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Contingencies - Additional Information (Detail) - USD ($) $ in Thousands |  |  |  | 1 Months Ended | 3 Months Ended | 9 Months Ended
--- | --- | --- | --- | --- | --- | ---
Nov. 01, 2018 | Sep. 28, 2018 | Jun. 27, 2018 | Dec. 31, 2017 | Sep. 30, 2018 | Sep. 30, 2017 | Mar. 31, 2017 | Sep. 30, 2018 | Sep. 30, 2017
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain on litigation settlement |  |  |  |  | $ 0 | $ 0 |  | $ 0 | $ 526,827
2015 US Office Of Inspector General Medicare Advantage Civil Investigation |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Loss Contingency, Settlement Agreement, Date |  | Sep. 28, 2018 |  |  |  |  |  |  |
Litigation Settlement, Amount Awarded to Other Party |  | $ 270,000 |  |  |  |  |  |  |
2016 U.S. Attorney Prescription Drug Investigation |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation Settlement, Amount Awarded to Other Party |  |  |  | $ 63,700 |  |  |  |  |
Loss Contingency Accrual, Payments |  |  |  | 41,500 |  |  |  |  |
Loss Contingency Accrual, Partial Payment |  |  |  | $ 22,200 |  |  |  |  |
White, Kathleen, et al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Loss Contingency, Settlement Agreement, Date |  |  | June 27, 2018 |  |  |  |  |  |
US Department Of Veterans Affairs Suit |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation Settlement, Amount Awarded from Other Party |  |  |  |  |  |  | $ 538,000 |  |
Gain on litigation settlement |  |  |  |  |  |  | 527,000 |  |
Noncontrolling Interest | US Department Of Veterans Affairs Suit |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain on litigation settlement |  |  |  |  |  |  | 9,000 |  |
Operating Income (Loss) | US Department Of Veterans Affairs Suit |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain on litigation settlement |  |  |  |  |  |  | 530,000 |  |
Equity Method Investments | Noncontrolling Interest | US Department Of Veterans Affairs Suit |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain on litigation settlement |  |  |  |  |  |  | $ 3,000 |  |
Compensatory Damages | White, Kathleen, et al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Loss Contingency, Damages Awarded, Value |  |  | $ 8,500 |  |  |  |  |  |
Punitive Damages | White, Kathleen, et al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Loss Contingency, Damages Awarded, Value |  |  | $ 375,000 |  |  |  |  |  |
Subsequent Event | White, Kathleen, et al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation Settlement, Amount Awarded to Other Party | $ 25,500 |  |  |  |  |  |  |  |

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