Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Operating activities:
Net income	$ 1,442	$ 4,560
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization of property and equipment	6,235	6,577
Amortization of intangible assets	4,327	5,043
Amortization of deferred financing costs	521	521
Stock-based compensation expense	5,386	4,240
Deferred income taxes	248	1,308
Loss on disposal of assets		10
Changes in operating assets and liabilities:
Accounts receivable	6,978	3,350
Prepaid expenses	(2,677)	(2,362)
Other current assets	433	328
Other assets	84	51
Income taxes receivable / (payable)	(734)	(3,589)
Accounts payable, accrued expenses and other liabilities	(19,646)	(16,963)
Estimated liability for appeals	789	(2,465)
Net cash provided by operating activities	3,386	609
Investing activities:
Purchases of land, property and equipment	(6,282)	(570)
Investment in capitalized software	(2,206)	(1,185)
Net cash used in investing activities	(8,488)	(1,755)
Financing activities:
Proceeds from Stock Options Exercised	2	26
Payments of tax withholdings on behalf of employees for net-share settlement for stock-based compensation	(2,608)	(1,002)
Payments on capital lease obligations	(2)	(37)
Net cash used in financing activities	(2,608)	(1,013)
Net decrease in cash and cash equivalents	(7,710)	(2,159)
Cash and cash equivalents at beginning of year	175,999	145,610
Cash and cash equivalents at end of period	168,289	143,451
Supplemental disclosure of cash flow information:
Cash paid for income taxes	734	5,052
Cash paid for interest	1,686	1,446
Supplemental disclosure of non-cash activities:
Change in balance of accrued property and equipment purchases	$ (1,244)	$ 122