CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Operating activities:
Net income	$ 33,809	$ 31,516
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization expense	9,024	8,685
Provision for bad debts	11,658	14,873
Stock-based compensation expense	3,518	3,150
Deferred income taxes	6,062	1,125
Impairment of intangibles and other		248
Loss on disposal of assets	1,389	680
Changes in operating assets and liabilities, net of acquisitions:
Receivables	(21,175)	(24,643)
Prepaid expenses and other assets	450	(3,660)
Prepaid income taxes	(2,482)	779
Accounts payable and accrued expenses	17,633	19,071
Net amounts due to/from governmental entities	(2,043)	(205)
Net cash provided by operating activities	57,843	51,619
Investing activities:
Purchases of property, building and equipment	(14,576)	(11,401)
Cash paid for acquisitions, primarily goodwill and intangible assets	(20,332)	(4,359)
Other	273
Net cash used in investing activities	(34,635)	(15,760)
Financing activities:
Proceeds from line of credit	38,000	64,000
Payments on line of credit	(44,000)	(32,000)
Proceeds from employee stock purchase plan	663	569
Payments on debt	(156)	(172)
Noncontrolling interest distributions	(6,859)	(6,372)
Excess tax benefits from vesting of stock awards	1,293	897
Withholding taxes paid on stock-based compensation	(1,931)	(1,449)
Purchase of additional controlling interest		(275)
Sale of noncontrolling interest	52
Proceeds from exercise of stock options	109	145
Net cash provided by (used in) financing activities	(12,829)	25,343
Change in cash	10,379	61,202
Cash at beginning of period	6,139	531
Cash at end of period	16,518	61,733
Supplemental disclosures of cash flow information:
Interest paid	2,329	1,227
Income taxes paid	$ 11,390	$ 14,242