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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) (USD $)
In Thousands, unless otherwise specified
 6 Months Ended
Jun. 30, 2014
Jun. 30, 2013
Cash flows from operating activities:    
Net income $ 142,685 $ 124,585
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 20,732 19,014
Net change in fair value of contingent consideration liabilities 460 706
Stock-based compensation expense 15,849 15,092
Equity in earnings of unconsolidated affiliate (150)  
Deferred income taxes 7,492 16,210
Changes in assets and liabilities:    
Accounts receivable (42,013) (21,708)
Prepaid expenses and other assets (3,055) (2,251)
Other assets 632 179
Accounts payable and accrued expenses (64,349) (53,409)
Income taxes payable 3,009 (3,924)
Payments of contingent consideration liabilities (3,767) (616)
Long-term professional liabilities 4,424 11,962
Other liabilities 2,472 2,392
Net cash provided from operating activities 84,421 108,232
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (135,497) (116,944)
Purchases of investments (9,726) (14,946)
Proceeds from sales or maturities of investments 8,050 2,263
Purchases of property and equipment (7,753) (9,345)
Net cash used in investing activities (144,926) (138,972)
Cash flows from financing activities:    
Borrowings on line of credit 634,000 565,000
Payments on line of credit (482,500) (555,200)
Payments of contingent consideration liabilities (6,910) (5,094)
Payments on capital lease obligations (42) (53)
Excess tax benefit from exercises of stock options 9,816 7,795
Proceeds from issuance of common stock 18,388 10,175
Contribution from noncontrolling interests 1,025  
Repurchases of common stock (126,696)  
Net cash provided from financing activities 47,081 22,623
Net decrease in cash and cash equivalents (13,424) (8,117)
Cash and cash equivalents at beginning of period 31,137 21,280
Cash and cash equivalents at end of period $ 17,713 $ 13,163