Other Accrued Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Accrued Liabilities, Current [Abstract]
Accrued professional liabilities	$ 14,319	$ 14,362
Contingent purchase price payable	5,509	5,509
Current income taxes payable	1,782	7,892
Refunds payable	45,175	48,415
Other	35,076	43,059
Total other accrued liabilities	$ 101,861	$ 119,237