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CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2016
Jun. 30, 2015
Cash flows from operating activities:    
Net income $ 232,662 $ 131,629
Adjustments to reconcile net income to net cash provided by operating activities:    
Settlement charge   495,000
Settlement payments   (493,775)
Depreciation and amortization 349,736 312,632
Debt redemption charges   48,072
Goodwill impairment charges 253,000 4,065
Stock-based compensation expense 23,717 28,299
Tax benefits from stock award exercises 23,658 28,040
Excess tax benefits from stock award exercises (10,604) (16,913)
Deferred income taxes 19,952 4,418
Equity investment income, net 14,275 5,257
Gain on sales of business interests, net (29,791)  
Other non-cash charges 23,120 20,653
Changes in operating assets and liabilities, other than from acquisitions and divestitures:    
Accounts receivable (104,005) (142,950)
Inventories (9,213) (22,780)
Other receivables and other current assets (107,610) (50,362)
Other long-term assets (431) 378
Accounts payable 22,809 50,823
Accrued compensation and benefits 41,098 (26,316)
Other current liabilities 112,825 177,733
Income taxes 121,972 (109,460)
Other long-term liabilities (31,531) (2,912)
Net cash provided by operating activities 945,639 441,531
Cash flows from investing activities:    
Additions of property and equipment (358,627) (290,873)
Acquisitions (473,314) (45,059)
Proceeds from asset and business sales 17,393 3,415
Purchase of investments available for sale (7,873) (3,872)
Purchase of investments held-to-maturity (518,965) (1,039,632)
Proceeds from sale of investments available for sale 5,337 1,550
Proceeds from investments held-to-maturity 545,685 434,684
Purchase of equity investments (8,785) (7,550)
Proceeds from sale of equity investments 40,920  
Net cash used in investing activities (758,229) (947,337)
Cash flows from financing activities:    
Borrowings 26,134,952 28,144,986
Payments on long-term debt and other financing costs (26,196,185) (27,476,994)
Deferred financing and debt redemption costs (188) (58,539)
Purchase of treasury stock (274,926) (84,113)
Distributions to noncontrolling interests (94,153) (79,040)
Stock award exercises and other share issuances, net 9,465 4,680
Excess tax benefits from stock award exercises 10,604 16,913
Contributions from noncontrolling interests 13,117 18,040
Purchase of noncontrolling interests (6,240) (10,840)
Net cash (used in) provided by financing activities (403,554) 475,093
Effect of exchange rate changes on cash and cash equivalents 444 (793)
Net decrease in cash and cash equivalents (215,700) (31,506)
Cash and cash equivalents at beginning of the year 1,499,116 965,241
Cash and cash equivalents at end of the period $ 1,283,416 $ 933,735