)

5 years

Conversion notice threshold minimum (in days)

30 days

Conversion notice threshold maximum (in days)

60 days

Convertible Debt | Notes Due February 1, 2033

Debt Instrument [Line Items]

Convertible notes, conversion

$ 143,200,000

Line of Credit

Debt Instrument [Line Items]

Weighted average interest rate (as a percent)

4.00%

4.70%

Equity securities | Convertible Debt | Notes Due February 1, 2033

Debt Instrument [Line Items]

Convertible debt, stock issued from conversion (in shares) | shares

21,539,873

Line of Credit | Unsecured Debt

Debt Instrument [Line Items]

Interest rate of notes payable

10.00%

Credit line capacity

$ 60,000,000

Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 75,000,000

$ 75,000,000

$ 100,000,000

Remaining borrowing capacity

$ 6,200,000

Commitment fee percentage

0.25%

Intercompany loan maximum borrowing capacity

$ 45,000,000

$ 35,000,000

$ 55,000,000

Bridge Loan | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 20,000,000

Letter of Credit | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 20,000,000

LIBOR | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Estimated credit spread (as a percent)

2.50%

LIBOR, First 12 Months | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Estimated credit spread (as a percent)

0.35%

LIBOR, Thereafter | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Estimated credit spread (as a percent)

0.50%

LIBOR, First 12 Months, Adjusted for Eurocurrency Liabilities | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Estimated credit spread (as a percent)

1.35%

LIBOR, Thereafter, Adjusted for Eurocurrency Liabilities | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Estimated credit spread (as a percent)

1.50%

Dr Frost | Line of Credit | Unsecured Debt

Debt Instrument [Line Items]

Repayments of line of credit

$ 28,800,000

Debt - Schedule of Notes (Detai

Debt - Schedule of Notes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
2025 Senior Notes
Issuance of 4.50% convertible notes	$ 200,293	$ 55,000	$ 0
Debt Issuance Cost
Amortization of debt discount and debt issuance costs	995	187	$ 224
Senior Notes
2025 Senior Notes
Beginning balance	0
Issuance of 4.50% convertible notes	200,000
Ending balance	200,000	0
Discount
Beginning balance	0
Issuance of 4.50% convertible notes	(52,600)
Amortization of debt discount and debt issuance costs	5,826
Ending balance	(46,774)	0
Debt Issuance Cost
Beginning balance	0
Issuance of 4.50% convertible notes	(5,720)
Amortization of debt discount and debt issuance costs	634
Ending balance	(5,086)	0
Long-term Debt, Unclassified [Abstract]
Beginning balance	0
Issuance of 4.50% convertible notes	141,680
Amortization of debt discount and debt issuance costs	6,460
Ending balance	$ 148,140	$ 0

Debt - Lines of Credit (Details

Debt - Lines of Credit (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Credit line capacity	$ 97,756,000
Line of credit	$ 52,077,000	$ 108,710,000
JP Morgan Chase
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	3.69%
Credit line capacity	$ 75,000,000
Line of credit	$ 44,750,000	105,198,000
Itau Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.50%
Credit line capacity	$ 1,810,000
Line of credit	$ 472,000	232,000
Bank of Chile
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	6.60%
Credit line capacity	$ 3,800,000
Line of credit	$ 851,000	432,000
BICE Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.50%
Credit line capacity	$ 2,500,000
Line of credit	$ 1,429,000	818,000
BBVA Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.50%
Credit line capacity	$ 3,250,000
Line of credit	$ 11,000	858,000
Security Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.50%
Credit line capacity	$ 588,000
Line of credit	$ 588,000	0
Estado Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.50%
Credit line capacity	$ 3,500,000
Line of credit	$ 1,365,000	308,000
Santander Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.50%
Credit line capacity	$ 4,500,000
Line of credit	$ 1,943,000	852,000
Scotiabank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	5.00%
Credit line capacity	$ 1,800,000
Line of credit	$ 668,000	2,000
Banco De Sabadell
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	1.45%
Credit line capacity	$ 336,000
Line of credit	$ 0	0
Banco Bilbao Vizcaya
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	2.45%
Credit line capacity	$ 336,000
Line of credit	$ 0	0
Santander Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings, period end	1.40%
Credit line capacity	$ 336,000
Line of credit	$ 0	$ 10,000

Debt - Mortgage Notes and Other

Debt - Mortgage Notes and Other Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Mortgage notes and other debt payables
Current portion of notes payable	$ 9,619	$ 5,851
Other long-term liabilities	3,906	4,654
Notes Payable and Other Long-Term Liabilities
Mortgage notes and other debt payables
Current portion of notes payable	2,494	2,560
Other long-term liabilities	4,723	5,693
Total	$ 7,217	$ 8,253

Shareholders' Equity - Narrativ

Shareholders' Equity - Narrative (Details) $ / shares in Units, $ in Millions	Oct. 29, 2019USD ($)$ / sharesshares	Nov. 08, 2018USD ($)$ / sharesshares	Nov. 30, 2019USD ($)$ / sharesshares	Dec. 31, 2019vote / shares$ / sharesshares	Dec. 31, 2018$ / sharesshares
Class of Stock [Line Items]
Common stock, shares authorized (in shares)				1,000,000,000	750,000,000
Common stock, par value (in dollars per share) | $ / shares				$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)				10,000,000
Preferred stock, par value (in dollars per share) | $ / shares				$ 0.01
Private placement agreement number of shares (in shares)		26,500,000
Private placement agreement price per share (in dollars per share) | $ / shares		$ 3.49
Private placement agreement value of shares | $		$ 92.5
Votes per common share | vote / shares				1
Designate shares of preferred stock (in shares)				10,000,000
Series A Preferred Stock
Class of Stock [Line Items]
Preferred stock, shares authorized (in shares)				4,000,000
Preferred stock, shares issued (in shares)				0	0
Preferred stock, shares outstanding (in shares)				0	0
Series C Preferred Stock
Class of Stock [Line Items]
Preferred stock, shares authorized (in shares)				500,000
Preferred stock, shares issued (in shares)				0	0
Preferred stock, shares outstanding (in shares)				0	0
Series D Preferred Stock
Class of Stock [Line Items]
Preferred stock, shares authorized (in shares)				2,000,000
Preferred stock, shares issued (in shares)				0	0
Preferred stock, shares outstanding (in shares)				0	0
Chief Executive Officer
Class of Stock [Line Items]
Private placement agreement value of shares | $		70
Chief Technical Officer
Class of Stock [Line Items]
Private placement agreement value of shares | $		$ 2
IPO
Class of Stock [Line Items]
Shares of common stock issued (in shares)	50,000,000
Price per share of common stock (in dollars per share) | $ / shares	$ 1.50
Net proceeds in transaction | $	$ 70
Over-Allotment Option
Class of Stock [Line Items]
Shares of common stock issued (in shares)			4,227,749
Price per share of common stock (in dollars per share) | $ / shares			$ 1.50
Net proceeds in transaction | $			$ 6
Members of Senior Management | IPO
Class of Stock [Line Items]
Shares of common stock issued (in shares)	2,415,000

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	$ 1,791,291	$ 1,843,623	$ 2,046,433
Other comprehensive income (loss) before reclassifications		(14,727)	26,481
Reclassification adjustment due to adoption of ASU 2016-01		(4,876)
Net other comprehensive income (loss)	(1,939)	(19,603)
Ending balance	1,614,759	1,791,291	1,843,623
Foreign currency translation
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	(20,131)	(5,404)
Other comprehensive income (loss) before reclassifications	(1,939)	(14,727)
Reclassification adjustment due to adoption of ASU 2016-01		0
Net other comprehensive income (loss)	(1,939)	(14,727)
Ending balance	(22,070)	(20,131)	(5,404)
Unrealized gain (loss) in Accumulated OCI
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	0	4,876
Other comprehensive income (loss) before reclassifications		0
Reclassification adjustment due to adoption of ASU 2016-01		(4,876)
Net other comprehensive income (loss)		(4,876)
Ending balance		0	4,876
Total
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	(20,131)	(528)	(27,009)
Other comprehensive income (loss) before reclassifications		(14,727)	26,481
Net other comprehensive income (loss)	(1,939)
Ending balance	$ (22,070)	$ (20,131)	$ (528)

Equity-Based Compensation - Na

Equity-Based Compensation - Narrative (Details)	12 Months Ended
	Dec. 31, 2019USD ($)plan$ / sharesshares	Dec. 31, 2018USD ($)$ / shares	Dec. 31, 2017USD ($)$ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of equity-based incentive compensation plans | plan	6
Expiration period	10 years
Vesting period	5 years
Excess tax benefits	$ 0	$ 0	$ 0
Unrecognized compensation cost	$ 15,400,000
Weighted-average expected period for recognition	1 year 8 months 15 days
Expected dividend yield	0.00%	0.00%	0.00%
Common stock shares reserved for issuance (in shares) | shares	22,304,368
Intrinsic value of stock options exercised	$ 100,000	$ 500,000	$ 6,400,000
Weighted average grant date fair value of stock options granted (in dollars per share) | $ / shares	$ 1.15	$ 2.08	$ 4.50
Fair value of stock options vested	$ 18,600,000	$ 25,800,000	$ 34,000,000
Selling, General and Administrative Expenses
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity based compensation expense	9,700,000	14,700,000	21,200,000
Research and Development Expense
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity based compensation expense	2,000,000	4,200,000	5,100,000
Cost of Revenue
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity based compensation expense	$ 1,600,000	2,800,000	2,000,000
Modigene
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of equity-based incentive compensation plans | plan	2
Continuing Operations
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Equity based compensation expense	$ 13,400,000	$ 21,800,000	$ 28,300,000
Minimum | 2007 Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	7 years
Maximum | 2007 Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	10 years
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	4 years
Non-employee Director | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	1 year

Equity-Based Compensation - Op

Equity-Based Compensation - Option-Pricing Formula (Details)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Schedule of stock options
Risk-free interest rate, minimum	1.35%	2.32%	1.32%
Risk-free interest rate, maximum	2.63%	3.09%	2.41%
Expected volatility, minimum	54.00%	40.00%	38.00%
Expected volatility, maximum	63.00%	54.00%	55.00%
Expected dividend yield	0.00%	0.00%	0.00%
Minimum
Schedule of stock options
Expected term	3 years	3 years	3 years
Maximum
Schedule of stock options
Expected term	10 years	10 years	10 years

Equity-Based Compensation - Su

Equity-Based Compensation - Summary of Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Summary of option activity under stock plans
Number of options outstanding, beginning balance (in shares)	33,031,298
Number of options, granted (in shares)	8,066,000
Number of options, exercised (in shares)	(24,877)
Number of options, forfeited (in shares)	(1,443,575)
Number of options, expired (in shares)	(2,258,425)
Number of options outstanding, ending balance (in shares)	37,370,421	33,031,298
Share-based Compensation Weighted Average Exercise Price [Abstract]
Weighted average exercise price, beginning balance (in dollars per share)	$ 9.31
Weighted average exercise price, granted (in dollars per share)	2.47
Weighted average exercise price, exercised (in dollars per share)	0.66
Weighted average exercise price, forfeited (in dollars per share)	7.32
Weighted average exercise price, expired (in dollars per share)	7.74
Weighted average exercise price, ending balance (in dollars per share)	$ 8.01	$ 9.31
Weighted average remaining contractual term, outstanding	6 years	5 years 11 months 4 days
Aggregate intrinsic value, outstanding	$ 0	$ 232
Vested and expected to vest, number of options (in shares)	37,370,421
Vested and expected to vest, weighted average exercise price (in dollars per share)	$ 8.01
Weighted average expected to vest, remaining contractual term	6 years
Aggregate intrinsic value, vested and expected to vest	$ 0
Number of options exercisable (in shares)	24,448,521
Weighted average exercise price exercisable (in dollars per share)	$ 10.18
Weighted average remaining contractual term, exercisable	4 years 5 months 26 days
Exercisable, aggregate intrinsic value	$ 0

Income Taxes - Benefits (Provi

Income Taxes - Benefits (Provision) for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Current
Federal	$ 0	$ 0	$ 2,398
State	(89)	6,318	(1,737)
Foreign	(2,647)	(2,738)	(3,424)
Current income tax benefit, total	(2,736)	3,580	(2,763)
Deferred
Federal	333	2,045	(10,759)
State	125	5,673	(2,738)
Foreign	(4,782)	27,428	(2,595)
Income tax benefit, total	(4,324)	35,146	(16,092)
Total, net	$ (7,060)	$ 38,726	$ (18,855)

Income Taxes - Deferred Income

Income Taxes - Deferred Income Taxes (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Deferred income tax assets:
Federal net operating loss	$ 121,125	$ 101,662
State net operating loss	64,648	59,126
Foreign net operating loss	32,162	34,407
Research and development expense	1,560	2,893
Tax credits	22,989	21,669
Stock options	30,640	30,430
Accruals	17,215	6,294
Equity investments	13,495	12,904
Bad debts	445	414
Lease liability	1,064	1,370
Foreign credits	9,909	10,837
Available-for-sale securities	2,478	2,447
Operating lease asset	10,204
Other	8,395	11,668
Deferred income tax assets	336,329	296,121
Deferred income tax liabilities:
Intangible assets	(230,662)	(250,640)
Convertible Debt	(12,219)	0
Operating lease liability	(10,204)
Fixed assets	(3,976)	(3,486)
Other	(2,130)	(2,272)
Deferred income tax liabilities	(259,191)	(256,398)
Net deferred income tax assets (liabilities)	77,138	39,723
Valuation allowance	(194,869)	(154,916)
Net deferred income tax liabilities	$ (117,731)	$ (115,193)

Income Taxes - Narrative (Deta

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Operating Loss Carryforwards [Line Items]
Approximate amount of federal net operating loss carryforward that may not be utilized	$ 47,400
Total gross unrecognized tax benefit	17,160	$ 17,513	$ 21,347	$ 27,545
Unrecognized tax benefits that would impact effective tax rate	(13,200)	(14,200)	$ (12,400)
Income tax interest and penalties	(100)	$ (1,900)
Approximate unrecognized tax benefits	$ 500
Minimum
Operating Loss Carryforwards [Line Items]
Tax credit expiration period	15 years
Maximum
Operating Loss Carryforwards [Line Items]
Tax credit expiration period	20 years
Research and development tax credit carryforwards
Operating Loss Carryforwards [Line Items]
Research and development tax credit carryforwards	$ 23,000
Federal
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	698,300
State
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	873,300
Foreign
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	139,600
Other Assets
Operating Loss Carryforwards [Line Items]
Deferred income tax liability	$ 986

Income Taxes - Change in Gross

Income Taxes - Change in Gross Unrecognized Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Summary of gross unrecognized income tax benefits
Unrecognized tax benefits at beginning of period	$ 17,513	$ 21,347	$ 27,545
Gross increases – tax positions in prior period	0	0	44
Gross increases – tax positions in current period	884	8,384	0
Gross decreases – tax positions in prior period	(298)	(7,597)	(1,724)
Lapse of Statute of Limitations	(939)	(4,621)	(4,518)
Unrecognized tax benefits at end of period	$ 17,160	$ 17,513	$ 21,347

Income Taxes - Difference in F

Income Taxes - Difference in Federal and Effective Tax Rate (Details)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Summary of difference between the federal statutory tax rate and the effective tax rate
Federal statutory rate	21.00%	21.00%	35.00%
State income taxes, net of federal benefit	2.80%	4.30%	5.10%
Foreign income tax	(6.60%)	(6.00%)	(5.30%)
Income Tax Refunds	0.00%	3.60%	0.00%
Research and development tax credits	0.30%	1.90%	0.60%
Non-Deductible components of Convertible Debt	0.00%	(0.20%)	0.10%
Valuation allowance	(17.90%)	(7.10%)	(28.40%)
Rate change effect	0.40%	8.10%	(10.80%)
Non-deductible items	(0.70%)	(2.90%)	(1.90%)
Unrecognized tax benefits	0.00%	(1.80%)	(0.70%)
Impairments	(1.60%)	0.00%	0.00%
Other	0.00%	(0.70%)	(0.40%)
Total	(2.30%)	20.20%	(6.70%)

Income Taxes - Reconciliation

Income Taxes - Reconciliation Losses Before Tax, US and Foreign Jurisdictions (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Summary of losses from continuing operations before income taxes between U.S. and foreign jurisdictions
U.S.	$ (236,544)	$ (132,102)	$ (247,938)
Foreign	(71,321)	(59,664)	(38,457)
Total	$ (307,865)	$ (191,766)	$ (286,395)

Related Party Transactions - N

Related Party Transactions - Narrative (Details)

Oct. 29, 2019USD ($)$ / sharesshares

Feb. 20, 2019USD ($)

Nov. 08, 2018USD ($)$ / sharesshares

Nov. 30, 2019USD ($)$ / sharesshares

Mar. 31, 2019USD ($)

Feb. 28, 2019USD ($)

May 31, 2018shares

Apr. 30, 2018shares

Feb. 28, 2018USD ($)

Nov. 30, 2017USD ($)shares

Jul. 31, 2017USD ($)shares

May 31, 2017USD ($)shares

Apr. 30, 2017USD ($)shares

Mar. 31, 2019USD ($)shares

Dec. 31, 2019USD ($)shares

Dec. 31, 2018USD ($)

Dec. 31, 2017USD ($)

Aug. 01, 2019USD ($)ft²

Mar. 01, 2019shares

Nov. 30, 2016USD ($)

Related Party Transaction [Line Items]

Private placement agreement number of shares (in shares) | shares

26,500,000

Private placement agreement price per share (in dollars per share) | $ / shares

$ 3.49

Private placement agreement value of shares

$ 92,500,000

Credit line capacity

$ 97,756,000

Repayments of line of credit

359,322,000

$ 34,681,000

$ 33,510,000

Investments in investees

$ 1,200,000

1,000,000

$ 9,625,000

Reverse stock split ratio

0.083

Pharmsynthez

Related Party Transaction [Line Items]

Investment ownership percentage

9.00%

Zebra

Related Party Transaction [Line Items]

Investment ownership percentage

29.00%

Neovasc

Related Party Transaction [Line Items]

Investment ownership percentage

4.00%

Payments in equity method investment

$ 3,000,000

Neovasc | Equity securities

Related Party Transaction [Line Items]

Equity method shares purchased in period (in shares) | shares

20,547

ChromaDex Corporation

Related Party Transaction [Line Items]

Equity security investments, ownership percentage

0.10%

MabVax

Related Party Transaction [Line Items]

Equity security investments, ownership percentage

1.00%

Investments in investees

$ 100,000

$ 500,000

MabVax | Series G Preferred Stock

Related Party Transaction [Line Items]

Available-for-sale securities shares purchased in period (in shares) | shares

50,714

MabVax | Series L Preferred Stock

Related Party Transaction [Line Items]

Available-for-sale securities shares purchased in period (in shares) | shares

1,667

MabVax | Series I Preferred Stock

Related Party Transaction [Line Items]

Available-for-sale securities shares purchased in period (in shares) | shares

107,607

Cocrystal Pharma

Related Party Transaction [Line Items]

Investment ownership percentage

7.00%

NIMS

Related Party Transaction [Line Items]

Investment ownership percentage

1.00%

BioCardia, Inc.

Related Party Transaction [Line Items]

Investment ownership percentage

3.00%

Warrants to purchase common shares (in shares) | shares

47,000

Cocrystal

Related Party Transaction [Line Items]

Payments in equity method investment

$ 1,000,000

Warrants to purchase common shares (in shares) | shares

33,000

Cocrystal | Equity securities

Related Party Transaction [Line Items]

Equity method shares purchased in period (in shares) | shares

138,889

InCellDx, Inc

Related Party Transaction [Line Items]

Investment ownership percentage

29.00%

Eloxx Pharmaceuticals

Related Party Transaction [Line Items]

Equity security investments, ownership percentage

3.00%

Dr Frost and Mr Pfenniger | Museum of Science, Inc

Related Party Transaction [Line Items]

Future contributions to related party

$ 1,000,000

Real Estate Holdings LLC

Related Party Transaction [Line Items]

Area of real estate property (in square feet) | ft²

29,500

Monthly operating lease payment in year one

$ 89,000

Monthly operating lease payment in year five

$ 101,000

OPKO Transaction Shares | Affiliated Entity | Xenetic Biosciences, Inc.

Related Party Transaction [Line Items]

Shares issued (in shares) | shares

164,062

Reimbursement Of Travel Expense | Dr Frost

Related Party Transaction [Line Items]

Reimbursement paid to related party for travel

$ 328,000

$ 238,000

$ 361,000

Shares Received Upon Closing of Xenetic Transaction | Director

Related Party Transaction [Line Items]

Shares received upon closing of transaction (in shares) | shares

31,240

Federal Trade Commission Filing Fees | Chief Technical Officer

Related Party Transaction [Line Items]

Filing fee

$ 125,000

Federal Trade Commission Filing Fees | Chief Executive Officer

Related Party Transaction [Line Items]

Filing fee

$ 280,000

Series A Warrant | Neovasc

Related Party Transaction [Line Items]

Warrants to purchase common shares (in shares) | shares

20,547

Proceeds from exercise of warrants

$ 1,200,000

Series B Warrant | Neovasc

Related Party Transaction [Line Items]

Warrants to purchase common shares (in shares) | shares

20,547

Exercise of warrant number of securities received (in shares) | shares

10,690

Series C Warrant | Neovasc

Related Party Transaction [Line Items]

Warrants to purchase common shares (in shares) | shares

8,221

Exercise of warrant number of securities received (in shares) | shares

22,660

Convertible Debt

Related Party Transaction [Line Items]

Interest rate of notes payable

4.50%

Convertible Debt | Cocrystal

Related Party Transaction [Line Items]

Payments in equity method investment

$ 1,000,000

Convertible Debt | Cocrystal | Equity securities

Related Party Transaction [Line Items]

Convertible debt shares issued (in shares) | shares

538,544

Convertible Debt | 5% Convertible Notes

Related Party Transaction [Line Items]

Interest rate of notes payable

5.00%

Debt face amount

$ 55,000,000

Chief Executive Officer

Related Party Transaction [Line Items]

Private placement agreement value of shares

70,000,000

Chief Technical Officer

Related Party Transaction [Line Items]

Private placement agreement value of shares

2,000,000

Line of Credit | Unsecured Debt

Related Party Transaction [Line Items]

Credit line capacity

$ 60,000,000

Interest rate of notes payable

10.00%

Line of Credit | Unsecured Debt | Dr Frost

Related Party Transaction [Line Items]

Repayments of line of credit

$ 28,800,000

IPO

Related Party Transaction [Line Items]

Shares of common stock issued (in shares) | shares

50,000,000

Price per share of common stock (in dollars per share) | $ / shares

$ 1.50

Net proceeds in transaction

$ 70,000,000

Over-Allotment Option

Related Party Transaction [Line Items]

Shares of common stock issued (in shares) | shares

4,227,749

Price per share of common stock (in dollars per share) | $ / shares

$ 1.50

Net proceeds in transaction

$ 6,000,000

Members of Senior Management | IPO

Related Party Transaction [Line Items]

Shares of common stock issued (in shares) | shares

2,415,000

Employee Benefit Plans (Details

Employee Benefit Plans (Details) - OPKO Health Savings and Retirement Plan - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Defined Contribution Plan Disclosure [Line Items]
Maximum annual contributions per employee, percent of compensation	100.00%
Employer matching contribution, percent of employee contribution	100.00%
Company's matching discretion on employee contributions to the Plan	4.00%
Employer discretionary contribution amount	$ 8.3	$ 8.3	$ 8.4

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($)	Dec. 27, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Business Acquisition, Contingent Consideration [Line Items]
Contingent consideration		$ 9,700,000	$ 24,600,000
Payment of SEC penalty	$ 100,000
Credit line capacity		97,756,000
Fixed purchase provisions		89,200,000
Accrued Expenses
Business Acquisition, Contingent Consideration [Line Items]
Contingent consideration		2,400,000	2,400,000
Other Long-term Liabilities
Business Acquisition, Contingent Consideration [Line Items]
Contingent consideration		7,300,000	22,200,000
BioReference
Business Acquisition, Contingent Consideration [Line Items]
Severance costs		$ 3,000,000	$ 4,900,000	$ 5,800,000

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($)	3 Months Ended								12 Months Ended			27 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Prior period performance obligation revenue recognized									$ 24,800,000	$ 22,800,000	$ 66,000,000
Overpayment reimbursement liability	$ 27,300,000				$ 35,900,000				27,300,000	35,900,000		$ 27,300,000
Revenue recognized												0
Total revenues	224,344,000	$ 228,772,000	$ 226,368,000	$ 222,451,000	221,852,000	$ 249,815,000	$ 263,685,000	$ 254,914,000	901,935,000	990,266,000	966,006,000
Contract liability	$ 21,800,000				$ 91,100,000				21,800,000	91,100,000		$ 21,800,000
Rayaldee
Disaggregation of Revenue [Line Items]
Revenue recognized									31,400,000	20,300,000
Total revenues									73,965,000	36,715,000
Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues									73,317,000	69,906,000	75,537,000
Pfizer | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues									$ 66,800,000	60,000,000	61,200,000
Tesaro | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Revenue recognized											$ 10,000,000
Vifor Fresenius Medical Care Pharma Ltd | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues										$ 2,000,000

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disaggregation of Revenue [Line Items]
Total revenues	$ 224,344	$ 228,772	$ 226,368	$ 222,451	$ 221,852	$ 249,815	$ 263,685	$ 254,914	$ 901,935	$ 990,266	$ 966,006
Healthcare insurers
Disaggregation of Revenue [Line Items]
Total revenues									419,101	492,995	495,209
Government payors
Disaggregation of Revenue [Line Items]
Total revenues									116,662	150,851	140,195
Client payors
Disaggregation of Revenue [Line Items]
Total revenues									159,972	148,070	126,264
Patients
Disaggregation of Revenue [Line Items]
Total revenues									20,699	21,332	21,042
Total
Disaggregation of Revenue [Line Items]
Total revenues									$ 716,434	$ 813,248	$ 782,710

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Product Sales Allowances and Accruals (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Provision related to current period sales									$ 500	$ 700
Total revenues	$ 224,344	$ 228,772	$ 226,368	$ 222,451	$ 221,852	$ 249,815	$ 263,685	$ 254,914	901,935	990,266	$ 966,006
Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance				4,043				1,018	4,043	1,018
Provision related to current period sales									42,528	16,445
Credits or payments made									(34,785)	(13,420)
Ending balance	11,786				4,043				11,786	4,043	1,018
Total revenues									$ 73,965	$ 36,715
Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales									57.00%	45.00%
Chargebacks, discounts, rebates and fees | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance				1,316				233	$ 1,316	$ 233
Provision related to current period sales									13,723	5,704
Credits or payments made									(11,845)	(4,621)
Ending balance	3,194				1,316				3,194	1,316	233
Governmental | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance				2,090				348	2,090	348
Provision related to current period sales									25,106	10,061
Credits or payments made									(21,355)	(8,319)
Ending balance	5,841				2,090				5,841	2,090	348
Returns | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance				$ 637				$ 437	637	437
Provision related to current period sales									3,699	680
Credits or payments made									(1,585)	(480)
Ending balance	$ 2,751				$ 637				$ 2,751	$ 637	$ 437

Strategic Alliances (Details)

Strategic Alliances (Details) - USD ($)

Oct. 21, 2019

Oct. 12, 2017

Jul. 31, 2018

May 31, 2016

Jan. 31, 2015

Dec. 31, 2010

Dec. 31, 2019

Dec. 31, 2018

Dec. 31, 2017

Dec. 31, 2019

Dec. 31, 2019

Mar. 31, 2013

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Initial upfront payment

$ 6,000,000

Milestone revenue recognized

$ 0

Contract liability

$ 21,800,000

$ 91,100,000

21,800,000

$ 21,800,000

Deferred revenue, current

19,196,000

63,503,000

19,196,000

19,196,000

Deferred revenue, noncurrent

2,571,000

27,566,000

2,571,000

2,571,000

Vifor Fresenius Medical Care Pharma Ltd | Exclusive Option

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payments, maximum

$ 555,000,000

Vifor Fresenius Medical Care Pharma Ltd | Launch and Sales-based Milestones

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payments, maximum

195,000,000

Vifor Fresenius Medical Care Pharma Ltd | Regulatory Milestones

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payment

$ 2,000,000

Milestone payments, maximum

35,000,000

Vifor Fresenius Medical Care Pharma Ltd | Development and License Agreement

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Proceeds from license fees received

$ 50,000,000

Pfizer | Product

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone revenue recognized

0

Milestone payments, maximum

$ 275,000,000

Non-refundable upfront payment

295,000,000

295,000,000

Additional milestone payment to be received

275,000,000

Contract liability

16,300,000

$ 16,300,000

$ 16,300,000

Tesaro

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payments, maximum

$ 85,000,000

Milestone payment ranges

30,000,000

Upfront payment under license agreements

$ 6,000,000

Maximum period to receive royalties

12 years

Tesaro | Product

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone revenue recognized

$ 0

$ 0

$ 10,000,000

Pharmsynthez

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Ownership percentage

9.00%

9.00%

9.00%

RXi Pharmaceuticals Corporation

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payments

$ 50,000,000

Minimum | Pfizer | Product

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payment ranges

20,000,000

Maximum | Pfizer | Product

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payment ranges

$ 90,000,000

Phase Two Initiation

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payments

6,000,000

Regulatory and Development

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payments

31,000,000

Sales Revenue

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payments

$ 75,000,000

Product | Pfizer

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Annual height velocity at point in time

12 months

Leases - Lease Assets and Liabi

Leases - Lease Assets and Liabilities (Details) $ in Thousands	Dec. 31, 2019USD ($)
Assets
Operating lease assets	$ 39,380
Finance lease assets	6,789
Current
Operating lease liabilities	12,038
Accrued expenses	2,743
Long-term
Operating lease liabilities	27,665
Other long-term liabilities	$ 4,046
Weighted average remaining lease term
Operating leases	5 years 7 months 6 days
Finance leases	2 years 7 months 6 days
Weighted average discount rate
Operating leases	6.30%
Finance leases	3.00%

Leases - Lease Liability Maturi

Leases - Lease Liability Maturity (Details) $ in Thousands	Dec. 31, 2019USD ($)
Operating
2020	$ 12,750
2021	6,526
2022	5,777
2023	5,450
2024	4,297
Thereafter	17,186
Total undiscounted future minimum lease payments	51,986
Less: Difference between lease payments and discounted lease liabilities	12,283
Total lease liabilities	39,703
Finance Lease, Liability, Payment, Due [Abstract]
2020	2,871
2021	2,186
2022	1,155
2023	563
2024	233
Thereafter	0
Total undiscounted future minimum lease payments	7,008
Less: Difference between lease payments and discounted lease liabilities	219
Total lease liabilities	$ 6,789

Leases (Details)

Leases (Details) $ in Millions	12 Months Ended
	Dec. 31, 2019USD ($)
Leases [Abstract]
Expenses under operating leases	$ 20.2
Expenses under finance leases	3.1
Variable lease costs	$ 3.4

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Leases [Abstract]
Operating cash out flows from operating leases	$ 20,712
Operating cash out flows from finance leases	374
Financing cash out flows from finance leases	2,833
Total	$ 23,919

Segments - Narrative (Details)

Segments - Narrative (Details)	12 Months Ended
	Dec. 31, 2019USD ($)segment
Segment Reporting Information [Line Items]
Number of reportable segments | segment	2
Intersegment Elimination
Segment Reporting Information [Line Items]
Revenues	$ 0
Inter-segment allocation of interest expense	$ 0

Segments - Operating Segments (

Segments - Operating Segments (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Total revenues	$ 224,344	$ 228,772	$ 226,368	$ 222,451	$ 221,852	$ 249,815	$ 263,685	$ 254,914	$ 901,935	$ 990,266	$ 966,006
Operating loss									(274,052)	(171,197)	(276,442)
Depreciation and amortization									93,807	97,344	102,093
Loss from investment in investees									(2,900)	(14,497)	(14,471)
Assets	2,309,272				2,451,072				2,309,272	2,451,072
Goodwill	671,940				700,193				671,940	700,193	717,099
U.S.
Segment Reporting Information [Line Items]
Total revenues									751,099	837,509	803,853
Ireland
Segment Reporting Information [Line Items]
Total revenues									81,170	78,102	80,905
Chile
Segment Reporting Information [Line Items]
Total revenues									33,642	41,216	44,286
Spain
Segment Reporting Information [Line Items]
Total revenues									18,747	18,195	18,285
Israel
Segment Reporting Information [Line Items]
Total revenues									8,769	9,479	13,951
Mexico
Segment Reporting Information [Line Items]
Total revenues									8,032	5,598	4,605
Other
Segment Reporting Information [Line Items]
Total revenues									476	167	121
Corporate, Non-Segment
Segment Reporting Information [Line Items]
Operating loss									(41,631)	(43,614)	(55,615)
Depreciation and amortization									59	91	138
Loss from investment in investees									0	0	0
Assets	99,521				52,413				99,521	52,413
Goodwill	0				0				0	0
Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Operating loss									(109,062)	(82,641)	(84,287)
Depreciation and amortization									30,073	28,007	27,513
Loss from investment in investees									(2,900)	(10,822)	(12,646)
Assets	1,174,639				1,236,499				1,174,639	1,236,499
Goodwill	237,131				247,407				237,131	247,407
Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Operating loss									(123,359)	(44,942)	(136,540)
Depreciation and amortization									63,675	69,246	74,442
Loss from investment in investees									0	(3,675)	(1,825)
Assets	1,035,112				1,162,160				1,035,112	1,162,160
Goodwill	$ 434,809				$ 452,786				434,809	452,786
Revenue from services
Segment Reporting Information [Line Items]
Total revenues									716,434	813,248	782,710
Revenue from services | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues									0	0
Revenue from services | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									0	0	0
Revenue from services | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									716,434	813,248	782,710
Product
Segment Reporting Information [Line Items]
Total revenues									112,184	107,112	107,759
Product | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues
Product | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									112,184	107,112	107,759
Product | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues
Revenue from transfer of intellectual property and other
Segment Reporting Information [Line Items]
Total revenues									73,317	69,906	75,537
Revenue from transfer of intellectual property and other | Corporate, Non-Segment
Segment Reporting Information [Line Items]
Total revenues									0	0
Revenue from transfer of intellectual property and other | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									73,317	69,906	75,537
Revenue from transfer of intellectual property and other | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues									$ 0	$ 0

Segments - Reconciliation Prop

Segments - Reconciliation Property Plant and Equipment, US and Foreign Jurisdictions (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property, plant and equipment, net	$ 127,111
Property, plant and equipment, net		$ 144,674
U.S.
Property, Plant and Equipment [Line Items]
Property, plant and equipment, net	62,158
Property, plant and equipment, net		76,907
Foreign
Property, Plant and Equipment [Line Items]
Property, plant and equipment, net	$ 64,953
Property, plant and equipment, net		$ 67,767

Fair Value Measurements - Asset

Fair Value Measurements - Assets and Liabilities Measured at Fair Value (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Assets:
Total assets	$ 19,123	$ 27,189
Liabilities:
Total liabilities	9,683	24,537
Level 1
Assets:
Total assets	18,870	26,313
Liabilities:
Total liabilities	0	0
Level 2
Assets:
Total assets	253	876
Liabilities:
Total liabilities	0	0
Level 3
Assets:
Total assets	0	0
Liabilities:
Total liabilities	9,683	24,537
Equity securities
Assets:
Total assets	18,870	26,313
Equity securities | Level 1
Assets:
Total assets	18,870	26,313
Equity securities | Level 2
Assets:
Total assets	0	0
Equity securities | Level 3
Assets:
Total assets	0	0
Common stock options/warrants
Assets:
Total assets	120	855
Common stock options/warrants | Level 1
Assets:
Total assets	0	0
Common stock options/warrants | Level 2
Assets:
Total assets	120	855
Common stock options/warrants | Level 3
Assets:
Total assets	0	0
Forward contracts
Assets:
Total assets	133	21
Forward contracts | Level 1
Assets:
Total assets	0	0
Forward contracts | Level 2
Assets:
Total assets	133	21
Forward contracts | Level 3
Assets:
Total assets	0	0
Contingent consideration
Liabilities:
Total liabilities	9,683	24,537
Contingent consideration | Level 1
Liabilities:
Total liabilities	0	0
Contingent consideration | Level 2
Liabilities:
Total liabilities	0	0
Contingent consideration | Level 3
Liabilities:
Total liabilities	$ 9,683	$ 24,537

Fair Value Measurements - Carry

Fair Value Measurements - Carrying Amount and Estimated Fair Value of Long-Term Debt (Details) - Notes $ in Thousands	Dec. 31, 2019USD ($)
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
2025 Notes	$ 158,174
Carrying Value
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
2025 Notes	148,140
Level 1
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
2025 Notes	158,174
Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
2025 Notes	0
Level 3
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
2025 Notes	$ 0

Fair Value Measurements - Level

Fair Value Measurements - Level 3 Reconciliation (Details) - Contingent consideration - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Total losses (gains) for the period:
Beginning Balance, liabilities	$ 24,537	$ 41,353
Included in results of operations	(14,854)	(16,816)
Ending Balance, liabilities	$ 9,683	$ 24,537

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Percentage of decrease in future sales	10.00%
Decrease of estimated future sales in amount	$ 0.8
Contingent consideration	9.7	$ 24.6
Accrued Expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	2.4	2.4
Other Long-term Liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	$ 7.3	$ 22.2

Derivative Contracts - Fair Val

Derivative Contracts - Fair Value and Presentation (Details) - Not Designated as Hedging Instrument - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Common stock options/warrants | Investments, net
Derivatives, Fair Value [Line Items]
Derivative asset, fair value	$ 120	$ 855
Forward contracts | Unrealized gains on forward contracts are recorded in Other current assets and prepaid expenses. Unrealized (losses) on forward contracts are recorded in Accrued expenses.
Derivatives, Fair Value [Line Items]
Derivative liability, fair value	$ 133	$ 21

Derivative Contracts - Losses a

Derivative Contracts - Losses and Gains on Derivative Instruments (Details) - Not Designated as Hedging Instrument - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Derivative Instruments, Gain (Loss) [Line Items]
Gain (loss) on derivative instruments	$ 174	$ 3,043	$ 52
Common stock options/warrants
Derivative Instruments, Gain (Loss) [Line Items]
Gain (loss) on derivative instruments	(601)	2,643	(2,533)
2033 Senior Notes
Derivative Instruments, Gain (Loss) [Line Items]
Gain (loss) on derivative instruments	0	0	3,185
Forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Gain (loss) on derivative instruments	$ 775	$ 400	$ (600)

Selected Quarterly Financial _3

Selected Quarterly Financial Data (Unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Quarterly Financial Information Disclosure [Abstract]
Total revenues	$ 224,344	$ 228,772	$ 226,368	$ 222,451	$ 221,852	$ 249,815	$ 263,685	$ 254,914	$ 901,935	$ 990,266	$ 966,006
Total costs and expenses	336,807	267,783	273,628	297,769	311,866	283,279	268,793	297,525	1,175,987	1,161,463	1,242,448
Net income (loss)	$ (112,350)	$ (62,007)	$ (59,806)	$ (80,762)	$ (76,070)	$ (27,655)	$ (6,201)	$ (43,114)	$ (314,925)	$ (153,040)	$ (305,250)
Earnings (loss) per share, basic and diluted (in dollars per share)	$ (0.18)	$ (0.11)	$ (0.10)	$ (0.14)	$ (0.13)	$ (0.05)	$ (0.01)	$ (0.08)

Subsequent Events (Details)

Subsequent Events (Details) - USD ($)	Nov. 05, 2015	Feb. 29, 2020	Sep. 30, 2019	Dec. 31, 2019	Nov. 04, 2019	Nov. 08, 2018	Nov. 30, 2015
Debt Instrument [Line Items]
Credit line capacity				$ 97,756,000
Line of Credit | Unsecured Debt
Debt Instrument [Line Items]
Credit line capacity						$ 60,000,000
Interest rate of notes payable						10.00%
Line of Credit | Unsecured Debt | Subsequent Event
Debt Instrument [Line Items]
Credit line capacity		$ 100,000,000
Interest rate of notes payable		11.00%
New Credit Agreement | Revolving Credit Facility | Line of Credit
Debt Instrument [Line Items]
Credit line capacity	$ 75,000,000				$ 75,000,000		$ 100,000,000
Commitment fee percentage	0.25%
New Credit Agreement | Revolving Credit Facility | Line of Credit | Subsequent Event
Debt Instrument [Line Items]
Commitment fee percentage		0.25%
Minimum
Debt Instrument [Line Items]
Total revolving commitment, minimum consecutive days			30 days	30 days
Maximum
Debt Instrument [Line Items]
Total revolving commitment (as a percent)			10.00%	10.00%

Uncategorized Items - opk-12312

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 31,665,000
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
AOCI Attributable to Parent [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(4,876,000)
Additional Paid-in Capital [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(926,000)
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	926,000
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	4,876,000
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 31,665,000