Segment Information Segment Details (Details) (USD $) In Thousands, unless otherwise specified	3 Months Ended		9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013	Sep. 30, 2014	Sep. 30, 2013
Revenue, Net	$ 1,608,055	$ 1,515,168	$ 4,789,677	$ 4,477,229
Depreciation and amortization expense	(33,332)	(34,040)	(100,429)	(99,527)
Settlement, litigation and other related charges	(12,868)	(143,484)	(27,467)	(169,615)
Other charges	(3,999)	(61,632)	(25,559)	96,906
Operating Income (Loss)	135,742	(60,776)	398,740	154,280
Corporate/Other [Member]
Revenue, Net	77	160	266	1,330
Depreciation and amortization expense	(14,849)	(14,953)	(44,798)	(42,318)
Settlement, litigation and other related charges	0	0	0	0
Other charges	(446)	(50,868)	(16,575)	(52,841)
Operating Income (Loss)	(40,746)	(91,828)	(142,719)	(187,678)
Long Term Care Group [Member]
Revenue, Net	1,183,398	1,157,951	3,565,092	3,458,772
Depreciation and amortization expense	(17,405)	(17,919)	(52,258)	(53,801)
Settlement, litigation and other related charges	(12,868)	(143,484)	(27,467)	(169,615)
Other charges	(3,553)	(10,764)	(8,984)	(44,065)
Operating Income (Loss)	142,285	4,207	444,402	259,953
specialty care group [Member]
Revenue, Net	424,580	357,057	1,224,319	1,017,127
Depreciation and amortization expense	(1,078)	(1,168)	(3,373)	(3,408)
Settlement, litigation and other related charges	0	0	0	0
Other charges	0	0	0	0
Operating Income (Loss)	$ 34,203	$ 26,845	$ 97,057	$ 82,005