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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2019
Mar. 31, 2018
Cash flows from operating activities:    
Net (loss) income $ (242,872) $ 63,428
Loss (income) from discontinued operations 284,525 (3,421)
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 20,033 19,914
Amortization of premiums, discounts and issuance costs 1,520 1,089
Stock-based compensation expense 10,989 9,686
Deferred income taxes (5,108) (399)
Other 2,767 (1,216)
Changes in assets and liabilities:    
Accounts receivable (15,915) (38,444)
Prepaid expenses and other current assets 4,790 634
Other long-term assets 9,580 (486)
Accounts payable and accrued expenses (132,559) (129,185)
Income taxes payable 14,373 (38,785)
Payments of contingent consideration liabilities (42) (65)
Long-term professional liabilities (496) (643)
Other liabilities (11,993) 1,016
Net cash used in operating activities – continuing operations (60,408) (116,877)
Net cash provided by operating activities - discontinued operations 3,591 3,243
Net cash used in operating activities (56,817) (113,634)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (4,250) (21,975)
Purchases of investments 0 (14,039)
Proceeds from maturities or sales of investments 4,800 3,500
Purchases of property and equipment (5,821) (8,463)
Proceeds from sale of controlling interest in assets 0 22,764
Net cash used in investing activities – continuing operations (5,271) (18,213)
Net cash used in investing activities - discontinued operations (3,420) (3,963)
Net cash used in investing activities (8,691) (22,176)
Cash flows from financing activities:    
Borrowings on credit agreement 518,500 506,000
Payments on credit agreement (866,000) (392,500)
Proceeds from issuance of senior notes 500,000  
Payments for financing costs (8,380)  
Payments of contingent consideration liabilities (1,308) (367)
Payments on finance lease obligations (42) (308)
Proceeds from issuance of common stock 2,876 3,731
Repurchases of common stock (78,982)  
Net cash provided from financing activities – continuing operations 66,664 116,556
Net cash provided from financing activities - discontinued operations 0 (7)
Net cash provided from financing activities 66,664 116,549
Net increase (decrease) in cash and cash equivalents 1,156 (19,261)
Cash, cash equivalents and restricted cash at beginning of period 56,745 80,200
Less cash and cash equivalents of discontinued operations at end of period (11,425) (13,116)
Cash, cash equivalents and restricted cash of continuing operations at end of period $ 46,476 $ 47,823