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General (Details 3) - USD ($)
$ in Thousands
3 Months Ended 9 Months Ended
Sep. 30, 2015
Sep. 30, 2014
Sep. 30, 2015
Sep. 30, 2014
Concentration of Business        
Net revenue $ 1,190,082 $ 923,170 $ 3,328,657 $ 2,777,659
Minimum        
Concentration of Business        
Term of Contract     1 year  
Term of renewed contract     1 year  
Notice period for termination of contract     60 days  
Maximum        
Concentration of Business        
Term of Contract     3 years  
Term of renewed contract     2 years  
Notice period for termination of contract     180 days  
Pennsylvania Counties        
Concentration of Business        
Net revenue     $ 294,900 $ 272,000