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Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2015
Sep. 30, 2014
Cash flows from operating activities:    
Net income $ 243,277 $ 228,923
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 46,079 32,088
Net change in fair value of contingent consideration liabilities (16) (506)
Stock-based compensation expense 23,960 23,914
Equity in earnings of unconsolidated affiliate (2,350) (875)
Distribution of earnings from unconsolidated affiliate 2,062  
Deferred income taxes 2,870 10,410
Changes in assets and liabilities:    
Accounts receivable (17,623) (49,996)
Prepaid expenses and other assets (4,480) (3,168)
Other assets 6,980 1,680
Accounts payable and accrued expenses (52,734) (12,573)
Income taxes payable 15,954 5,502
Payments of contingent consideration liabilities (1,045) (3,851)
Long-term professional liabilities 2,814 9,575
Other liabilities (1,183) 2,711
Net cash provided from operating activities 264,565 243,834
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (806,304) (346,071)
Purchases of investments (20,382) (19,604)
Proceeds from sales or maturities of investments 23,208 14,500
Purchases of property and equipment (19,908) (11,405)
Net cash used in investing activities (823,386) (362,580)
Cash flows from financing activities:    
Borrowings on credit facility 1,846,500 1,084,000
Payments on credit facility (1,056,500) (823,500)
Payments for credit facility amendment (1,227)  
Payments of contingent consideration liabilities (9,040) (9,550)
Payments on capital lease obligations (1,063) (84)
Excess tax benefit from vesting of restricted and deferred stock and exercises of stock options 11,467 11,159
Proceeds from issuance of common stock 16,722 24,140
Contribution from noncontrolling interests   1,025
Repurchases of common stock (235,051) (127,759)
Net cash provided from financing activities 571,808 159,431
Net increase in cash and cash equivalents 12,987 40,685
Cash and cash equivalents at beginning of period 47,928 31,137
Cash and cash equivalents at end of period $ 60,915 $ 71,822