Segment Information Segment Details (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Revenue, Net	$ 1,733,317	$ 1,610,584	$ 3,393,159	$ 3,181,622
Depreciation and amortization expense	(34,372)	(33,361)	(65,735)	(67,097)
Settlement, litigation and other related charges	(57,702)	(7,547)	(67,522)	(14,599)
Other charges	(11,405)	(11,284)	(12,454)	(21,560)
Operating Income (Loss)	96,930	130,246	248,910	262,998
Corporate/Other [Member]
Revenue, Net	78	76	129	189
Depreciation and amortization expense	(15,546)	(14,811)	(28,918)	(29,949)
Settlement, litigation and other related charges	0	0	0	0
Other charges	(7,773)	(8,364)	(7,431)	(16,129)
Operating Income (Loss)	(47,556)	(50,412)	(86,282)	(101,973)
Long Term Care Group [Member]
Revenue, Net	1,159,099	1,190,441	2,353,619	2,381,694
Depreciation and amortization expense	(17,588)	(17,382)	(34,403)	(34,853)
Settlement, litigation and other related charges	(57,702)	(7,547)	(67,522)	(14,599)
Other charges	(3,632)	(2,920)	(5,023)	(5,431)
Operating Income (Loss)	104,025	149,533	255,728	302,117
specialty care group [Member]
Revenue, Net	574,140	420,067	1,039,411	799,739
Depreciation and amortization expense	(1,238)	(1,168)	(2,414)	(2,295)
Settlement, litigation and other related charges	0	0	0	0
Other charges	0	0	0	0
Operating Income (Loss)	$ 40,461	$ 31,125	$ 79,464	$ 62,854