Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $) In Thousands, unless otherwise specified	3 Months Ended
Mar. 31, 2015	Mar. 31, 2014
Cash flows from operating activities:
Net income	$ 68,589us-gaap_ProfitLoss	$ 63,660us-gaap_ProfitLoss
Adjustments to reconcile net income to net cash used in operating activities:
Depreciation and amortization	13,612	10,370
Net change in fair value of contingent consideration liabilities	289	346
Stock-based compensation expense	7,836us-gaap_ShareBasedCompensation	8,071us-gaap_ShareBasedCompensation
Equity in earnings of unconsolidated affiliate	(821)
Distribution of earnings from unconsolidated affiliate	2,062
Deferred income taxes	2,023us-gaap_DeferredIncomeTaxExpenseBenefit	(387)us-gaap_DeferredIncomeTaxExpenseBenefit
Changes in assets and liabilities:
Accounts receivable	(8,683)	(30,292)
Prepaid expenses and other assets	1,999	(1,480)
Other assets	705	341
Accounts payable and accrued expenses	(169,622)	(131,370)
Income taxes payable	19,552	26,076
Payments of contingent consideration liabilities	(34)	(2,779)
Long-term professional liabilities	4,945	6,419
Other liabilities	3,864	1,203
Net cash used in operating activities	(53,684)	(49,822)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(37,724)	(69,375)
Purchases of investments	(3,719)us-gaap_PaymentsToAcquireInvestments	(3,904)us-gaap_PaymentsToAcquireInvestments
Proceeds from sales or maturities of investments	3,265	3,635
Purchases of property and equipment	(5,388)	(4,570)
Net cash used in investing activities	(43,566)	(74,214)
Cash flows from financing activities:
Borrowings on credit facility	634,500us-gaap_ProceedsFromLinesOfCredit	371,500us-gaap_ProceedsFromLinesOfCredit
Payments on credit facility	(306,500)us-gaap_RepaymentsOfLinesOfCredit	(150,500)us-gaap_RepaymentsOfLinesOfCredit
Payments of contingent consideration liabilities	(371)	(645)
Payments on capital lease obligations	(159)	(25)
Excess tax benefit from exercises of stock options and vesting of restricted stock	1,076	1,935
Proceeds from issuance of common stock	4,596	7,398
Repurchases of common stock	(233,601)	(116,989)
Net cash provided from financing activities	99,541	112,674
Net increase (decrease) in cash and cash equivalents	2,291	(11,362)
Cash and cash equivalents at beginning of period	47,928	31,137
Cash and cash equivalents at end of period	$ 50,219	$ 19,775

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- Definition

Amount of cash outflow for payment of an obligation from a lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements.

+ References

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 235

-SubTopic 10

-Section S99

-Paragraph 1

-Subparagraph (SX 210.4-08.(f))

-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690

Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher SEC

-Name Regulation S-X (SX)

-Number 210

-Section 08

-Paragraph f

-Article 4

Reference 3: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 230

-SubTopic 10

-Section 45

-Paragraph 15

-Subparagraph (b)

-URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585

Reference 4: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Glossary Financing Activities

-URI http://asc.fasb.org/extlink&oid=6513228

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Period Type:	duration

- Definition

The cash outflow for the obligation for a lease meeting the criteria for capitalization (with maturities exceeding one year or beyond the operating cycle of the entity, if longer).

+ References

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 230

-SubTopic 10

-Section 45

-Paragraph 15

-Subparagraph (b)

-URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585

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- Definition

The aggregate amount of noncash, equity-based employee remuneration. This may include the value of stock or unit options, amortization of restricted stock or units, and adjustment for officers' compensation. As noncash, this element is an add back when calculating net cash generated by operating activities using the indirect method.

+ References

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