CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2015	Dec. 31, 2014	Dec. 31, 2013
Operating activities
Income from continuing operations	$ 41,650	$ 28,752	$ 29,146
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Depreciation and Amortization Expense	11,955	9,571	8,325
Provision for bad debts	19,243	15,780	13,929
Stock-based compensation expense	4,225	4,094	3,886
Deferred income taxes	1,518	2,402	2,351
Impairment of intangibles and other	1,990	3,650	520
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(27,951)	(16,372)	(18,961)
Prepaid expenses and other assets	(3,793)	191	(749)
Prepaid income taxes	441	911	3,299
Accounts payable and accrued expenses	10,526	(10,460)	4,395
Net amounts due to/from governmental entities	130	138	(226)
Net cash provided by (used in) operating activities	59,934	38,657	45,915
Investing activities
Cash paid for acquisitions, primarily goodwill and intangible assets	(70,572)	(73,933)	(26,920)
Purchases of property, building and equipment	(13,283)	(8,105)	(8,343)
Net cash (used in) investing activities	(83,855)	(82,038)	(35,263)
Financing activities
Proceeds from line of credit	83,000	75,000	73,000
Payments on line of credit	(45,000)	(37,000)	(70,500)
Excess tax benefits from vesting of restricted stock	914	124	18
Proceeds from issuance of common stock under ESPP	782	782	786
Proceeds from debt issuance	0	0	1,212
Payments on debt	(233)	(202)	0
Noncontrolling interest distributions	(8,324)	(6,843)	(8,126)
Payments of deferred financing fees	0	(852)	0
Purchase of Additional Controlling Interest	(275)	(359)	(1,879)
Sale of noncontrolling interest	0	193	0
Redemption of treasury stock to pay income tax	(1,479)	(945)	(869)
Proceeds from Stock Options Exercised	144	0	0
Net cash provided by (used in) financing activities	29,529	29,898	(6,358)
Change in cash	5,608	(13,483)	4,294
Cash at beginning of period	531	14,014
Cash at end of period	6,139	531	14,014
Supplemental disclosures of cash flow information
Interest paid	1,870	2,461	1,961
Income taxes paid	$ 20,361	$ 11,781	$ 21,606