Medical Liabilities (Details) - USD ($)	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Dec. 31, 2018
Medical Liabilities, Current [Roll Forward]
Balance, beginning of period	$ 33,641,701	$ 63,972,318
Acquisition	26,404,372
Claims paid for previous period	(49,164,084)	(36,549,348)
Incurred health care costs	178,472,645	209,002,961
Claims paid for current period	(135,580,214)	(167,537,480)
Payment to CMS based on APAACO 2017 year settlement	0	(34,464,826)
Adjustments	45,227	(781,924)
Balance, end of period	$ 53,819,647	$ 33,641,701