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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2021
Sep. 30, 2020
Cash flows from operating activities:    
Net income (loss) $ 83,448 $ (732,192)
(Income) loss from discontinued operations (15,716) 718,125
Adjustments to reconcile net income (loss) to net cash from operating activities:    
Depreciation and amortization 24,288 20,749
Amortization of premiums, discounts and issuance costs 3,520 4,076
Loss on early extinguishment of debt 14,532
Stock-based compensation expense 14,947 36,120
Deferred income taxes (30,191) 30,214
Other (1,639) (30)
Gain on sale of building (7,280)
Changes in assets and liabilities:    
Accounts receivable (42,027) 30,006
Prepaid expenses and other current assets 26,391 (1,716)
Other long-term assets 9,412 7,703
Accounts payable and accrued expenses (5,316) (36,433)
Income taxes receivable (16,391) (28,837)
Long-term professional liabilities 557 15,703
Other liabilities (19,817) 8,157
Net cash provided by operating activities - continuing operations 38,718 71,645
Net cash (used in) provided by operating activities - discontinued operations (6,217) 144,841
Net cash provided by operating activities 32,501 216,486
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (19,550) (2,225)
Purchases of investments (11,431) (36,090)
Proceeds from maturities or sales of investments 15,495 30,865
Purchases of property and equipment (29,081) (21,809)
Proceeds from sale of building 24,728 0
Strategic investments (20,000) 0
Other 0 1,080
Net cash used in investing activities - continuing operations (39,839) (28,179)
Net cash provided by investing activities-discontinued operations 2,350 3,079
Net cash used in investing activities (37,489) (25,100)
Cash flows from financing activities:    
Borrowings on credit agreement 0 527,500
Payments on credit agreement 0 (527,500)
Redemption of senior notes, including call premium (759,848) 0
Payments for credit facility amendment 0 (510)
Payments of contingent consideration liabilities (189) 0
Payments on finance lease obligations (1,796) (433)
Proceeds from issuance of common stock 5,611 5,697
Repurchases of common stock (4,719) (8,495)
Contribution from noncontrolling interest 0 245
Net cash used in from financing activities - continuing operations (760,941) (3,496)
Net cash used in financing activities - discontinued operations 0 (1,248)
Net cash used in financing activities (760,941) (4,744)
Net (decrease) increase in cash and cash equivalents (765,929) 186,642
Cash and cash equivalents at beginning of period 1,123,843 107,870
Cash and cash equivalents at end of period $ 357,914 $ 294,512