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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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