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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Cash flows from operating activities:    
Net loss $ (691,148) $ (251,117)
Loss from discontinued operations 684,999 293,710
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 28,792 27,584
Amortization of premiums, discounts and issuance costs 2,785 2,934
Stock-based compensation expense 13,819 20,853
Deferred income taxes 55,812 (12,378)
Other (2,092) 8,284
Changes in assets and liabilities:    
Accounts receivable 44,296 1,703
Prepaid expenses and other current assets (16,281) 3,715
Other long-term assets 5,560 14,233
Accounts payable and accrued expenses (86,609) (52,307)
Income taxes payable / receivable (49,757) (40,181)
Payments of contingent consideration liabilities (102) (418)
Long-term professional liabilities 2,931 4,628
Other liabilities 26,888 (14,212)
Net cash provided by operating activities – continuing operations 19,893 7,031
Net cash provided by operating activities - discontinued operations 26,658 56,184
Net cash provided by operating activities 46,551 63,215
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (75) (11,450)
Purchases of investments (32,335) 0
Proceeds from maturities or sales of investments 18,135 8,180
Purchases of property and equipment (23,326) (15,926)
Proceeds from sale of business, net of cash sold 476 0
Net cash used in investing activities – continuing operations (37,125) (19,196)
Net cash provided by (used in) investing activities—discontinued operations 15,466 (8,438)
Net cash used in investing activities (21,659) (27,634)
Cash flows from financing activities:    
Borrowings on credit agreement 527,500 898,500
Payments on credit agreement (527,500) (1,286,500)
Proceeds from issuance of senior notes 0 500,000
Payments for credit facility amendment and financing costs (510) (9,194)
Payments of contingent consideration liabilities (1,248) (5,171)
Payments on finance lease obligations (186) (98)
Proceeds from issuance of common stock 4,376 6,551
Repurchases of common stock (3,043) (144,509)
Net cash used in financing activities – continuing operations (611) (40,421)
Net cash used in financing activities - discontinued operations 0 0
Net cash used in financing activities (611) (40,421)
Net increase (decrease) in cash and cash equivalents 24,281 (4,840)
Cash and cash equivalents at beginning of period 107,870 40,774
Cash and cash equivalents at end of period $ 132,151 $ 35,934