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CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2016
Mar. 31, 2015
Cash flows from operating activities:    
Net income (loss) $ 138,159 $ (76,148)
Adjustments to reconcile net income to net cash provided by operating activities:    
Settlement charge   495,000
Depreciation and amortization 169,355 153,789
Goodwill impairment charge 77,000  
Stock-based compensation expense 13,097 12,762
Tax benefits from stock award exercises 8,668 9,366
Excess tax benefits from stock award exercises (4,383) (7,584)
Deferred income taxes 47,519 (203,940)
Equity investment income, net 5,238 2,539
Other non-cash charges 11,507 7,865
Changes in operating assets and liabilities, other than from acquisitions and divestitures:    
Accounts receivable (78,097) (151,743)
Inventories (4,924) (9,193)
Other receivables and other current assets (75,326) (18,619)
Other long-term assets (965) 153
Accounts payable 7,782 (10,933)
Accrued compensation and benefits (32,909) 30,638
Other current liabilities 55,673 60,772
Income taxes 72,400 106,970
Other long-term liabilities 19,208 8,395
Net cash provided by operating activities 429,002 410,089
Cash flows from investing activities:    
Additions of property and equipment (173,187) (121,421)
Acquisitions (405,154) (40,650)
Proceeds from asset and business sales 4,657 2,565
Purchase of investments available for sale (4,435) (1,448)
Purchase of investments held-to-maturity (228,198) (290,774)
Proceeds from sale of investments available for sale 5,155 1,217
Proceeds from investments held-to-maturity 252,701 205,650
Purchase of equity investments (5,850) (7,426)
Net cash used in investing activities (554,311) (252,287)
Cash flows from financing activities:    
Borrowings 13,098,553 13,353,767
Payments on long-term debt and other financing costs (13,123,124) (13,382,203)
Purchase of treasury stock (274,926) (70,063)
Distributions to noncontrolling interests (50,409) (41,499)
Stock award exercises and other share issuances, net 3,167 5,648
Excess tax benefits from stock award exercises 4,383 7,584
Contributions from noncontrolling interests 10,190 15,898
Proceeds from sales of additional noncontrolling interests 3,557  
Purchase of noncontrolling interests (4,300)  
Deferred financing costs (188)  
Net cash used in financing activities (333,097) (110,868)
Effect of exchange rate changes on cash and cash equivalents 717 (904)
Net (decrease) increase in cash and cash equivalents (457,689) 46,030
Cash and cash equivalents at beginning of the year 1,499,116 965,241
Cash and cash equivalents at end of the period $ 1,041,427 $ 1,011,271