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Held for Sale and Discontinued Operations Held for Sale and Discontinued Operations
 9 Months Ended
Sep. 30, 2019
Held for Sale and Discontinued Operations [Abstract]  
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block] Held for sale and discontinued operations
DaVita Medical Group
On June 19, 2019, the Company completed the sale of its DMG division to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc., for an aggregate purchase price of $4,340,000, prior to certain closing and post-closing adjustments specified in the related equity purchase agreement dated as of December 5, 2017, as amended as of September 20, 2018 and as of December 11, 2018 (as amended, the equity purchase agreement).
The Company has recorded a preliminary estimated pre-tax net loss of approximately $23,022 on the sale of its DMG division for the nine months ended September 30, 2019. This preliminary net loss is based on initial estimates of the Company's expected aggregate proceeds from the sale, net of transaction costs and obligations, as well as the estimated values of DMG net assets sold as of the closing date. These estimated net proceeds include $4,465,476 in cash received from Optum at closing, or $3,824,509 net of cash and restricted cash included in DMG net assets sold.
The ultimate net proceeds from the DMG sale, as well as the value of its previously held for sale net assets sold, remain subject to estimate revisions and post-closing adjustments pursuant to the equity purchase agreement, which could be material. Under the equity purchase agreement, the Company also has certain indemnification obligations that could require payments to the buyer relating to the Company's previous ownership and operation of the DMG business. Potential payments under these provisions, if any, remain subject to significant uncertainties and could have a material adverse effect on the net proceeds ultimately retained by the Company or the total amount of its loss on the sale of this business.
The following table presents the financial results of discontinued operations related to DMG:
 
Three months ended September 30,
 
Nine months ended September 30,
 
2019
 
2018
 
2019
 
2018
Revenues
$
—

 
$
1,252,909

 
$
2,713,059

 
$
3,733,270

Expenses
1,996

 
1,260,814

 
2,541,783

 
3,679,747

Valuation adjustment
—

 
98,201

 
—

 
98,201

(Loss) income from discontinued operations before taxes
(1,996
)
 
(106,106
)
 
171,276

 
(44,678
)
Loss on sale of discontinued operations before taxes
—

 
—

 
(23,022
)
 
—

Income tax expense
4,847

 
105,633

 
45,400

 
103,151

Net (loss) income from discontinued operations, net of tax
$
(6,843
)
 
$
(211,739
)
 
$
102,854

 
$
(147,829
)

The following table presents cash flows of discontinued operations related to DMG:
 
Nine months ended September 30,
 
2019
 
2018
Net cash provided by operating activities from discontinued operations
$
97,005

 
$
208,570

Net cash used in investing activities from discontinued operations
$
(43,442
)
 
$
(32,860
)

DMG acquisitions
During the period from January 1, 2019 to June 18, 2019 immediately prior to sale, the Company's DMG business acquired two medical businesses for a total of $2,025 in cash and deferred purchase price of $212.