Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Document Period End Date	Sep. 30, 2015
Cash flows from operating activities:
Net income	$ 57,604	$ 47,011
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	7,932	7,442
Benefit for deferred taxes	(5,749)	(1,810)
Share based compensation	1,244	1,333
Provision for doubtful accounts	1,950	1,083
Debt discount amortization on convertible debt	13	26
Unrealized foreign exchange (gain) loss	(2,008)	(256)
Loss on put option	0	(296)
Reduction of acquisition earnout accruals	(1,533)	(7,533)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(6,328)	(1,901)
Other assets	(3,606)	(3,977)
Accounts payable and accrued expenses	(21,448)	(8,064)
Accrued payroll and related benefits	1,100	1,027
Deferred revenue	(3,096)	(704)
Deferred rent	(111)	(272)
Unrecognized tax benefits, period increase (decrease)	594	9,337
Loss Contingency Accrual, Period Increase (Decrease)	(690)	(3,868)
Other current liabilities	(205)	(188)
Net cash provided by operating activities	25,663	38,390
Cash flows from investing activities:
Payments to Acquire Interest in Joint Venture	(6,000)	0
Purchases of marketable securities	(940)	(595)
Capital expenditures	(12,713)	(15,922)
Net cash used in investing activities	(32,128)	(24,620)
Cash flows from financing activities:
Proceeds from Lines of Credit	66,000	40,625
Principal payments of term loan obligation	0	(31,938)
Repurchases of common stock	(67,780)	(16,482)
Excess tax benefit from share-based compensation	63	(3,200)
Proceeds from the exercise of stock options	1,117	788
Forfeiture of certain shares to satisfy exercise costs and the recipients income tax obligations related to stock options exercised and restricted stock vested	(1,141)	(37)
Dividend payments	(7,989)	(8,652)
Cash consideration for shares reacquired in connection with put option	0	(3,535)
Principal payments of debt obligations	(638)	(336)
Payments of capital lease obligations	(3)	(144)
Net cash used in financing activities	(10,371)	(22,911)
Effect of foreign exchange rates on cash	(2,264)	(183)
Net change in cash and cash equivalents	(19,100)	(9,324)
Cash and cash equivalents at the beginning of the period	52,300	56,674
Cash and cash equivalents at the end of the period	33,200	47,350
Supplemental disclosures of cash flow information:
Interest paid	4,002	802
Income taxes paid	24,663	10,782
Via Media Health [Member]
Cash flows from investing activities:
Acquisition of business, net of cash acquired	(1,000)	0
PB Systems [Member]
Cash flows from investing activities:
Acquisition of business, net of cash acquired	(11,475)	0
Healthcare Magic [Member]
Cash flows from investing activities:
Acquisition of business, net of cash acquired	0	(5,856)
Curepet, Inc. [Member]
Cash flows from investing activities:
Acquisition of business, net of cash acquired	0	3
Taimma [Member]
Payment of acquisition earn-out contingency, Taimma	$ 0	$ (2,250)