Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2012	Dec. 31, 2011	Dec. 31, 2010
Operating activities
Net income (loss)	$ 35,428	$ (3,651)	$ 64,546
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Depreciation and amortization expense	7,806	7,521	7,496
Provision for bad debts	11,875	12,320	7,607
Stock based compensation expense	4,390	4,092	3,742
Deferred income taxes	2,204	4,378	2,771
(Gain) loss on sale of assets	105
Loss on impairment of intangible assets	650	0	0
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(4,497)	(21,024)	(16,195)
Prepaid expenses, other assets	1,780	6,247	(2,319)
Prepaid taxes	18,855	(17,926)	(2,194)
Accounts payable and accrued expenses	(4,288)	4,478	5,777
Net amounts due from governmental entities	464	189	706
Net cash provided by (used in) operating activities	74,772	(3,376)	71,937
Investing activities
Cash paid for acquisitions, primarily goodwill, intangible assets and advance payment on acquisitions	(6,758)	(11,680)	(31,747)
Proceeds from sale of assets	33
Purchases of property, building and equipment	(8,415)	(7,945)	(11,586)
Net cash used in investing activities	(15,140)	(19,625)	(43,333)
Financing activities
Proceeds from line of credit	188,561	142,995	9,023
Payments on line of credit	(203,881)	(108,175)	(14,746)
Principal payments on debt			(4,483)
Payments on capital leases		(14)	(31)
Payment of contingent consideration			(1,726)
Excess tax benefits from vesting of restricted stock		320	476
Proceeds from issuance of common stock under ESPP	783	860	781
Proceeds from exercise of stock options			74
Noncontrolling interest distributions	(8,444)	(11,857)	(15,666)
Purchase of additional controlling interest	(309)	(891)	(1,914)
Sale of noncontrolling interest	80	308
Payment of deferred financing fees			(498)
Repurchase of common stock	(26,958)	(577)
Net cash provided by (used in) financing activities	(50,168)	22,969	(28,710)
Change in cash	9,464	(32)	(106)
Cash at beginning of period	256	288	394
Cash at end of period	9,720	256	288
Supplemental disclosures of cash flow information
Interest paid	1,550	1,018	134
Income taxes paid	$ 8,645	$ 11,363	$ 30,605