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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Cash flows from operating activities:      
Net (loss) income $ (796,488) $ (1,497,702) $ 268,629
Loss (income) from discontinued operations 786,908 1,539,910 (147,115)
Adjustments to reconcile net income to net cash provided from operating activities:      
Depreciation and amortization 28,441 25,931 24,355
Amortization of premiums, discounts and issuance costs 7,163 5,672 4,572
Stock-based compensation expense 39,042 33,410 36,589
Deferred income taxes 36,292 (55,715) (35,894)
Other (198) 6,553 (1,886)
Changes in assets and liabilities:      
Accounts receivable 37,937 6,512 (35,262)
Prepaid expenses and other current assets (47,956) (24,621) 15,087
Other long-term assets 13,916 32,121 (1,736)
Accounts payable and accrued expenses 47,908 46,196 (3,039)
Income taxes payable (6,931) (24,120) (61,408)
Payment of contingent consideration liabilities 0 0 (1,093)
Long-term professional liabilities 4,336 5,413 (6,393)
Other liabilities 3,518 (25,469) 3,615
Net cash provided by operating activities – continuing operations 153,888 74,091 59,021
Net cash provided by operating activities – discontinued operations 50,732 283,620 254,687
Net cash provided by operating activities 204,620 357,711 313,708
Cash flows from investing activities:      
Acquisition payments, net of cash acquired (2,225) (46,975) (65,370)
Purchases of investments (61,845) (35,101) (15,884)
Proceeds from maturities or sales of investments 33,432 51,105 13,710
Purchases of property and equipment (28,788) (19,269) (17,120)
Proceeds from sales of businesses, net of cash sold 1,080 0 0
Net cash (used in) provided by investing activities – continuing operations (58,346) (50,240) (84,664)
Net cash provided by (used in) investing activities – discontinued operations 873,857 152,695 (58,105)
Net cash provided by (used in) investing activities 815,511 102,455 (142,769)
Cash flows from financing activities:      
Borrowings on credit agreement 527,500 1,247,300 1,723,500
Payments on credit agreement (527,500) (1,986,800) (2,094,500)
Proceeds from issuance of senior notes 0 500,000 500,000
Payments for credit facility amendment and financing costs (510) (9,194) (7,090)
Payments of contingent consideration liabilities 0 (1,394) (5,263)
Payments on finance lease obligations (1,161) 0 0
Proceeds from issuance of common stock 7,009 11,258 16,258
Contribution from noncontrolling interests 245 0 0
Repurchases of common stock (8,493) (145,280) (302,160)
Net cash used in financing activities – continuing operations (2,910) (384,110) (169,255)
Net cash used in financing activities – discontinued operations (1,248) (8,960) (1,355)
Net cash used in financing activities (4,158) (393,070) (170,610)
Net increase in cash and cash equivalents 1,015,973 67,096 329
Cash, cash equivalents at beginning of year 107,870 40,774 40,445
Cash and cash equivalents at end of year 1,123,843 107,870 40,774
Supplemental disclosure of cash flow information:      
Interest 110,488 95,444 82,540
Income taxes (27,775) 86,268 185,416
Non-cash investing and financing activities:      
Equipment financed through finance leases 12,507 0 0
Property and equipment included in accounts payable $ 2,305 $ 2,400 $ 2,415