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Contingencies - Additional Information (Details) $ in Thousands |  |  |  | 1 Months Ended | 3 Months Ended | 12 Months Ended
--- | --- | --- | --- | --- | --- | ---
Nov. 01, 2018 USD ($) | Sep. 28, 2018 USD ($) | Jun. 27, 2018 USD ($) | Dec. 31, 2017 USD ($) | Dec. 31, 2018 USD ($) | Mar. 31, 2017 USD ($) | Dec. 31, 2018 USD ($) | Dec. 31, 2017 USD ($) | Dec. 31, 2016 USD ($)
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain (loss) related to litigation settlement |  |  |  |  |  |  | $ 0 | $ 526,827 | $ 0
US Attorney Prescription Drug Investigation |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation settlement amount awarded to other party |  |  |  | $ 63,700 |  |  |  |  |
U.S. Department of Veterans Affairs (VA) |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation settlement amount awarded from other party |  |  |  |  |  | $ 538,000 |  |  |
Gain (loss) related to litigation settlement |  |  |  |  |  | $ (529,504) |  | 527,000 |
OIG Medicare Advantage Civil Investigation |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation settlement amount awarded to other party |  | $ 270,000 |  |  |  |  |  |  |
Settlement agreement date |  | September 28, 2018 |  |  |  |  |  |  |
White, Kathleen, Et Al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation settlement amount awarded to other party | $ 25,500 |  |  |  |  |  |  |  |
Settlement agreement date |  |  | Jun. 27, 2018 |  |  |  |  |  |
Number of claims dismissed | 3 |  |  |  |  |  |  |  |
Insurance recoveries |  |  |  |  | $ 9,200 |  |  |  |
Operating Income (Loss) | U.S. Department of Veterans Affairs (VA) |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain (loss) related to litigation settlement |  |  |  |  |  |  |  | 530,000 |
Noncontrolling Interest | U.S. Department of Veterans Affairs (VA) |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain (loss) related to litigation settlement |  |  |  |  |  |  |  | 9,000 |
Equity Method Investments | Noncontrolling Interest | U.S. Department of Veterans Affairs (VA) |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Gain (loss) related to litigation settlement |  |  |  |  |  |  |  | $ 3,000 |
Incremental Cash Portion | US Attorney Prescription Drug Investigation |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation settlement amount awarded to other party |  |  |  | 41,500 |  |  |  |  |
Cash Paid For Portion Previously Refunded | US Attorney Prescription Drug Investigation |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Litigation settlement amount awarded to other party |  |  |  | $ 22,200 |  |  |  |  |
Compensatory Damages | White, Kathleen, Et Al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Value of damages awarded |  |  | $ 8,500 |  |  |  |  |  |
Punitive Damages | White, Kathleen, Et Al |  |  |  |  |  |  |  |  |
Other Commitments [Line Items] |  |  |  |  |  |  |  |  |
Value of damages awarded |  |  | $ 375,000 |  |  |  |  |  |

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