Other Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Accrued Liabilities, Current [Abstract]
Accrued professional liabilities	$ 15,346	$ 14,362
Contingent purchase price payable	1,000	5,509
Current income taxes payable	1,449	7,892
Refunds payable	31,331	48,415
Other	52,499	43,059
Total other accrued liabilities	$ 101,625	$ 119,237