RE:RE:Adapthealth 2nd try.
Adapthealth CC:
For the fourth quarter ended December 31, 2022, adjusted EBITDA was $146.0 million, which fell below what we expected when we revised guidance downward in January.
We also locked in purchasing agreements in special terms to ensure we receive the products our patients needed when they needed it. Many of those agreements came with surcharges related to raw materials, shipping expense and fuel pass-throughs. Others came with cost increases related to new product launches.
However, the cost of these factors were approximately $10 million more in the fourth quarter than we had anticipated in January. We also experienced an increase in payer refund and recoupment activity which caused a reduction in net revenue and adjusted EBITDA for the quarter of $10 million. Although refunds and recoupments are normal course for health care providers, the size and timing of this activity was unexpected and very recent so it was not accounted for in our January 10 guidance.
Finally, we experienced $6 million of unanticipated variable labor and other operating expense in December.