OPKO Health (OPK) 10-Q 9 May 22 2022 Q1 Quarterly report Financial data

COVER PAGE

COVER PAGE - shares	3 Months Ended
	Mar. 31, 2022	Apr. 25, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2022
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, par value $0.01 per share
Trading Symbol	OPK
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		681,525,181
Entity Central Index Key	0000944809
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 102,281	$ 134,710
Accounts receivable, net	212,755	259,637
Inventory, net	99,406	86,502
Other current assets and prepaid expenses	23,274	27,170
Assets held for sale	316,353	314,994
Total current assets	754,069	823,013
Property, plant and equipment, net	81,899	79,727
Intangible assets, net	890,498	321,683
In-process research and development	0	590,200
Goodwill	519,052	520,601
Investments	9,472	10,729
Operating lease right-of-use assets	42,768	44,228
Other assets	9,100	9,534
Total assets	2,306,858	2,399,715
Current liabilities:
Accounts payable	94,240	82,040
Accrued expenses	157,316	193,493
Current maturities of operating leases	11,690	11,624
Liabilities associated with assets held-for-sale	28,512	28,156
Current portion of lines of credit and notes payable	17,412	14,695
Total current liabilities	309,170	330,008
Operating lease liabilities	31,596	33,097
Convertible notes	210,520	187,935
Deferred tax liabilities	125,030	148,487
Other long-term liabilities, principally contract liabilities, contingent consideration and lines of credit	15,658	15,062
Total long-term liabilities	382,804	384,581
Total liabilities	691,974	714,589
Equity:
Common Stock - $0.01 par value, 1,000,000,000 shares authorized; 690,138,033 and 690,082,283 shares issued at March 31, 2022 and December 31, 2021, respectively	6,902	6,901
Treasury Stock - 8,655,082 and 8,655,082 shares at March 31, 2022 and December 31, 2021, respectively	(1,791)	(1,791)
Additional paid-in capital	3,191,139	3,222,487
Accumulated other comprehensive loss	(31,415)	(30,495)
Accumulated deficit	(1,549,951)	(1,511,976)
Total shareholders’ equity	1,614,884	1,685,126
Total liabilities and equity	$ 2,306,858	$ 2,399,715

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2022	Dec. 31, 2021
Equity:
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	1,000,000,000	1,000,000,000
Common stock, shares issued (in shares)	690,138,033	690,082,283
Treasury stock, shares (in shares)	8,655,082	8,655,082

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenues:
Total revenues	$ 329,219	$ 545,165
Costs and expenses:
Selling, general and administrative	117,537	112,286
Research and development	18,312	19,315
Contingent consideration	(106)	(957)
Amortization of intangible assets	22,025	12,577
Total costs and expenses	401,643	506,728
Operating income (loss)	(72,424)	38,437
Other income and (expense), net:
Interest income	10	5
Interest expense	(2,662)	(5,395)
Fair value changes of derivative instruments, net	(132)	(439)
Other income (expense), net	(1,442)	(927)
Other income and (expense), net	(4,226)	(6,756)
Income (loss) before income taxes and investment losses	(76,650)	31,681
Income tax benefit (provision)	21,266	(560)
Net income (loss) before investment losses	(55,384)	31,121
Loss from investments in investees	(49)	(43)
Net income (loss)	$ (55,433)	$ 31,078
Income (loss) per share, basic and diluted:
Income (loss) per share, basic (in dollars per share)	$ (0.08)	$ 0.05
Income (loss) per share, diluted (in dollars per share)	$ (0.08)	$ 0.05
Weighted average common shares outstanding, basic (in shares)	660,302,426	640,853,200
Weighted average common shares outstanding, diluted (in shares)	660,302,426	640,853,200
Services
Revenues:
Total revenues	$ 286,599	$ 506,951
Costs and expenses:
Cost of service revenue	221,202	339,429
Products
Revenues:
Total revenues	36,658	33,945
Costs and expenses:
Cost of service revenue	22,673	24,078
Revenue from transfer of intellectual property and other
Revenues:
Total revenues	$ 5,962	$ 4,269

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Statement of Comprehensive Income [Abstract]
Net income (loss)	$ (55,433)	$ 31,078
Other comprehensive loss, net of tax:
Change in foreign currency translation and other comprehensive loss	(920)	(9,070)
Comprehensive income (loss)	$ (56,353)	$ 22,008

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Treasury	Additional Paid-In Capital	Additional Paid-In CapitalCumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit	Accumulated DeficitCumulative Effect, Period of Adoption, Adjustment
Beginning balance, shares (in shares) at Dec. 31, 2020			670,585,576	549,907
Beginning balance at Dec. 31, 2020	$ 1,671,551		$ 6,706	$ (1,791)	$ 3,152,694		$ (4,225)	$ (1,481,833)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	2,647				2,647
Exercise of Common Stock options and warrants (in shares)			117,500
Exercise of common stock options and warrants	308		$ 1		307
Net income (loss)	31,078							31,078
Other comprehensive income (loss)	(9,070)						(9,070)
Ending balance, shares (in shares) at Mar. 31, 2021			670,703,076	549,907
Ending balance at Mar. 31, 2021	1,696,514		$ 6,707	$ (1,791)	3,155,648		(13,295)	(1,450,755)
Beginning balance, shares (in shares) at Dec. 31, 2020			670,585,576	549,907
Beginning balance at Dec. 31, 2020	1,671,551		$ 6,706	$ (1,791)	3,152,694		(4,225)	(1,481,833)
Ending balance, shares (in shares) at Dec. 31, 2021			690,082,283	8,655,082
Ending balance at Dec. 31, 2021	$ 1,685,126	$ (21,642)	$ 6,901	$ (1,791)	3,222,487	$ (39,100)	(30,495)	(1,511,976)	$ 17,458
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	Accounting Standards Update 2020-06
Equity-based compensation expense	$ 7,617				7,617
Exercise of Common Stock options and warrants (in shares)			55,750
Exercise of common stock options and warrants	136		$ 1		135
Net income (loss)	(55,433)							(55,433)
Other comprehensive income (loss)	(920)						(920)
Ending balance, shares (in shares) at Mar. 31, 2022			690,138,033	8,655,082
Ending balance at Mar. 31, 2022	$ 1,614,884		$ 6,902	$ (1,791)	$ 3,191,139		$ (31,415)	$ (1,549,951)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities:
Net income (loss)	$ (55,433)	$ 31,078
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities:
Depreciation and amortization	27,814	19,989
Non-cash interest	678	2,585
Amortization of deferred financing costs	281	222
Losses from investments in investees	49	43
Equity-based compensation – employees and non-employees	7,617	2,647
Realized loss (gain) on disposal of fixed assets and sales of equity securities	61	(3,039)
Change in fair value of equity securities and derivative instruments	1,299	(279)
Change in fair value of contingent consideration	(106)	(957)
Deferred income tax benefit	(22,356)	(1,033)
Changes in assets and liabilities:
Accounts receivable, net	44,421	(35,238)
Inventory, net	(9,463)	(27,912)
Other current assets and prepaid expenses	2,612	1,415
Other assets	511	1,255
Accounts payable	16,143	62,231
Foreign currency measurement	2,197	946
Contract liabilities	(4)	(790)
Accrued expenses and other liabilities	(36,177)	(27,126)
Net cash (used in) provided by operating activities	(19,856)	26,037
Cash flows from investing activities:
Proceeds from sale of investments	0	8,079
Proceeds from the sale of property, plant and equipment	348	60
Capital expenditures	(5,251)	(9,245)
Net cash (used in) provided by used in investing activities	(4,903)	(1,106)
Cash flows from financing activities:
Proceeds from the exercise of common stock options and warrants	136	308
Borrowings on lines of credit	1,649,166	472,213
Repayments of lines of credit	(1,657,193)	(479,713)
Net cash used in financing activities	(7,891)	(7,192)
Effect of exchange rate changes on cash and cash equivalents	221	(447)
Net increase (decrease) in cash and cash equivalents	(32,429)	17,292
Cash and cash equivalents at beginning of period	134,710	72,211
Cash and cash equivalents at end of period	102,281	89,503
SUPPLEMENTAL INFORMATION:
Interest paid	3,420	4,689
Income taxes paid, net of refunds	$ 1,063	$ 1,470

Business and Organization

Business and Organization	3 Months Ended
	Mar. 31, 2022
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 Health, LLC, formerly known as BioReference Laboratories, Inc. (“BioReference”), one of the nation’s largest full service laboratories with an almost 250-person sales and marketing team to drive growth and leverage new products. Our pharmaceutical business features Rayaldee , a U.S. Food and Drug Administration (“FDA”) approved treatment for secondary hyperparathyroidism (“SHPT”) in adults with stage 3 or 4 chronic kidney disease (“CKD”) and vitamin D insufficiency and a pipeline of products in various stages of development. Our leading product in development is Somatrogon (hGH-CTP), a once-weekly human growth hormone for which we have partnered with Pfizer, Inc. (“Pfizer”) and successfully completed a phase 3 study in August 2019. Regulatory applications for Somatrogon (hGH-CTP) have been submitted to the applicable regulatory bodies for review in several countries around the world. In February 2022, the European Commission granted marketing authorization in the European Union for Somatrogon (hGH-CTP) under the brand name NGENLA® to treat children and adolescents from as young as three years of age with growth disturbance due to insufficient secretion of growth hormone, and we recently received pricing approval in Germany. In January 2022, the Ministry of Health, Labour and Welfare in Japan approved NGENLA® (Somatrogon) for the long-term treatment of pediatric patients who have growth failure due to an inadequate secretion of endogenous growth hormone and we recently received pricing approval. In October 2021, Health Canada approved NGENLA® for the long-term treatment of pediatric patients who have growth hormone deficiency, and Australia’s Therapeutic Goods Administration approved NGENLA® for the long-term treatment of pediatric patients with growth disturbance due to insufficient secretion of growth hormone. We also submitted the initial Biologics License Application (“BLA”) with the FDA for approval of Somatrogon (hGH-CTP) in the United States and Pfizer received a Complete Response Letter in January 2022. Pfizer and OPKO are evaluating the FDA’s comments and will work with the agency to determine the best path forward for Somatrogon (hGH-CTP) in the United States. 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 in New York, New Jersey, Florida, Texas, Maryland, California, Pennsylvania, Delaware, Washington, DC, 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 Woburn, MA, Waterford, Ireland, Kiryat Gat, Israel, and Barcelona, Spain. On January 18, 2022, Sema4 Holdings Corp. (“Sema4”) and OPKO entered into an Agreement and Plan of Merger and Reorganization (the “GeneDx Merger Agreement”), pursuant to which Sema4 agreed to acquire OPKO’s wholly owned subsidiary, GeneDx LLC, formerly GeneDx, Inc. (“GeneDx”), subject to satisfaction of customary closing conditions (the “GeneDx Transaction”). The GeneDx Transaction closed on April 29, 2022. Under the terms of the GeneDx Merger Agreement, Sema4 acquired GeneDx for an upfront payment of $150 million in cash, subject to adjustments, plus 80.0 million shares of Sema4’s Class A common stock, and Sema4 has agreed to pay up to an additional $150 million in consideration subject to the satisfaction of certain revenue-based milestones over the next two years (which will be payable in cash or shares of Sema4’s Class A common stock at Sema4’s discretion). Based on the closing stock price of Sema4 as of April 29, 2022, the total upfront consideration represents approximately $322 million, and the total aggregate consideration including potential milestones is approximately $472 million. As of March 31, 2022 and December 31, 2021, GeneDx met the held-for-sale accounting criteria and, its related assets and liabilities are classified as held for sale in the consolidated balance sheet. GeneDx was included in our diagnostics segment as of March 31, 2022 and December 31, 2021.

Impact of COVID-19

Impact of COVID-19	3 Months Ended
	Mar. 31, 2022
Unusual or Infrequent Items, or Both [Abstract]
Impact of COVID-19	IMPACT OF COVID-19 We continue to be a part of the coordinated public and private sector response to SARS-CoV-2, a novel strain of coronavirus, referred to as COVID-19. There continues to be a high level of uncertainty relating to how the pandemic will evolve, how governments and consumers will react, progress on the distribution of vaccines and whether the pandemic will have a longer-term effect on the healthcare industry and patient habits. BioReference is providing COVID-19 solutions, including diagnostic molecular testing and serology antibody testing, to meet the testing needs of its customers, including physicians, health systems, long-term care facilities, governments, schools, employers, professional sports teams and entertainment venues, as well as the general public through relationships with retail pharmacy chains. Since the pandemic began in the U.S., we have invested in testing capabilities and infrastructure to meet demand for our molecular and antibody testing for COVID-19. Throughout the last two years, we have managed our company-wide lab operations specimen acquisition, logistics, procurement, customer service, and initiatives to manage our cost structure to match the ever changing COVID-19 testing volumes and to manage efficiency gains in our core clinical lines of business. We anticipate that COVID-19 will continue to impact our business in 2022 and demand for COVID-19 testing will fluctuate with the potential for increases and decreases in demand at different times and across different geographies; however, overall, we expect COVID-19 test demand to trend down in 2022 as compared to 2021. Revenue from services for the three months ended March 31, 2022 decreased by $220.4 million as compared to the three months ended March 31, 2021 due to lower COVID-19 testing volumes. We maintain our ability to quickly scale-up COVID-19 PCR testing capacity, even during periods of reduced demand. In doing so, we are able to immediately and effectively respond to surges in positive cases and testing needs. We are unable to predict how long the demand will continue for our COVID-19 related testing, or whether pricing and reimbursement policies for testing will be sustained. Excluding COVID-19 test volumes, for the three months ended March 31, 2022, genomic and routine clinical test volume increased 14.0% and 0.4% respectively, as compared to such volumes for the three months ended March 31, 2021. In March 2022, the U.S. Health Resources and Services Administration ("HRSA") informed providers that, after March 22, 2022, it would stop accepting claims for testing and treatment for uninsured individuals under the HRSA COVID-19 Uninsured Program and that claims submitted prior to that date would be subject to eligibility and availability of funds. For the three months ended March 31, 2022, revenue for testing of uninsured individuals under the HRSA COVID-19 Uninsured Program represented approximately 7.9% of our COVID-19 testing revenue. As of March 31, 2022, less than 6% of our net accounts receivable was associated with claims for reimbursement for COVID-19 testing of uninsured individuals. Although we believe that our estimates for contractual allowances and patient price concessions are appropriate, actual results could differ from those estimates.

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2022
Accounting Policies [Abstract]
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of presentation . The accompanying unaudited Condensed Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the U.S. (“GAAP”) and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of only normal recurring adjustments or adjustments otherwise disclosed herein) considered necessary to present fairly the Company’s results of operations, financial position and cash flows have been made. The results of operations and cash flows for the three months ended March 31, 2022 are not necessarily indicative of the results of operations and cash flows that may be reported for the remainder of 2022 or any other future periods. The unaudited Condensed Consolidated Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and the Notes to Consolidated Financial Statements included in our Annual Report on Form 10-K for the year ended December 31, 2021. Principles of consolidation . The accompanying unaudited Condensed Consolidated Financial Statements include the accounts of OPKO Health, Inc. and 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 are used in our testing laboratories. Inventory obsolescence expense for the three months ended March 31, 2022 and 2021 was $0.6 million and $3.1 million, respectively. 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 was $1.4 billion at both March 31, 2022 and December 31, 2021. 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 their 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 $519.1 million and $520.6 million, respectively, at March 31, 2022 and December 31, 2021, Assets held for sale includes $151.8 million of goodwill related to GeneDx. 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 was $890.5 million and $911.9 million, including IPR&D of $590.2 million at December 31, 2021, respectively. 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 may 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. We believe that our estimates and assumptions in testing goodwill and other intangible assets, including IPR&D, for impairment 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, including as a result of the COVID-19 global pandemic, then we may be exposed to additional impairment charges, which could be material. We submitted the initial BLA with the FDA for approval of Somatrogon (hGH-CTP) in the United States and Pfizer received a Complete Response Letter in January 2022. Pfizer and OPKO are evaluating the FDA’s comments and will work with the agency to determine the best path forward for Somatrogon (hGH-CTP) in the United States. In the first quarter of 2022, we reclassified $590.0 million of IPR&D related to Somatrogon (hGH-CTP) from IPR&D in our Condensed Consolidated Balance Sheet upon the approval of NGENLA (Somatrogon) in Europe and Japan. The assets will be amortized on a straight-line basis over their estimated useful life of approximately 12 years. 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 $22.0 million and $12.6 million for the three months ended March 31, 2022 and 2021, 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 March 31, 2022 and December 31, 2021 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 applicable to such debt. 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 9. 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 Condensed Consolidated Balance Sheet at their fair value and recognize the changes in the fair value in our Condensed 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 March 31, 2022 and December 31, 2021, our foreign currency forward contracts held to economically hedge inventory purchases did not meet the documentation requirements to be designated as hedges. Accordingly, we recognized all changes in the fair values of our derivatives instruments, net, in our Condensed Consolidated Statement of Operations. Refer to Note 10. Property, plant and equipment . Property, plant and equipment are recorded at cost or fair value if acquired in a business combination. 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 $5.8 million and $7.4 million for three months ended March 31, 2022 and 2021, 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 and assets held for sale, 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. We operate in various countries and tax jurisdictions globally. For interim reporting purposes, we record income taxes based on the expected effective income tax rate, taking into consideration year to date and global forecasted tax results. For the three months ended March 31, 2022, 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. 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 13. Concentration of credit risk and allowance for credit losses . 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 healthcare 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 because the related healthcare programs are funded by federal and state governments, and payment is primarily dependent upon submitting appropriate documentation. On March 31, 2022 and December 31, 2021, receivable balances (net of explicit and implicit price concessions) from Medicare and Medicaid were 10% and 6%, respectively, of our consolidated Accounts receivable, net. On March 31, 2022 and December 31, 2021, receivable balances (net of explicit and implicit price concessions) due directly from states, cities and other municipalities, specifically related to our real-time reverse-transcription polymerase chain reaction (real-time RT-PCR) assay to detect COVID-19, were 4.8% and 4.1% of our consolidated accounts receivable, net, respectively. The portion of our accounts receivable due from individual patients comprises the largest portion of credit risk. At March 31, 2022 and December 31, 2021, receivables due from patients represented approximately 2.0% and 0.7%, 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 credit losses was $2.0 million and $1.8 million at March 31, 2022 and December 31, 2021, respectively. The credit loss expense for the three months ended March 31, 2022 and 2021 was $0.1 million and $0.3 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 Condensed 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. For the three months ended March 31, 2022 and 2021 we recorded $7.6 million and $2.6 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 estimated 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 and genomics 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 15. 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 Condensed 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 Condensed Consolidated Statement of Operations and foreign currency translation gains (losses) have been included as a component of the Condensed Consolidated Statement of Comprehensive Income (Loss). During the three months ended March 31, 2022 and 2021, we recorded $1.1 million and $4.8 million, respectively of transaction 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 6. 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 Condensed Consolidated Statement of Operations. Refer to Note 6. For investments classified as equity securities, we record changes in their fair value as Other income (expense) in our Condensed 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 6. Recently adopted accounting pronouncements . In August 2020, the FASB issued ASU No. 2020-06, “Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity's Own Equity (Subtopic 815-40).” ASU 2020-06 simplifies the accounting for convertible instruments by reducing the number of accounting models for convertible debt instruments and convertible preferred stock. The ASU is effective for public entities for fiscal years beginning after December 15, 2021, with early adoption permitted. As required, we adopted ASU 2020-06 on January 1, 2022 and used the modified retrospective approach for all convertible debt instruments at the beginning of the period of adoptions. Results for reporting periods beginning January 1, 2022 are presented under ASU 2020-06, while prior period amounts were not adjusted and continue to be reported in accordance with historic with accounting guidance. Under the modified approach, entities will apply the guidance to all financial instruments that are outstanding as of the beginning of the year of adoption with the cumulative effect recognized as an adjustment to the opening balance of retained earnings. ASU 2020-06 eliminates the cash conversion and beneficial conversion feature models in ASC 470-20 that require an issuer of certain convertible debt and preferred stock to separately account for embedded conversion features as a component of

Earnings (Loss) Per Share

Earnings (Loss) Per Share	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
EARNINGS (LOSS) PER SHARE	EARNINGS (LOSS) PER SHARE Basic income (loss) per share is computed by dividing our net income (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 7) 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 7. 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 and discussed in Note 7) has been considered using the “if converted” method. For periods in which their effect would be antidilutive, no effect is given to Common Stock issuable under outstanding options or 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 57,985,925 and 74,623,270 potential shares of Common Stock were excluded from the calculation of diluted net loss per share for the three months ended March 31, 2022, and 2021, 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 three months ended March 31, 2022, 55,750 Common Stock options and Common Stock warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 55,750 shares of Common Stock. Of the 55,750 Common Stock options and Common Stock warrants exercised, no shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the agreements. During the three months ended March 31, 2021, 117,500 Common Stock options or Common Stock warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 117,500 shares of Common Stock. Of the 117,500 Common Stock options and Common Stock warrants exercised, no shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the agreements.

Composition of Certain Financia

Composition of Certain Financial Statement Captions	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
COMPOSITION OF CERTAIN FINANCIAL STATEMENT CAPTIONS	COMPOSITION OF CERTAIN FINANCIAL STATEMENT CAPTIONS (In thousands) March 31, December 31, Accounts receivable, net: Accounts receivable $ 214,734 $ 261,476 Less: allowance for credit losses (1,979) (1,839) $ 212,755 $ 259,637 Inventories, net: Consumable supplies $ 48,740 $ 39,447 Finished products 46,594 44,107 Work in-process 2,795 1,615 Raw materials 6,435 6,112 Less: inventory reserve (5,158) (4,779) $ 99,406 $ 86,502 Other current assets and prepaid expenses: Taxes recoverable $ 6,105 $ 5,598 Prepaid expenses 8,171 10,641 Prepaid insurance 1,731 4,383 Other receivables 2,435 353 Other 4,832 6,195 $ 23,274 $ 27,170 Intangible assets, net: Customer relationships $ 314,324 $ 314,823 Technologies 832,727 246,101 Trade names 49,774 49,770 Covenants not to compete 12,917 12,920 Licenses 5,766 5,766 Product registrations 7,251 6,995 Other 6,033 6,128 Less: accumulated amortization (338,294) (320,820) $ 890,498 $ 321,683 Accrued expenses: Inventory received but not invoiced $ 22,811 $ 40,446 Commitments and contingencies 26,940 27,819 Employee benefits 50,332 45,939 Contract liabilities 258 258 Clinical trials 4,167 4,867 Contingent consideration 487 487 Finance leases short-term 2,451 2,257 Professional fees 2,717 2,121 Other 47,153 69,299 $ 157,316 $ 193,493 (In thousands) March 31, December 31, Other long-term liabilities: Contingent consideration $ 2,242 $ 2,350 Mortgages and other debts payable 1,973 2,224 Finance leases long-term 3,865 2,924 Contract liabilities 204 208 Other 7,374 7,356 $ 15,658 $ 15,062 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. As of March 31, 2022 and December 31, 2021, GeneDx met the held-for-sale accounting criteria and its related assets and liabilities are recognized at the lower of carrying value or fair value less costs to sell in the consolidated balance sheet. In addition, at March 31, 2022 and December 31, 2021, Assets held for sale included $151.8 million of goodwill related to GeneDx. In the first quarter of 2022, we reclassified $590.0 million of IPR&D related to Somatrogon from IPR&D in our Condensed Consolidated Balance Sheet upon the approval of NGENLA (Somatrogon) in Europe and Japan. The assets will be amortized on a straight-line basis over their estimated useful life of approximately 12 years. Other changes in value of the intangible assets and goodwill during the three months ended March 31, 2022 and 2021 were primarily due to foreign currency fluctuations between the Chilean Peso, and the Euro against the U.S. dollar. The following table summarizes the changes in Goodwill by reporting unit during the three months ended March 31, 2022. 2022 (In thousands) Gross goodwill at January 1 Cumulative impairment at January 1 Foreign exchange and other Balance at March 31 Pharmaceuticals CURNA $ 4,827 $ (4,827) $ — $ — Rayaldee 86,554 — (1,701) 84,853 FineTech 11,698 (11,698) — — OPKO Biologics 139,784 — — 139,784 OPKO Chile 3,760 — 302 4,062 OPKO Health Europe 7,478 — (150) 7,328 OPKO Mexico 100 (100) — — Transition Therapeutics 3,421 (3,421) — — Diagnostics BioReference 434,809 — (151,784) 283,025 OPKO Diagnostics 17,977 (17,977) — — $ 710,408 $ (38,023) $ (153,333) $ 519,052 Foreign exchange and other amounts for three months ended March 31, 2022 includes amounts related to GeneDx which is included as Assets held for sale at March 31, 2022.

Investments

Investments	3 Months Ended
	Mar. 31, 2022
Equity Method Investments, Warrants and Options, and Variable Interest Entities [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 March 31, 2022 and December 31, 2021: (in thousands) As of March 31, 2022 As of December 31, 2021 Investment type Investment Carrying Value Underlying Equity in Net Assets Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ 217 $ 4,497 $ 263 $ 3,577 Variable interest entity, equity method 773 2,772 816 3,043 Equity securities 3,064 4,226 Equity securities with no readily determinable fair value 5,403 5,408 Warrants and options 15 16 Total carrying value of investments $ 9,472 $ 10,729 Equity method investments Our equity method investments consist of investments in Pharmsynthez (ownership 9%), Cocrystal Pharma, Inc. (“COCP”) (3%), Non-Invasive Monitoring Systems, Inc. (“NIMS”) (1%), Neovasc, Inc. (“Neovasc”) (1%), InCellDx, Inc. (“InCellDx”) (29%), BioCardia, Inc. (“BioCardia”) (1%), Xenetic Biosciences, Inc. (“Xenetic”) (1%), and LeaderMed Health Group Limited (“LeaderMed”) (47%). The aggregate amount of assets, liabilities, and net losses of our equity method investees as of and for the three months ended March 31, 2022 were $222.1 million, $37.6 million, and $19.0 million, respectively. The aggregate amount of assets, liabilities, and net losses of our equity method investees as of and for the year ended December 31, 2021 were $223.6 million, $37.9 million, and $69.4 million, respectively. We have determined that we and/or our related parties can significantly influence control of our equity method investments 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 losses in Loss from investments in investees in our Condensed Consolidated Statement of Operations. The aggregate value of our equity method investments based on the quoted market prices of their respective shares of common stock and the number of shares held by us as of March 31, 2022 and December 31, 2021 was $3.6 million and $4.5 million, respectively. Investments in Equity Securities Our equity securities consist of investments in Phio Pharmaceuticals (“Phio”) (ownership 0.01%), VBI Vaccines Inc. (“VBI”) (1%), ChromaDex Corporation (“ChromaDex”) (0.1%), Eloxx Pharmaceuticals, Inc. (“Eloxx”) (1%), and CAMP4 Therapeutics Corporation (“CAMP4”) (5%) and HealthSnap, Inc. (7%). 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 there is an observable price change. Net gains and losses on our equity securities for the three months ended March 31, 2022, and 2021 were as follows: For the three months ended March 31 (in thousands) 2022 2021 Equity Securities: Net gains and losses recognized during the period on equity securities $ (1,162) $ 2,780 Less: Net gains realized during the period on equity securities — (2,981) Unrealized net gains and losses recognized during the period on equity securities still held at the reporting date $ (1,162) $ (201) Sales of investments Gains (losses) included in earnings from sales of our investments are recorded in Other income (expense), net in our Condensed Consolidated Statement of Operations. 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, all of which were vested as of March 31, 2022 and December 31, 2021, and 33 thousand and 0.7 million to purchase additional shares of COCP and InCellDx, respectively. We recorded the changes in the fair value of the options and warrants in Fair value changes of derivative instruments, net in our Condensed Consolidated Statement of Operations. We also recorded the fair value of the options and warrants in Investments, net in our Condensed Consolidated Balance Sheet. See further discussion of the Company’s options and warrants in Note 9 and Note 10. Investments in variable interest entities We have determined that we hold variable interests in LeaderMed, Detect Genomix, LLC (“Detect Genomix”) and Zebra Biologics, Inc. (“Zebra”). We made this determination as a result of our assessment that they do not have sufficient resources to carry out their principal activities without additional financial support. On September 14, 2021, we and LeaderMed, a pharmaceutical development company with operations based in Asia, announced the formation of a joint venture to develop, manufacture and commercialize two of OPKO’s clinical stage, long-acting drug products in Greater China and eight other Asian territories. Under the terms of the agreements, we have granted the joint venture exclusive rights to develop, manufacture and commercialize (a) OPK88003, an oxyntomodulin analog being developed for the treatment of obesity and diabetes, and (b) Factor VIIa-CTP, a novel long acting coagulation factor being developed to treat hemophilia, in exchange for 4,703 shares 47% ownership interest in the joint venture. In addition, we received an upfront payment of $1.0 million and will be reimbursed for clinical trial material and technical support we provide the joint venture. In order to determine the primary beneficiary of the joint venture, 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 the joint venture. Based on the capital structure, governing documents and overall business operations of the joint venture, we determined that, while a VIE, we do not have the power to direct the activities that most significantly impact the joint venture’s economic performance and do not have an obligation to fund expected losses. We did determine that we can significantly influence control of the joint venture through our board representation and voting power. Therefore, we have the ability to exercise significant influence over the joint venture’s operations and account for our investment in the joint venture under the equity method. In August 2020, GeneDx LLC, a subsidiary of the Company, announced that it had entered into an agreement with Pediatrix Medical Group (“Pediatrix”), a provider of maternal-fetal, and pediatric medical and surgical subspecialty physician services, to offer genomic sequencing to support clinical diagnosis in neonatal intensive care units staffed by Pediatrix’s affiliated neonatologists. The offering is planned to include whole exome and whole genome sequencing and genomic support services under the brand Detect Genomix. Our initial capital investment in Detect Genomix was $245,000 for which we received a 49% ownership interest in Detect Genomix. We had been required to make additional capital contributions to Detect Genomix in accordance with our percentage interests if Detect Genomix were unable to generate positive cash flow from operations or is unable to obtain alternative financing. We have not made any other investments in or loans to Detect Genomix through March 31, 2021. In January 2022, the Detect Genomix agreement was terminated. In order to determine the primary beneficiary of Detect Genomix, we evaluated our investment to identify if we had the power to direct the activities that most significantly impact the economic performance of Detect Genomix. Based on the capital structure, governing documents and overall business operations of Detect Genomix, we determined that, while a VIE, we do not have the power to direct the activities that most significantly impact Detect Genomix’s economic performance. We determined, however, that we can significantly influence control of Detect Genomix through our board representation and voting power. Therefore, we have the ability to exercise significant influence over Detect Genomix’s operations and account for our investment in Detect Genomix under the equity method. The joint venture was dissolved in January 2022. 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 March 31, 2022). 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 former 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.

Debt

Debt	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
DEBT	DEBT As of March 31, 2022 and December 31, 2021, our debt consisted of the following: (In thousands) March 31, December 31, 2025 Notes $ 141,267 $ 119,360 2023 Convertible Notes 66,203 65,525 2033 Senior Notes 3,050 3,050 Chilean and Spanish lines of credit 16,531 13,672 Current portion of notes payable 882 1,022 Long term portion of notes payable 2,331 2,642 Total $ 230,264 $ 205,272 Balance sheet captions Convertible Notes $ 210,520 $ 187,935 Current portion of lines of credit and notes payable 17,412 14,695 LT notes payable included in long-term liabilities 2,331 2,642 Total $ 230,264 $ 205,272 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. The line of credit called for a commitment fee equal to 0.25% per annum of the unused portion of the line. No funds were borrowed under this line of credit and we terminated this line of credit in June 2021. In February 2019, we issued $200.0 million aggregate principal amount of Convertible Senior 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 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 requires 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 2025 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 May 2021, we entered into exchange agreements with certain holders of the 2025 Notes, pursuant to which the holders exchanged $55.4 million in aggregate principal amount of the outstanding 2025 Notes for 19,051,270 shares of our Common Stock (the “Exchange”). We recorded an $11.1 million non-cash loss related to the Exchange during the second quarter of 2021. 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. Following consummation of the Exchange, the number of outstanding borrowed shares of Common Stock was reduced by approximately 8,105,175 shares. As of March 31, 2022 and December 31, 2021, a total of 21,144,825 and 21,144,825 shares remained outstanding under the share lending arrangement, respectively. 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 4. 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 Condensed Consolidated Balance Sheet as of March 31, 2022: (In thousands) 2025 Senior Notes Discount Debt Issuance Cost Total Balance at December 31, 2021 $ 144,580 $ (22,747) $ (2,473) $ 119,360 Amortization of debt discount and debt issuance costs — — 264 264 Adoption of ASU 2020-06 $ — $ 22,747 $ (1,104) $ 21,643 Balance at March 31, 2022 $ 144,580 $ — $ (3,313) $ 141,267 In August 2020, the FASB issued ASU No. 2020-06, “Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity's Own Equity (Subtopic 815-40).” ASU 2020-06 simplifies the accounting for convertible instruments by reducing the number of accounting models for convertible debt instruments and convertible preferred stock. The ASU is effective for public entities for fiscal years beginning after December 15, 2021, with early adoption permitted. As required, we adopted ASU 2020-06 on January 1, 2022 and used the modified retrospective approach for all convertible debt instruments at the beginning of the period of adoptions. Results for reporting periods beginning January 1, 2022 are presented under ASU 2020-06, while prior period amounts were not adjusted and continue to be reported in accordance with historic accounting guidance. Under the modified approach, entities will apply the guidance to all financial instruments that are outstanding as of the beginning of the year of adoption with the cumulative effect recognized as an adjustment to the opening balance of retained earnings. ASU 2020-06 eliminates the cash conversion and beneficial conversion feature models in ASC 470-20 that require an issuer of certain convertible debt and preferred stock to separately account for embedded conversion features as a component of equity. The adoption of ASU 2020-06 at January 1, 2022 resulted in an increase of the Convertible notes of $21.6 million, a reduction of the Accumulated deficit of $17.5 million and a reduction of Additional paid-in capital of $39.1 million. 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 five years following 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. 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. Purchasers of the 2023 Convertible Notes included 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 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, governing the 2033 Senior Notes, 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 described above. 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 2015, BioReference and certain of its subsidiaries entered into a credit agreement with JPMorgan Chase Bank, N.A. (“CB”), as lender and administrative agent, as amended (the “Credit Agreement”). 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. On August 30, 2021, the Credit Agreement was amended and restated (the “A&R Credit Agreement”). The A&R Credit Agreement is guaranteed by all of BioReference’s domestic subsidiaries. The A&R 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 A&R Credit Agreement is based on a borrowing base composed of eligible accounts receivables of BioReference and certain of its subsidiaries, as specified therein. As of March 31, 2022, $64.8 million remained available for borrowing under the Credit Agreement. Principal under the Credit Agreement is due upon maturity on August 30, 2024. At BioReference’s option, borrowings under the A&R 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 0.75% or (ii) the LIBOR rate (adjusted for statutory reserve requirements for Eurocurrency liabilities) plus an applicable margin of 1.75%. Swingline loans will bear interest at the CB floating rate plus the applicable margin. The A&R Credit Agreement also calls for other customary fees and charges, including an unused commitment fee of 0.375% if the average quarterly availability is 50% or more of the revolving commitment, or 0.25% if the average quarterly availability is less than or equal to 50% of the revolving commitments. As of March 31, 2022 and December 31, 2021, no amount was outstanding under the A&R Credit Agreement. The A&R 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 A&R Credit Agreement, notwithstanding the ability of BioReference to meet its debt service obligations. The A&R 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 A&R Credit Agreement and execution upon the collateral securing obligations under the A&R 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. As of March 31, 2022, BioReference and its subsidiaries had net assets of approximately $1,037.1 million, which included goodwill of $283.0 million and intangible assets of $199.5 million. On April 29, 2022, the A&R Credit Agreement was amended to, among other things, (i) waive specified defaults under the A&R Credit Agreement resulting from certain internal reorganization transactions that resulted in both BioReference and GeneDx changing their respective forms of organization from New Jersey corporations to Delaware limited liability companies, (ii) provide for the disposition of GeneDx pursuant to the transactions contemplated by the merger agreement with Sema4, (iii) amend certain reporting requirements under the A&R Credit Agreement and (iv) provide that the borrowers under the A&R Credit Agreement may effect certain restricted payments to the extent necessary for their parent entities to pay income tax in respect of income earned by the borrowers. In addition to the A&R Credit Agreement with CB, we had line of credit agreements with thirteen other financial institutions as of March 31, 2022 and eleven other financial institutions as of December 31, 2021 in the U.S., Chile and Spain. These lines of credit are used primarily as sources 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 Credit line March 31, December 31, JPMorgan Chase 3.25% $ 75,000 $ — $ — Itau Bank 5.50% 1,900 1,890 1,603 Bank of Chile 6.60% 2,500 1,914 1,048 BICE Bank 5.50% 2,500 1,156 850 Scotiabank 5.50% 5,500 2,203 567 Santander Bank 5.50% 5,000 3,068 503 Security Bank 5.50% 1,400 378 1,111 Estado Bank 5.50% 2,052 2,052 2,540 BCI Bank 5.00% 2,740 2,740 2,515 Corpbanca 5.00% — — 2,935 International Bank 5.50% 1,500 881 — Consoorcio Bank 5.00% 2,000 249 — Banco De Sabadell 1.75% 556 — — Santander Bank 1.82% 556 — — Total $ 103,204 $ 16,531 $ 13,672 At March 31, 2022 and December 31, 2021, the weighted average interest rate on our lines of credit was approximately 5.5% and 5.4%, respectively. At March 31, 2022 and December 31, 2021, we had notes payable and other debt (excluding the 2033 Senior Notes, the 2023 Convertible Notes, the 2025 Notes, the A&R Credit Agreement and amounts outstanding under lines of credit described above) as follows: (In thousands) March 31, December 31, Current portion of notes payable $ 882 $ 1,022 Other long-term liabilities 2,331 2,642 Total $ 3,213 $ 3,664

Accumulated Other Comprehensive

Accumulated Other Comprehensive Loss	3 Months Ended
	Mar. 31, 2022
Equity [Abstract]
ACCUMULATED OTHER COMPREHENSIVE LOSS	ACCUMULATED OTHER COMPREHENSIVE LOSS For the three months ended March 31, 2022, changes in Accumulated other comprehensive loss, net of tax, were as follows: (In thousands) Foreign Balance at December 31, 2021 $ (30,495) Other comprehensive loss (920) Balance at March 31, 2022 $ (31,415)

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2022
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 are: 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 March 31, 2022, we had equity securities (refer to Note 6), forward foreign currency exchange contracts for inventory purchases (refer to Note 10) 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 and InCellDx. Our financial assets and liabilities measured at fair value on a recurring basis are as follows: Fair value measurements as of March 31, 2022 (In thousands) Quoted Significant Significant Total Assets: Equity securities $ 3,064 $ — $ — $ 3,064 Common stock options/warrants — 15 — 15 Total assets $ 3,064 $ 15 $ — $ 3,079 Liabilities: Forward contracts — 462 — 462 Contingent consideration — — 2,729 2,729 Total liabilities $ — $ 462 $ 2,729 $ 3,191 Fair value measurements as of December 31, 2021 (In thousands) Quoted Significant Significant Total Assets: Equity securities $ 4,226 $ — $ — $ 4,226 Common stock options/warrants — 16 — 16 Forward contracts — 122 — 122 Total assets $ 4,226 $ 138 $ — $ 4,364 Liabilities: Contingent consideration — — 2,837 2,837 Total liabilities $ — $ — $ 2,837 $ 2,837 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 inputs other than quoted prices in active markets that are directly observable. March 31, 2022 (In thousands) Carrying Total Level 1 Level 2 Level 3 2025 Notes $ 141,267 $ 164,270 $ — $ 164,270 $ — 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 March 31, 2022 and December 31, 2021, the carrying value of our other financial instrument assets approximates their fair value due to their short-term nature or variable rate of interest. The following table reconciles the beginning and ending balances of our Level 3 assets and liabilities as of March 31, 2022: March 31, 2022 (In thousands) Contingent Balance at December 31, 2021 $ 2,837 Change in fair value: Included in results of operations (106) Foreign currency impact (2) Balance at March 31, 2022 $ 2,729 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:

Derivative Contracts

Derivative Contracts	3 Months Ended
	Mar. 31, 2022
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 Condensed Consolidated Balance Sheets: (In thousands) Balance Sheet Component March 31, December 31, Derivative financial instruments: Common Stock options/warrants Investments, net $ 15 $ 16 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. $ (462) $ 122 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 March 31, 2022 and December 31, 2021, our derivative financial instruments did not meet the documentation requirements to be designated as hedges. Accordingly, we recognize the changes in Fair value of derivative instruments, net in our Condensed Consolidated Statement of Operations. The following table summarizes the losses and gains recorded for the three and three months ended March 31, 2022 and 2021: Three months ended March 31, (In thousands) 2022 2021 Derivative gain (loss): Common Stock options/warrants $ (1) $ 21 Forward contracts (131) (460) Total $ (132) $ (439)

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2022
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONS In August 2020, GeneDx entered into an agreement with Mednax Services, Inc. (“Mednax Services”), a subsidiary of MEDNAX, Inc., (“MEDNAX”) pursuant to which the parties formed a joint venture under the brand Detect Genomix. GeneDx’s initial capital investment in Detect Genomix was $245,000 for which GeneDx received a 49% ownership interest in Detect Genomix, and Mednax Services contributed $255,000 in exchange for a 51% ownership interest in Detect Genomix. Adam Logal, the Company’s CFO, was the chair and sat on the Board of Managers of the joint venture. Mednax Services provided administrative services to the joint venture pursuant to an administrative services agreement. GeneDx provided laboratory services to the joint venture. Dr. Roger Medel, a director of the Company, is the former Chief Executive Officer of MEDNAX and Mednax Services. Dr. Medel continues to serve on the board of MEDNAX. The joint venture was dissolved in January 2022. 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. The line of credit called for a commitment fee equal to 0.25% per annum of the unused portion of the line. We terminated this line of credit in June 2021 and as of March 31, 2022 and December 31, 2021, no amount was outstanding thereunder. The Company owns approximately 9% of Pharmsynthez and Pharmsynthez is Xenetic’s largest and controlling stockholder. Dr. Richard Lerner, a director of the Company until his death on December 2, 2021, was 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. We hold investments in Zebra (ownership 29%), Neovasc (1%), ChromaDex Corporation (0.1%), COCP (3%), NIMS (1%), Eloxx (1%), BioCardia (1%) and LeaderMed Health Group Limited (47%). 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 6. 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 agreed to 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 (“Frost Holdings”) 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 three months ended March 31, 2022 and 2021, we reimbursed approximately $31 thousand and $0 thousand, respectively, for Company-related travel by Dr. Frost and other OPKO executives.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2022
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 March 31, 2022, we recorded $2.7 million as contingent consideration, with $0.5 million recorded within Accrued expenses and $2.2 million recorded within Other long-term liabilities in the accompanying Condensed Consolidated Balance Sheets. Refer to Note 5 and Note 17. On March 1, 2019, the Company received a Civil Investigative Demand (“CID”) from the U.S. Department of Justice (“DOJ”), Washington, DC. The CID sets forth document requests and interrogatories in connection with allegations that the Company and certain of its affiliates violated the False Claims Act and/or the Anti-Kickback Statute. On January 13, 2022, the Federal Government notified the U.S.D.C., Middle District Florida, Jacksonville Division, that it is declining to intervene in the matter but retains the right, via the Attorney General, to consent to any proposed dismissal of the action by the Court. On February 9, 2022, the States of Florida, Georgia, and Commonwealth of Massachusetts notified the U.S.D.C., Middle District Florida, Jacksonville Division, that they are declining to intervene in the matter. Notwithstanding the above declinations, on February 17, 2022, the Company was served with the Relator’s Summons and Complaint (“Complaint”), which had been previously sealed. The complaint alleges violations of the False Claims Act, the California Fraud Preventions Act, the Florida False Claims Act, the Massachusetts False Claims Act, the Georgia False Medicaid Claims Act, and illegal kickbacks. The Company is reviewing and assessing the allegations made in the Complaint and, at this point, has not determined whether there is any merit to these claims nor can it determine the extent of any potential liability. While management cannot predict the outcome of these matters at this time, the ultimate outcome could be material to our business, financial condition, results of operations, and cash flows. As previously reported, BioReference receives and is routinely required to respond to Civil Investigative Demands (“CID”) in the ordinary course of business. On November 26, 2019, BioReference received a CID from the DOJ. The CID states that DOJ is investigating whether BioReference paid unlawful remuneration to health care practitioners in violation of the Anti-Kickback Statute or Stark law and thus submitted or caused to be submitted false claims to government health care programs in violation of the False Claims Act. The time period covered by DOJ’s requests is January 1, 2011 through November 26, 2019. BioReference has fully cooperated with the DOJ by submitting the requested information and making current employees available for interviews, and the DOJ made a presentation to BioReference regarding its position. The parties have reached verbal agreement on the settlement amount, which is anticipated to be approximately $10 million, excluding attorney fees. As of March 31, 2022 and December 31, 2021, $10.5 million and $10.0 million was recorded in Accrued expenses, respectively. On April 8, 2019, MabVax Therapeutics Holdings, Inc. filed a lawsuit in the Superior Court of California, County of San Diego against a number of individuals and entities, including the Company, Dr. Frost, Steven Rubin, the Company’s Executive Vice President-Administration, and an entity affiliated with Dr. Frost, based on the allegations raised in the SEC Complaint. The lawsuit seeks an award for actual and punitive damages, pre- and post-judgment interest; that the defendants be required to make full disclosure and accounting of their interests and transactions in plaintiff’s securities; costs of the suit, and reasonable attorney’s fees; and such other legal and equitable relief as the Court may deem proper under the circumstances. On January 31, 2022, plaintiffs entered into a confidential mutual release and settlement agreement with the Company, Dr. Frost, Frost Gamma Investment Trust, and Steve Rubin (the “Settlement Agreement”). The Settlement Agreement has been approved by the United States Bankruptcy Court for the District of Delaware. On April 5, 2019, former shareholders of Claros Diagnostics, Inc. filed a complaint in the Chancery Court of Delaware against the Company, alleging among other things, that the Company breached the Agreement and Plan of Merger dated October 13, 2011 by and among the Company, Claros Merger Subsidiary, LLC and Claros Diagnostics, Inc. (the “Claros Merger Agreement”): (i) by failing to make a milestone payment of $2.375 million (payable in OPKO Common Stock) upon obtaining FDA approval of the Claros PSA test; and (ii) by repudiating its obligations to make additional future milestone payments as required under the Claros Merger Agreement. In January 2021, the Company and the shareholder representative entered into a settlement agreement providing, among other things, that the Company pay the shareholders $1.2 million, which the Company has paid in full. 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 believed that, from 2008 to 2012, 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 believed 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 and the SDNY reached a settlement with respect to these matters and a final settlement and release, including BioReference’s payment of an approximately $11.5 million settlement amount, was approved on September 22, 2020. The settlement amount has been paid. The amount of relator attorneys’ fees is currently being negotiated. From time to time, we may receive inquiries, document requests, 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. At March 31, 2022, we were committed to make future purchases for inventory and other items in 2022 that occur in the ordinary course of business under various purchase arrangements with fixed purchase provisions aggregating approximately $252.4 million.

Revenue Recognition

Revenue Recognition	3 Months Ended
	Mar. 31, 2022
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. Client payors also include cities, states and companies for which BioReference provides COVID-19 testing services. 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 three months ended March 31, 2022 and 2021, positive revenue adjustments due to changes in estimates of implicit price concessions for performance obligations satisfied in prior periods of $2.0 million and $28.0 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 payor 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 March 31, 2022 and December 31, 2021, we had liabilities of approximately $2.1 million and $5.0 million, respectively, within Accrued expenses and Other long-term liabilities related to reimbursements for payor overpayments. The composition of Revenue from services by payor for the three months ended March 31, 2022 and 2021 was as follows: Three months ended March 31, (In thousands) 2022 2021 Healthcare insurers $ 95,779 $ 164,829 Government payers 27,588 73,658 Client payers 159,040 262,907 Patients 4,192 5,557 Total $ 286,599 $ 506,951 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 three months ended March 31, 2022 and 2021, we recognized $5.1 million and $5.8 million, respectively, in net product revenue from sales of Rayaldee . The following table presents an analysis of product sales allowances and accruals for the three months ended March 31, 2022 and 2021: (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2021 $ 2,014 $ 5,499 $ 2,639 $ 10,152 Provision related to current period sales 3,215 4,869 269 8,353 Credits or payments made (3,641) (5,086) (575) (9,302) Balance at March 31, 2022 $ 1,588 $ 5,282 $ 2,333 $ 9,203 Total gross Rayaldee sales $ 13,479 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 62% (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2020 $ 2,332 $ 5,812 $ 3,593 $ 11,737 Provision related to current period sales 3,815 5,694 313 9,822 Credits or payments made (4,454) (5,297) (419) (10,170) Balance at March 31, 2021 $ 1,693 $ 6,209 $ 3,487 $ 11,389 Total gross Rayaldee sales $ 15,645 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 63% Taxes collected from customers related to revenues from services and revenues from products are excluded from revenues. Revenue from intellectual property and other 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 Three months ended March 31, 2022 and 2021, revenue from transfer of intellectual property and other reflects $2.2 million and $2.8 million of revenue related to the Pfizer Transaction (as defined below). For the three months ended March 31, 2022 revenue from transfer of intellectual property and other includes $3.0 million related to a sales milestone from VFMCRP (as defined below). Contract liabilities relate to cash consideration that OPKO receives in advance of satisfying the related performance obligations. Changes in the contractual liabilities balance during the three months ended March 31, 2022 are as follows: (In thousands) Balance at December 31, 2021 $ 466 Balance at March 31, 2022 462 Revenue recognized in the period from: Amounts included in contracts liability at the beginning of the period 4

Strategic Alliances

Strategic Alliances	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
STRATEGIC ALLIANCES	STRATEGIC ALLIANCES LeaderMed On September 14, 2021, we and LeaderMed Health Group Limited (“LeaderMed”), a pharmaceutical development company with operations based in Asia, announced the formation of a joint venture to develop, manufacture and commercialize two of OPKO’s clinical stage, long-acting drug products in Greater China and eight other Asian territories. Under the terms of the agreements, we have granted the joint venture exclusive rights to develop, manufacture and commercialize (a) OPK88003, an oxyntomodulin analog being developed for the treatment of obesity and diabetes, and (b) Factor VIIa-CTP, a novel long-acting coagulation factor being developed to treat hemophilia, in exchange for a 47% ownership interest in the joint venture. In addition, we received an upfront payment of $1 million and will be reimbursed for clinical trial material and technical support we provide the joint venture. We recognized the upfront payment of $1 million as revenue from transfer of intellectual property and other during the year ended December 31, 2021. LeaderMed has agreed to be responsible for funding the joint venture’s operations, development and commercialization efforts and, together with its syndicate partners, initially invested $11 million in exchange for a 53% ownership interest. We retain full rights to oxyntomodulin and Factor VIIa-CTP in all other geographies. CAMP4 Therapeutics On July 6, 2021, we entered into an exclusive license agreement (the “CAMP4 Agreement”) with CAMP4, pursuant to which we granted to CAMP4 an exclusive license to develop, manufacture, commercialize or improve therapeutics utilizing the AntagoNAT technology, an oligonucleotide platform developed under OPKO CURNA, which includes the molecule for the treatment of Dravet syndrome, together with any derivative or modification thereof (the “Licensed Compound”) and any pharmaceutical product that comprises or contains the Licensed Compound, alone or in combination with one or more other active ingredients (“Licensed Product”), worldwide. The CAMP4 Agreement grant covers human pharmaceutical, prophylactic, and therapeutic and certain diagnostic uses. We received an initial upfront payment of $1.5 million and 3,373,008 shares of CAMP4’s Series A Prime Preferred Stock (“Preferred Stock”), which equates to approximately 9% of the outstanding shares of CAMP4, and we are eligible to receive up to $3.5 million in development milestone payments for Dravet syndrome products, and $4 million for non-Dravet syndrome products, as well as sales milestones of up to $90 million for Dravet syndrome products and up to $90 million for non-Dravet syndrome products. We may also receive double digit royalty payments on the net sales of royalty bearing products, subject to adjustment. In addition, upon achievement of certain development milestones, we will be eligible to receive equity consideration of up to 5,782,299 shares of Preferred Stock in connection with Dravet syndrome products and up to 1,082,248 shares of Preferred Stock in connection with non-Dravet syndrome products. In connection with our acquisition of CURNA, we agreed to pay future consideration to the sellers upon the achievement of certain events. As a result of our execution of the CAMP4 Agreement, we will have to pay a percentage of any payments received under the CAMP4 Agreement to the former CURNA stockholders. Unless earlier terminated, the CAMP4 Agreement will remain in effect on a Licensed Product-by-Licensed Product and country by-country basis until such time as the royalty term expires for a Licensed Product in a country, and expires in its entirety upon the expiration of the royalty term for the last Licensed Product in the last country. CAMP4’s royalty obligations expire on the later of (i) the expiration, invalidation or abandonment date of the last patent right in connection with the royalty bearing product, or (ii) ten (10) years after a royalty bearing product’s first commercial sale in a country. In addition to termination rights for material breach and bankruptcy, CAMP4 is permitted to terminate the Agreement after a specified notice period. NICOYA Macau Limited On June 18, 2021, EirGen, our wholly owned subsidiary, and NICOYA Macau Limited (“Nicoya”), a Macau corporation and an affiliate of NICOYA Therapeutics, entered into a Development and License Agreement (the “Nicoya Agreement”) granting Nicoya the exclusive rights for the development and commercialization of extended release calcifediol (the “Nicoya Product”) in Greater China, which includes mainland China, Hong Kong, Macau, and Taiwan (collectively, the “Nicoya Territory”). Extended release calcifediol is marketed in the U.S. by OPKO under the tradename Rayaldee . The license grant to Nicoya covers the therapeutic and preventative use of the Nicoya Product for SHPT in non-dialysis and hemodialysis chronic kidney disease patients (the “Nicoya Field”). EirGen has received an initial upfront payment of $5 million and is eligible to receive an additional $5 million upon the first to occur of (A) a predetermined milestone and (B) the first anniversary of the effective date. EirGen is also eligible to receive up to an additional aggregate amount of $115 million upon the achievement of certain development, regulatory and sales-based milestones by Nicoya for the Nicoya Product in the Nicoya Territory. EirGen will also receive tiered, double digit royalty payments at rates in the low double digits on net product sales within the Nicoya Territory and in the Nicoya Field. Nicoya will, at its sole cost and expense, be responsible for performing all development activities necessary to obtain all regulatory approvals for the Nicoya Product in the Nicoya Territory and for all commercial activities pertaining to the Nicoya Product in the Nicoya Territory. Unless earlier terminated, the Nicoya Agreement will remain in effect until such time as all royalty payment terms and extended payment terms have expired, and Nicoya shall have no further payment obligations to EirGen under the terms of the Nicoya Agreement. Nicoya’s royalty obligations expire on the later of (i) expiration of the last to expire valid patent claim covering the Nicoya Product sold in the Nicoya Territory, (ii) expiration of all regulatory and data exclusivity applicable to the Nicoya Product in the Nicoya Territory, and (iii) on a product-by-product basis, ten (10) years after such Nicoya Product’s first commercial sale in the Nicoya Territory. In addition to termination rights for material breach and bankruptcy, Nicoya is permitted to terminate the Nicoya Agreement after a specified notice period. Vifor Fresenius Medical Care Renal Pharma Ltd In May 2016, EirGen 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 (including Mexico), (iii) Russia, (iv) China, (v) South Korea, (vi) Ukraine, (vii) Belorussia, (viii) Azerbaijan, (ix) Kazakhstan, (x) Taiwan (xi) the Middle East, and (xii) all countries of Africa (the “VFMCRP Territory”), as amended. 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”). For the three months ended March 31, 2022 we recognized a milestone payment of $3.0 million in revenue from transfer of intellectual property and other for the first sale of Rayaldee in Europe. Effective May 23, 2021, we entered into an amendment to the VFMCRP Agreement pursuant to which the parties thereto agreed to include Japan as part of the VFMCRP Territory. Effective May 5, 2020, we entered into an amendment to the VFMCRP Agreement pursuant to which the parties agreed to exclude Mexico, South Korea, the Middle East and all of the countries of Africa from the VFMCRP Territory. In addition, the parties agreed to certain amendments to the milestone structure and to reduce minimum royalties payable. As revised, the Company has received a $3 million payment triggered by the first marketing approval of Rayaldee in Europe and is eligible to receive up to an additional $17 million in regulatory milestones and $207 million in milestone payments tied to launch, pricing and sales of Rayaldee , and tiered, double-digit royalties. 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 Somatrogon (hGH-CTP) 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”). In early 2022, the European Commission and Ministry of Health, Labour and Welfare in Japan approved the next-generation long-acting recombinant human growth hormone NGENLA (Somatrogon), a once-weekly injection to treat pediatric growth hormone deficiency, and we received pricing approvals in Germany and Japan. With the achievement of these milestones, we are entitled to receive an aggregate of $85.0 million in milestone payments. Further, Canada and Australia approved NGENLA in October and November of 2021, respectively. In January 2022, the FDA issued a Complete Response Letter for the BLA for Somatrogon (hGH-CTP). Pfizer and OPKO are evaluating the FDA’s comments and will work with the agency to determine the best path forward for Somatrogon (hGH-CTP) in the United States. In May 2020, we entered into an Amended and Restated Development and Commercialization License Agreement (the “Restated Pfizer Agreement”) with Pfizer, effective January 1, 2020, pursuant to which the parties agreed, among other things, to share all costs for Manufacturing Activities, as defined in the Restated Pfizer Agreement, for developing a licensed product for the three indications included in the Restated Agreement. On October 21, 2019, we and Pfizer announced that the global phase 3 trial evaluating Somatrogon 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. Under the terms of the Pfizer Transaction, as restated, 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 Somatrogon worldwide. In addition, we are eligible to receive initial tiered royalty payments associated with the commercialization of Somatrogon for adult GHD with percentage rates ranging from the high teens to mid-twenties. Upon the launch of Somatrogon for pediatric GHD in certain major markets, the royalties will transition to regional, tiered gross profit sharing for both Somatrogon 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 recognized the non-refundable $295.0 million upfront payments as revenue as the research and development services were completed and as of both March 31, 2022 and December 31, 2021, we had no contract liabilities related to the Pfizer Transaction. 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. See Note 17, Subsequent Events. 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.

Segments

Segments	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
SEGMENTS	SEGMENTS 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 our clinical and genomics 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 three months ended March 31, (In thousands) 2022 2021 Revenue from services: Pharmaceutical $ — $ — Diagnostics 286,599 506,951 Corporate — — $ 286,599 $ 506,951 Revenue from products: Pharmaceutical $ 36,658 $ 33,945 Diagnostics — — Corporate — — $ 36,658 $ 33,945 Revenue from transfer of intellectual property and other: Pharmaceutical $ 5,962 $ 4,269 Diagnostics — — Corporate — — $ 5,962 $ 4,269 Operating income (loss): Pharmaceutical $ (18,108) $ (19,157) Diagnostics (43,548) 67,014 Corporate (10,768) (9,420) $ (72,424) $ 38,437 Depreciation and amortization: Pharmaceutical $ 15,402 $ 7,413 Diagnostics 12,412 12,576 Corporate — — $ 27,814 $ 19,989 Loss from investment in investees: Pharmaceutical $ (49) $ (43) Diagnostics — — Corporate — — $ (49) $ (43) Revenues: United States $ 291,808 $ 512,871 Ireland 8,462 7,129 Chile 16,339 14,152 Spain 7,109 5,919 Israel 1,558 2,512 Mexico 3,750 2,418 Other 193 164 $ 329,219 $ 545,165 (In thousands) March 31, December 31, Assets: Pharmaceutical $ 1,099,633 $ 1,114,460 Diagnostics 1,152,173 1,238,583 Corporate 55,052 46,672 $ 2,306,858 $ 2,399,715 Goodwill: Pharmaceutical $ 236,028 $ 237,576 Diagnostics 283,024 283,025 $ 519,052 $ 520,601

Leases

Leases	3 Months Ended
	Mar. 31, 2022
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. We elected the use of permitted practical expedients 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 following table presents the lease balances within the Condensed Consolidated Balance Sheet as of March 31, 2022 and December 31, 2021: (in thousands) Classification on the Balance Sheet March 31, 2022 December 31, 2021 Assets Operating lease assets Operating lease right-of-use assets $ 42,768 $ 44,228 Finance lease assets Property, plant and equipment, net 6,316 5,181 Liabilities Current Operating lease liabilities Current maturities of operating leases 11,690 11,624 Accrued expenses Current maturities of finance leases 2,451 2,257 Long-term Operating lease liabilities Operating lease liabilities 31,596 33,097 Other long-term liabilities Finance lease liabilities $ 3,865 $ 2,924 Weighted average remaining lease term Operating leases 7.1 years 7.2 years Finance leases 2.9 years 2.4 years Weighted average discount rate Operating leases 4.5 % 4.6 % Finance leases 5.8 % 4.8 % 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 Condensed Consolidated Balance Sheet as of March 31, 2022: (in thousands) Operating Finance April 1, 2022 through December 31, 2022 $ 10,435 $ 1,930 2023 10,115 2,050 2024 8,220 1,454 2025 5,847 919 2026 5,397 329 Thereafter 24,621 — Total undiscounted future minimum lease payments 64,635 6,682 Less: Difference between lease payments and discounted lease liabilities 10,429 366 Total lease liabilities $ 54,206 $ 6,316 Expense under operating leases and finance leases was $4.6 million and $0.7 million, respectively, for the three months ended March 31, 2022, which includes $0.4 million of variable lease costs. Expense under operating leases and finance leases was $4.5 million and $0.6 million, respectively, for the three months ended March 31, 2021, which includes $0.7 million of variable lease costs. Operating lease costs and finance lease costs are included within Operating loss in the Condensed Consolidated Statement of Operations. Short-term lease costs were not material. Supplemental cash flow information is as follows: (in thousands) For the three months ended March 31, 2022 2021 Operating cash out flows from operating leases $ 4,288 $ 4,245 Operating cash out flows from finance leases 33 33 Financing cash out flows from finance leases 498 525 Total $ 4,819 $ 4,803
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. We elected the use of permitted practical expedients 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 following table presents the lease balances within the Condensed Consolidated Balance Sheet as of March 31, 2022 and December 31, 2021: (in thousands) Classification on the Balance Sheet March 31, 2022 December 31, 2021 Assets Operating lease assets Operating lease right-of-use assets $ 42,768 $ 44,228 Finance lease assets Property, plant and equipment, net 6,316 5,181 Liabilities Current Operating lease liabilities Current maturities of operating leases 11,690 11,624 Accrued expenses Current maturities of finance leases 2,451 2,257 Long-term Operating lease liabilities Operating lease liabilities 31,596 33,097 Other long-term liabilities Finance lease liabilities $ 3,865 $ 2,924 Weighted average remaining lease term Operating leases 7.1 years 7.2 years Finance leases 2.9 years 2.4 years Weighted average discount rate Operating leases 4.5 % 4.6 % Finance leases 5.8 % 4.8 % 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 Condensed Consolidated Balance Sheet as of March 31, 2022: (in thousands) Operating Finance April 1, 2022 through December 31, 2022 $ 10,435 $ 1,930 2023 10,115 2,050 2024 8,220 1,454 2025 5,847 919 2026 5,397 329 Thereafter 24,621 — Total undiscounted future minimum lease payments 64,635 6,682 Less: Difference between lease payments and discounted lease liabilities 10,429 366 Total lease liabilities $ 54,206 $ 6,316 Expense under operating leases and finance leases was $4.6 million and $0.7 million, respectively, for the three months ended March 31, 2022, which includes $0.4 million of variable lease costs. Expense under operating leases and finance leases was $4.5 million and $0.6 million, respectively, for the three months ended March 31, 2021, which includes $0.7 million of variable lease costs. Operating lease costs and finance lease costs are included within Operating loss in the Condensed Consolidated Statement of Operations. Short-term lease costs were not material. Supplemental cash flow information is as follows: (in thousands) For the three months ended March 31, 2022 2021 Operating cash out flows from operating leases $ 4,288 $ 4,245 Operating cash out flows from finance leases 33 33 Financing cash out flows from finance leases 498 525 Total $ 4,819 $ 4,803

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2022
Subsequent Events [Abstract]
SUBSEQUENT EVENTS	SUBSEQUENT EVENTS On January 18, 2022, Sema4 and OPKO announced they had entered into a definitive agreement pursuant to which Sema4 has agreed to acquire OPKO’s wholly owned subsidiary, GeneDx, a leader in genomic testing and analysis. The GeneDx Transaction closed on April 29, 2022. Under the terms of the GeneDx Merger Agreement, Sema4 acquired GeneDx for an upfront payment of $150 million in cash, subject to adjustments, plus 80.0 million shares in Sema4, with up to an additional $150 million revenue-based milestones over the next two years (which will be payable in cash or Sema4 shares at Sema4’s discretion). Based on the closing stock price of Sema4 as of April 29, 2022, the total upfront consideration represents approximately $322 million, and the total aggregate consideration including potential milestones is approximately $472 million. In April 2022, Pfizer notified OPKO that NGENLA (Somatrogon), a once-weekly injection to treat pediatric growth hormone deficiency, has received pricing approval in Germany and Japan. NGENLA was granted marketing authorization by the Ministry of Health, Labour and Welfare in Japan and by the European Commission in January and February of this year, respectively. With the achievement of these milestones, we are entitled to receive an aggregate of $85.0 million in milestone payments. On May 9, 2022, the Company entered into an Agreement and Plan of Merger with Orca Acquisition Sub, Inc. (“Merger Sub “, a subsidiary of the Company formed for the purposes of this transaction), ModeX Therapeutics, Inc., (“ModeX” or “Seller”) and Sellers’ representative (the “Merger Agreement”), pursuant to which Merger Sub was merged with and into ModeX, with ModeX becoming a wholly owned subsidiary of the Company (the “Merger”). The Company paid an aggregate of $300 million for all of the outstanding equity of ModeX, as adjusted by customary adjustments. The consideration paid at closing consisted of shares of our common stock, which was valued based on the average of the daily volume-weighted average price over the thirty (30) trading days prior to the date that is two (2) trading days prior to the signing of the Merger Agreement . In addition, the Company has made a number of management changes in connection with the Merger. Elias Zerhouni, M.D., Gary Nabel, M.D., PhD., and Alexis Borisy were appointed to the Board of the Company, with Dr. Zerhouni appointed as the Vice Chair. Elizabeth Nabel, one of the founders of ModeX, is the new Chief Medical Officer of the Company. Dr. Gary Nabel has been named the CEO of ModeX and Chief Innovation Officer of the Company and Dr. Zerhouni has been named the President of the Company. We have reviewed all events and transactions that occurred after the March 31, 2022 Condensed Consolidated Balance Sheet date, through the time of filing this Quarterly Report on Form 10-Q.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2022
Accounting Policies [Abstract]
Basis of presentation	Basis of presentation. The accompanying unaudited Condensed Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the U.S. (“GAAP”) and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of only normal recurring adjustments or adjustments otherwise disclosed herein) considered necessary to present fairly the Company’s results of operations, financial position and cash flows have been made. The results of operations and cash flows for the three months ended March 31, 2022 are not necessarily indicative of the results of operations and cash flows that may be reported for the remainder of 2022 or any other future periods. The unaudited Condensed Consolidated Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and the Notes to Consolidated Financial Statements included in our Annual Report on Form 10-K for the year ended December 31, 2021.
Principles of consolidation	Principles of consolidation. The accompanying unaudited Condensed Consolidated Financial Statements include the accounts of OPKO Health, Inc. and 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
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 or less as cash equivalents. These investments include money markets, bank deposits, certificates of deposit and U.S. treasury securities.
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 are used in our testing laboratories. Inventory obsolescence expense for the three months ended March 31, 2022 and 2021 was $0.6 million and $3.1 million, respectively.
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 was $1.4 billion at both March 31, 2022 and December 31, 2021. 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 their 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 $519.1 million and $520.6 million, respectively, at March 31, 2022 and December 31, 2021, Assets held for sale includes $151.8 million of goodwill related to GeneDx. 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 was $890.5 million and $911.9 million, including IPR&D of $590.2 million at December 31, 2021, respectively. 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 may 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. We believe that our estimates and assumptions in testing goodwill and other intangible assets, including IPR&D, for impairment 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, including as a result of the COVID-19 global pandemic, then we may be exposed to additional impairment charges, which could be material. We submitted the initial BLA with the FDA for approval of Somatrogon (hGH-CTP) in the United States and Pfizer received a Complete Response Letter in January 2022. Pfizer and OPKO are evaluating the FDA’s comments and will work with the agency to determine the best path forward for Somatrogon (hGH-CTP) in the United States.
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 March 31, 2022 and December 31, 2021 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 applicable to such debt.
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 Condensed Consolidated Balance Sheet at their fair value and recognize the changes in the fair value in our Condensed 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 March 31, 2022 and December 31, 2021, our foreign currency forward contracts held to economically hedge inventory purchases did not meet the documentation requirements to be designated as hedges. Accordingly, we recognized all changes in the fair values of our derivatives instruments, net, in our Condensed Consolidated Statement of Operations.
Property, plant and equipment	Property, plant and equipment . Property, plant and equipment are recorded at cost or fair value if acquired in a business combination. 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 $5.8 million and $7.4 million for three months ended March 31, 2022 and 2021, 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 and assets held for sale, 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. We operate in various countries and tax jurisdictions globally. For interim reporting purposes, we record income taxes based on the expected effective income tax rate, taking into consideration year to date and global forecasted tax results. For the three months ended March 31, 2022, 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.
Revenue recognition and shipping and handling costs	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. 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 Condensed Consolidated Statement of Operations.
Concentration of credit risk and allowance for credit losses	Concentration of credit risk and allowance for credit losses . 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 healthcare 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.
Allowance for doubtful accounts	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.
Equity-based compensation	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 Condensed 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.
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 estimated 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 translation	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 Condensed Consolidated Statement of Operations and foreign currency translation gains (losses) have been included as a component of the Condensed Consolidated Statement of Comprehensive Income (Loss). During the three months ended March 31, 2022 and 2021, we recorded $1.1 million and $4.8 million, respectively of transaction losses.
Variable interest entities	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.
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 Condensed Consolidated Statement of Operations. Refer to Note 6. For investments classified as equity securities, we record changes in their fair value as Other income (expense) in our Condensed 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.
Recently adopted accounting pronouncements	Recently adopted accounting pronouncements . In August 2020, the FASB issued ASU No. 2020-06, “Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity's Own Equity (Subtopic 815-40).” ASU 2020-06 simplifies the accounting for convertible instruments by reducing the number of accounting models for convertible debt instruments and convertible preferred stock. The ASU is effective for public entities for fiscal years beginning after December 15, 2021, with early adoption permitted. As required, we adopted ASU 2020-06 on January 1, 2022 and used the modified retrospective approach for all convertible debt instruments at the beginning of the period of adoptions. Results for reporting periods beginning January 1, 2022 are presented under ASU 2020-06, while prior period amounts were not adjusted and continue to be reported in accordance with historic with accounting guidance. Under the modified approach, entities will apply the guidance to all financial instruments that are outstanding as of the beginning of the year of adoption with the cumulative effect recognized as an adjustment to the opening balance of retained earnings. ASU 2020-06 eliminates the cash conversion and beneficial conversion feature models in ASC 470-20 that require an issuer of certain convertible debt and preferred stock to separately account for embedded conversion features as a component of

Composition of Certain Financ_2

Composition of Certain Financial Statement Captions (Tables)	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Composition of Certain Financial Statement Captions	(In thousands) March 31, December 31, Accounts receivable, net: Accounts receivable $ 214,734 $ 261,476 Less: allowance for credit losses (1,979) (1,839) $ 212,755 $ 259,637 Inventories, net: Consumable supplies $ 48,740 $ 39,447 Finished products 46,594 44,107 Work in-process 2,795 1,615 Raw materials 6,435 6,112 Less: inventory reserve (5,158) (4,779) $ 99,406 $ 86,502 Other current assets and prepaid expenses: Taxes recoverable $ 6,105 $ 5,598 Prepaid expenses 8,171 10,641 Prepaid insurance 1,731 4,383 Other receivables 2,435 353 Other 4,832 6,195 $ 23,274 $ 27,170 Intangible assets, net: Customer relationships $ 314,324 $ 314,823 Technologies 832,727 246,101 Trade names 49,774 49,770 Covenants not to compete 12,917 12,920 Licenses 5,766 5,766 Product registrations 7,251 6,995 Other 6,033 6,128 Less: accumulated amortization (338,294) (320,820) $ 890,498 $ 321,683 Accrued expenses: Inventory received but not invoiced $ 22,811 $ 40,446 Commitments and contingencies 26,940 27,819 Employee benefits 50,332 45,939 Contract liabilities 258 258 Clinical trials 4,167 4,867 Contingent consideration 487 487 Finance leases short-term 2,451 2,257 Professional fees 2,717 2,121 Other 47,153 69,299 $ 157,316 $ 193,493 (In thousands) March 31, December 31, Other long-term liabilities: Contingent consideration $ 2,242 $ 2,350 Mortgages and other debts payable 1,973 2,224 Finance leases long-term 3,865 2,924 Contract liabilities 204 208 Other 7,374 7,356 $ 15,658 $ 15,062
Changes in Goodwill	The following table summarizes the changes in Goodwill by reporting unit during the three months ended March 31, 2022. 2022 (In thousands) Gross goodwill at January 1 Cumulative impairment at January 1 Foreign exchange and other Balance at March 31 Pharmaceuticals CURNA $ 4,827 $ (4,827) $ — $ — Rayaldee 86,554 — (1,701) 84,853 FineTech 11,698 (11,698) — — OPKO Biologics 139,784 — — 139,784 OPKO Chile 3,760 — 302 4,062 OPKO Health Europe 7,478 — (150) 7,328 OPKO Mexico 100 (100) — — Transition Therapeutics 3,421 (3,421) — — Diagnostics BioReference 434,809 — (151,784) 283,025 OPKO Diagnostics 17,977 (17,977) — — $ 710,408 $ (38,023) $ (153,333) $ 519,052

Investments (Tables)

Investments (Tables)	3 Months Ended
	Mar. 31, 2022
Equity Method Investments, Warrants and Options, and Variable Interest Entities [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 March 31, 2022 and December 31, 2021: (in thousands) As of March 31, 2022 As of December 31, 2021 Investment type Investment Carrying Value Underlying Equity in Net Assets Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ 217 $ 4,497 $ 263 $ 3,577 Variable interest entity, equity method 773 2,772 816 3,043 Equity securities 3,064 4,226 Equity securities with no readily determinable fair value 5,403 5,408 Warrants and options 15 16 Total carrying value of investments $ 9,472 $ 10,729
Schedule of Net Gains and Losses on Equity Securities	Net gains and losses on our equity securities for the three months ended March 31, 2022, and 2021 were as follows: For the three months ended March 31 (in thousands) 2022 2021 Equity Securities: Net gains and losses recognized during the period on equity securities $ (1,162) $ 2,780 Less: Net gains realized during the period on equity securities — (2,981) Unrealized net gains and losses recognized during the period on equity securities still held at the reporting date $ (1,162) $ (201)

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Schedule of Debt	As of March 31, 2022 and December 31, 2021, our debt consisted of the following: (In thousands) March 31, December 31, 2025 Notes $ 141,267 $ 119,360 2023 Convertible Notes 66,203 65,525 2033 Senior Notes 3,050 3,050 Chilean and Spanish lines of credit 16,531 13,672 Current portion of notes payable 882 1,022 Long term portion of notes payable 2,331 2,642 Total $ 230,264 $ 205,272 Balance sheet captions Convertible Notes $ 210,520 $ 187,935 Current portion of lines of credit and notes payable 17,412 14,695 LT notes payable included in long-term liabilities 2,331 2,642 Total $ 230,264 $ 205,272
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 Condensed Consolidated Balance Sheet as of March 31, 2022: (In thousands) 2025 Senior Notes Discount Debt Issuance Cost Total Balance at December 31, 2021 $ 144,580 $ (22,747) $ (2,473) $ 119,360 Amortization of debt discount and debt issuance costs — — 264 264 Adoption of ASU 2020-06 $ — $ 22,747 $ (1,104) $ 21,643 Balance at March 31, 2022 $ 144,580 $ — $ (3,313) $ 141,267 At March 31, 2022 and December 31, 2021, we had notes payable and other debt (excluding the 2033 Senior Notes, the 2023 Convertible Notes, the 2025 Notes, the A&R Credit Agreement and amounts outstanding under lines of credit described above) as follows: (In thousands) March 31, December 31, Current portion of notes payable $ 882 $ 1,022 Other long-term liabilities 2,331 2,642 Total $ 3,213 $ 3,664
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 Credit line March 31, December 31, JPMorgan Chase 3.25% $ 75,000 $ — $ — Itau Bank 5.50% 1,900 1,890 1,603 Bank of Chile 6.60% 2,500 1,914 1,048 BICE Bank 5.50% 2,500 1,156 850 Scotiabank 5.50% 5,500 2,203 567 Santander Bank 5.50% 5,000 3,068 503 Security Bank 5.50% 1,400 378 1,111 Estado Bank 5.50% 2,052 2,052 2,540 BCI Bank 5.00% 2,740 2,740 2,515 Corpbanca 5.00% — — 2,935 International Bank 5.50% 1,500 881 — Consoorcio Bank 5.00% 2,000 249 — Banco De Sabadell 1.75% 556 — — Santander Bank 1.82% 556 — — Total $ 103,204 $ 16,531 $ 13,672

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Loss (Tables)	3 Months Ended
	Mar. 31, 2022
Equity [Abstract]
Changes in Accumulated Other Comprehensive Loss, Net of Tax	For the three months ended March 31, 2022, changes in Accumulated other comprehensive loss, net of tax, were as follows: (In thousands) Foreign Balance at December 31, 2021 $ (30,495) Other comprehensive loss (920) Balance at March 31, 2022 $ (31,415)

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2022
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 March 31, 2022 (In thousands) Quoted Significant Significant Total Assets: Equity securities $ 3,064 $ — $ — $ 3,064 Common stock options/warrants — 15 — 15 Total assets $ 3,064 $ 15 $ — $ 3,079 Liabilities: Forward contracts — 462 — 462 Contingent consideration — — 2,729 2,729 Total liabilities $ — $ 462 $ 2,729 $ 3,191 Fair value measurements as of December 31, 2021 (In thousands) Quoted Significant Significant Total Assets: Equity securities $ 4,226 $ — $ — $ 4,226 Common stock options/warrants — 16 — 16 Forward contracts — 122 — 122 Total assets $ 4,226 $ 138 $ — $ 4,364 Liabilities: Contingent consideration — — 2,837 2,837 Total liabilities $ — $ — $ 2,837 $ 2,837
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 inputs other than quoted prices in active markets that are directly observable. March 31, 2022 (In thousands) Carrying Total Level 1 Level 2 Level 3 2025 Notes $ 141,267 $ 164,270 $ — $ 164,270 $ —
Reconciliation of the Beginning and Ending Balances of Level 3 Assets	The following table reconciles the beginning and ending balances of our Level 3 assets and liabilities as of March 31, 2022: March 31, 2022 (In thousands) Contingent Balance at December 31, 2021 $ 2,837 Change in fair value: Included in results of operations (106) Foreign currency impact (2) Balance at March 31, 2022 $ 2,729
Reconciliation of the Beginning and Ending Balances of Level 3 Liabilities	The following table reconciles the beginning and ending balances of our Level 3 assets and liabilities as of March 31, 2022: March 31, 2022 (In thousands) Contingent Balance at December 31, 2021 $ 2,837 Change in fair value: Included in results of operations (106) Foreign currency impact (2) Balance at March 31, 2022 $ 2,729

Derivative Contracts (Tables)

Derivative Contracts (Tables)	3 Months Ended
	Mar. 31, 2022
Derivative Instruments and Hedging Activities Disclosure [Abstract]
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 Condensed Consolidated Balance Sheets: (In thousands) Balance Sheet Component March 31, December 31, Derivative financial instruments: Common Stock options/warrants Investments, net $ 15 $ 16 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. $ (462) $ 122
Summary of Derivative Instrument Losses and Gains Recorded	The following table summarizes the losses and gains recorded for the three and three months ended March 31, 2022 and 2021: Three months ended March 31, (In thousands) 2022 2021 Derivative gain (loss): Common Stock options/warrants $ (1) $ 21 Forward contracts (131) (460) Total $ (132) $ (439)

Revenue Recognition (Tables)

Revenue Recognition (Tables)	3 Months Ended
	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The composition of Revenue from services by payor for the three months ended March 31, 2022 and 2021 was as follows: Three months ended March 31, (In thousands) 2022 2021 Healthcare insurers $ 95,779 $ 164,829 Government payers 27,588 73,658 Client payers 159,040 262,907 Patients 4,192 5,557 Total $ 286,599 $ 506,951
Schedule of Product Sales Allowances and Accruals	The following table presents an analysis of product sales allowances and accruals for the three months ended March 31, 2022 and 2021: (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2021 $ 2,014 $ 5,499 $ 2,639 $ 10,152 Provision related to current period sales 3,215 4,869 269 8,353 Credits or payments made (3,641) (5,086) (575) (9,302) Balance at March 31, 2022 $ 1,588 $ 5,282 $ 2,333 $ 9,203 Total gross Rayaldee sales $ 13,479 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 62% (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2020 $ 2,332 $ 5,812 $ 3,593 $ 11,737 Provision related to current period sales 3,815 5,694 313 9,822 Credits or payments made (4,454) (5,297) (419) (10,170) Balance at March 31, 2021 $ 1,693 $ 6,209 $ 3,487 $ 11,389 Total gross Rayaldee sales $ 15,645 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 63%
Changes in Contractual Liabilities Balance	Changes in the contractual liabilities balance during the three months ended March 31, 2022 are as follows: (In thousands) Balance at December 31, 2021 $ 466 Balance at March 31, 2022 462 Revenue recognized in the period from: Amounts included in contracts liability at the beginning of the period 4

Segments (Tables)

Segments (Tables)	3 Months Ended
	Mar. 31, 2022
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 three months ended March 31, (In thousands) 2022 2021 Revenue from services: Pharmaceutical $ — $ — Diagnostics 286,599 506,951 Corporate — — $ 286,599 $ 506,951 Revenue from products: Pharmaceutical $ 36,658 $ 33,945 Diagnostics — — Corporate — — $ 36,658 $ 33,945 Revenue from transfer of intellectual property and other: Pharmaceutical $ 5,962 $ 4,269 Diagnostics — — Corporate — — $ 5,962 $ 4,269 Operating income (loss): Pharmaceutical $ (18,108) $ (19,157) Diagnostics (43,548) 67,014 Corporate (10,768) (9,420) $ (72,424) $ 38,437 Depreciation and amortization: Pharmaceutical $ 15,402 $ 7,413 Diagnostics 12,412 12,576 Corporate — — $ 27,814 $ 19,989 Loss from investment in investees: Pharmaceutical $ (49) $ (43) Diagnostics — — Corporate — — $ (49) $ (43) Revenues: United States $ 291,808 $ 512,871 Ireland 8,462 7,129 Chile 16,339 14,152 Spain 7,109 5,919 Israel 1,558 2,512 Mexico 3,750 2,418 Other 193 164 $ 329,219 $ 545,165 (In thousands) March 31, December 31, Assets: Pharmaceutical $ 1,099,633 $ 1,114,460 Diagnostics 1,152,173 1,238,583 Corporate 55,052 46,672 $ 2,306,858 $ 2,399,715 Goodwill: Pharmaceutical $ 236,028 $ 237,576 Diagnostics 283,024 283,025 $ 519,052 $ 520,601

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Lease Assets and Liabilities	The following table presents the lease balances within the Condensed Consolidated Balance Sheet as of March 31, 2022 and December 31, 2021: (in thousands) Classification on the Balance Sheet March 31, 2022 December 31, 2021 Assets Operating lease assets Operating lease right-of-use assets $ 42,768 $ 44,228 Finance lease assets Property, plant and equipment, net 6,316 5,181 Liabilities Current Operating lease liabilities Current maturities of operating leases 11,690 11,624 Accrued expenses Current maturities of finance leases 2,451 2,257 Long-term Operating lease liabilities Operating lease liabilities 31,596 33,097 Other long-term liabilities Finance lease liabilities $ 3,865 $ 2,924 Weighted average remaining lease term Operating leases 7.1 years 7.2 years Finance leases 2.9 years 2.4 years Weighted average discount rate Operating leases 4.5 % 4.6 % Finance leases 5.8 % 4.8 %
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 Condensed Consolidated Balance Sheet as of March 31, 2022: (in thousands) Operating Finance April 1, 2022 through December 31, 2022 $ 10,435 $ 1,930 2023 10,115 2,050 2024 8,220 1,454 2025 5,847 919 2026 5,397 329 Thereafter 24,621 — Total undiscounted future minimum lease payments 64,635 6,682 Less: Difference between lease payments and discounted lease liabilities 10,429 366 Total lease liabilities $ 54,206 $ 6,316
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 Condensed Consolidated Balance Sheet as of March 31, 2022: (in thousands) Operating Finance April 1, 2022 through December 31, 2022 $ 10,435 $ 1,930 2023 10,115 2,050 2024 8,220 1,454 2025 5,847 919 2026 5,397 329 Thereafter 24,621 — Total undiscounted future minimum lease payments 64,635 6,682 Less: Difference between lease payments and discounted lease liabilities 10,429 366 Total lease liabilities $ 54,206 $ 6,316
Lease Cash Flow Information	Supplemental cash flow information is as follows: (in thousands) For the three months ended March 31, 2022 2021 Operating cash out flows from operating leases $ 4,288 $ 4,245 Operating cash out flows from finance leases 33 33 Financing cash out flows from finance leases 498 525 Total $ 4,819 $ 4,803

Business and Organization (Deta

Business and Organization (Details) shares in Millions, $ in Millions	Apr. 29, 2022USD ($)shares	Jun. 30, 2021facility	Mar. 31, 2022employee	Sep. 30, 2021USD ($)	Dec. 31, 2021USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of sales employees | employee			250
Gain on sale of assets				$ 31.5
Detect Genomix | Sema4 | Subsequent Event
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Payments to acquire business	$ 150
Number of shares issued in business combination (in shares) | shares	80
Additional revenue-based milestones	$ 150
Revenue-based milestone period	2 years
Total upfront consideration transferred	$ 322
Total aggregate consideration	$ 472
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Waterford, Ireland Facility
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold | facility		1
Consideration from sale of facility					$ 65

Impact of COVID-19 (Details)

Impact of COVID-19 (Details) $ in Millions	3 Months Ended
	Mar. 31, 2022USD ($)
Genomic Test
Unusual or Infrequent Item, or Both [Line Items]
Change in testing volume (as a percent)	14.00%
Routine Clinical Test
Unusual or Infrequent Item, or Both [Line Items]
Change in testing volume (as a percent)	0.40%
Services
Unusual or Infrequent Item, or Both [Line Items]
Increase (decrease) in revenue	$ (220.4)
COVID-19 Testing | COVID-19 Testing Revenue Concentration Risk | Revenue Benchmark
Unusual or Infrequent Item, or Both [Line Items]
Concentration risk (as a percent)	7.90%
COVID-19 Testing | COVID-19 Testing Revenue Concentration Risk | Accounts Receivable
Unusual or Infrequent Item, or Both [Line Items]
Concentration risk (as a percent)	6.00%

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Details) $ in Thousands	Mar. 31, 2022USD ($)	Dec. 31, 2021USD ($)	Mar. 31, 2022USD ($)segment	Mar. 31, 2021USD ($)	Jan. 01, 2022USD ($)	Dec. 31, 2020USD ($)
Summary of Significant Accounting Policies [Line Items]
Provision for inventory obsolescence			$ 600	$ 3,100
Goodwill, in-process research and development and other intangible assets acquired	$ 1,400,000	$ 1,400,000	1,400,000
Goodwill	519,052	520,601	519,052		$ 710,408
Net intangible assets other than goodwill	890,500	911,900	890,500
Intangible assets, net	890,498	321,683	890,498
In-process research and development	0	590,200	0
Amortization expense			22,025	12,577
Depreciation expense			5,800	7,400
Allowance for credit losses	1,979	1,839	1,979
Provision related to current period sales			100	300
Equity-based compensation expense			$ 7,600	2,600
Number of reportable segments | segment			2
Foreign currency transaction gains (losses)			$ 1,100	4,800
Equity	1,614,884	1,685,126	1,614,884	1,696,514		$ 1,671,551
Retained Earnings
Summary of Significant Accounting Policies [Line Items]
Equity	(1,549,951)	(1,511,976)	(1,549,951)	(1,450,755)		(1,481,833)
Additional Paid-in Capital
Summary of Significant Accounting Policies [Line Items]
Equity	3,191,139	3,222,487	3,191,139	$ 3,155,648		$ 3,152,694
Cumulative Effect, Period of Adoption, Adjustment
Summary of Significant Accounting Policies [Line Items]
Equity		(21,642)			21,600
Cumulative Effect, Period of Adoption, Adjustment | Retained Earnings
Summary of Significant Accounting Policies [Line Items]
Equity		17,458			17,500
Cumulative Effect, Period of Adoption, Adjustment | Additional Paid-in Capital
Summary of Significant Accounting Policies [Line Items]
Equity		(39,100)			$ (39,100)
In Process Research and Development
Summary of Significant Accounting Policies [Line Items]
Intangible assets, net	590,000		$ 590,000
Intangible assets, estimated useful lives			12 years
Detect Genomix
Summary of Significant Accounting Policies [Line Items]
Goodwill	151,800	$ 151,800	$ 151,800
OPKO Biologics
Summary of Significant Accounting Policies [Line Items]
In-process research and development	$ (590,000)		$ (590,000)
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
Credit Concentration Risk | Accounts Receivable | Federal and State Governments
Summary of Significant Accounting Policies [Line Items]
Concentration percentage	10.00%	6.00%
Geographic Concentration Risk | Accounts Receivable | States, Cities and Other Municipalities
Summary of Significant Accounting Policies [Line Items]
Concentration percentage	4.80%	4.10%
Customer Concentration Risk | Accounts Receivable | Individual Patients
Summary of Significant Accounting Policies [Line Items]
Concentration percentage	2.00%	0.70%
Software
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			3 years
Machinery, Medical and Other Equipment | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			5 years
Machinery, Medical and Other Equipment | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			8 years
Furniture and Fixtures | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			5 years
Furniture and Fixtures | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			12 years
Buildings and Improvements | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			10 years
Buildings and Improvements | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			40 years
Automobiles and Aircraft | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			3 years
Automobiles and Aircraft | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives			5 years
In Process Research and Development
Summary of Significant Accounting Policies [Line Items]
Net intangible assets other than goodwill		$ 590,200

Earnings (Loss) Per Share (Deta

Earnings (Loss) Per Share (Details) - $ / shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
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)	55,750	117,500
Number of common stock issued for stock warrant and stock options exercised (in shares)	55,750	117,500
Shares surrendered in lieu of cash payment (in shares)	0	0
Common Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Dilutive potential shares (in shares)	57,985,925	74,623,270

Composition of Certain Financ_3

Composition of Certain Financial Statement Captions (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Accounts receivable, net:
Accounts receivable	$ 214,734	$ 261,476
Less: allowance for credit losses	(1,979)	(1,839)
Accounts receivable, net	212,755	259,637
Inventories, net:
Consumable supplies	48,740	39,447
Finished products	46,594	44,107
Work in-process	2,795	1,615
Raw materials	6,435	6,112
Less: inventory reserve	(5,158)	(4,779)
Inventory, net	99,406	86,502
Other current assets and prepaid expenses:
Taxes recoverable	6,105	5,598
Prepaid expenses	8,171	10,641
Prepaid insurance	1,731	4,383
Other receivables	2,435	353
Other	4,832	6,195
Other current assets and prepaid expenses	23,274	27,170
Intangible assets, net:
Less: accumulated amortization	(338,294)	(320,820)
Intangible assets, net	890,498	321,683
Accrued expenses:
Inventory received but not invoiced	22,811	40,446
Commitments and contingencies	26,940	27,819
Employee benefits	50,332	45,939
Contract liabilities	258	258
Clinical trials	4,167	4,867
Contingent consideration	487	487
Finance leases short-term	2,451	2,257
Professional fees	2,717	2,121
Other	47,153	69,299
Accrued expenses	157,316	193,493
Other long-term liabilities:
Contingent consideration	2,242	2,350
Mortgages and other debts payable	1,973	2,224
Finance leases long-term	3,865	2,924
Contract liabilities	204	208
Other	7,374	7,356
Other long-term liabilities	15,658	15,062
Customer relationships
Intangible assets, net:
Intangible assets	314,324	314,823
Technologies
Intangible assets, net:
Intangible assets	832,727	246,101
Trade names
Intangible assets, net:
Intangible assets	49,774	49,770
Covenants not to compete
Intangible assets, net:
Intangible assets	12,917	12,920
Licenses
Intangible assets, net:
Intangible assets	5,766	5,766
Product registrations
Intangible assets, net:
Intangible assets	7,251	6,995
Other
Intangible assets, net:
Intangible assets	$ 6,033	$ 6,128

Composition of Certain Financ_4

Composition of Certain Financial Statement Captions - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Jan. 01, 2022	Dec. 31, 2021
Acquired Finite-Lived Intangible Assets [Line Items]
Goodwill	$ 519,052	$ 710,408	$ 520,601
Intangible assets, net	890,498		321,683
In-Process Research and Development	0		(590,200)
Detect Genomix
Acquired Finite-Lived Intangible Assets [Line Items]
Goodwill	151,800		$ 151,800
OPKO Biologics
Acquired Finite-Lived Intangible Assets [Line Items]
In-Process Research and Development	$ 590,000
Covenants not to compete
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
In Process Research and Development
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	$ 590,000
Intangible assets, estimated useful lives	12 years
Minimum
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets, estimated useful lives	3 years
Minimum | Technologies
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	7 years
Minimum | Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	7 years
Minimum | Products
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	7 years
Minimum | Trade names
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Minimum | Other
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	9 years
Maximum
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets, estimated useful lives	20 years
Maximum | Technologies
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	17 years
Maximum | Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	20 years
Maximum | Products
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Maximum | Trade names
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Maximum | Other
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	13 years

Composition of Certain Financ_5

Composition of Certain Financial Statement Captions - Changes in Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Jan. 01, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 519,052	$ 710,408	$ 520,601
Cumulative impairment at January 1			(38,023)
Foreign exchange and other	(153,333)
Goodwill, ending balance	519,052	710,408	520,601
BioReference
Goodwill [Roll Forward]
Goodwill, beginning balance	283,000
Goodwill, ending balance	283,000
Pharmaceutical | CURNA
Goodwill [Roll Forward]
Goodwill, beginning balance	0	4,827
Cumulative impairment at January 1			(4,827)
Foreign exchange and other	0
Goodwill, ending balance	0	4,827
Pharmaceutical | Rayaldee
Goodwill [Roll Forward]
Goodwill, beginning balance	84,853	86,554
Cumulative impairment at January 1			0
Foreign exchange and other	(1,701)
Goodwill, ending balance	84,853	86,554
Pharmaceutical | FineTech
Goodwill [Roll Forward]
Goodwill, beginning balance	0	11,698
Cumulative impairment at January 1			(11,698)
Foreign exchange and other	0
Goodwill, ending balance	0	11,698
Pharmaceutical | OPKO Biologics
Goodwill [Roll Forward]
Goodwill, beginning balance	139,784	139,784
Cumulative impairment at January 1			0
Foreign exchange and other	0
Goodwill, ending balance	139,784	139,784
Pharmaceutical | OPKO Chile
Goodwill [Roll Forward]
Goodwill, beginning balance	4,062	3,760
Cumulative impairment at January 1			0
Foreign exchange and other	302
Goodwill, ending balance	4,062	3,760
Pharmaceutical | OPKO Health Europe
Goodwill [Roll Forward]
Goodwill, beginning balance	7,328	7,478
Cumulative impairment at January 1			0
Foreign exchange and other	(150)
Goodwill, ending balance	7,328	7,478
Pharmaceutical | OPKO Mexico
Goodwill [Roll Forward]
Goodwill, beginning balance	0	100
Cumulative impairment at January 1			(100)
Foreign exchange and other	0
Goodwill, ending balance	0	100
Pharmaceutical | Transition Therapeutics
Goodwill [Roll Forward]
Goodwill, beginning balance	0	3,421
Cumulative impairment at January 1			(3,421)
Foreign exchange and other	0
Goodwill, ending balance	0	3,421
Diagnostics | BioReference
Goodwill [Roll Forward]
Goodwill, beginning balance	283,025	434,809
Cumulative impairment at January 1			0
Foreign exchange and other	(151,784)
Goodwill, ending balance	283,025	434,809
Diagnostics | OPKO Diagnostics
Goodwill [Roll Forward]
Goodwill, beginning balance	0	17,977
Cumulative impairment at January 1			$ (17,977)
Foreign exchange and other	0
Goodwill, ending balance	$ 0	$ 17,977

Investments - Summary of Invest

Investments - Summary of Investments (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Investment Carrying Value
Equity method investments	$ 217	$ 263
Variable interest entity, equity method	773	816
Equity securities	3,064	4,226
Equity securities with no readily determinable fair value	5,403	5,408
Warrants and options	15	16
Total carrying value of investments	9,472	10,729
Underlying Equity in Net Assets
Equity method investment, underlying equity in net assets	4,497	3,577
Variable interest entity, equity method, underlying equity in net assets	$ 2,772	$ 3,043

Investments - Narrative (Detail

Investments - Narrative (Details) - USD ($) $ in Thousands	Sep. 14, 2021	Aug. 31, 2020	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Total assets of equity method investees			$ 2,306,858		$ 2,399,715
Total liabilities of equity method investees			691,974		714,589
Market value			3,600		4,500
Total revenues			329,219	$ 545,165
Transfer of intellectual property and other
Schedule of Equity Method Investments [Line Items]
Total revenues			5,962	$ 4,269
LeaderMed | LeaderMed Joint Venture | Corporate Joint Venture
Schedule of Equity Method Investments [Line Items]
Joint venture (in shares)	4,703
Ownership interest in joint venture (as a percent)	47.00%
LeaderMed | LeaderMed Joint Venture | Corporate Joint Venture | Transfer of intellectual property and other
Schedule of Equity Method Investments [Line Items]
Total revenues	$ 1,000		1,000
Equity Method Investment, Nonconsolidated Investee or Group of Investees
Schedule of Equity Method Investments [Line Items]
Total assets of equity method investees			222,100		223,600
Total liabilities of equity method investees			37,600		37,900
Net losses of equity method investees			$ 19,000		$ 69,400
Pharmsynthez
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			9.00%
Cocrystal
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			3.00%
Number of shares into which warrants may be converted (in shares)			33,000
Non-Invasive Monitoring Systems, Inc.
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			1.00%
Neovasc
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			1.00%
InCellDx, Inc
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			29.00%
Number of shares into which warrants may be converted (in shares)			700,000
BioCardia, Inc.
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			1.00%
Equity security investments (as a percent)			1.00%
Number of shares into which warrants may be converted (in shares)			47,000		47,000
Xenetic Biosciences, Inc.
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			1.00%
Phio Pharmaceuticals
Schedule of Equity Method Investments [Line Items]
Equity security investments (as a percent)			0.01%
VBI Vaccines Inc
Schedule of Equity Method Investments [Line Items]
Equity security investments (as a percent)			1.00%
ChromaDex
Schedule of Equity Method Investments [Line Items]
Equity security investments (as a percent)			0.10%
Eloxx Pharmaceuticals
Schedule of Equity Method Investments [Line Items]
Equity security investments (as a percent)			1.00%
CAMP4
Schedule of Equity Method Investments [Line Items]
Equity security investments (as a percent)			5.00%
HealthSnap
Schedule of Equity Method Investments [Line Items]
Equity security investments (as a percent)			7.00%
Detect Genomix | Variable Interest Entity, Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)		49.00%
Additional investment in equity method investment		$ 245
Zebra | Variable Interest Entity, Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Equity method investments (as a percent)			29.00%
Series A Preferred Stock | Zebra | Variable Interest Entity, Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Investment owned (in shares)			1,260,000
Restricted Stock | Zebra | Variable Interest Entity, Not Primary Beneficiary
Schedule of Equity Method Investments [Line Items]
Shares received as a gift (in shares)			900,000

Investments - Schedule of Net G

Investments - Schedule of Net Gains and Losses on Equity Securities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Equity Securities:
Net gains and losses recognized during the period on equity securities	$ (1,162)	$ 2,780
Less: Net gains realized during the period on equity securities	0	(2,981)
Unrealized net gains and losses recognized during the period on equity securities still held at the reporting date	$ (1,162)	$ (201)

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021	Feb. 01, 2019
Debt Instrument [Line Items]
Long-term debt	$ 230,264	$ 205,272
Convertible Notes
Debt Instrument [Line Items]
Long-term debt	210,520	187,935
Current portion of lines of credit and notes payable
Debt Instrument [Line Items]
Long-term debt	17,412	14,695
LT notes payable included in long-term liabilities
Debt Instrument [Line Items]
Long-term debt	2,331	2,642
Line of Credit
Debt Instrument [Line Items]
Long-term debt	16,531	13,672
Notes Payable, Other Payables
Debt Instrument [Line Items]
Long-term debt, current maturities	882	1,022
Long-term debt, excluding current maturities	2,331	2,642
Convertible Senior Notes Due 2025 | Convertible Debt
Debt Instrument [Line Items]
Long-term debt	141,267	119,360
5% Convertible Notes | Convertible Debt
Debt Instrument [Line Items]
Long-term debt	66,203	65,525
Notes Due February 1, 2033 | Notes
Debt Instrument [Line Items]
Long-term debt	$ 3,050	$ 3,050	$ 3,000

Debt - Narrative (Details)

Debt - Narrative (Details)

Feb. 25, 2020USD ($)

Jan. 30, 2013USD ($)

May 31, 2021USD ($)shares

Feb. 28, 2019USD ($)day$ / sharesshares

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

Nov. 30, 2015USD ($)

Jan. 31, 2013

Mar. 31, 2022USD ($)dayinstitutionshares

Dec. 31, 2021USD ($)institutionshares

Dec. 31, 2016USD ($)shares

Jan. 01, 2022USD ($)

Mar. 31, 2021USD ($)

Dec. 31, 2020USD ($)

Feb. 01, 2019USD ($)

Debt Instrument [Line Items]

Credit line capacity

$ 103,204,000

Amounts outstanding under line of credit

16,531,000

$ 13,672,000

Equity

1,614,884,000

1,685,126,000

$ 1,696,514,000

$ 1,671,551,000

Remaining principal

230,264,000

205,272,000

Goodwill

$ 519,052,000

$ 520,601,000

$ 710,408,000

Number of financial institutions | institution

13

13

Retained Earnings

Debt Instrument [Line Items]

Equity

$ (1,549,951,000)

$ (1,511,976,000)

(1,450,755,000)

(1,481,833,000)

Additional Paid-in Capital

Debt Instrument [Line Items]

Equity

3,191,139,000

3,222,487,000

$ 3,155,648,000

$ 3,152,694,000

Cumulative Effect, Period of Adoption, Adjustment

Debt Instrument [Line Items]

Equity

(21,642,000)

21,600,000

Cumulative Effect, Period of Adoption, Adjustment | Retained Earnings

Debt Instrument [Line Items]

Equity

17,458,000

17,500,000

Cumulative Effect, Period of Adoption, Adjustment | Additional Paid-in Capital

Debt Instrument [Line Items]

Equity

$ (39,100,000)

$ (39,100,000)

BioReference

Debt Instrument [Line Items]

Net assets

1,037,100,000

Goodwill

283,000,000

Intangible assets

$ 199,500,000

OPKO Health Europe

Debt Instrument [Line Items]

Weighted average interest rate

1.50%

1.50%

Minimum | OPKO Health Europe

Debt Instrument [Line Items]

Variable interest rates

0.70%

Maximum | OPKO Health Europe

Debt Instrument [Line Items]

Variable interest rates

3.80%

Line of Credit

Debt Instrument [Line Items]

Remaining principal

$ 16,531,000

$ 13,672,000

Weighted average interest rate

5.50%

5.40%

Convertible Debt

Debt Instrument [Line Items]

Interest rate on notes payable

4.50%

Convertible Debt | Convertible Senior Notes Due 2025

Debt Instrument [Line Items]

Debt face amount

$ 200,000,000

Debt instrument, conversion ratio

0.2367424

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

$ 4.22

Converted debt amount

$ 55,400,000

Shares issued on converted debt (in shares) | shares

19,051,270

21,144,825

21,144,825

Loss on conversion of the 2025 Notes

$ 11,100,000

Shares issuable under debt agreement (in shares) | shares

30,000,000

Decrease in shares issuable under debt agreement (in shares) | shares

8,105,175

Proceeds one-time nominal fee

$ 300,000

Equity component of convertible debt

$ 52,600,000

Effective interest rate (as a percent)

11.20%

Remaining principal

$ 141,267,000

$ 119,360,000

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period one

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 | Redemption period one | Minimum

Debt Instrument [Line Items]

Number of trading days | day

20

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period one | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

30

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period two

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

98.00%

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period two | Minimum

Debt Instrument [Line Items]

Number of trading days | day

5

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period two | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

5

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period three

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 | Redemption period three | Minimum

Debt Instrument [Line Items]

Number of trading days | day

20

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period three | 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 on notes payable

5.00%

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

$ 5

Debt instrument, term

5 years

Minimum conversion notice

30 days

Maximum conversion notice

60 days

Remaining principal

$ 66,203,000

65,525,000

Convertible Debt | Notes Due February 1, 2033

Debt Instrument [Line Items]

Converted debt amount

$ 143,200,000

Senior Notes

Debt Instrument [Line Items]

Remaining principal

141,267,000

119,360,000

Senior Notes | Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06

Debt Instrument [Line Items]

Remaining principal

21,643,000

Senior Notes | Notes Due February 1, 2033

Debt Instrument [Line Items]

Debt face amount

$ 175,000,000

Interest rate on notes payable

3.00%

Equivalent redemption price

100.00%

Notes | Notes Due February 1, 2033

Debt Instrument [Line Items]

Equivalent redemption price

100.00%

Debt repurchase amount

$ 28,800,000

Remaining principal

3,050,000

$ 3,050,000

$ 3,000,000

Line of Credit | Unsecured Debt

Debt Instrument [Line Items]

Credit line capacity

$ 100,000,000

Amounts outstanding under line of credit

0

Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 75,000,000

Commitment fee (as a percent)

0.25%

Remaining borrowing capacity

64,800,000

Long-term line of credit, noncurrent

$ 0

Revolving Credit Facility | Line of Credit | New Credit Agreement | 50% or more of revolving commitment

Debt Instrument [Line Items]

Commitment fee (as a percent)

0.375%

Revolving Credit Facility | Line of Credit | New Credit Agreement | Less than or equal to 50% of revolving commitment

Debt Instrument [Line Items]

Commitment fee (as a percent)

0.25%

Swingline | 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]

Basis spread on variable rate

2.50%

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

Debt Instrument [Line Items]

Basis spread on variable rate

0.75%

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

Debt Instrument [Line Items]

Basis spread on variable rate

1.75%

Common Stock | Convertible Debt | Notes Due February 1, 2033

Debt Instrument [Line Items]

Shares issued on converted debt (in shares) | shares

21,539,873

Debt - Schedule of Notes (Detai

Debt - Schedule of Notes (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Debt Issuance Cost
Amortization of debt discount and debt issuance costs	$ 281	$ 222
Total
Beginning balance	205,272
Ending balance	230,264
Senior Notes
2025 Senior Notes
Beginning balance	144,580
Ending balance	144,580
Discount
Beginning balance	(22,747)
Amortization of debt discount and debt issuance costs	0
Ending balance	0
Debt Issuance Cost
Beginning balance	(2,473)
Amortization of debt discount and debt issuance costs	264
Ending balance	(3,313)
Total
Beginning balance	119,360
Amortization of debt discount and debt issuance costs	264
Ending balance	141,267
Senior Notes | Accounting Standards Update 2020-06 | Cumulative Effect, Period of Adoption, Adjustment
2025 Senior Notes
Beginning balance	0
Discount
Beginning balance	22,747
Debt Issuance Cost
Beginning balance	(1,104)
Total
Beginning balance	$ 21,643

Debt - Lines of Credit (Details

Debt - Lines of Credit (Details) - USD ($)	Mar. 31, 2022	Dec. 31, 2021
Line of Credit Facility [Line Items]
Credit line capacity	$ 103,204,000
Balance Outstanding	$ 16,531,000	$ 13,672,000
JPMorgan Chase
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	3.25%
Credit line capacity	$ 75,000,000
Balance Outstanding	$ 0	0
Itau Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 1,900,000
Balance Outstanding	$ 1,890,000	1,603,000
Bank of Chile
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	6.60%
Credit line capacity	$ 2,500,000
Balance Outstanding	$ 1,914,000	1,048,000
BICE Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 2,500,000
Balance Outstanding	$ 1,156,000	850,000
Scotiabank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 5,500,000
Balance Outstanding	$ 2,203,000	567,000
Santander Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 5,000,000
Balance Outstanding	$ 3,068,000	503,000
Security Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 1,400,000
Balance Outstanding	$ 378,000	1,111,000
Estado Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 2,052,000
Balance Outstanding	$ 2,052,000	2,540,000
BCI Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.00%
Credit line capacity	$ 2,740,000
Balance Outstanding	$ 2,740,000	2,515,000
Corpbanca
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.00%
Credit line capacity	$ 0
Balance Outstanding	$ 0	2,935,000
International Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.50%
Credit line capacity	$ 1,500,000
Balance Outstanding	$ 881,000	0
Consoorcio Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	5.00%
Credit line capacity	$ 2,000,000
Balance Outstanding	$ 249,000	0
Banco De Sabadell
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	1.75%
Credit line capacity	$ 556,000
Balance Outstanding	$ 0	0
Santander Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at March 31, 2022	1.82%
Credit line capacity	$ 556,000
Balance Outstanding	$ 0	$ 0

Debt - Notes Payable and Other

Debt - Notes Payable and Other Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Mortgage notes and other debt payables
Other long-term liabilities	$ 15,658	$ 15,062
Long-term debt	230,264	205,272
Notes Payable and Other Long-Term Liabilities
Mortgage notes and other debt payables
Current portion of notes payable	882	1,022
Other long-term liabilities	2,331	2,642
Long-term debt	$ 3,213	$ 3,664

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Loss (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Accumulated Other Comprehensive Income (Loss), Net [Rollforward]
Other comprehensive loss	$ (920)	$ (9,070)
Foreign currency translation
Accumulated Other Comprehensive Income (Loss), Net [Rollforward]
Beginning balance	(30,495)
Other comprehensive loss	(920)
Ending balance	$ (31,415)

Fair Value Measurements - Asset

Fair Value Measurements - Assets And Liabilities Measured At Fair Value (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Assets:
Equity securities	$ 3,064	$ 4,226
Total assets	3,079	4,364
Liabilities:
Contingent consideration	2,729	2,837
Total liabilities	3,191	2,837
Quoted prices in active markets for identical assets (Level 1)
Assets:
Equity securities	3,064	4,226
Total assets	3,064	4,226
Liabilities:
Contingent consideration	0	0
Total liabilities	0	0
Significant other observable inputs (Level 2)
Assets:
Equity securities	0	0
Total assets	15	138
Liabilities:
Contingent consideration	0	0
Total liabilities	462	0
Significant unobservable inputs (Level 3)
Assets:
Equity securities	0	0
Total assets	0	0
Liabilities:
Contingent consideration	2,729	2,837
Total liabilities	2,729	2,837
Common stock options/warrants
Assets:
Derivative assets	15	16
Common stock options/warrants | Quoted prices in active markets for identical assets (Level 1)
Assets:
Derivative assets	0	0
Common stock options/warrants | Significant other observable inputs (Level 2)
Assets:
Derivative assets	15	16
Common stock options/warrants | Significant unobservable inputs (Level 3)
Assets:
Derivative assets	0	0
Forward contracts
Assets:
Derivative assets		122
Liabilities:
Forward contracts	462
Forward contracts | Quoted prices in active markets for identical assets (Level 1)
Assets:
Derivative assets		0
Liabilities:
Forward contracts	0
Forward contracts | Significant other observable inputs (Level 2)
Assets:
Derivative assets		122
Liabilities:
Forward contracts	462
Forward contracts | Significant unobservable inputs (Level 3)
Assets:
Derivative assets		$ 0
Liabilities:
Forward contracts	$ 0

Fair Value Measurements - Carry

Fair Value Measurements - Carrying Amount and Estimated Fair Value of Long-Term Debt (Details) - Notes $ in Thousands	Mar. 31, 2022USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notes payable, fair value disclosure	$ 164,270
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notes payable, fair value disclosure	0
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notes payable, fair value disclosure	164,270
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notes payable, fair value disclosure	0
Carrying Value
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Notes payable, fair value disclosure	$ 141,267

Fair Value Measurements - Level

Fair Value Measurements - Level 3 Reconciliation (Details) - Contingent consideration $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning Balance	$ 2,837
Change in fair value:
Included in results of operations	(106)
Foreign currency impact	(2)
Ending Balance	$ 2,729

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	$ 2,729	$ 2,837
Accrued Expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	500	500
LT notes payable included in long-term liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	$ 2,200	$ 2,300

Derivative Contracts - Balance

Derivative Contracts - Balance Sheet Component (Details) - Not Designated as Hedging Instrument - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Common Stock options/warrants | Investments, net
Derivatives, Fair Value [Line Items]
Derivative asset	$ 15	$ 16
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 asset	$ (462)	$ 122

Derivative Contracts - Derivati

Derivative Contracts - Derivative Gains (Losses) (Details) - Not Designated as Hedging Instrument - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Derivative Instruments, Gain (Loss) [Line Items]
Derivative gain (loss)	$ (132)	$ (439)
Common Stock options/warrants
Derivative Instruments, Gain (Loss) [Line Items]
Derivative gain (loss)	(1)	21
Forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Derivative gain (loss)	$ (131)	$ (460)

Related Party Transactions (Det

Related Party Transactions (Details)	Feb. 25, 2020USD ($)	Aug. 31, 2020USD ($)	Nov. 30, 2016USD ($)	Mar. 31, 2022USD ($)shares	Mar. 31, 2021USD ($)	Dec. 31, 2021USD ($)	Aug. 01, 2019USD ($)ft²	Nov. 30, 2015USD ($)
Related Party Transaction [Line Items]
Credit line capacity				$ 103,204,000
Amounts outstanding under line of credit				16,531,000		$ 13,672,000
Reimbursement paid to related party for travel				$ 31,000	$ 0
Detect Genomix | Variable Interest Entity, Not Primary Beneficiary
Related Party Transaction [Line Items]
Additional investment in equity method investment		$ 245,000
Equity method investments (as a percent)		49.00%
Pharmsynthez
Related Party Transaction [Line Items]
Equity method investments (as a percent)				9.00%
Zebra
Related Party Transaction [Line Items]
Stock ownership (as a percent)				29.00%
Zebra | Variable Interest Entity, Not Primary Beneficiary
Related Party Transaction [Line Items]
Equity method investments (as a percent)				29.00%
Neovasc
Related Party Transaction [Line Items]
Equity method investments (as a percent)				1.00%
ChromaDex Corporation
Related Party Transaction [Line Items]
Equity security investments (as a percent)				0.10%
COCP
Related Party Transaction [Line Items]
Equity method investments (as a percent)				3.00%
NIMS
Related Party Transaction [Line Items]
Equity security investments (as a percent)				1.00%
Eloxx Pharmaceuticals
Related Party Transaction [Line Items]
Equity security investments (as a percent)				1.00%
BioCardia, Inc.
Related Party Transaction [Line Items]
Equity method investments (as a percent)				1.00%
Equity security investments (as a percent)				1.00%
LeaderMed
Related Party Transaction [Line Items]
Stock ownership (as a percent)				47.00%
InCellDx, Inc
Related Party Transaction [Line Items]
Equity method investments (as a percent)				29.00%
Frost Real Estate Holdings LLC
Related Party Transaction [Line Items]
Area of real estate property (in square feet) | ft²							29,500
Lease payments per month in first year							$ 89,000
Lease payments per month in fifth year							$ 101,000
Shares Received Upon Closing of Xenetic Transaction | Director
Related Party Transaction [Line Items]
Shares received upon closing of transaction (in shares) | shares				31,240
Mednax Services, Inc. | Detect Genomix | Variable Interest Entity, Not Primary Beneficiary
Related Party Transaction [Line Items]
Additional investment in equity method investment		$ 255,000
Equity method investments (as a percent)		51.00%
Museum of Science, Inc | Dr Frost and Mr Pfenniger
Related Party Transaction [Line Items]
Related party future contribution			$ 1,000,000
Related party future contribution term			4 years
Line of Credit | Unsecured Debt
Related Party Transaction [Line Items]
Credit line capacity	$ 100,000,000
Amounts outstanding under line of credit				$ 0
Revolving Credit Facility | New Credit Agreement | Line of Credit
Related Party Transaction [Line Items]
Credit line capacity								$ 75,000,000
Commitment fee (as a percent)	0.25%

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($) $ in Thousands	Sep. 22, 2020	Jan. 31, 2021	Mar. 31, 2022	Dec. 31, 2021	Apr. 05, 2019
Business Acquisition, Contingent Consideration
Contingent consideration			$ 2,729	$ 2,837
Inventory received but not invoiced			252,400
Settled Litigation | Civil Investigative Demands
Business Acquisition, Contingent Consideration
Litigation settlement amount			10,000
Current litigation liability			10,500	10,000
Settled Litigation | Chancery Court of Delaware vs Company
Business Acquisition, Contingent Consideration
Litigation settlement amount		$ 1,200
Milestone payment					$ 2,375
Settled Litigation | Southern District of New York vs BioReference
Business Acquisition, Contingent Consideration
Litigation settlement amount	$ 11,500
Accrued Liabilities
Business Acquisition, Contingent Consideration
Contingent consideration			500	500
LT notes payable included in long-term liabilities
Business Acquisition, Contingent Consideration
Contingent consideration			$ 2,200	$ 2,300

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($)	May 05, 2020	Mar. 31, 2022	Mar. 31, 2021	Mar. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Prior period performance obligation revenue recognized		$ 2,000,000	$ 28,000,000
Overpayment reimbursement liability		2,100,000		$ 2,100,000	$ 5,000,000
Revenue recognized		4,000
Total revenues		329,219,000	545,165,000
Rayaldee
Disaggregation of Revenue [Line Items]
Revenue recognized		5,100,000	5,800,000
Total revenues		13,479,000	15,645,000
Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues		5,962,000	4,269,000
Products | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues	$ 3,000,000
Pfizer | Products
Disaggregation of Revenue [Line Items]
Revenue recognized				$ 0
Pfizer | Products | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues		2,200,000	$ 2,800,000
VFMCRP | Products | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues		$ 3,000,000

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Disaggregation of Revenue [Line Items]
Total revenues	$ 329,219	$ 545,165
Services
Disaggregation of Revenue [Line Items]
Total revenues	286,599	506,951
Healthcare insurers
Disaggregation of Revenue [Line Items]
Total revenues	95,779	164,829
Government payers
Disaggregation of Revenue [Line Items]
Total revenues	27,588	73,658
Client payers
Disaggregation of Revenue [Line Items]
Total revenues	159,040	262,907
Patients
Disaggregation of Revenue [Line Items]
Total revenues	$ 4,192	$ 5,557

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Product Sales Allowances and Accruals (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Provision related to current period sales	$ 100	$ 300
Total revenues	329,219	545,165
Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	10,152	11,737
Provision related to current period sales	8,353	9,822
Credits or payments made	(9,302)	(10,170)
Ending balance	9,203	11,389
Total revenues	$ 13,479	$ 15,645
Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales	62.00%	63.00%
Chargebacks, discounts, rebates and fees | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 2,014	$ 2,332
Provision related to current period sales	3,215	3,815
Credits or payments made	(3,641)	(4,454)
Ending balance	1,588	1,693
Governmental | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	5,499	5,812
Provision related to current period sales	4,869	5,694
Credits or payments made	(5,086)	(5,297)
Ending balance	5,282	6,209
Returns | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	2,639	3,593
Provision related to current period sales	269	313
Credits or payments made	(575)	(419)
Ending balance	$ 2,333	$ 3,487

Revenue Recognition - Changes i

Revenue Recognition - Changes in Contractual Liabilities Balance (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Contract with Customer, Liability [Abstract]
Beginning balance	$ 466
Revenue recognized	4
Ending balance	$ 462

Strategic Alliances (Details)

Strategic Alliances (Details) - USD ($)	Sep. 14, 2021	Jul. 06, 2021	Jun. 18, 2021	May 05, 2020	Oct. 21, 2019	Apr. 30, 2022	May 31, 2016	Jan. 31, 2015	Mar. 31, 2022	Mar. 31, 2021	Mar. 31, 2022
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues									$ 329,219,000	$ 545,165,000
Milestone revenue recognized									4,000
LeaderMed | LeaderMed Joint Venture | Corporate Joint Venture
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Ownership interest in joint venture (as a percent)	47.00%
Initial investment in joint venture	$ 11,000,000
Ownership percentage by related parties (as a percent)	53.00%
CAMP4
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Upfront payment (in shares)		3,373,008
Outstanding shares (as a percent)		9.00%
Period following first commercial sale in a country		10 years
Nicoya
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Upfront payment from development and license agreement			$ 5,000,000
Period after first commercial sale			10 years
Pfizer | Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Maximum milestone payments								$ 275,000,000
Annual height velocity at point in time					12 months
Initial upfront payment								295,000,000
Additional milestone payment								275,000,000
Milestone revenue recognized											$ 0
Pfizer | Products | Subsequent Event
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Milestone payments						$ 85,000,000
Minimum | Pfizer | Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Milestone payments								20,000,000
Maximum | Pfizer | Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Milestone payments								$ 90,000,000
Phase Three Initiation | Nicoya
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Upfront payment from development and license agreement			$ 5,000,000
Regulatory and Development | Nicoya
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Milestone payment from development and license agreement			$ 115,000,000
Transfer of intellectual property and other
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues									5,962,000	4,269,000
Transfer of intellectual property and other | Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues				$ 3,000,000
Transfer of intellectual property and other | LeaderMed | LeaderMed Joint Venture | Corporate Joint Venture
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues	$ 1,000,000								1,000,000
Transfer of intellectual property and other | CAMP4
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues		$ 1,500,000
Transfer of intellectual property and other | VFMCRP | Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues									3,000,000
Transfer of intellectual property and other | Pfizer | Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues									2,200,000	2,800,000
Dravet Syndrome Products | CAMP4
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Development milestone payments		3,500,000
Sales milestone payments		$ 90,000,000
Development milestone payments (in shares)		5,782,299
Non-Dravet Syndrome Products | CAMP4
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Development milestone payments		$ 4,000,000
Sales milestone payments		$ 90,000,000
Development milestone payments (in shares)		1,082,248
Products
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenues									$ 36,658,000	$ 33,945,000
Regulatory Milestones | EirGen Pharma Limited
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Maximum milestone payments				17,000,000
Sales Milestones | EirGen Pharma Limited
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Maximum milestone payments				$ 207,000,000
Exclusive Option | VFMCRP
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Maximum milestone payments							$ 555,000,000

Segments - Narrative (Details)

Segments - Narrative (Details)	3 Months Ended
	Mar. 31, 2022USD ($)segment
Segment Reporting Information [Line Items]
Number of reportable segments | segment	2
Intersegment Elimination
Segment Reporting Information [Line Items]
Inter-segment sales	$ 0
Inter-segment allocation of interest expense	$ 0

Segments - Operations and Asset

Segments - Operations and Assets Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Jan. 01, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Total revenues	$ 329,219	$ 545,165
Operating income (loss)	(72,424)	38,437
Depreciation and amortization	27,814	19,989
Loss from investment in investees	(49)	(43)
Assets	2,306,858			$ 2,399,715
Goodwill	519,052		$ 710,408	520,601
United States
Segment Reporting Information [Line Items]
Total revenues	291,808	512,871
Ireland
Segment Reporting Information [Line Items]
Total revenues	8,462	7,129
Chile
Segment Reporting Information [Line Items]
Total revenues	16,339	14,152
Spain
Segment Reporting Information [Line Items]
Total revenues	7,109	5,919
Israel
Segment Reporting Information [Line Items]
Total revenues	1,558	2,512
Mexico
Segment Reporting Information [Line Items]
Total revenues	3,750	2,418
Other
Segment Reporting Information [Line Items]
Total revenues	193	164
Corporate
Segment Reporting Information [Line Items]
Operating income (loss)	(10,768)	(9,420)
Depreciation and amortization	0	0
Loss from investment in investees	0	0
Assets	55,052			46,672
Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Operating income (loss)	(18,108)	(19,157)
Depreciation and amortization	15,402	7,413
Loss from investment in investees	(49)	(43)
Assets	1,099,633			1,114,460
Goodwill	236,028			237,576
Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Operating income (loss)	(43,548)	67,014
Depreciation and amortization	12,412	12,576
Loss from investment in investees	0	0
Assets	1,152,173			1,238,583
Goodwill	283,024			$ 283,025
Services
Segment Reporting Information [Line Items]
Total revenues	286,599	506,951
Services | Corporate
Segment Reporting Information [Line Items]
Total revenues	0	0
Services | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	0	0
Services | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	286,599	506,951
Products
Segment Reporting Information [Line Items]
Total revenues	36,658	33,945
Products | Corporate
Segment Reporting Information [Line Items]
Total revenues	0	0
Products | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	36,658	33,945
Products | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	0	0
Transfer of intellectual property and other
Segment Reporting Information [Line Items]
Total revenues	5,962	4,269
Transfer of intellectual property and other | Corporate
Segment Reporting Information [Line Items]
Total revenues	0	0
Transfer of intellectual property and other | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	5,962	4,269
Transfer of intellectual property and other | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	$ 0	$ 0

Leases - Lease Assets and Liabi

Leases - Lease Assets and Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Assets
Operating lease assets	$ 42,768	$ 44,228
Finance lease assets	$ 6,316	5,181
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization
Current
Operating lease liabilities	$ 11,690	11,624
Accrued expenses	2,451	2,257
Long-term
Operating lease liabilities	31,596	33,097
Other long-term liabilities	$ 3,865	$ 2,924
Weighted average remaining lease term
Operating leases	7 years 1 month 6 days	7 years 2 months 12 days
Finance leases	2 years 10 months 24 days	2 years 4 months 24 days
Weighted average discount rate
Operating leases	4.50%	4.60%
Finance leases	5.80%	4.80%

Leases - Lease Liability Maturi

Leases - Lease Liability Maturity (Details) $ in Thousands	Mar. 31, 2022USD ($)
Operating
April 1, 2022 through December 31, 2022	$ 10,435
2023	10,115
2024	8,220
2025	5,847
2026	5,397
Thereafter	24,621
Total undiscounted future minimum lease payments	64,635
Less: Difference between lease payments and discounted lease liabilities	10,429
Total lease liabilities	54,206
Finance
April 1, 2022 through December 31, 2022	1,930
2023	2,050
2024	1,454
2025	919
2026	329
Thereafter	0
Total undiscounted future minimum lease payments	6,682
Less: Difference between lease payments and discounted lease liabilities	366
Total lease liabilities	$ 6,316

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Operating lease expense	$ 4.6	$ 4.5
Finance lease expense	0.7	0.6
Variable lease expense	$ 0.4	$ 0.7

Leases - Lease Cash Flow Inform

Leases - Lease Cash Flow Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Operating cash out flows from operating leases	$ 4,288	$ 4,245
Operating cash out flows from finance leases	33	33
Financing cash out flows from finance leases	498	525
Total	$ 4,819	$ 4,803

Subsequent Events (Details)

Subsequent Events (Details) - Subsequent Event - USD ($) shares in Millions, $ in Millions	May 09, 2022	Apr. 29, 2022	Apr. 30, 2022
Detect Genomix | Sema4
Subsequent Event [Line Items]
Payments to acquire business		$ 150
Number of shares issued in business combination (in shares)		80
Additional revenue-based milestones		$ 150
Revenue-based milestone period		2 years
Total upfront consideration transferred		$ 322
Total aggregate consideration		$ 472
Agreement and Plan of Merger
Subsequent Event [Line Items]
Total aggregate consideration	$ 300
Trading day period prior to closing date	30 days
Period prior to signing of agreement	2 days
Pfizer | Product
Subsequent Event [Line Items]
Milestone payments			$ 85