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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2019
Jun. 30, 2018
Cash flows from operating activities:    
Net (loss) income $ (251,117) $ 142,840
Loss (income) from discontinued operations 328,286 (8,059)
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 39,842 40,195
Amortization of premiums, discounts and issuance costs 2,934 2,212
Stock-based compensation expense 20,950 20,012
Deferred income taxes (10,953) (21,946)
Other 13,150 (2,148)
Changes in assets and liabilities:    
Accounts receivable 2,533 (28,235)
Prepaid expenses and other current assets 805 (1,775)
Other long-term assets 14,036 (283)
Accounts payable and accrued expenses (57,105) (80,667)
Income taxes payable (28,942) (39,909)
Payments of contingent consideration liabilities (418) (65)
Long-term professional liabilities (3,474) (5,863)
Other liabilities (15,605) (1,079)
Net cash provided by operating activities – continuing operations 54,922 15,230
Net cash provided by operating activities - discontinued operations 7,913 6,374
Net cash provided by operating activities 62,835 21,604
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (11,450) (25,575)
Purchases of investments 0 (15,884)
Proceeds from maturities or sales of investments 8,180 5,995
Purchases of property and equipment (16,480) (18,296)
Proceeds from sale of controlling interest in assets 0 22,764
Net cash used in investing activities – continuing operations (19,750) (30,996)
Net cash used in investing activities - discontinued operations (7,553) (7,978)
Net cash used in investing activities (27,303) (38,974)
Cash flows from financing activities:    
Borrowings on credit agreement 898,500 821,500
Payments on credit agreement (1,286,500) (782,500)
Proceeds from issuance of senior notes 500,000 0
Payments for financing costs (9,194) 0
Payments of contingent consideration liabilities (5,171) (367)
Payments on finance lease obligations (98) (623)
Proceeds from issuance of common stock 6,551 9,389
Repurchases of common stock (144,509) (52,160)
Net cash used in financing activities – continuing operations (40,421) (4,761)
Net cash used in financing activities - discontinued operations 0 (13)
Net cash used in financing activities (40,421) (4,774)
Net decrease in cash and cash equivalents (4,889) (22,144)
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 (11,614) (12,226)
Cash, cash equivalents and restricted cash of continuing operations at end of period $ 40,242 $ 45,830