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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash flows from operating activities:      
Net income $ 209,850 $ 224,652 $ 197,725
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 72,387 62,355 55,985
Amortization of deferred financing fees 1,067 1,036 859
Non-cash leasing arrangement 870 493 485
Write-off of deferred financing fees 0 566 0
Deferred income taxes (27,481) (6,496) (724)
Provision for doubtful accounts 3,408 2,390 2,609
Stock-based compensation 30,767 22,720 18,678
Cash received from insurance proceeds 1,396 1,282 2,382
Gain on sale of assets (123) (3,467) (1,371)
(Gain)/loss on insurance claims, legal matters and asset disposals (1,368) 3,926 (977)
Litigation 48,000 0 0
Change in operating assets and liabilities      
Accounts receivable (79,818) (82,426) (30,771)
Prepaid income taxes 814 809 (4,228)
Prepaid expenses and other assets 6,993 (9,141) (4,898)
Deferred employer portion of social security taxes (Note 3) 0 (24,155) (24,154)
Cash surrender value of life insurance policy premiums (16,072) (7,614) (10,953)
Deferred compensation liability 16,044 7,637 11,078
Operating lease obligations (6,564) 345 (5,814)
Accounts payable 15,924 17,870 7,117
Accrued wages and related liabilities 47,967 38,982 47,701
Other accrued liabilities 23,828 3,010 1,297
Accrued self-insurance liabilities 28,827 17,785 13,724
Other long-term liabilities (50) (46) (66)
NET CASH PROVIDED BY OPERATING ACTIVITIES 376,666 272,513 275,684
Cash flows from investing activities:      
Purchase of property and equipment (106,180) (87,545) (69,550)
Cash payments for business acquisitions (Note 7) 0 (16,400) (6,000)
Cash payments for asset acquisitions (Note 7) (67,798) (84,736) (98,224)
Escrow deposits (1,216) 0 100
Cash from insurance proceeds 2,029 1,339 6,899
Cash proceeds from the sale of assets 248 8,630 1,854
Deconsolidation of an ancillary business 0 0 (1,984)
Cash payments for Medicare and Medicaid licenses 0 0 (106)
Purchases of investments (29,603) (21,975) (32,257)
Maturities of investments 18,852 14,356 27,481
Other restricted assets 970 149 (2,120)
NET CASH USED IN INVESTING ACTIVITIES (182,698) (186,182) (173,907)
Cash flows from financing activities:      
Proceeds from debt (Note 15) 150 411 45,218
Payments on debt (Note 15) (4,033) (4,106) (3,056)
Issuance of common stock upon exercise of options 18,369 12,677 9,180
Repurchase of shares of common stock to satisfy tax withholding obligations (1,929) (1,702) (1,711)
Repurchase of shares of common stock (Note 21) 0 (29,882) (10,118)
Dividends paid (12,890) (12,168) (11,548)
Proceeds from sale of subsidiary shares (Note 6) 0 6,693 0
Non-controlling interest distribution (4) (284) (2,908)
Purchase of non-controlling interest (256) (704) 2,000
Payments of deferred financing costs (19) (3,197) (1,172)
Proceeds from CARES Act Provider Relief Fund and Medicare Advance Payment Program (Note 3) 0 0 11,637
Repayments of CARES Act Provider Relief Fund and Medicare Advance Payment Program (Note 3) 0 0 (113,660)
NET CASH USED IN FINANCING ACTIVITIES (612) (32,262) (76,138)
Net increase in cash and cash equivalents 193,356 54,069 25,639
Cash and cash equivalents beginning of period 316,270 262,201 236,562
Cash and cash equivalents end of period 509,626 316,270 262,201
Cash paid during the period for:      
Interest 7,025 7,604 5,690
Income taxes 89,730 70,055 65,547
Lease liabilities 196,942 151,870 138,795
Non-cash financing and investing activity      
Accrued capital expenditures 4,600 4,800 3,700
Accrued dividends declared 3,396 3,201 3,035
Right-of-use assets obtained in exchange for new and modified operating lease obligations $ 376,550 $ 370,753 $ 198,593