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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $)
In Thousands, unless otherwise specified
 3 Months Ended
Mar. 31, 2013
Mar. 31, 2012
Cash flows from operating activities:    
Net income $ 55,367 $ 48,350
Adjustments to reconcile net income to net cash used in operating activities:    
Depreciation and amortization 9,144 7,113
Accretion of contingent consideration liabilities 242 265
Stock-based compensation expense 7,284 7,036
Deferred income taxes (4,372) (11,136)
Changes in assets and liabilities:    
Accounts receivable (15,754) (6,329)
Prepaid expenses and other assets 1,363 2,155
Other assets (87) (21)
Accounts payable and accrued expenses (107,724) (114,362)
Income taxes payable 27,629 30,323
Long-term professional liabilities 7,148 2,934
Other liabilities 1,373 1,556
Net cash used in operating activities (18,387) (32,116)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (1,295) (28,095)
Purchases of investments (12,018) (5,576)
Proceeds from sales or maturities of investments 2,015 7,200
Purchases of property and equipment (4,337) (2,920)
Net cash used in investing activities (15,635) (29,391)
Cash flows from financing activities:    
Borrowings on line of credit 295,500 133,000
Payments on line of credit (255,500) (78,500)
Payment of contingent consideration liabilities (410) (410)
Payments on capital lease obligations (30) (43)
Excess tax benefit from exercises of stock options and vesting of restricted stock 2,414 1,990
Proceeds from issuance of common stock 5,193 9,262
Net cash provided from financing activities 47,167 65,299
Net increase in cash and cash equivalents 13,145 3,792
Cash and cash equivalents at beginning of period 21,280 18,596
Cash and cash equivalents at end of period $ 34,425 $ 22,388