Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2012	Sep. 30, 2011
Operating activities
Net income (loss)	$ 25,503	$ (13,059)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Depreciation and amortization expense	5,801	5,719
Provision for bad debts	8,395	8,903
Stock-based compensation expense	3,398	3,041
Deferred income taxes	1,552	2,834
(Gain) loss on sale of assets	100
Other intangibles impairment charge	650
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(7,084)	(5,871)
Prepaid expenses and other assets	2,247	6,762
Prepaid income taxes	13,960	(21,569)
Accounts payable and accrued expenses	(6,597)	(2,627)
Net amounts due to/from governmental entities	135	217
Net cash provided by (used in) operating activities	48,060	(15,650)
Investing activities
Purchases of property, building and equipment	(6,508)	(6,058)
Proceeds from sale of assets	25
Cash paid for acquisitions, primarily goodwill and intangible assets	(6,764)	(11,745)
Net cash (used in) investing activities	(13,247)	(17,803)
Financing activities
Proceeds from line of credit	173,562	103,187
Payments on line of credit	(183,297)	(49,187)
Payments on capital leases		(14)
Excess tax benefits from vesting of restricted stock		319
Proceeds from employee stock purchase plan	587	648
Noncontrolling interest distributions	(6,582)	(9,537)
Payments on repurchase of common stock	(19,017)	(577)
Purchase of additional controlling interest	(126)	(816)
Sale of noncontrolling interest	80	276
Net cash provided by (used in) financing activities	(34,793)	44,299
Change in cash	20	10,846
Cash at beginning of period	256	288
Cash at end of period	276	11,134
Supplemental disclosures of cash flow information
Interest paid	972	507
Income taxes paid	$ 8,644	$ 12,335