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Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2025
Mar. 31, 2024
Cash flows from operating activities:    
Net income $ 20,737 $ 4,035
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 5,332 10,308
Amortization of premiums, discounts and issuance costs 230 200
Stock-based compensation expense 3,641 3,067
Deferred income taxes 4,398 686
Other (758) (1,265)
Changes in assets and liabilities:    
Accounts receivable 17,461 (9,936)
Prepaid expenses and other current assets (1,125) 3,756
Other long-term assets 4,649 5,900
Accounts payable and accrued expenses (159,685) (141,463)
Income taxes payable 2,748 3,017
Long-term professional liabilities (7,590) 4,082
Other liabilities (6,149) (5,011)
Net cash used in operating activities - continuing operations (116,111) (122,624)
Net cash used in operating activities - discontinued operations (1,352) (2,602)
Net cash used in operating activities (117,463) (125,226)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired 0 (8,167)
Purchases of investments (7,761) (16,896)
Proceeds from maturities or sales of investments 7,300 14,155
Purchases of property and equipment (3,318) (5,330)
Other (3,685) 0
Net cash used in investing activities (7,464) (16,238)
Cash flows from financing activities:    
Borrowings on line of credit 0 170,500
Payments on line of credit 0 (90,500)
Payments on term loan (4,688) (3,125)
Payment on finance lease obligation (339) (690)
Proceeds from issuance of common stock 662 860
Repurchases of common stock (1,569) (887)
Other (101) 46
Net cash provided by financing activities (6,035) 76,204
Net decrease in cash and cash equivalents (130,962) (65,260)
Cash and cash equivalents at beginning of period 229,940 73,258
Cash and cash equivalents at end of period $ 98,978 $ 7,998