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Medical Liabilities (Detail) - USD ($)
3 Months Ended 12 Months Ended
Mar. 31, 2019
Dec. 31, 2018
Balance, beginning of period $ 33,641,701 $ 63,972,318
Claims paid for previous period (28,850,325) (36,549,348)
Incurred health care costs 34,974,952 209,002,961
Claims paid for current period (16,586,584) (167,537,480)
Payment to CMS based on APAACO 2017 year settlement 0 (34,464,826)
Adjustments 86,121 (781,924)
 Balance, end of period $ 23,265,865 $ 33,641,701