CONSOLIDATED STATEMENTS OF CASH FLOW (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013
Operating activities:
Net income and comprehensive income	$ 16,341	$ 28,904
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization of property and equipment	24,459	23,274
Amortization of intangibles	15,572	18,485
Amortization of deferred financing costs	1,563	2,556
Stock-based compensation expense	9,095	8,749
Excess tax benefit from exercised stock options	(870)	(5,154)
Deferred income taxes	(9,322)	(6,178)
Allowance for doubtful accounts	(6,549)	8,454
Change in fair value of contingent consideration	17	23
Loss on disposal of fixed assets	191	186
Changes in operating assets and liabilities
Accounts receivable	9,152	(23,184)
Prepaid expenses	2,666	1,175
Prepaid income taxes	7,662	4,160
Other current assets	(2,189)	(89)
Other assets	125	16
Income taxes payable	9,841
Accounts payable, accrued expenses and other liabilities	8,978	1,966
Estimated liability for appeals	(6,937)	11,861
Net cash provided by operating activities	79,795	75,204
Investing activities:
Purchase of short-term investments		(21,460)
Purchases of land, property and equipment	(16,594)	(18,272)
Investment in common stock		(500)
Investment in capitalized software	(2,726)	(2,951)
Net cash used in investing activities	(19,320)	(43,183)
Financing activities:
Repayment of term loan		(8,750)
Proceeds from revolving credit facility		4,046
Payment of financing fees related to revolving debt		(2,915)
Repayment of revolving credit facility	(35,000)	(60,000)
Payments on contingent consideration	(428)
Payments on capital lease obligations	(1,241)	(1,291)
Proceeds from exercise of stock options	3,279	7,381
Payments of tax withholdings on behalf of employees for net-share settlement for stock-based compensation	(1,128)	(1,498)
Excess tax benefit from exercised stock options	870	5,154
Net cash used in financing activities	(33,648)	(57,873)
Net increase (decrease) in cash and cash equivalents	26,827	(25,852)
Cash and cash equivalents at beginning of year	93,366	135,227
Cash and cash equivalents at end of year	120,193	109,375
Supplemental disclosure of cash flow information:
Cash paid for income taxes	3,541	24,090
Cash paid for interest	4,438	7,666
Supplemental disclosure of noncash activities:
Accrued property and equipment purchases	974	1,040
Equipment purchased through capital leases	$ 20	$ 2,401