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Segment reporting (Tables)
 9 Months Ended
Sep. 30, 2017
Segment Reporting [Abstract]  
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes
The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes:
 
Three months ended
September 30,
 
Nine months ended
September 30,
 
2017
 
2016
 
2017
 
2016
Segment net revenues:
 
 
 
 
 
 
 
U.S. dialysis and related lab services
 
 
 
 
 
 
 
Patient service revenues:
 
 
 
 
 
 
 
External sources
$
2,457,302

 
$
2,412,818

 
$
7,209,424

 
$
7,079,054

Intersegment revenues
26,342

 
16,040

 
76,538

 
44,819

Total dialysis and related lab services revenues
2,483,644

 
2,428,858

 
7,285,962

 
7,123,873

Less: Provision for uncollectible accounts
(117,973
)
 
(109,299
)
 
(334,078
)
 
(320,565
)
Net dialysis and related lab services patient service revenues
2,365,671

 
2,319,559

 
6,951,884

 
6,803,308

Other revenues(1)
4,803

 
3,912

 
14,998

 
12,134

Total net dialysis and related lab services revenues
2,370,474

 
2,323,471

 
6,966,882

 
6,815,442

DMG
 
 
 
 
 
 
 
DMG revenues:
 
 
 
 
 
 
 
Capitated revenues
975,526

 
846,245

 
2,852,631

 
2,586,383

Net patient service revenues
187,678

 
166,622

 
556,179

 
448,222

Other revenues(2)
15,170

 
15,195

 
52,509

 
41,766

Intersegment capitated and other revenues
69

 
75

 
174

 
189

Total net DMG revenues
1,178,443

 
1,028,137

 
3,461,493

 
3,076,560

Other—Ancillary services and strategic initiatives
 
 
 
 
 
 
 
Net patient service revenues
95,490

 
57,498

 
246,349

 
165,742

Capitated revenues
40,839

 
26,293

 
103,848

 
74,149

Other external sources
263,996

 
311,292

 
795,731

 
942,478

Intersegment revenues
13,743

 
16,642

 
39,958

 
43,189

Total ancillary services and strategic initiatives revenues
414,068

 
411,725

 
1,185,886

 
1,225,558

Total net segment revenues
3,962,985

 
3,763,333

 
11,614,261

 
11,117,560

Elimination of intersegment revenues
(40,154
)
 
(32,757
)
 
(116,670
)
 
(88,197
)
Consolidated net revenues
$
3,922,831

 
$
3,730,576

 
$
11,497,591

 
$
11,029,363

Segment operating margin:
 
 
 
 
 
 
 
U.S. dialysis and related lab services(3)
$
442,777

 
$
452,187

 
$
1,837,989

 
$
1,341,432

DMG
(587,817
)
 
33,094

 
(588,389
)
 
(126,110
)
Other—Ancillary services and strategic initiatives
(36,518
)
 
361,903

 
(142,984
)
 
338,159

Total segment operating margin
(181,558
)
 
847,184

 
1,106,616

 
1,553,481

Reconciliation of segment operating margin to consolidated income
before income taxes:
 
 
 
 
 
 
 
Corporate administrative support(4)
(10,965
)
 
(28,028
)
 
(32,587
)
 
(40,366
)
Consolidated operating (loss) income
(192,523
)
 
819,156

 
1,074,029

 
1,513,115

Debt expense
(109,623
)
 
(104,581
)
 
(322,014
)
 
(310,359
)
Other income, net
4,370

 
1,876

 
13,866

 
8,067

Consolidated (loss) income before income taxes
$
(297,776
)
 
$
716,451

 
$
765,881

 
$
1,210,823

 
(1)
Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties and legal entities in which the Company owns a noncontrolling equity investment.
(2)
Includes medical consulting service fees and management fees for providing management and administrative services to unconsolidated joint ventures and revenue related to the maintenance of existing physician networks.
(3)
U.S. dialysis and related lab services operating income includes the net gain on the settlement with the VA for the nine months ended September 30, 2017.
(4)
Corporate administrative support costs includes an adjustment of $27,040 to reduce a receivable associated with the DMG acquisition escrow provision relating to an income tax item for the three and nine months ended September 30, 2016.
Summary of Depreciation and Amortization Expense by Reportable Segment
Depreciation and amortization expense by reportable segment was as follows:
 
Three months ended
September 30,
 
Nine months ended
September 30,
 
2017
 
2016
 
2017
 
2016
U.S. dialysis and related lab services
$
132,112

 
$
122,540

 
$
387,142

 
$
358,427

DMG
60,649

 
52,595

 
177,983

 
153,068

Ancillary services and strategic initiatives
10,522

 
6,604

 
28,402

 
19,980

 
$
203,283

 
$
181,739

 
$
593,527

 
$
531,475
Summary of Assets by Reportable Segment
The Company therefore has not amended its financial statements filed on its 2016 10-K to correct this misstatement, but has provided the corrected disclosure here.
Assets by reportable segment were as follows: 
 
September 30,
2017
 
December 31,
2016
Segment assets
 

 
 

U.S. dialysis and related lab services (including equity
investments of $87,549 and $66,924, respectively)
$
11,649,092

 
$
11,099,137

DMG (including equity investments of $9,155 and $10,350,
 respectively)
5,788,387

 
6,213,091

Other—Ancillary services and strategic initiatives (including
equity investments of $448,349 and $425,115, respectively)
1,575,860

 
1,429,029

Consolidated assets
$
19,013,339

 
$
18,741,257
Summary of Expenditures for Property and Equipment by Reportable Segment
Expenditures for property and equipment by reportable segment were as follows: 
 
Three months ended
September 30,
 
Nine months ended
September 30,
 
2017
 
2016
 
2017
 
2016
U.S. dialysis and related lab services
$
205,266

 
$
182,741

 
$
531,027

 
$
467,121

DMG
24,282

 
17,396

 
72,953

 
55,639

Ancillary services and strategic initiatives
11,341

 
16,479

 
35,849

 
52,483

 
$
240,889

 
$
216,616

 
$
639,829

 
$
575,243