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Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
CASH FLOWS FROM OPERATING ACTIVITIES:    
Net income $ 79,912 $ 85,171
Adjustments to reconcile net income to net cash provided by operating activities:    
Asset impairment 228  
Depreciation and amortization expense 14,856 11,802
Bad debt expense 32,284 36,360
Compensation expense related to share-based awards 6,234 11,287
Deferred income taxes 1,099 9,938
Changes in operating assets and liabilities (26,973) (10,352)
Net cash provided by operating activities 107,640 144,206
CASH FLOWS FROM INVESTING ACTIVITIES:    
Purchases of available-for-sale investments (410,493) (269,739)
Sales of available-for-sale investments 202,927 357,280
Purchases of property and equipment (9,105) (6,276)
Business acquisitions, net of cash acquired (39,037) (56,947)
Net cash (used in) provided by investing activities (255,708) 24,318
CASH FLOWS FROM FINANCING ACTIVITIES:    
Issuance of common stock 916 793
Purchase of treasury stock (23,117) (5,372)
Payments of employee tax associated with stock compensation (1,612) (2,034)
Release of cash held in escrow (3,986)  
Net cash used in financing activities (27,799) (6,613)
NET (DECREASE) INCREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH (175,867) 161,911
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, beginning of the period 325,178 109,684
CASH, CASH EQUIVALENTS AND RESTRICTED CASH, end of the period 149,311 271,595
Supplemental non-cash disclosure:    
Amounts placed in escrow during the period to secure indemnification obligations from business acquisitions $ 1,000 $ 1,210