CONSOLIDATED STATEMENT OF CASH FLOWS (USD $) In Thousands, unless otherwise specified	3 Months Ended
	Mar. 31, 2014	Mar. 31, 2013
Operating activities:
Net income and comprehensive income	$ 3,353	$ 6,976
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	13,671	14,158
Stock-based compensation expense	2,940	3,028
Excess tax benefit from exercised stock options	(854)	(3,021)
Deferred income taxes	(967)	(850)
Allowance for doubtful accounts	(4,159)	3,383
Change in fair value of contingent consideration	6	43
Loss on disposal of fixed assets		46
Changes in operating assets and liabilities:
Accounts receivable	982	(1,519)
Prepaid expenses	1,292	169
Prepaid income taxes	2,829	(2,861)
Other current assets	(42)	(371)
Other assets	(125)	(34)
Accounts payable, accrued expenses and other liabilities	(3,057)	(6,140)
Estimated liability for appeals	5,455	2,946
Net cash provided by operating activities	21,324	15,953
Investing activities:
Purchases of property and equipment	(2,603)	(9,100)
Purchases of land	(1,605)
Investment in capitalized software	(649)	(734)
Net cash used in investing activities	(4,857)	(9,834)
Financing activities:
Repayment of term loan		(8,750)
Repayment of revolving credit facility	(35,000)
Payments on contingent consideration	(428)
Proceeds from exercise of stock options	2,532	5,375
Payments on capital lease obligations	(413)	(287)
Payments of tax withholdings on behalf of employees for net-share settlement for stock-based compensation	(1,088)	(1,483)
Excess tax benefit from exercised stock options	854	3,021
Net cash used in financing activities	(33,543)	(2,124)
Net increase (decrease) in cash and cash equivalents	(17,076)	3,995
Cash and cash equivalents at beginning of period	93,366	135,227
Cash and cash equivalents at end of period	76,290	139,222
Supplemental disclosure of cash flow information:
Cash paid for income taxes	419	11,837
Cash paid for interest	1,188	2,879
Supplemental disclosure of noncash activities:
Accrued property and equipment purchases	584	1,128
Equipment purchased through capital leases		1,626
Decrease in appeals liability for lost appeals offset with a reduction in accounts receivable	$ 12,300