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Intangible Assets and Goodwill (Details Narrative) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2021
Sep. 30, 2020
Sep. 30, 2021
Sep. 30, 2020
Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]          
[custom:CapitalizedIntangibleAssets]     $ 30,100    
Amortization of Intangible Assets $ 9,100 $ 14,300 27,300 $ 33,800  
Impairment of Intangible Assets, Finite-lived   $ 88,100 $ 88,059  
Goodwill includes accumulated Impairment         $ 148,100
Software and Technology [Member]          
Finite-Lived Intangible Assets [Line Items]          
Payments for Software     400    
Market Access Agreements [Member]          
Finite-Lived Intangible Assets [Line Items]          
[custom:PaymentsForAcquiringLicense]     $ 29,700