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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
9 Months Ended
Sep. 30, 2017
Sep. 30, 2016
Cash flows from operating activities:    
Net income $ 55,632 $ 40,012
Adjustments to reconcile net income to net cash from operating activities:    
Depreciation and amortization 82,896 77,472
Non-cash impairment of intangible assets   4,800
Non-cash interest expense 3,120 385
Non-cash stock compensation expense 31,834 27,573
Non-cash income tax provision (benefit) (2,160) 2,998
Non-cash amortization on investments 3,052 4,224
Changes in assets and liabilities, net of effects from acquisitions of businesses:    
Accounts receivable, net (13,539) (31,926)
Pharmaceutical inventory 9,609 (10,425)
Other assets (15,481) (72,374)
Accounts payable and accrued liabilities (70,006) 23,870
Medical claims payable and other medical liabilities 25,578 (18,017)
Contingent consideration (631) (50,591)
Tax contingencies 158 (111)
Deferred credits and other long-term liabilities 2,408 (5,393)
Other 210 (57)
Net cash (used in) provided by operating activities 112,680 (7,560)
Cash flows from investing activities:    
Capital expenditures (42,703) (44,345)
Acquisitions and investments in businesses, net of cash acquired (3,200) (126,931)
Purchase of investments (341,280) (365,521)
Maturity of investments 320,045 373,694
Net cash used in investing activities (67,138) (163,103)
Cash flows from financing activities:    
Proceeds from issuance of debt 949,239 290,000
Payments to acquire treasury stock (15,457) (106,806)
Proceeds from exercise of stock options and warrants 28,328 10,933
Payments on debt and capital lease obligations (798,359) (13,569)
Payments on contingent consideration (1,032) (40,559)
Other (8,005) 1,274
Net cash provided by financing activities 154,714 141,273
Net (decrease) increase in cash and cash equivalents 200,256 (29,390)
Cash and cash equivalents at beginning of period 304,508 249,029
Cash and cash equivalents at end of period 504,764 219,639
Non-cash investing activities:    
Property and equipment acquired under capital leases $ 2,418 $ 4,193