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General - Concentration of Business (Details) - USD ($)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2017
Jun. 30, 2016
Jun. 30, 2017
Jun. 30, 2016
Concentration of Business        
Net revenue $ 1,419,139 $ 1,164,345 $ 2,724,762 $ 2,281,367
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  
CMS        
Concentration of Business        
Net revenue     $ 236,100 115,500
Pennsylvania Counties        
Concentration of Business        
Net revenue     232,400 226,000
Agencies and departments of the United States federal government        
Concentration of Business        
Net revenue     $ 177,500 $ 82,500