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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2021
Mar. 31, 2020
Cash flows from operating activities:    
Net income (loss) $ 17,642 $ (18,712)
(Income) loss from discontinued operations (12,290) 213
Adjustments to reconcile net income (loss) to net cash from operating activities:    
Depreciation and amortization 8,031 6,803
Amortization of premiums, discounts and issuance costs 994 1,458
Loss on early extinguishment of debt 14,532 0
Stock-based compensation expense 3,717 7,443
Deferred income taxes (16,016) 23,958
Other (638) (689)
Changes in assets and liabilities:    
Accounts receivable (11,633) 1,619
Prepaid expenses and other current assets 47,799 4,539
Other long-term assets (90) 1,235
Accounts payable and accrued expenses (106,937) (145,355)
Income taxes receivable (18,501) (32,955)
Long-term professional liabilities (916) 3,333
Other liabilities (24,620) (5,935)
Net cash used in operating activities – continuing operations (98,926) (153,045)
Net cash provided by operating activities - discontinued operations 16,738 11,161
Net cash used in operating activities (82,188) (141,884)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (5,957) (75)
Purchases of investments (5,138) (21,042)
Proceeds from maturities or sales of investments 7,433 9,860
Purchases of property and equipment (9,052) (9,802)
Net cash used in investing activities - continuing operations (12,714) (21,059)
Net cash used in investing activities - discontinued operations 2,350 839
Net cash used in investing activities (10,364) (20,220)
Cash flows from financing activities:    
Borrowings on credit agreement 0 515,000
Payments on credit agreement 0 (146,500)
Redemption of senior notes, including call premium (759,848) 0
Payments for credit facility amendment 0 (500)
Payments of contingent consideration liabilities (189) 0
Payments on finance lease obligations (672) 0
Proceeds from issuance of common stock 1,042 1,832
Repurchases of common stock (1,994) (2,542)
Net cash provided from financing activities - continuing operations (761,661) 367,290
Net cash provided from financing activities - discontinued operations 0 (1,251)
Net cash provided from financing activities (761,661) 366,039
Net increase in cash and cash equivalents (854,213) 203,935
Cash and cash equivalents at beginning of period 1,123,843 107,870
Cash and cash equivalents at end of period $ 269,630 $ 311,805