Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015
Operating activities:
Net income	$ 4,560	$ 3,522
Adjustments to reconcile net income to net cash provided by (used in) operating activities:
Depreciation and amortization of property and equipment	6,577	8,163
Amortization of intangible assets	5,043	5,077
Amortization of deferred financing costs	521	521
Stock-based compensation expense	4,240	3,245
Excess tax benefit from exercised stock options	(10)	(1,448)
Deferred income taxes	1,308	(226)
Loss on disposal of fixed assets	10	10
Changes in operating assets and liabilities:
Accounts receivable	3,350	(9,344)
Prepaid expenses	$ (2,362)	(983)
Prepaid income taxes		2,049
Other current assets	$ 328	51
Other assets	51	$ (147)
Income taxes payable	(3,589)
Accounts payable, accrued expenses and other liabilities	(16,963)	$ (10,772)
Estimated liability for appeals	(2,465)	187
Net cash provided by (used in) operating activities	599	(95)
Investing activities:
Purchases of land, property and equipment	(570)	(2,513)
Investment in capitalized software	(1,185)	(721)
Net cash used in investing activities	(1,755)	(3,234)
Financing activities:
Proceeds from exercise of stock options	26	3,273
Excess tax benefit from exercised stock options	10	1,448
Payments of tax withholdings on behalf of employees for net-share settlement for stock-based compensation	(1,002)	(596)
Payments on capital lease obligations	(37)	(366)
Net cash provided by (used in) financing activities	(1,003)	3,759
Net increase (decrease) in cash and cash equivalents	(2,159)	430
Cash and cash equivalents at beginning of year	145,610	133,116
Cash and cash equivalents at end of year	143,451	133,546
Supplemental disclosure of cash flow information:
Cash paid for income taxes	5,052	656
Cash paid for interest	1,446	2,826
Supplemental disclosure of non-cash activities:
Accrued property and equipment purchases	$ 122	$ 959