Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Cash flows from operating activities:
Net loss	$ (76,969)	$ (87,336)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	73,440	76,677
Non-cash interest	3,559	1,944
Amortization of deferred financing costs	155	168
Losses from investments in investees	11,542	11,771
Equity-based compensation – employees and non-employees	16,591	22,292
Gain (loss) on disposal of fixed assets	34	(2,683)
Change in fair value of equity securities and derivative instruments	(14,346)	(1,969)
Change in fair value of contingent consideration	(12,406)	(4,475)
Deferred income tax benefit	(14,541)	(46,366)
Changes in assets and liabilities, net of the effects of acquisitions:
Accounts receivable, net	7,701	(13,594)
Inventory, net	4,057	1,729
Other current assets and prepaid expenses	(4,304)	(2,857)
Other assets	(4,633)	(449)
Accounts payable	(9,329)	12,013
Foreign currency measurement	57	608
Contract liabilities	(50,531)	(49,771)
Accrued expenses and other liabilities	(4,559)	(11,892)
Net cash used in operating activities	(74,482)	(94,190)
Cash flows from investing activities:
Investments in investees	(1,000)	(4,625)
Proceeds from sale of equity securities	1,516	0
Purchase of marketable securities	0	(6)
Proceeds from the sale of property, plant and equipment	1,070	3,979
Capital expenditures	(24,823)	(32,061)
Net cash used in investing activities	(23,237)	(32,713)
Cash flows from financing activities:
Issuance of 2033 Senior Notes, including to related parties	55,000	0
Proceeds from the exercise of Common Stock options and warrants	1,173	1,916
Borrowings on lines of credit	22,468	75,544
Repayments of lines of credit	(28,435)	(20,643)
Net cash provided by financing activities	50,206	56,817
Effect of exchange rate changes on cash and cash equivalents	(268)	1,715
Net decrease in cash and cash equivalents	(47,781)	(68,371)
Cash and cash equivalents at beginning of period	91,499	168,733
Cash and cash equivalents at end of period	43,718	100,362
SUPPLEMENTAL INFORMATION:
Interest paid	1,631	1,409
Income taxes paid, net of refunds	3,883	5,899
Shares issued upon the conversion of:
Common Stock options and warrants, surrendered in net exercise	806	1,546
OPKO Health Europe
Issuance of capital stock for contingent consideration settlement:
OPKO Health Europe	$ 0	$ 303