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Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2016
Mar. 31, 2015
Cash flows from operating activities:    
Net income $ 67,771 $ 68,589
Adjustments to reconcile net income to net cash used in operating activities:    
Depreciation and amortization 19,584 13,612
Amortization of premiums, discounts and issuance costs 1,296 381
Net change in fair value of contingent consideration liabilities 274 289
Stock-based compensation expense 8,913 7,836
Equity in earnings of unconsolidated affiliate (794) (821)
Distribution of earnings from unconsolidated affiliate   2,062
Deferred income taxes 2,595 2,023
Changes in assets and liabilities:    
Accounts receivable (21,089) (8,683)
Prepaid expenses and other assets 1,273 1,999
Other assets 1,164 324
Accounts payable and accrued expenses (135,356) (169,622)
Income taxes payable 19,429 19,552
Payments of contingent consideration liabilities (29) (34)
Long-term professional liabilities 1,601 4,945
Other liabilities 329 3,864
Net cash used in operating activities (33,039) (53,684)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (59,540) (37,724)
Purchases of investments (18,291) (3,719)
Proceeds from maturities of investments 12,130 3,265
Purchases of property and equipment (10,443) (5,388)
Net cash used in investing activities (76,144) (43,566)
Cash flows from financing activities:    
Borrowings on credit agreement 550,000 634,500
Payments on credit agreement (382,000) (306,500)
Payments of contingent consideration liabilities (432) (371)
Payments on capital lease obligations (536) (159)
Excess tax benefit from exercises of stock options and vesting of restricted stock 319 1,076
Proceeds from issuance of common stock 4,397 4,596
Repurchases of common stock (58,646) (233,601)
Net cash provided from financing activities 113,102 99,541
Net increase in cash and cash equivalents 3,919 2,291
Cash and cash equivalents at beginning of period 51,572 47,928
Cash and cash equivalents at end of period $ 55,491 $ 50,219