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Accounts Payable and Accrued Expenses (Details) (USD $)
 6 Months Ended 12 Months Ended
Jun. 30, 2011
Dec. 31, 2010
Accounts Payable and Accrued Expenses    
Accounts payable $ 10,817,000 $ 9,581,000
Accrued salaries and bonuses 79,715,000 132,221,000
Accrued payroll taxes and benefits 25,950,000 26,122,000
Accrued professional liabilities 11,933,000 11,876,000
Accrual for uncertain tax positions 10,480,000 10,948,000
Other accrued expenses 20,215,000 17,189,000
Accounts payable and accrued expenses, total 159,110,000 207,937,000
Net decrease in accrued salaries and bonuses   52,500,000
Accrued salaries and bonuses, net $ 79,700,000 $ 132,200,000