Condensed Consolidated Statements Of Cash Flows (USD $) In Thousands	9 Months Ended
	Sep. 30, 2011	Sep. 30, 2010
Operating activities
Net income (loss)	$ (13,059)	$ 49,224
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization expense	5,719	5,354
Provision for bad debts	8,903	5,299
Stock-based compensation expense	3,041	2,791
Deferred income taxes	2,834	818
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(5,871)	(9,858)
Prepaid expenses and other assets	6,762	(199)
Prepaid income taxes	(21,569)
Accounts payable and accrued expenses	(2,627)	4,523
Net amounts due to/from governmental entities	217	498
Net cash provided by (used in) operating activities	(15,650)	58,450
Investing activities
Purchases of property, building and equipment	(6,058)	(11,145)
Cash paid for acquisitions, primarily goodwill, intangible assets and advance payments on acquisition	(11,745)	(21,994)
Net cash used in investing activities	(17,803)	(33,139)
Financing activities
Proceeds from line of credit	103,187	9,023
Payments on line of credit	(49,187)	(14,746)
Principal payments on debt		(303)
Payments on capital leases	(14)	(24)
Excess tax benefits from vesting of restricted stock	319	634
Proceeds from employee stock purchase plan	648	595
Noncontrolling interest distributions	(9,537)	(11,763)
Payments on repurchase of common stock	(577)
Purchase of additional controlling interest	(816)	(1,914)
Sale of noncontrolling interest	276
Net cash provided by (used in) financing activities	44,299	(18,498)
Change in cash	10,846	6,813
Cash at beginning of period	288	394
Cash at end of period	11,134	7,207
Supplemental disclosures of cash flow information
Interest paid	507	83
Income taxes paid	$ 12,335	$ 25,170