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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2020
Mar. 31, 2019
Cash flows from operating activities:    
Net income (loss) $ (18,712) $ (242,872)
Loss from discontinued operations 2,602 284,525
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 18,673 20,033
Amortization of premiums, discounts and issuance costs 1,458 1,520
Stock-based compensation expense 8,035 10,989
Deferred income taxes 33,582 (5,108)
Other (1,883) 2,767
Changes in assets and liabilities:    
Accounts receivable 25,904 (15,915)
Prepaid expenses and other current assets 5,101 4,790
Other long-term assets 11,189 9,580
Accounts payable and accrued expenses (198,452) (132,559)
Income taxes payable (32,883) 14,373
Payments of contingent consideration liabilities (102) (42)
Long-term professional liabilities 6,969 (496)
Other liabilities (7,912) (11,993)
Net cash used in operating activities – continuing operations (146,431) (60,408)
Net cash provided by operating activities - discontinued operations 0 3,591
Net cash used in operating activities (146,431) (56,817)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (75) (4,250)
Purchases of investments (21,042) 0
Proceeds from maturities or sales of investments 9,860 4,800
Purchases of property and equipment (13,713) (5,821)
Proceeds from sales of businesses 4,750 0
Net cash used in investing activities – continuing operations (20,220) (5,271)
Net cash used in investing activities - discontinued operations 0 (3,420)
Net cash used in investing activities (20,220) (8,691)
Cash flows from financing activities:    
Borrowings on credit agreement 515,000 518,500
Payments on credit agreement (146,500) (866,000)
Proceeds from issuance of senior notes 0 500,000
Payments for credit facility amendment and financing costs (500) (8,380)
Payments of contingent consideration liabilities (1,248) (1,308)
Payments on finance lease obligations (3) (42)
Proceeds from issuance of common stock 1,832 2,876
Repurchases of common stock (2,542) (78,982)
Net cash (used in) provided by financing activities—continuing operations 366,039 66,664
Net cash used in financing activities - discontinued operations 0 0
Net cash (used in) provided by financing activities 366,039 66,664
Net increase in cash and cash equivalents 199,388 1,156
Cash and cash equivalents at beginning of period 112,767 56,745
Less cash and cash equivalents of discontinued operations at end of period 0 (11,425)
Cash and cash equivalents of continuing operations at end of period $ 312,155 $ 46,476