CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities
Net income	$ 50,531	$ 49,294	$ 122,320
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	17,543	17,517	18,350
Amortization of debt issuance cost	939	1,078	1,347
Share-based compensation	16,101	6,745	3,383
Gain on sale of investments	(2,272)	(2,193)	(99,839)
Loss (gain) on consolidation of equity method investment	901	(2,752)	0
Gain on contingent equity securities	0	(4,270)	0
Unrealized loss on investments	25,506	10,845	11
Gain from investment in warrants	0	(1,145)	0
Loss (income) from equity method investments, net	(5,622)	4,306	(3,694)
Impairment of beneficial interest	0	15,723	0
Unrealized (gain) loss on interest rate swaps	(4,235)	1,071	0
Loss of disposal of property and equipment	0	0	91
Deferred tax	(7,681)	(5,952)	(6,620)
Other		189	0
Changes in operating assets and liabilities, net of acquisition amounts:
Receivable, net	(41,192)	(1,518)	4,134
Receivable, net – related parties	4,229	(20,116)	(1,123)
Other receivable	8,196	(5,351)	12,589
Prepaid expenses and other current assets	818	2,708	(6,432)
Right-of-use assets	3,759	3,133	3,325
Other assets	(243)	(1,529)	(5,530)
Accounts payable and accrued expenses	(49)	3,217	8,204
Fiduciary accounts payable	(2,470)	892	7,615
Medical liabilities	25,784	5,279	(8,691)
Income taxes payable	(4,470)	(3,621)	(304)
Operating lease liabilities	(3,945)	(3,215)	(2,973)
Net cash provided by operating activities	82,128	70,335	46,163
Cash flows from investing activities
Payments for business acquisition, net of cash acquired	(16,352)	(2,585)	(11,354)
Proceeds from repayment of loans receivable - related parties	4,067	56	16,500
Advances on loans receivable	0	0	(145)
Purchases of marketable securities	(1,854)	(28,000)	(1,793)
Purchases of investments – equity method	0	(13,622)	(9,969)
Proceeds from sale of equity method investment	0	6,375	52,743
Purchases of property and equipment	(22,940)	(19,223)	(1,164)
Proceeds from sale of fixed assets	0	0	50
Proceeds from sale of marketable securities	31,671	67,612	50,625
Cash recorded from consolidation of VIE	0	5,927	0
Distribution from investment - equity method	400	0	0
Contribution to investment - equity method	(2,105)	0	0
Net cash (used in) provided by investing activities	(7,113)	16,540	95,493
Cash flows from financing activities
Dividends paid	(14,030)	(31,089)	(51,319)
Repayments on long-term debt	(3,865)	(238,326)	(9,500)
Payment of finance lease obligations	(561)	(208)	(105)
Proceeds from exercise of stock options and warrants	8,633	9,061	10,802
Repurchase of common stock	(9,250)	(5,739)	(537)
Proceeds from sale of common stock	0	40,134	0
Purchase of non-controlling interest	(5,046)	(1,471)	(1,037)
Proceeds from sale of noncontrolling interest	436	48	0
Borrowings on loans	3,598	180,569	0
Cost of debt and equity issuances	0	(727)	0
Net cash used in financing activities	(20,085)	(47,748)	(51,696)
Net increase in cash, cash equivalents, and restricted cash	54,930	39,127	89,960
Cash, cash equivalents, and restricted cash, beginning of year	233,097	193,970	104,010
Cash, cash equivalents and restricted cash, end of year	288,027	233,097	193,970
Supplemental disclosures of cash flow information
Cash paid for income taxes	47,311	37,201	62,002
Cash paid for interest	6,672	4,158	8,510
Supplemental disclosures of non-cash investing and financing activities
Dividend declared included in dividend payable	0	71	485
Issuance of financing obligation for business combinations	0	12,706	0
Cashless exercise of warrants	694	0	599
Fixed asset obtained in exchange for finance lease liabilities	971	0	0
Common stock issued in business combination	1,000	0	0
Mortgage loan	16,275	0	0
Cancellation of Restricted Stock Awards	0	334	0
Deferred tax liability adjustment related to warrant exercises	0	0	690
Preferred shares received from sale of equity method investment	0	0	36,179
Beneficial interest acquired from sale of equity method investment	0	0	15,723
Reconciliation of cash, cash equivalents, and restricted cash
Cash and cash equivalents	288,027	233,097	193,470
Restricted cash – long-term - letters of credit	0	0	500
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows	$ 288,027	$ 233,097	$ 193,970