$DVA
DAVITA INC. Stock $dva

$dva Overview Financials Valuation SEC Filings Company Website

2018 Q4 Form 10-Q Financial Statement

#000092706618000196 Filed on November 07, 2018

Income Statement

Concept	2018 Q4	2018 Q3	2017 Q4
Revenue	$2.821B	$2.847B	$2.781B
YoY Change	1.45%	2.97%	3.02%
Cost Of Revenue	$2.027B	$2.064B	$1.942B
YoY Change	4.4%	5.75%	-473.84%
Gross Profit	$794.1M	$783.6M	$839.2M
YoY Change	-5.37%	-3.68%	324.91%
Gross Profit Margin	28.15%	27.52%	30.18%
Selling, General & Admin	$268.5M	$337.1M	$259.8M
YoY Change	3.35%	24.76%	-346.02%
% of Gross Profit	33.81%	43.02%	30.96%
Research & Development
YoY Change
% of Gross Profit
Depreciation & Amortization	$155.1M	$146.0M	$184.0M
YoY Change	-15.71%	-28.18%	-2.54%
% of Gross Profit	19.53%	18.63%	21.93%
Operating Expenses	$423.7M	$483.1M	$404.1M
YoY Change	4.85%	17.0%	-416.94%
Operating Profit	$387.9M	$289.0M	$150.3M
YoY Change	158.03%	-26.88%	-58.64%
Interest Expense	-$138.9M	-$129.7M	-$112.2M
YoY Change	23.8%	13.18%	21.96%
% of Operating Profit	-35.81%	-44.87%	-74.63%
Other Income/Expense, Net	-$500.0K	$4.007M	$5.500M
YoY Change	-109.09%	17.99%	-1016.67%
Pretax Income	$259.1M	$167.1M	$46.83M
YoY Change	453.34%	-42.25%	-81.97%
Income Tax	$51.70M	$52.05M	$101.7M
% Of Pretax Income	19.95%	31.14%	217.19%
Net Earnings	-$149.8M	-$136.8M	$303.4M
YoY Change	-149.37%	-36.22%	92.36%
Net Earnings / Revenue	-5.31%	-4.8%	10.91%
Basic Earnings Per Share	-$0.90	-$0.82	$1.66
Diluted Earnings Per Share	-$0.90	-$0.82	$1.64
COMMON SHARES
Basic Shares Outstanding	166.0M shares	166.8M shares	183.3M shares
Diluted Shares Outstanding		167.3M shares

Balance Sheet

Concept	2018 Q4	2018 Q3	2017 Q4
SHORT-TERM ASSETS
Cash & Short-Term Investments	$361.4M	$488.0M	$578.8M
YoY Change	-37.56%	-55.78%	-42.8%
Cash & Equivalents	$323.0M	$448.2M	$508.2M
Short-Term Investments	$38.36M	$39.78M	$70.53M
Other Short-Term Assets	$5.594B	$6.129B	$112.1M
YoY Change	4892.06%	2886.68%	12.61%
Inventory	$107.4M	$91.10M	$181.8M
Prepaid Expenses	$108.3M		$104.7M
Receivables	$1.859B	$1.847B	$1.715B
Other Receivables	$469.8M	$383.8M	$399.3M
Total Short-Term Assets	$8.424B	$8.930B	$8.771B
YoY Change	-3.95%	121.38%	119.56%
LONG-TERM ASSETS
Property, Plant & Equipment	$3.394B	$3.276B	$3.149B
YoY Change	7.76%	-3.26%	9.95%
Goodwill	$6.842B	$6.703B	$6.610B
YoY Change	3.5%	-28.82%	9.89%
Intangibles	$118.8M	$97.61M	$113.8M
YoY Change	4.41%	-93.27%	54.86%
Long-Term Investments	$0.00	$0.00	$0.00
YoY Change
Other Assets	$71.58M	$76.52M	$47.29M
YoY Change	51.38%	24.13%	39.67%
Total Long-Term Assets	$10.69B	$10.43B	$10.20B
YoY Change	4.73%	-30.38%	-30.87%
TOTAL ASSETS
Total Short-Term Assets	$8.424B	$8.930B	$8.771B
Total Long-Term Assets	$10.69B	$10.43B	$10.20B
Total Assets	$19.11B	$19.36B	$18.97B
YoY Change	0.72%	1.81%	1.17%
SHORT-TERM LIABILITIES
YoY Change
Accounts Payable	$463.3M	$458.9M	$509.1M
YoY Change	-9.01%	-19.05%	11.5%
Accrued Expenses	$659.0M	$632.0M	$616.0M
YoY Change	6.98%	-18.45%	-36.95%
Deferred Revenue
YoY Change
Short-Term Debt	$0.00	$0.00	$0.00
YoY Change
Long-Term Debt Due	$1.929B	$1.784B	$178.0M
YoY Change	983.71%	838.95%	11.25%
Total Short-Term Liabilities	$4.891B	$4.855B	$3.068B
YoY Change	59.45%	68.89%	13.15%
LONG-TERM LIABILITIES
Long-Term Debt	$8.173B	$8.441B	$9.158B
YoY Change	-10.76%	-5.25%	2.38%
Other Long-Term Liabilities	$450.7M	$452.4M	$365.3M
YoY Change	23.36%	-17.47%	15.11%
Total Long-Term Liabilities	$450.7M	$452.4M	$365.3M
YoY Change	23.36%	-17.47%	15.11%
TOTAL LIABILITIES
Total Short-Term Liabilities	$4.891B	$4.855B	$3.068B
Total Long-Term Liabilities	$450.7M	$452.4M	$365.3M
Total Liabilities	$14.08B	$14.26B	$13.08B
YoY Change	7.65%	9.58%	1.12%
SHAREHOLDERS EQUITY
Retained Earnings	$2.743B	$3.951B	$3.634B
YoY Change	-24.51%	-2.93%	-2.06%
Common Stock	$995.2M	$1.056B	$1.043B
YoY Change	-4.59%	-0.32%	1.53%
Preferred Stock
YoY Change
Treasury Stock (at cost)	$0.00	$1.154B	$0.00
YoY Change		230.71%
Treasury Stock Shares
Shareholders Equity	$3.703B	$3.825B	$4.690B
YoY Change
Total Liabilities & Shareholders Equity	$19.11B	$19.36B	$18.97B
YoY Change	0.72%	1.81%	1.17%

Cashflow Statement

Concept	2018 Q4	2018 Q3	2017 Q4
OPERATING ACTIVITIES
Net Income	-$149.8M	-$136.8M	$303.4M
YoY Change	-149.37%	-36.22%	92.36%
Depreciation, Depletion And Amortization	$155.1M	$146.0M	$184.0M
YoY Change	-15.71%	-28.18%	-2.54%
Cash From Operating Activities	$419.1M	$417.0M	$480.7M
YoY Change	-12.81%	-17.13%	-5.11%
INVESTING ACTIVITIES
Capital Expenditures	-$281.4M	$231.7M	-$265.5M
YoY Change	5.99%	-3.82%	4.57%
Acquisitions
YoY Change
Other Investing Activities	-$62.80M	-$5.600M	$6.200M
YoY Change	-1112.9%	-56.92%	-98.0%
Cash From Investing Activities	-$344.3M	-$237.2M	-$259.2M
YoY Change	32.83%	-6.58%	-567.03%
FINANCING ACTIVITIES
Cash Dividend Paid
YoY Change
Common Stock Issuance & Retirement, Net
YoY Change
Debt Paid & Issued, Net
YoY Change
Cash From Financing Activities	-202.1M	-117.4M	-236.5M
YoY Change	-14.55%	-28.68%	-56.53%
NET CHANGE
Cash From Operating Activities	419.1M	417.0M	480.7M
Cash From Investing Activities	-344.3M	-237.2M	-259.2M
Cash From Financing Activities	-202.1M	-117.4M	-236.5M
Net Change In Cash	-127.3M	62.40M	-15.00M
YoY Change	748.67%	-26.33%	-182.87%
FREE CASH FLOW
Cash From Operating Activities	$419.1M	$417.0M	$480.7M
Capital Expenditures	-$281.4M	$231.7M	-$265.5M
Free Cash Flow	$700.5M	$185.3M	$746.2M
YoY Change	-6.12%	-29.35%	-1.88%

Facts In Submission

Frame	Concept Type	Concept / XBRL Key	Value	Unit
	dei	Amendment Flag AmendmentFlag	false
	dei	Current Fiscal Year End Date CurrentFiscalYearEndDate	--12-31
	dei	Document Fiscal Period Focus DocumentFiscalPeriodFocus	Q3
	dei	Document Fiscal Year Focus DocumentFiscalYearFocus	2018
	dei	Document Period End Date DocumentPeriodEndDate	2018-09-30
	dei	Document Type DocumentType	10-Q
	dei	Entity Central Index Key EntityCentralIndexKey	0000927066
CY2018Q4	dei	Entity Common Stock Shares Outstanding EntityCommonStockSharesOutstanding	166000000	shares
	dei	Entity Emerging Growth Company EntityEmergingGrowthCompany	false
	dei	Entity Filer Category EntityFilerCategory	Large Accelerated Filer
	dei	Entity Registrant Name EntityRegistrantName	DAVITA INC.
	dei	Entity Small Business EntitySmallBusiness	false
	dei	Trading Symbol TradingSymbol	DVA
CY2017Q4	dva	Acquisition Obligations And Other Notes Payable AcquisitionObligationsAndOtherNotesPayable	150512000	USD
CY2018Q3	dva	Acquisition Obligations And Other Notes Payable AcquisitionObligationsAndOtherNotesPayable	167779000	USD
	dva	Adjustment Income Loss From Equity Method Investments AdjustmentIncomeLossFromEquityMethodInvestments	-19071000	USD
	dva	Adjustment Income Loss From Equity Method Investments AdjustmentIncomeLossFromEquityMethodInvestments	-8611000	USD
	dva	Business Combination Contingent Consideration Acquisitions BusinessCombinationContingentConsiderationAcquisitions	14042000	USD
	dva	Business Combination Contingent Consideration Acquisitions Fair Value Remeasurement Gain Loss BusinessCombinationContingentConsiderationAcquisitionsFairValueRemeasurementGainLoss	401000	USD
CY2017Q3	dva	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Purchase Or Sale Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesPurchaseOrSaleOfInterestByParent	0	USD
	dva	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Purchase Or Sale Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesPurchaseOrSaleOfInterestByParent	195000	USD
CY2017Q4	dva	Current Liabilities CurrentLiabilities	1856107000	USD
CY2018Q3	dva	Current Liabilities CurrentLiabilities	3435483000	USD
	dva	Debt Expense Including Debt Refinancing Charges DebtExpenseIncludingDebtRefinancingCharges	359135000	USD
CY2017Q4	dva	Discount And Deferred Finance Costs DiscountAndDeferredFinanceCosts	63951000	USD
CY2018Q3	dva	Discount And Deferred Finance Costs DiscountAndDeferredFinanceCosts	53624000	USD
	dva	Employee Service Share Based Compensation Estimated Tax Benefit From Compensation Expense EmployeeServiceShareBasedCompensationEstimatedTaxBenefitFromCompensationExpense	8497000	USD
	dva	Employee Service Share Based Compensation Estimated Tax Benefit From Compensation Expense EmployeeServiceShareBasedCompensationEstimatedTaxBenefitFromCompensationExpense	10887000	USD
CY2017Q3	dva	Equity In Earnings Loss Of Consolidated Affiliates EquityInEarningsLossOfConsolidatedAffiliates	0	USD
	dva	Equity In Earnings Loss Of Consolidated Affiliates EquityInEarningsLossOfConsolidatedAffiliates	0	USD
CY2018Q3	dva	Equity In Earnings Loss Of Consolidated Affiliates EquityInEarningsLossOfConsolidatedAffiliates	0	USD
	dva	Equity In Earnings Loss Of Consolidated Affiliates EquityInEarningsLossOfConsolidatedAffiliates	0	USD
	dva	Gain Loss On Sale Of Business Including Activity From Discontinued Operations GainLossOnSaleOfBusinessIncludingActivityFromDiscontinuedOperations	23402000	USD
	dva	Gain Loss On Sale Of Business Including Activity From Discontinued Operations GainLossOnSaleOfBusinessIncludingActivityFromDiscontinuedOperations	57547000	USD
CY2017Q3	dva	Income Loss From Continuing Operations Attributableto Parent Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAttributabletoParentAvailableToCommonStockholdersBasic	-214476000	USD
	dva	Income Loss From Continuing Operations Attributableto Parent Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAttributabletoParentAvailableToCommonStockholdersBasic	360222000	USD
CY2018Q3	dva	Income Loss From Continuing Operations Attributableto Parent Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAttributabletoParentAvailableToCommonStockholdersBasic	-136698000	USD
	dva	Income Loss From Continuing Operations Attributableto Parent Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAttributabletoParentAvailableToCommonStockholdersBasic	309166000	USD
CY2017Q3	dva	Income Loss From Continuing Operations Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAvailableToCommonStockholdersBasic	152870000	USD
	dva	Income Loss From Continuing Operations Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAvailableToCommonStockholdersBasic	745067000	USD
CY2018Q3	dva	Income Loss From Continuing Operations Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAvailableToCommonStockholdersBasic	73469000	USD
	dva	Income Loss From Continuing Operations Available To Common Stockholders Basic IncomeLossFromContinuingOperationsAvailableToCommonStockholdersBasic	463989000	USD
	dva	Increase Decrease In Other Current Receivables And Other Current Assets IncreaseDecreaseInOtherCurrentReceivablesAndOtherCurrentAssets	43556000	USD
	dva	Increase Decrease In Other Current Receivables And Other Current Assets IncreaseDecreaseInOtherCurrentReceivablesAndOtherCurrentAssets	757000	USD
CY2017Q4	dva	Investments And Other Current Assets InvestmentsAndOtherCurrentAssets	749046000	USD
CY2018Q3	dva	Investments And Other Current Assets InvestmentsAndOtherCurrentAssets	594474000	USD
CY2017Q4	dva	Long Term Debt And Other Noncurrent LongTermDebtAndOtherNoncurrent	10009590000	USD
CY2018Q3	dva	Long Term Debt And Other Noncurrent LongTermDebtAndOtherNoncurrent	9409011000	USD
CY2018Q3	dva	Longterm Incentive Program Awards Compensation Cost Not Yet Recognized Net LongtermIncentiveProgramAwardsCompensationCostNotYetRecognizedNet	122887000	USD
	dva	Longterm Incentive Program Awards Compensation Cost Not Yet Recognized Period For Recognition LongtermIncentiveProgramAwardsCompensationCostNotYetRecognizedPeriodForRecognition	P10M24D
	dva	Longterm Incentive Program Compensation Cost LongtermIncentiveProgramCompensationCost	46972000	USD
	dva	Longterm Incentive Program Compensation Cost LongtermIncentiveProgramCompensationCost	74077000	USD
CY2017Q3	dva	Patient Care Costs PatientCareCosts	1951609000	USD
	dva	Patient Care Costs PatientCareCosts	5698318000	USD
CY2018Q3	dva	Patient Care Costs PatientCareCosts	2063770000	USD
	dva	Patient Care Costs PatientCareCosts	6168444000	USD
	dva	Payments For Other Financing Activities PaymentsForOtherFinancingActivities	-421369000	USD
	dva	Payments For Other Financing Activities PaymentsForOtherFinancingActivities	-1269175000	USD
	dva	Payments For Proceeds From Sale Of Investments In Securities And Other PaymentsForProceedsFromSaleOfInvestmentsInSecuritiesAndOther	-168289000	USD
	dva	Payments For Proceeds From Sale Of Investments In Securities And Other PaymentsForProceedsFromSaleOfInvestmentsInSecuritiesAndOther	-22598000	USD
	dva	Proceeds From Repayments Of Long Term Debt ProceedsFromRepaymentsOfLongTermDebt	-108463000	USD
	dva	Proceeds From Repayments Of Long Term Debt ProceedsFromRepaymentsOfLongTermDebt	845836000	USD
CY2017Q3	dva	Segment Reporting Information Corporate Expenses SegmentReportingInformationCorporateExpenses	10965000	USD
	dva	Segment Reporting Information Corporate Expenses SegmentReportingInformationCorporateExpenses	32587000	USD
CY2018Q3	dva	Segment Reporting Information Corporate Expenses SegmentReportingInformationCorporateExpenses	40836000	USD
	dva	Segment Reporting Information Corporate Expenses SegmentReportingInformationCorporateExpenses	70605000	USD
CY2018Q3	dva	Stock Repurchase Program Additional Authorized Amount StockRepurchaseProgramAdditionalAuthorizedAmount	1389999000	USD
CY2017Q4	us-gaap	Accounts Payable Current AccountsPayableCurrent	509116000	USD
CY2018Q3	us-gaap	Accounts Payable Current AccountsPayableCurrent	458927000	USD
CY2017Q4	us-gaap	Accounts Receivable Net Current AccountsReceivableNetCurrent	1714750000	USD
CY2018Q3	us-gaap	Accounts Receivable Net Current AccountsReceivableNetCurrent	1847086000	USD
CY2017Q4	us-gaap	Accumulated Other Comprehensive Income Loss Net Of Tax AccumulatedOtherComprehensiveIncomeLossNetOfTax	13235000	USD
CY2018Q3	us-gaap	Accumulated Other Comprehensive Income Loss Net Of Tax AccumulatedOtherComprehensiveIncomeLossNetOfTax	-29109000	USD
CY2017Q4	us-gaap	Additional Paid In Capital Common Stock AdditionalPaidInCapitalCommonStock	1042899000	USD
CY2018Q3	us-gaap	Additional Paid In Capital Common Stock AdditionalPaidInCapitalCommonStock	1055839000	USD
	us-gaap	Adjustments To Reconcile Net Income Loss To Cash Provided By Used In Operating Activities AdjustmentsToReconcileNetIncomeLossToCashProvidedByUsedInOperatingActivities	1078274000	USD
	us-gaap	Adjustments To Reconcile Net Income Loss To Cash Provided By Used In Operating Activities AdjustmentsToReconcileNetIncomeLossToCashProvidedByUsedInOperatingActivities	947365000	USD
CY2017Q4	us-gaap	Allowance For Doubtful Accounts Receivable AllowanceForDoubtfulAccountsReceivable	218399000	USD
CY2018Q3	us-gaap	Allowance For Doubtful Accounts Receivable AllowanceForDoubtfulAccountsReceivable	71108000	USD
CY2017Q3	us-gaap	Antidilutive Securities Excluded From Computation Of Earnings Per Share Amount AntidilutiveSecuritiesExcludedFromComputationOfEarningsPerShareAmount	5201000	shares
	us-gaap	Antidilutive Securities Excluded From Computation Of Earnings Per Share Amount AntidilutiveSecuritiesExcludedFromComputationOfEarningsPerShareAmount	5239000	shares
CY2018Q3	us-gaap	Antidilutive Securities Excluded From Computation Of Earnings Per Share Amount AntidilutiveSecuritiesExcludedFromComputationOfEarningsPerShareAmount	5281000	shares
	us-gaap	Antidilutive Securities Excluded From Computation Of Earnings Per Share Amount AntidilutiveSecuritiesExcludedFromComputationOfEarningsPerShareAmount	4987000	shares
CY2017Q4	us-gaap	Assets Assets	18948193000	USD
CY2018Q3	us-gaap	Assets Assets	19357789000	USD
CY2017Q4	us-gaap	Assets Current AssetsCurrent	8744358000	USD
CY2018Q3	us-gaap	Assets Current AssetsCurrent	8929501000	USD
CY2018Q3	us-gaap	Assets Held In Trust Current AssetsHeldInTrustCurrent	78951000	USD
CY2017Q4	us-gaap	Assets Of Disposal Group Including Discontinued Operation Current AssetsOfDisposalGroupIncludingDiscontinuedOperationCurrent	5761642000	USD
CY2018Q3	us-gaap	Assets Of Disposal Group Including Discontinued Operation Current AssetsOfDisposalGroupIncludingDiscontinuedOperationCurrent	5947786000	USD
CY2017Q4	us-gaap	Available For Sale Securities AvailableForSaleSecurities	38895000	USD
CY2017Q4	us-gaap	Available For Sale Securities Current AvailableForSaleSecuritiesCurrent	1200000	USD
CY2017Q4	us-gaap	Available For Sale Securities Noncurrent AvailableForSaleSecuritiesNoncurrent	37695000	USD
	us-gaap	Business Combination Contingent Consideration Arrangements Change In Amount Of Contingent Consideration Liability1 BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1	-1246000	USD
CY2017Q4	us-gaap	Business Combination Contingent Consideration Liability BusinessCombinationContingentConsiderationLiability	6388000	USD
CY2018Q3	us-gaap	Business Combination Contingent Consideration Liability BusinessCombinationContingentConsiderationLiability	7233000	USD
CY2017Q4	us-gaap	Capital Lease Obligations CapitalLeaseObligations	297170000	USD
CY2018Q3	us-gaap	Capital Lease Obligations CapitalLeaseObligations	289333000	USD
CY2017Q4	us-gaap	Cash And Cash Equivalents At Carrying Value CashAndCashEquivalentsAtCarryingValue	508234000	USD
CY2018Q3	us-gaap	Cash And Cash Equivalents At Carrying Value CashAndCashEquivalentsAtCarryingValue	448215000	USD
CY2016Q4	us-gaap	Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalents	683463000	USD
CY2017Q3	us-gaap	Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalents	538987000	USD
CY2017Q4	us-gaap	Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalents	518920000	USD
CY2018Q3	us-gaap	Common Stock Shares Issued CommonStockSharesIssued	182828547	shares
CY2018Q3	us-gaap	Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalents	540155000	USD
	us-gaap	Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents Period Increase Decrease Including Exchange Rate Effect CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalentsPeriodIncreaseDecreaseIncludingExchangeRateEffect	-61782000	USD
	us-gaap	Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents Period Increase Decrease Including Exchange Rate Effect CashCashEquivalentsRestrictedCashAndRestrictedCashEquivalentsPeriodIncreaseDecreaseIncludingExchangeRateEffect	291800000	USD
CY2017Q3	us-gaap	Cash Provided By Used In Investing Activities Discontinued Operations CashProvidedByUsedInInvestingActivitiesDiscontinuedOperations	-187606000	USD
CY2018Q3	us-gaap	Cash Provided By Used In Investing Activities Discontinued Operations CashProvidedByUsedInInvestingActivitiesDiscontinuedOperations	-32860000	USD
CY2017Q3	us-gaap	Cash Provided By Used In Operating Activities Discontinued Operations CashProvidedByUsedInOperatingActivitiesDiscontinuedOperations	298974000	USD
CY2018Q3	us-gaap	Cash Provided By Used In Operating Activities Discontinued Operations CashProvidedByUsedInOperatingActivitiesDiscontinuedOperations	208570000	USD
CY2017Q4	us-gaap	Common Stock Par Or Stated Value Per Share CommonStockParOrStatedValuePerShare	0.001
CY2018Q3	us-gaap	Common Stock Par Or Stated Value Per Share CommonStockParOrStatedValuePerShare	0.001
CY2017Q4	us-gaap	Common Stock Shares Authorized CommonStockSharesAuthorized	450000000	shares
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CY2017Q4	us-gaap	Common Stock Shares Issued CommonStockSharesIssued	182462278	shares
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CY2018Q3	us-gaap	Common Stock Shares Outstanding CommonStockSharesOutstanding	165984480	shares
CY2017Q4	us-gaap	Common Stock Value CommonStockValue	182000	USD
CY2018Q3	us-gaap	Common Stock Value CommonStockValue	183000	USD
CY2017Q3	us-gaap	Comprehensive Income Net Of Tax ComprehensiveIncomeNetOfTax	-183692000	USD
	us-gaap	Comprehensive Income Net Of Tax ComprehensiveIncomeNetOfTax	453341000	USD
CY2018Q3	us-gaap	Comprehensive Income Net Of Tax ComprehensiveIncomeNetOfTax	-143980000	USD
	us-gaap	Comprehensive Income Net Of Tax ComprehensiveIncomeNetOfTax	275190000	USD
CY2017Q3	us-gaap	Comprehensive Income Net Of Tax Attributable To Noncontrolling Interest ComprehensiveIncomeNetOfTaxAttributableToNoncontrollingInterest	42442000	USD
	us-gaap	Comprehensive Income Net Of Tax Attributable To Noncontrolling Interest ComprehensiveIncomeNetOfTaxAttributableToNoncontrollingInterest	129652000	USD
CY2018Q3	us-gaap	Comprehensive Income Net Of Tax Attributable To Noncontrolling Interest ComprehensiveIncomeNetOfTaxAttributableToNoncontrollingInterest	40128000	USD
	us-gaap	Comprehensive Income Net Of Tax Attributable To Noncontrolling Interest ComprehensiveIncomeNetOfTaxAttributableToNoncontrollingInterest	125717000	USD
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	us-gaap	Comprehensive Income Net Of Tax Including Portion Attributable To Noncontrolling Interest ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	582993000	USD
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	us-gaap	Comprehensive Income Net Of Tax Including Portion Attributable To Noncontrolling Interest ComprehensiveIncomeNetOfTaxIncludingPortionAttributableToNoncontrollingInterest	400907000	USD
CY2017Q3	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Change Due To Net Income Attributable To Parent And Effects Of Changes Net ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangeDueToNetIncomeAttributableToParentAndEffectsOfChangesNet	-214476000	USD
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	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Change Due To Net Income Attributable To Parent And Effects Of Changes Net ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangeDueToNetIncomeAttributableToParentAndEffectsOfChangesNet	291763000	USD
CY2017Q3	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Net ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesNet	0	USD
	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Net ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesNet	195000	USD
CY2018Q3	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Net ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesNet	-5285000	USD
	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Net ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesNet	-17403000	USD
CY2018Q3	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Purchase Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesPurchaseOfInterestByParent	5285000	USD
	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Purchase Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesPurchaseOfInterestByParent	17482000	USD
CY2017Q3	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Sale Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesSaleOfInterestByParent	0	USD
	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Sale Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesSaleOfInterestByParent	0	USD
CY2018Q3	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Sale Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesSaleOfInterestByParent	0	USD
	us-gaap	Consolidation Less Than Wholly Owned Subsidiary Parent Ownership Interest Changes Sale Of Interest By Parent ConsolidationLessThanWhollyOwnedSubsidiaryParentOwnershipInterestChangesSaleOfInterestByParent	79000	USD
CY2018Q3	us-gaap	Cost Method Investments Aggregate Carrying Amount Not Evaluated For Impairment CostMethodInvestmentsAggregateCarryingAmountNotEvaluatedForImpairment	12386000	USD
CY2017Q3	us-gaap	Costs And Expenses CostsAndExpenses	2369777000	USD
	us-gaap	Costs And Expenses CostsAndExpenses	7445811000	USD
	us-gaap	Costs And Expenses CostsAndExpenses	6433303000	USD
CY2018Q3	us-gaap	Costs And Expenses CostsAndExpenses	2558292000	USD
	us-gaap	Depreciation Amortization And Accretion Net DepreciationAmortizationAndAccretionNet	593527000	USD
CY2017Q4	us-gaap	Debt Instrument Carrying Amount DebtInstrumentCarryingAmount	9400182000	USD
CY2018Q3	us-gaap	Debt Instrument Carrying Amount DebtInstrumentCarryingAmount	10278362000	USD
CY2018Q3	us-gaap	Debt Instrument Interest Rate During Period DebtInstrumentInterestRateDuringPeriod	0.0493
	us-gaap	Debt Instrument Interest Rate During Period DebtInstrumentInterestRateDuringPeriod	0.0492
	us-gaap	Deferred Income Tax Expense Benefit DeferredIncomeTaxExpenseBenefit	-132781000	USD
	us-gaap	Deferred Income Tax Expense Benefit DeferredIncomeTaxExpenseBenefit	200056000	USD
CY2017Q4	us-gaap	Deferred Tax Liabilities Noncurrent DeferredTaxLiabilitiesNoncurrent	486247000	USD
CY2018Q3	us-gaap	Deferred Tax Liabilities Noncurrent DeferredTaxLiabilitiesNoncurrent	515893000	USD
	us-gaap	Depreciation Amortization And Accretion Net DepreciationAmortizationAndAccretionNet	435878000	USD
CY2017Q3	us-gaap	Depreciation And Amortization DepreciationAndAmortization	142634000	USD
	us-gaap	Depreciation And Amortization DepreciationAndAmortization	415544000	USD
CY2018Q3	us-gaap	Depreciation And Amortization DepreciationAndAmortization	146000000	USD
	us-gaap	Depreciation And Amortization DepreciationAndAmortization	435878000	USD
CY2017Q3	us-gaap	Discontinued Operation Income Loss From Discontinued Operation Net Of Tax Per Diluted Share DiscontinuedOperationIncomeLossFromDiscontinuedOperationNetOfTaxPerDilutedShare	-1.92
	us-gaap	Discontinued Operation Income Loss From Discontinued Operation Net Of Tax Per Diluted Share DiscontinuedOperationIncomeLossFromDiscontinuedOperationNetOfTaxPerDilutedShare	-1.99
CY2018Q3	us-gaap	Discontinued Operation Income Loss From Discontinued Operation Net Of Tax Per Diluted Share DiscontinuedOperationIncomeLossFromDiscontinuedOperationNetOfTaxPerDilutedShare	-1.26
	us-gaap	Discontinued Operation Income Loss From Discontinued Operation Net Of Tax Per Diluted Share DiscontinuedOperationIncomeLossFromDiscontinuedOperationNetOfTaxPerDilutedShare	-0.89
CY2017Q4	us-gaap	Due From Related Parties Noncurrent DueFromRelatedPartiesNoncurrent	0	USD
CY2018Q3	us-gaap	Due From Related Parties Noncurrent DueFromRelatedPartiesNoncurrent	0	USD
CY2017Q4	us-gaap	Due To Related Parties Noncurrent DueToRelatedPartiesNoncurrent	0	USD
CY2018Q3	us-gaap	Due To Related Parties Noncurrent DueToRelatedPartiesNoncurrent	0	USD
CY2017Q3	us-gaap	Earnings Per Share Basic EarningsPerShareBasic	-1.14
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CY2018Q3	us-gaap	Earnings Per Share Basic EarningsPerShareBasic	-0.82
	us-gaap	Earnings Per Share Basic EarningsPerShareBasic	1.79
CY2017Q3	us-gaap	Earnings Per Share Diluted EarningsPerShareDiluted	-1.12
	us-gaap	Earnings Per Share Diluted EarningsPerShareDiluted	1.86
CY2018Q3	us-gaap	Earnings Per Share Diluted EarningsPerShareDiluted	-0.82
	us-gaap	Earnings Per Share Diluted EarningsPerShareDiluted	1.77
	us-gaap	Effect Of Exchange Rate On Cash Cash Equivalents Restricted Cash And Restricted Cash Equivalents Including Disposal Group And Discontinued Operations EffectOfExchangeRateOnCashCashEquivalentsRestrictedCashAndRestrictedCashEquivalentsIncludingDisposalGroupAndDiscontinuedOperations	5449000	USD
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CY2017Q3	us-gaap	Effective Income Tax Rate Reconciliation At Federal Statutory Income Tax Rate EffectiveIncomeTaxRateReconciliationAtFederalStatutoryIncomeTaxRate	0.313
CY2018Q2	us-gaap	Effective Income Tax Rate Reconciliation At Federal Statutory Income Tax Rate EffectiveIncomeTaxRateReconciliationAtFederalStatutoryIncomeTaxRate	0.262
CY2018Q3	us-gaap	Effective Income Tax Rate Reconciliation At Federal Statutory Income Tax Rate EffectiveIncomeTaxRateReconciliationAtFederalStatutoryIncomeTaxRate	0.311
CY2017Q4	us-gaap	Employee Related Liabilities Current EmployeeRelatedLiabilitiesCurrent	616116000	USD
CY2018Q3	us-gaap	Employee Related Liabilities Current EmployeeRelatedLiabilitiesCurrent	631799000	USD
CY2018Q3	us-gaap	Employee Service Share Based Compensation Nonvested Awards Total Compensation Cost Not Yet Recognized EmployeeServiceShareBasedCompensationNonvestedAwardsTotalCompensationCostNotYetRecognized	103923000	USD
	us-gaap	Employee Service Share Based Compensation Nonvested Awards Total Compensation Cost Not Yet Recognized Period For Recognition1 EmployeeServiceShareBasedCompensationNonvestedAwardsTotalCompensationCostNotYetRecognizedPeriodForRecognition1	P1Y6M0D
	us-gaap	Employee Service Share Based Compensation Tax Benefit From Compensation Expense EmployeeServiceShareBasedCompensationTaxBenefitFromCompensationExpense	6046000	USD
	us-gaap	Employee Service Share Based Compensation Tax Benefit From Compensation Expense EmployeeServiceShareBasedCompensationTaxBenefitFromCompensationExpense	7919000	USD
CY2018Q3	us-gaap	Equity Method Investment Other Than Temporary Impairment EquityMethodInvestmentOtherThanTemporaryImpairment	0	USD
CY2017Q4	us-gaap	Equity Method Investments EquityMethodInvestments	0	USD
CY2018Q3	us-gaap	Equity Method Investments EquityMethodInvestments	0	USD
CY2018Q3	us-gaap	Equity Securities Fv Ni EquitySecuritiesFvNi	37547000	USD
CY2017Q4	us-gaap	Finite Lived Intangible Assets Accumulated Amortization FiniteLivedIntangibleAssetsAccumulatedAmortization	356774000	USD
CY2018Q3	us-gaap	Finite Lived Intangible Assets Accumulated Amortization FiniteLivedIntangibleAssetsAccumulatedAmortization	225862000	USD
CY2017Q3	us-gaap	Gain Loss On Sale Of Business GainLossOnSaleOfBusiness	0	USD
	us-gaap	Gain Loss On Sale Of Business GainLossOnSaleOfBusiness	6273000	USD
CY2018Q3	us-gaap	Gain Loss On Sale Of Business GainLossOnSaleOfBusiness	-1506000	USD
CY2017	us-gaap	Goodwill Written Off Related To Sale Of Business Unit GoodwillWrittenOffRelatedToSaleOfBusinessUnit	32386000	USD
	us-gaap	Goodwill Written Off Related To Sale Of Business Unit GoodwillWrittenOffRelatedToSaleOfBusinessUnit	15497000	USD
CY2018Q3	us-gaap	Goodwill Impairment Loss GoodwillImpairmentLoss	0	USD
	us-gaap	Goodwill Impairment Loss GoodwillImpairmentLoss	3106000	USD
CY2017Q4	us-gaap	Held To Maturity Securities Noncurrent HeldToMaturitySecuritiesNoncurrent	0	USD
CY2018Q3	us-gaap	Held To Maturity Securities Noncurrent HeldToMaturitySecuritiesNoncurrent	0	USD
	us-gaap	Gain Loss On Sale Of Business GainLossOnSaleOfBusiness	32451000	USD
CY2017Q3	us-gaap	Gain Loss Related To Litigation Settlement GainLossRelatedToLitigationSettlement	0	USD
	us-gaap	Gain Loss Related To Litigation Settlement GainLossRelatedToLitigationSettlement	526827000	USD
CY2018Q3	us-gaap	Gain Loss Related To Litigation Settlement GainLossRelatedToLitigationSettlement	0	USD
	us-gaap	Gain Loss Related To Litigation Settlement GainLossRelatedToLitigationSettlement	0	USD
CY2017Q3	us-gaap	General And Administrative Expense GeneralAndAdministrativeExpense	272911000	USD
	us-gaap	General And Administrative Expense GeneralAndAdministrativeExpense	798602000	USD
CY2018Q3	us-gaap	General And Administrative Expense GeneralAndAdministrativeExpense	336299000	USD
	us-gaap	General And Administrative Expense GeneralAndAdministrativeExpense	866922000	USD
CY2016Q4	us-gaap	Goodwill Goodwill	6015375000	USD
CY2017Q4	us-gaap	Goodwill Goodwill	6610279000	USD
CY2018Q3	us-gaap	Goodwill Goodwill	6702659000	USD
CY2017	us-gaap	Goodwill Acquired During Period GoodwillAcquiredDuringPeriod	617032000	USD
	us-gaap	Goodwill Acquired During Period GoodwillAcquiredDuringPeriod	135654000	USD
	us-gaap	Goodwill And Intangible Asset Impairment GoodwillAndIntangibleAssetImpairment	701523000	USD
	us-gaap	Goodwill And Intangible Asset Impairment GoodwillAndIntangibleAssetImpairment	20444000	USD
CY2017	us-gaap	Goodwill Foreign Currency Translation Gain Loss GoodwillForeignCurrencyTranslationGainLoss	46454000	USD
	us-gaap	Goodwill Foreign Currency Translation Gain Loss GoodwillForeignCurrencyTranslationGainLoss	-24671000	USD
CY2018Q3	us-gaap	Goodwill Gross GoodwillGross	6730260000	USD
CY2018Q3	us-gaap	Goodwill Impaired Accumulated Impairment Loss GoodwillImpairedAccumulatedImpairmentLoss	27601000	USD
CY2017Q3	us-gaap	Goodwill Impairment Loss GoodwillImpairmentLoss	0	USD
	us-gaap	Goodwill Impairment Loss GoodwillImpairmentLoss	34696000	USD
CY2017	us-gaap	Goodwill Impairment Loss GoodwillImpairmentLoss	36196000	USD
CY2017Q3	us-gaap	Health Care Organization Patient Service Revenue Less Provision For Bad Debts HealthCareOrganizationPatientServiceRevenueLessProvisionForBadDebts	2442222000	USD
	us-gaap	Health Care Organization Patient Service Revenue Less Provision For Bad Debts HealthCareOrganizationPatientServiceRevenueLessProvisionForBadDebts	7142959000	USD
CY2018Q3	us-gaap	Health Care Organization Patient Service Revenue Less Provision For Bad Debts HealthCareOrganizationPatientServiceRevenueLessProvisionForBadDebts	2658724000	USD
	us-gaap	Health Care Organization Patient Service Revenue Less Provision For Bad Debts HealthCareOrganizationPatientServiceRevenueLessProvisionForBadDebts	7944340000	USD
CY2017Q3	us-gaap	Health Care Organization Patient Service Revenue Provisionfor Bad Debts HealthCareOrganizationPatientServiceRevenueProvisionforBadDebts	119321000	USD
	us-gaap	Health Care Organization Patient Service Revenue Provisionfor Bad Debts HealthCareOrganizationPatientServiceRevenueProvisionforBadDebts	335979000	USD
CY2018Q3	us-gaap	Health Care Organization Patient Service Revenue Provisionfor Bad Debts HealthCareOrganizationPatientServiceRevenueProvisionforBadDebts	11977000	USD
	us-gaap	Health Care Organization Patient Service Revenue Provisionfor Bad Debts HealthCareOrganizationPatientServiceRevenueProvisionforBadDebts	35838000	USD
CY2017Q4	us-gaap	Held To Maturity Securities HeldToMaturitySecurities	31630000	USD
CY2018Q3	us-gaap	Held To Maturity Securities HeldToMaturitySecurities	2230000	USD
CY2017Q4	us-gaap	Held To Maturity Securities Current HeldToMaturitySecuritiesCurrent	31630000	USD
CY2018Q3	us-gaap	Held To Maturity Securities Current HeldToMaturitySecuritiesCurrent	2230000	USD
CY2017Q3	us-gaap	Income Loss From Continuing Operations IncomeLossFromContinuingOperations	152870000	USD
	us-gaap	Income Loss From Continuing Operations IncomeLossFromContinuingOperations	745067000	USD
CY2018Q3	us-gaap	Income Loss From Continuing Operations IncomeLossFromContinuingOperations	73371000	USD
	us-gaap	Income Loss From Continuing Operations IncomeLossFromContinuingOperations	463989000	USD
CY2017Q3	us-gaap	Income Loss From Continuing Operations Before Income Taxes Minority Interest And Income Loss From Equity Method Investments IncomeLossFromContinuingOperationsBeforeIncomeTaxesMinorityInterestAndIncomeLossFromEquityMethodInvestments	289384000	USD
	us-gaap	Income Loss From Continuing Operations Before Income Taxes Minority Interest And Income Loss From Equity Method Investments IncomeLossFromContinuingOperationsBeforeIncomeTaxesMinorityInterestAndIncomeLossFromEquityMethodInvestments	1352961000	USD
CY2018Q3	us-gaap	Income Loss From Continuing Operations Before Income Taxes Minority Interest And Income Loss From Equity Method Investments IncomeLossFromContinuingOperationsBeforeIncomeTaxesMinorityInterestAndIncomeLossFromEquityMethodInvestments	167118000	USD
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CY2017Q3	us-gaap	Income Loss From Continuing Operations Including Portion Attributable To Noncontrolling Interest IncomeLossFromContinuingOperationsIncludingPortionAttributableToNoncontrollingInterest	198838000	USD
	us-gaap	Income Loss From Continuing Operations Including Portion Attributable To Noncontrolling Interest IncomeLossFromContinuingOperationsIncludingPortionAttributableToNoncontrollingInterest	878835000	USD
CY2018Q3	us-gaap	Income Loss From Continuing Operations Including Portion Attributable To Noncontrolling Interest IncomeLossFromContinuingOperationsIncludingPortionAttributableToNoncontrollingInterest	115071000	USD
	us-gaap	Income Loss From Continuing Operations Including Portion Attributable To Noncontrolling Interest IncomeLossFromContinuingOperationsIncludingPortionAttributableToNoncontrollingInterest	582712000	USD
CY2017Q3	us-gaap	Income Loss From Continuing Operations Per Basic Share IncomeLossFromContinuingOperationsPerBasicShare	0.81
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CY2018Q3	us-gaap	Income Loss From Continuing Operations Per Basic Share IncomeLossFromContinuingOperationsPerBasicShare	0.44
	us-gaap	Income Loss From Continuing Operations Per Basic Share IncomeLossFromContinuingOperationsPerBasicShare	2.69
CY2017Q3	us-gaap	Income Loss From Continuing Operations Per Diluted Share IncomeLossFromContinuingOperationsPerDilutedShare	0.80
	us-gaap	Income Loss From Continuing Operations Per Diluted Share IncomeLossFromContinuingOperationsPerDilutedShare	3.85
CY2018Q3	us-gaap	Income Loss From Continuing Operations Per Diluted Share IncomeLossFromContinuingOperationsPerDilutedShare	0.44
	us-gaap	Income Loss From Continuing Operations Per Diluted Share IncomeLossFromContinuingOperationsPerDilutedShare	2.66
CY2017Q3	us-gaap	Income Loss From Discontinued Operations Net Of Tax IncomeLossFromDiscontinuedOperationsNetOfTax	-370872000	USD
	us-gaap	Income Loss From Discontinued Operations Net Of Tax IncomeLossFromDiscontinuedOperationsNetOfTax	-388959000	USD
CY2018Q3	us-gaap	Income Loss From Discontinued Operations Net Of Tax IncomeLossFromDiscontinuedOperationsNetOfTax	-211739000	USD
	us-gaap	Income Loss From Discontinued Operations Net Of Tax IncomeLossFromDiscontinuedOperationsNetOfTax	-147829000	USD
CY2017Q3	us-gaap	Income Loss From Discontinued Operations Net Of Tax Attributable To Reporting Entity IncomeLossFromDiscontinuedOperationsNetOfTaxAttributableToReportingEntity	-367346000	USD
	us-gaap	Income Loss From Discontinued Operations Net Of Tax Attributable To Reporting Entity IncomeLossFromDiscontinuedOperationsNetOfTaxAttributableToReportingEntity	-384845000	USD
CY2018Q3	us-gaap	Income Loss From Discontinued Operations Net Of Tax Attributable To Reporting Entity IncomeLossFromDiscontinuedOperationsNetOfTaxAttributableToReportingEntity	-210167000	USD
	us-gaap	Income Loss From Discontinued Operations Net Of Tax Attributable To Reporting Entity IncomeLossFromDiscontinuedOperationsNetOfTaxAttributableToReportingEntity	-154823000	USD
CY2017Q3	us-gaap	Income Loss From Discontinued Operations Net Of Tax Per Basic Share IncomeLossFromDiscontinuedOperationsNetOfTaxPerBasicShare	1.95
	us-gaap	Income Loss From Discontinued Operations Net Of Tax Per Basic Share IncomeLossFromDiscontinuedOperationsNetOfTaxPerBasicShare	2.02
CY2018Q3	us-gaap	Income Loss From Discontinued Operations Net Of Tax Per Basic Share IncomeLossFromDiscontinuedOperationsNetOfTaxPerBasicShare	1.26
	us-gaap	Income Loss From Discontinued Operations Net Of Tax Per Basic Share IncomeLossFromDiscontinuedOperationsNetOfTaxPerBasicShare	0.90
CY2017Q3	us-gaap	Income Loss From Equity Method Investments IncomeLossFromEquityMethodInvestments	-5308000	USD
	us-gaap	Income Loss From Equity Method Investments IncomeLossFromEquityMethodInvestments	-5456000	USD
CY2018Q3	us-gaap	Income Loss From Equity Method Investments IncomeLossFromEquityMethodInvestments	-3824000	USD
	us-gaap	Income Loss From Equity Method Investments IncomeLossFromEquityMethodInvestments	6126000	USD
CY2017Q3	us-gaap	Income Tax Expense Benefit IncomeTaxExpenseBenefit	90546000	USD
	us-gaap	Income Tax Expense Benefit IncomeTaxExpenseBenefit	474126000	USD
CY2018Q3	us-gaap	Income Tax Expense Benefit IncomeTaxExpenseBenefit	52047000	USD
	us-gaap	Income Tax Expense Benefit IncomeTaxExpenseBenefit	206652000	USD
CY2017Q4	us-gaap	Income Taxes Receivable IncomeTaxesReceivable	49440000	USD
CY2018Q3	us-gaap	Income Taxes Receivable IncomeTaxesReceivable	26002000	USD
	us-gaap	Increase Decrease In Accounts Payable IncreaseDecreaseInAccountsPayable	18595000	USD
	us-gaap	Increase Decrease In Accounts Payable IncreaseDecreaseInAccountsPayable	-12800000	USD
	us-gaap	Increase Decrease In Accounts Receivable IncreaseDecreaseInAccountsReceivable	146024000	USD
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	us-gaap	Increase Decrease In Accrued Income Taxes Payable IncreaseDecreaseInAccruedIncomeTaxesPayable	22669000	USD
	us-gaap	Increase Decrease In Accrued Income Taxes Payable IncreaseDecreaseInAccruedIncomeTaxesPayable	21749000	USD
	us-gaap	Increase Decrease In Employee Related Liabilities IncreaseDecreaseInEmployeeRelatedLiabilities	-60063000	USD
	us-gaap	Increase Decrease In Employee Related Liabilities IncreaseDecreaseInEmployeeRelatedLiabilities	40225000	USD
	us-gaap	Increase Decrease In Inventories IncreaseDecreaseInInventories	-14272000	USD
	us-gaap	Increase Decrease In Inventories IncreaseDecreaseInInventories	-88355000	USD
	us-gaap	Increase Decrease In Other Current Liabilities IncreaseDecreaseInOtherCurrentLiabilities	39445000	USD
	us-gaap	Increase Decrease In Other Current Liabilities IncreaseDecreaseInOtherCurrentLiabilities	45624000	USD
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	us-gaap	Increase Decrease In Other Noncurrent Liabilities IncreaseDecreaseInOtherNoncurrentLiabilities	18648000	USD
	us-gaap	Increase Decrease In Other Noncurrent Liabilities IncreaseDecreaseInOtherNoncurrentLiabilities	5546000	USD
CY2017Q3	us-gaap	Incremental Common Shares Attributable To Share Based Payment Arrangements IncrementalCommonSharesAttributableToShareBasedPaymentArrangements	330000	shares
	us-gaap	Incremental Common Shares Attributable To Share Based Payment Arrangements IncrementalCommonSharesAttributableToShareBasedPaymentArrangements	582000	shares
CY2018Q3	us-gaap	Incremental Common Shares Attributable To Share Based Payment Arrangements IncrementalCommonSharesAttributableToShareBasedPaymentArrangements	443000	shares
	us-gaap	Incremental Common Shares Attributable To Share Based Payment Arrangements IncrementalCommonSharesAttributableToShareBasedPaymentArrangements	473000	shares
CY2017Q4	us-gaap	Intangible Assets Net Excluding Goodwill IntangibleAssetsNetExcludingGoodwill	113827000	USD
CY2018Q3	us-gaap	Intangible Assets Net Excluding Goodwill IntangibleAssetsNetExcludingGoodwill	97609000	USD
CY2017Q3	us-gaap	Interest And Debt Expense InterestAndDebtExpense	109306000	USD
	us-gaap	Interest And Debt Expense InterestAndDebtExpense	321637000	USD
CY2018Q3	us-gaap	Interest And Debt Expense InterestAndDebtExpense	125927000	USD
	us-gaap	Interest And Debt Expense InterestAndDebtExpense	359135000	USD
CY2017Q4	us-gaap	Inventory Net InventoryNet	181799000	USD
CY2018Q3	us-gaap	Inventory Net InventoryNet	91102000	USD
CY2017Q4	us-gaap	Investments And Other Noncurrent Assets InvestmentsAndOtherNoncurrentAssets	330516000	USD
CY2018Q3	us-gaap	Investments And Other Noncurrent Assets InvestmentsAndOtherNoncurrentAssets	352384000	USD
CY2017Q4	us-gaap	Investments In Affiliates Subsidiaries Associates And Joint Ventures InvestmentsInAffiliatesSubsidiariesAssociatesAndJointVentures	245534000	USD
CY2018Q3	us-gaap	Investments In Affiliates Subsidiaries Associates And Joint Ventures InvestmentsInAffiliatesSubsidiariesAssociatesAndJointVentures	240820000	USD
CY2017Q4	us-gaap	Liabilities Liabilities	13050767000	USD
CY2018Q3	us-gaap	Liabilities Liabilities	14264115000	USD
CY2017Q4	us-gaap	Liabilities And Stockholders Equity LiabilitiesAndStockholdersEquity	18948193000	USD
CY2018Q3	us-gaap	Liabilities And Stockholders Equity LiabilitiesAndStockholdersEquity	19357789000	USD
CY2017Q4	us-gaap	Liabilities Current LiabilitiesCurrent	3041177000	USD
CY2018Q3	us-gaap	Liabilities Current LiabilitiesCurrent	4855104000	USD
CY2017Q4	us-gaap	Liabilities Of Disposal Group Including Discontinued Operation Current LiabilitiesOfDisposalGroupIncludingDiscontinuedOperationCurrent	1185070000	USD
CY2018Q3	us-gaap	Liabilities Of Disposal Group Including Discontinued Operation Current LiabilitiesOfDisposalGroupIncludingDiscontinuedOperationCurrent	1419621000	USD
CY2017Q4	us-gaap	Long Term Debt And Capital Lease Obligations LongTermDebtAndCapitalLeaseObligations	9158018000	USD
CY2018Q3	us-gaap	Long Term Debt And Capital Lease Obligations LongTermDebtAndCapitalLeaseObligations	8440673000	USD
CY2017Q4	us-gaap	Long Term Debt And Capital Lease Obligations Current LongTermDebtAndCapitalLeaseObligationsCurrent	178213000	USD
CY2018Q3	us-gaap	Long Term Debt And Capital Lease Obligations Current LongTermDebtAndCapitalLeaseObligationsCurrent	1784065000	USD
CY2017Q4	us-gaap	Long Term Debt And Capital Lease Obligations Including Current Maturities LongTermDebtAndCapitalLeaseObligationsIncludingCurrentMaturities	9336231000	USD
CY2018Q3	us-gaap	Long Term Debt And Capital Lease Obligations Including Current Maturities LongTermDebtAndCapitalLeaseObligationsIncludingCurrentMaturities	10224738000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal After Year Five LongTermDebtMaturitiesRepaymentsOfPrincipalAfterYearFive	3487390000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal In Next Twelve Months LongTermDebtMaturitiesRepaymentsOfPrincipalInNextTwelveMonths	2028808000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal In Year Five LongTermDebtMaturitiesRepaymentsOfPrincipalInYearFive	36437000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal In Year Four LongTermDebtMaturitiesRepaymentsOfPrincipalInYearFour	1289539000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal In Year Three LongTermDebtMaturitiesRepaymentsOfPrincipalInYearThree	3311502000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal In Year Two LongTermDebtMaturitiesRepaymentsOfPrincipalInYearTwo	74985000	USD
CY2017Q3	us-gaap	Net Income Loss NetIncomeLoss	-214476000	USD
CY2017Q3	us-gaap	Operating Income Loss OperatingIncomeLoss	395294000	USD
	us-gaap	Operating Income Loss OperatingIncomeLoss	1662418000	USD
CY2018Q3	us-gaap	Long Term Debt Maturities Repayments Of Principal Remainder Of Fiscal Year LongTermDebtMaturitiesRepaymentsOfPrincipalRemainderOfFiscalYear	49701000	USD
CY2018Q3	us-gaap	Long Term Debt Percentage Bearing Fixed Interest Rate LongTermDebtPercentageBearingFixedInterestRate	0.4743
CY2017Q4	us-gaap	Long Term Investments LongTermInvestments	37695000	USD
CY2018Q3	us-gaap	Long Term Investments LongTermInvestments	35047000	USD
CY2018Q3	us-gaap	Longterm Debt Weighted Average Interest Rate LongtermDebtWeightedAverageInterestRate	0.0503
CY2017Q4	us-gaap	Marketable Securities MarketableSecurities	70525000	USD
CY2018Q3	us-gaap	Marketable Securities MarketableSecurities	39777000	USD
CY2017Q4	us-gaap	Marketable Securities Current MarketableSecuritiesCurrent	32830000	USD
CY2018Q3	us-gaap	Marketable Securities Current MarketableSecuritiesCurrent	4730000	USD
CY2017Q4	us-gaap	Marketable Securities Noncurrent MarketableSecuritiesNoncurrent	37695000	USD
CY2018Q3	us-gaap	Marketable Securities Noncurrent MarketableSecuritiesNoncurrent	35047000	USD
CY2017Q4	us-gaap	Minority Interest MinorityInterest	196037000	USD
CY2018Q3	us-gaap	Minority Interest MinorityInterest	204613000	USD
CY2017Q3	us-gaap	Minority Interest Change In Redemption Value MinorityInterestChangeInRedemptionValue	0	USD
	us-gaap	Minority Interest Change In Redemption Value MinorityInterestChangeInRedemptionValue	0	USD
CY2018Q3	us-gaap	Minority Interest Change In Redemption Value MinorityInterestChangeInRedemptionValue	98000	USD
	us-gaap	Minority Interest Change In Redemption Value MinorityInterestChangeInRedemptionValue	0	USD
	us-gaap	Net Cash Provided By Used In Financing Activities NetCashProvidedByUsedInFinancingActivities	-529832000	USD
	us-gaap	Net Cash Provided By Used In Financing Activities NetCashProvidedByUsedInFinancingActivities	-423339000	USD
	us-gaap	Net Cash Provided By Used In Financing Activities Continuing Operations NetCashProvidedByUsedInFinancingActivitiesContinuingOperations	-529832000	USD
	us-gaap	Net Cash Provided By Used In Financing Activities Continuing Operations NetCashProvidedByUsedInFinancingActivitiesContinuingOperations	-423339000	USD
	us-gaap	Net Cash Provided By Used In Investing Activities NetCashProvidedByUsedInInvestingActivities	-1105549000	USD
	us-gaap	Net Cash Provided By Used In Investing Activities NetCashProvidedByUsedInInvestingActivities	-661319000	USD
	us-gaap	Net Cash Provided By Used In Investing Activities Continuing Operations NetCashProvidedByUsedInInvestingActivitiesContinuingOperations	-1105549000	USD
	us-gaap	Net Cash Provided By Used In Investing Activities Continuing Operations NetCashProvidedByUsedInInvestingActivitiesContinuingOperations	-661319000	USD
	us-gaap	Net Cash Provided By Used In Operating Activities NetCashProvidedByUsedInOperatingActivities	1568150000	USD
	us-gaap	Net Cash Provided By Used In Operating Activities NetCashProvidedByUsedInOperatingActivities	1382248000	USD
	us-gaap	Net Cash Provided By Used In Operating Activities Continuing Operations NetCashProvidedByUsedInOperatingActivitiesContinuingOperations	1568150000	USD
	us-gaap	Net Cash Provided By Used In Operating Activities Continuing Operations NetCashProvidedByUsedInOperatingActivitiesContinuingOperations	1382248000	USD
	us-gaap	Net Income Loss NetIncomeLoss	360222000	USD
CY2018Q3	us-gaap	Net Income Loss NetIncomeLoss	-136796000	USD
	us-gaap	Net Income Loss NetIncomeLoss	309166000	USD
CY2017Q3	us-gaap	Net Income Loss Attributable To Noncontrolling Interest NetIncomeLossAttributableToNoncontrollingInterest	42442000	USD
	us-gaap	Net Income Loss Attributable To Noncontrolling Interest NetIncomeLossAttributableToNoncontrollingInterest	129654000	USD
CY2018Q3	us-gaap	Net Income Loss Attributable To Noncontrolling Interest NetIncomeLossAttributableToNoncontrollingInterest	40128000	USD
	us-gaap	Net Income Loss Attributable To Noncontrolling Interest NetIncomeLossAttributableToNoncontrollingInterest	125717000	USD
CY2017Q3	us-gaap	Net Income Loss Including Portion Attributable To Nonredeemable Noncontrolling Interest NetIncomeLossIncludingPortionAttributableToNonredeemableNoncontrollingInterest	-214476000	USD
	us-gaap	Net Income Loss Including Portion Attributable To Nonredeemable Noncontrolling Interest NetIncomeLossIncludingPortionAttributableToNonredeemableNoncontrollingInterest	360222000	USD
CY2018Q3	us-gaap	Net Income Loss Including Portion Attributable To Nonredeemable Noncontrolling Interest NetIncomeLossIncludingPortionAttributableToNonredeemableNoncontrollingInterest	-136796000	USD
	us-gaap	Net Income Loss Including Portion Attributable To Nonredeemable Noncontrolling Interest NetIncomeLossIncludingPortionAttributableToNonredeemableNoncontrollingInterest	309166000	USD
	us-gaap	Number Of Operating Segments NumberOfOperatingSegments	2	Segment
CY2018Q3	us-gaap	Operating Income Loss OperatingIncomeLoss	289038000	USD
	us-gaap	Operating Income Loss OperatingIncomeLoss	1137916000	USD
CY2017Q3	us-gaap	Other Asset Impairment Charges OtherAssetImpairmentCharges	0	USD
	us-gaap	Other Asset Impairment Charges OtherAssetImpairmentCharges	15168000	USD
CY2018Q3	us-gaap	Other Asset Impairment Charges OtherAssetImpairmentCharges	6093000	USD
	us-gaap	Other Asset Impairment Charges OtherAssetImpairmentCharges	17338000	USD
CY2017Q4	us-gaap	Other Assets Noncurrent OtherAssetsNoncurrent	47287000	USD
CY2018Q3	us-gaap	Other Assets Noncurrent OtherAssetsNoncurrent	76517000	USD
CY2017Q3	us-gaap	Other Comprehensive Income Foreign Currency Transaction And Translation Gain Loss Arising During Period Net Of Tax OtherComprehensiveIncomeForeignCurrencyTransactionAndTranslationGainLossArisingDuringPeriodNetOfTax	29143000	USD
	us-gaap	Other Comprehensive Income Foreign Currency Transaction And Translation Gain Loss Arising During Period Net Of Tax OtherComprehensiveIncomeForeignCurrencyTransactionAndTranslationGainLossArisingDuringPeriodNetOfTax	91546000	USD
CY2018Q3	us-gaap	Other Comprehensive Income Foreign Currency Transaction And Translation Gain Loss Arising During Period Net Of Tax OtherComprehensiveIncomeForeignCurrencyTransactionAndTranslationGainLossArisingDuringPeriodNetOfTax	-8827000	USD
	us-gaap	Other Comprehensive Income Foreign Currency Transaction And Translation Gain Loss Arising During Period Net Of Tax OtherComprehensiveIncomeForeignCurrencyTransactionAndTranslationGainLossArisingDuringPeriodNetOfTax	-39475000	USD
CY2017Q3	us-gaap	Other Comprehensive Income Loss Net Of Tax OtherComprehensiveIncomeLossNetOfTax	30784000	USD
	us-gaap	Other Comprehensive Income Loss Net Of Tax OtherComprehensiveIncomeLossNetOfTax	93117000	USD
CY2018Q3	us-gaap	Other Comprehensive Income Loss Net Of Tax OtherComprehensiveIncomeLossNetOfTax	-7184000	USD
	us-gaap	Other Comprehensive Income Loss Net Of Tax OtherComprehensiveIncomeLossNetOfTax	-33976000	USD
CY2017Q3	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci For Sale Of Securities Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIForSaleOfSecuritiesNetOfTax	9000	USD
	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci For Sale Of Securities Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIForSaleOfSecuritiesNetOfTax	221000	USD
CY2018Q3	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci For Sale Of Securities Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIForSaleOfSecuritiesNetOfTax	0	USD
	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci For Sale Of Securities Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIForSaleOfSecuritiesNetOfTax	0	USD
CY2017Q3	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci On Derivatives Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIOnDerivativesNetOfTax	-1265000	USD
	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci On Derivatives Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIOnDerivativesNetOfTax	-3793000	USD
CY2018Q3	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci On Derivatives Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIOnDerivativesNetOfTax	-1606000	USD
	us-gaap	Other Comprehensive Income Loss Reclassification Adjustment From Aoci On Derivatives Net Of Tax OtherComprehensiveIncomeLossReclassificationAdjustmentFromAOCIOnDerivativesNetOfTax	-4680000	USD
CY2017Q3	us-gaap	Other Comprehensive Income Unrealized Gain Loss On Derivatives Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedGainLossOnDerivativesArisingDuringPeriodNetOfTax	-478000	USD
	us-gaap	Other Comprehensive Income Unrealized Gain Loss On Derivatives Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedGainLossOnDerivativesArisingDuringPeriodNetOfTax	-5479000	USD
CY2018Q3	us-gaap	Other Comprehensive Income Unrealized Gain Loss On Derivatives Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedGainLossOnDerivativesArisingDuringPeriodNetOfTax	37000	USD
	us-gaap	Other Comprehensive Income Unrealized Gain Loss On Derivatives Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedGainLossOnDerivativesArisingDuringPeriodNetOfTax	819000	USD
CY2017Q3	us-gaap	Other Comprehensive Income Unrealized Holding Gain Loss On Securities Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedHoldingGainLossOnSecuritiesArisingDuringPeriodNetOfTax	863000	USD
	us-gaap	Other Comprehensive Income Unrealized Holding Gain Loss On Securities Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedHoldingGainLossOnSecuritiesArisingDuringPeriodNetOfTax	3478000	USD
CY2018Q3	us-gaap	Other Comprehensive Income Unrealized Holding Gain Loss On Securities Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedHoldingGainLossOnSecuritiesArisingDuringPeriodNetOfTax	0	USD
	us-gaap	Other Comprehensive Income Unrealized Holding Gain Loss On Securities Arising During Period Net Of Tax OtherComprehensiveIncomeUnrealizedHoldingGainLossOnSecuritiesArisingDuringPeriodNetOfTax	0	USD
CY2017Q3	us-gaap	Other Income OtherIncome	322849000	USD
	us-gaap	Other Income OtherIncome	952762000	USD
CY2018Q3	us-gaap	Other Income OtherIncome	188606000	USD
	us-gaap	Other Income OtherIncome	639387000	USD
CY2017Q4	us-gaap	Other Liabilities Current OtherLiabilitiesCurrent	552662000	USD
CY2018Q3	us-gaap	Other Liabilities Current OtherLiabilitiesCurrent	560692000	USD
CY2017Q4	us-gaap	Other Liabilities Noncurrent OtherLiabilitiesNoncurrent	365325000	USD
CY2018Q3	us-gaap	Other Liabilities Noncurrent OtherLiabilitiesNoncurrent	452445000	USD
	us-gaap	Other Noncash Income Expense OtherNoncashIncomeExpense	-41703000	USD
	us-gaap	Other Noncash Income Expense OtherNoncashIncomeExpense	-164856000	USD
CY2017Q3	us-gaap	Other Nonoperating Income Expense OtherNonoperatingIncomeExpense	3396000	USD
	us-gaap	Other Nonoperating Income Expense OtherNonoperatingIncomeExpense	12180000	USD
CY2018Q3	us-gaap	Other Nonoperating Income Expense OtherNonoperatingIncomeExpense	4007000	USD
	us-gaap	Other Nonoperating Income Expense OtherNonoperatingIncomeExpense	10583000	USD
CY2017Q4	us-gaap	Other Receivables Net Current OtherReceivablesNetCurrent	372919000	USD
CY2018Q3	us-gaap	Other Receivables Net Current OtherReceivablesNetCurrent	383783000	USD
	us-gaap	Payments For Proceeds From Businesses And Interest In Affiliates PaymentsForProceedsFromBusinessesAndInterestInAffiliates	113526000	USD
	us-gaap	Payments For Repurchase Of Common Stock PaymentsForRepurchaseOfCommonStock	321411000	USD
	us-gaap	Payments For Repurchase Of Common Stock PaymentsForRepurchaseOfCommonStock	1161511000	USD
	us-gaap	Payments Of Distributions To Affiliates PaymentsOfDistributionsToAffiliates	165463000	USD
	us-gaap	Payments Of Distributions To Affiliates PaymentsOfDistributionsToAffiliates	139673000	USD
	us-gaap	Payments To Acquire Available For Sale Securities PaymentsToAcquireAvailableForSaleSecurities	9882000	USD
	us-gaap	Payments To Acquire Available For Sale Securities PaymentsToAcquireAvailableForSaleSecurities	5791000	USD
	us-gaap	Payments To Acquire Businesses Gross PaymentsToAcquireBusinessesGross	726538000	USD
	us-gaap	Payments To Acquire Businesses Gross PaymentsToAcquireBusinessesGross	113526000	USD
	us-gaap	Payments To Acquire Equity Method Investments PaymentsToAcquireEquityMethodInvestments	3014000	USD
	us-gaap	Payments To Acquire Equity Method Investments PaymentsToAcquireEquityMethodInvestments	12874000	USD
	us-gaap	Payments To Acquire Held To Maturity Securities PaymentsToAcquireHeldToMaturitySecurities	223482000	USD
	us-gaap	Payments To Acquire Held To Maturity Securities PaymentsToAcquireHeldToMaturitySecurities	3728000	USD
CY2017Q3	us-gaap	Payments To Acquire Property Plant And Equipment PaymentsToAcquirePropertyPlantAndEquipment	240889000	USD
	us-gaap	Payments To Acquire Property Plant And Equipment PaymentsToAcquirePropertyPlantAndEquipment	639829000	USD
CY2018Q3	us-gaap	Payments To Acquire Property Plant And Equipment PaymentsToAcquirePropertyPlantAndEquipment	231682000	USD
	us-gaap	Payments To Acquire Property Plant And Equipment PaymentsToAcquirePropertyPlantAndEquipment	705659000	USD
	us-gaap	Payments To Minority Shareholders PaymentsToMinorityShareholders	1432000	USD
	us-gaap	Payments To Minority Shareholders PaymentsToMinorityShareholders	19988000	USD
CY2017Q4	us-gaap	Preferred Stock Par Or Stated Value Per Share PreferredStockParOrStatedValuePerShare	0.001
CY2018Q3	us-gaap	Preferred Stock Par Or Stated Value Per Share PreferredStockParOrStatedValuePerShare	0.001
CY2017Q4	us-gaap	Preferred Stock Shares Authorized PreferredStockSharesAuthorized	5000000	shares
CY2018Q3	us-gaap	Preferred Stock Shares Authorized PreferredStockSharesAuthorized	5000000	shares
CY2017Q4	us-gaap	Preferred Stock Shares Issued PreferredStockSharesIssued	0	shares
CY2018Q3	us-gaap	Preferred Stock Shares Issued PreferredStockSharesIssued	0	shares
CY2017Q4	us-gaap	Preferred Stock Value PreferredStockValue		USD
CY2018Q3	us-gaap	Preferred Stock Value PreferredStockValue		USD
CY2017Q4	us-gaap	Prepaid Expense And Other Assets Current PrepaidExpenseAndOtherAssetsCurrent	112058000	USD
CY2018Q3	us-gaap	Prepaid Expense And Other Assets Current PrepaidExpenseAndOtherAssetsCurrent	88857000	USD
	us-gaap	Proceeds From Contributions From Affiliates ProceedsFromContributionsFromAffiliates	51156000	USD
	us-gaap	Proceeds From Contributions From Affiliates ProceedsFromContributionsFromAffiliates	43179000	USD
	us-gaap	Proceeds From Equity Method Investment Dividends Or Distributions Return Of Capital ProceedsFromEquityMethodInvestmentDividendsOrDistributionsReturnOfCapital	80000	USD
	us-gaap	Proceeds From Equity Method Investment Dividends Or Distributions Return Of Capital ProceedsFromEquityMethodInvestmentDividendsOrDistributionsReturnOfCapital	3580000	USD
	us-gaap	Proceeds From Issuance Of Long Term Debt ProceedsFromIssuanceOfLongTermDebt	38160821000	USD
	us-gaap	Proceeds From Issuance Of Long Term Debt ProceedsFromIssuanceOfLongTermDebt	41674279000	USD
	us-gaap	Proceeds From Minority Shareholders ProceedsFromMinorityShareholders	0	USD
	us-gaap	Proceeds From Minority Shareholders ProceedsFromMinorityShareholders	15000	USD
	us-gaap	Proceeds From Repayments Of Related Party Debt ProceedsFromRepaymentsOfRelatedPartyDebt	0	USD
	us-gaap	Proceeds From Repayments Of Related Party Debt ProceedsFromRepaymentsOfRelatedPartyDebt	0	USD
	us-gaap	Proceeds From Sale And Maturity Of Held To Maturity Securities ProceedsFromSaleAndMaturityOfHeldToMaturitySecurities	398765000	USD
	us-gaap	Proceeds From Sale And Maturity Of Held To Maturity Securities ProceedsFromSaleAndMaturityOfHeldToMaturitySecurities	32628000	USD
	us-gaap	Proceeds From Sale Of Available For Sale Securities ProceedsFromSaleOfAvailableForSaleSecurities	5822000	USD
	us-gaap	Proceeds From Sale Of Available For Sale Securities ProceedsFromSaleOfAvailableForSaleSecurities	8783000	USD
	us-gaap	Proceeds From Sales Of Business Affiliate And Productive Assets ProceedsFromSalesOfBusinessAffiliateAndProductiveAssets	92529000	USD
	us-gaap	Proceeds From Sales Of Business Affiliate And Productive Assets ProceedsFromSalesOfBusinessAffiliateAndProductiveAssets	135268000	USD
	us-gaap	Proceeds From Stock Options Exercised ProceedsFromStockOptionsExercised	15781000	USD
CY2017Q3	us-gaap	Revenues Revenues	2765071000	USD
	us-gaap	Revenues Revenues	8095721000	USD
CY2018Q3	us-gaap	Revenues Revenues	2847330000	USD
	us-gaap	Revenues Revenues	8583727000	USD
CY2017Q4	us-gaap	Senior Notes SeniorNotes	4500000000	USD
CY2018Q3	us-gaap	Senior Notes SeniorNotes	4500000000	USD
	us-gaap	Share Based Compensation ShareBasedCompensation	28478000	USD
	us-gaap	Share Based Compensation ShareBasedCompensation	59605000	USD
	us-gaap	Proceeds From Stock Options Exercised ProceedsFromStockOptionsExercised	8803000	USD
CY2017Q3	us-gaap	Profit Loss ProfitLoss	-172034000	USD
	us-gaap	Profit Loss ProfitLoss	489876000	USD
CY2018Q3	us-gaap	Profit Loss ProfitLoss	-96668000	USD
	us-gaap	Profit Loss ProfitLoss	434883000	USD
CY2017Q4	us-gaap	Property Plant And Equipment Net PropertyPlantAndEquipmentNet	3149213000	USD
CY2018Q3	us-gaap	Property Plant And Equipment Net PropertyPlantAndEquipmentNet	3275636000	USD
CY2017Q4	us-gaap	Property Plant And Equipment Owned Accumulated Depreciation PropertyPlantAndEquipmentOwnedAccumulatedDepreciation	3103662000	USD
CY2018Q3	us-gaap	Property Plant And Equipment Owned Accumulated Depreciation PropertyPlantAndEquipmentOwnedAccumulatedDepreciation	3454107000	USD
CY2017Q3	us-gaap	Provision For Doubtful Accounts ProvisionForDoubtfulAccounts	-2685000	USD
	us-gaap	Provision For Doubtful Accounts ProvisionForDoubtfulAccounts	-1381000	USD
CY2018Q3	us-gaap	Provision For Doubtful Accounts ProvisionForDoubtfulAccounts	800000	USD
	us-gaap	Provision For Doubtful Accounts ProvisionForDoubtfulAccounts	-7300000	USD
CY2017Q4	us-gaap	Redeemable Noncontrolling Interest Equity Carrying Amount RedeemableNoncontrollingInterestEquityCarryingAmount	1011360000	USD
CY2018Q3	us-gaap	Redeemable Noncontrolling Interest Equity Carrying Amount RedeemableNoncontrollingInterestEquityCarryingAmount	1064412000	USD
CY2018Q3	us-gaap	Related Party Transaction Due From To Related Party Noncurrent RelatedPartyTransactionDueFromToRelatedPartyNoncurrent	0	USD
	us-gaap	Repayments Of Debt And Capital Lease Obligations RepaymentsOfDebtAndCapitalLeaseObligations	38269284000	USD
	us-gaap	Repayments Of Debt And Capital Lease Obligations RepaymentsOfDebtAndCapitalLeaseObligations	40828443000	USD
CY2017Q4	us-gaap	Restricted Cash And Cash Equivalents RestrictedCashAndCashEquivalents	10686000	USD
CY2018Q3	us-gaap	Restricted Cash And Cash Equivalents RestrictedCashAndCashEquivalents	91940000	USD
CY2017Q4	us-gaap	Retained Earnings Accumulated Deficit RetainedEarningsAccumulatedDeficit	3633713000	USD
CY2018Q3	us-gaap	Retained Earnings Accumulated Deficit RetainedEarningsAccumulatedDeficit	3951247000	USD
CY2017Q3	us-gaap	Revenue From Contract With Customer Including Assessed Tax RevenueFromContractWithCustomerIncludingAssessedTax	2561543000	USD
	us-gaap	Revenue From Contract With Customer Including Assessed Tax RevenueFromContractWithCustomerIncludingAssessedTax	7478938000	USD
CY2018Q3	us-gaap	Revenue From Contract With Customer Including Assessed Tax RevenueFromContractWithCustomerIncludingAssessedTax	2670701000	USD
	us-gaap	Revenue From Contract With Customer Including Assessed Tax RevenueFromContractWithCustomerIncludingAssessedTax	7980178000	USD
	us-gaap	Share Based Compensation Arrangement By Share Based Payment Award Accelerated Compensation Cost ShareBasedCompensationArrangementByShareBasedPaymentAwardAcceleratedCompensationCost	8790000	USD
	us-gaap	Share Based Compensation Arrangement By Share Based Payment Award Plan Modification Incremental Compensation Cost ShareBasedCompensationArrangementByShareBasedPaymentAwardPlanModificationIncrementalCompensationCost	14680000	USD
CY2017Q4	us-gaap	Stock Repurchase Program Number Of Shares Authorized To Be Repurchased StockRepurchaseProgramNumberOfSharesAuthorizedToBeRepurchased	110001000	shares
CY2017Q4	us-gaap	Stockholders Equity StockholdersEquity	4690029000	USD
CY2018Q3	us-gaap	Stockholders Equity StockholdersEquity	3824649000	USD
CY2017Q4	us-gaap	Stockholders Equity Including Portion Attributable To Noncontrolling Interest StockholdersEquityIncludingPortionAttributableToNoncontrollingInterest	4886066000	USD
CY2018Q3	us-gaap	Stockholders Equity Including Portion Attributable To Noncontrolling Interest StockholdersEquityIncludingPortionAttributableToNoncontrollingInterest	4029262000	USD
	us-gaap	Treasury Stock Acquired Average Cost Per Share TreasuryStockAcquiredAverageCostPerShare	68.48
CY2017Q4	us-gaap	Treasury Stock Common Shares TreasuryStockCommonShares	0	shares
CY2018Q3	us-gaap	Treasury Stock Common Shares TreasuryStockCommonShares	16844067	shares
	us-gaap	Treasury Stock Shares Acquired TreasuryStockSharesAcquired	16844000	shares
CY2017Q4	us-gaap	Treasury Stock Value TreasuryStockValue	0	USD
CY2018Q3	us-gaap	Treasury Stock Value TreasuryStockValue	1153511000	USD
	us-gaap	Treasury Stock Value Acquired Cost Method TreasuryStockValueAcquiredCostMethod	1153511000	USD
CY2017Q4	us-gaap	Unrecognized Tax Benefits UnrecognizedTaxBenefits	32776000	USD
CY2018Q3	us-gaap	Unrecognized Tax Benefits UnrecognizedTaxBenefits	40376000	USD
CY2017Q4	us-gaap	Unrecognized Tax Benefits Income Tax Penalties And Interest Accrued UnrecognizedTaxBenefitsIncomeTaxPenaltiesAndInterestAccrued	4195000	USD
CY2018Q3	us-gaap	Unrecognized Tax Benefits Income Tax Penalties And Interest Accrued UnrecognizedTaxBenefitsIncomeTaxPenaltiesAndInterestAccrued	8296000	USD
	us-gaap	Unrecognized Tax Benefits Period Increase Decrease UnrecognizedTaxBenefitsPeriodIncreaseDecrease	7600000	USD
CY2018Q3	us-gaap	Unrecognized Tax Benefits That Would Impact Effective Tax Rate UnrecognizedTaxBenefitsThatWouldImpactEffectiveTaxRate	37533000	USD
CY2018Q3	us-gaap	Variable Interest Entity Consolidated Carrying Amount Assets VariableInterestEntityConsolidatedCarryingAmountAssets	916672000	USD
CY2018Q3	us-gaap	Variable Interest Entity Consolidated Carrying Amount Liabilities VariableInterestEntityConsolidatedCarryingAmountLiabilities	508743000	USD
CY2017Q3	us-gaap	Weighted Average Number Of Diluted Shares Outstanding WeightedAverageNumberOfDilutedSharesOutstanding	191408000	shares
	us-gaap	Weighted Average Number Of Diluted Shares Outstanding WeightedAverageNumberOfDilutedSharesOutstanding	193546000	shares
CY2018Q3	us-gaap	Weighted Average Number Of Diluted Shares Outstanding WeightedAverageNumberOfDilutedSharesOutstanding	167262000	shares
	us-gaap	Weighted Average Number Of Diluted Shares Outstanding WeightedAverageNumberOfDilutedSharesOutstanding	174348000	shares
CY2017Q3	us-gaap	Weighted Average Number Of Shares Contingently Issuable WeightedAverageNumberOfSharesContingentlyIssuable	2194000	shares
	us-gaap	Weighted Average Number Of Shares Contingently Issuable WeightedAverageNumberOfSharesContingentlyIssuable	2194000	shares
CY2018Q3	us-gaap	Weighted Average Number Of Shares Contingently Issuable WeightedAverageNumberOfSharesContingentlyIssuable	48000	shares
	us-gaap	Weighted Average Number Of Shares Contingently Issuable WeightedAverageNumberOfSharesContingentlyIssuable	1471000	shares
CY2017Q3	us-gaap	Weighted Average Number Of Shares Issued Basic WeightedAverageNumberOfSharesIssuedBasic	191078000	shares
	us-gaap	Weighted Average Number Of Shares Issued Basic WeightedAverageNumberOfSharesIssuedBasic	192964000	shares
CY2018Q3	us-gaap	Weighted Average Number Of Shares Issued Basic WeightedAverageNumberOfSharesIssuedBasic	166819000	shares
	us-gaap	Weighted Average Number Of Shares Issued Basic WeightedAverageNumberOfSharesIssuedBasic	173875000	shares
CY2017Q3	us-gaap	Weighted Average Number Of Shares Outstanding Basic WeightedAverageNumberOfSharesOutstandingBasic	188884000	shares
	us-gaap	Weighted Average Number Of Shares Outstanding Basic WeightedAverageNumberOfSharesOutstandingBasic	190770000	shares
CY2018Q3	us-gaap	Weighted Average Number Of Shares Outstanding Basic WeightedAverageNumberOfSharesOutstandingBasic	166771000	shares
	us-gaap	Weighted Average Number Of Shares Outstanding Basic WeightedAverageNumberOfSharesOutstandingBasic	172404000	shares
	us-gaap	Description Of New Accounting Pronouncements Not Yet Adopted DescriptionOfNewAccountingPronouncementsNotYetAdopted	<div style="font-family:Times New Roman;font-size:10pt;"><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">New accounting standards</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">On May 28, 2014, the FASB issued ASU No. 2014-09, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Revenue from Contracts with Customers (Topic 606),</font><font style="font-family:inherit;font-size:10pt;"> which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. In 2015, 2016 and 2017, the FASB issued ASU 2015-14, ASU 2016-08, ASU 2016-10, ASU 2016-11, ASU 2016-12, and ASU 2017-10, each of which amends the guidance in ASU 2014-09. These ASUs replaced most existing revenue recognition guidance in GAAP. The Company adopted these ASUs beginning January 1, 2018. See Note </font><font style="font-family:inherit;font-size:10pt;">2</font><font style="font-family:inherit;font-size:10pt;"> for further details.</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In January 2016, the FASB issued ASU No. 2016-01, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities</font><font style="font-family:inherit;font-size:10pt;">. In February 2018, the FASB issued ASU 2018-03, which provides various related technical corrections and improvements. The Company adopted these ASUs beginning January 1, 2018. See Note </font><font style="font-family:inherit;font-size:10pt;">5</font><font style="font-family:inherit;font-size:10pt;"> for further details.</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In February 2016, the FASB issued ASU No. 2016-02, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Leases (Topic 842)</font><font style="font-family:inherit;font-size:10pt;">. The amendments in this ASU revise the accounting related to lessee accounting. Under the new guidance, lessees will be required to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The new lease guidance also simplifies the accounting for sale and leaseback transactions primarily because lessees must recognize lease assets and lease liabilities. In July 2018, the FASB issued ASU No. 2018-10, Codification Amendments to Topic 842, and ASU No. 2018-11, which include targeted improvements to the guidance issued in ASU 2016-02. The amendments in these ASUs are effective for the Company beginning on January 1, 2019 and are to be applied through a modified retrospective transition approach for leases existing at, or entered into after, either at the beginning of the earliest comparative period presented in the financial statements or at the adoption date with a cumulative effect adjustment. Early adoption is permitted. The Company has assembled an internal cross-functional lease task force that meets regularly to discuss and evaluate the current lease portfolio and related systems, processes, controls and policy changes necessary. The Company has made progress in gathering the necessary data elements for the lease population and a system provider has been selected, with system configuration and implementation underway. The Company is currently evaluating the impact of the new guidance on its consolidated financial statements and believes it will have a material impact on its consolidated balance sheet but will not have a material impact on its results of operations or liquidity. The Company expects to adopt these ASUs by applying the new guidance on January 1, 2019 and recognizing a cumulative effect adjustment. The Company is currently planning on electing the package of practical expedients to not reassess prior conclusions related to contracts containing leases, lease classification and initial direct costs. The Company continues to evaluate other practical expedients available under the guidance as well as the effect that the implementation of this guidance will have on its consolidated financial statements, related disclosures and controls, and ongoing business policies and processes.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"> In August 2016, the FASB issued ASU No. 2016-15, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments</font><font style="font-family:inherit;font-size:10pt;">. The amendments in this ASU clarify how certain cash receipts and cash payments should be classified on the statement of cash flows. In November 2016, the FASB issued ASU No. 2016-18, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Statement of Cash Flows (Topic 230): Restricted cash.</font><font style="font-family:inherit;font-size:10pt;"> The amendments in this ASU require that the statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. The adoption of these ASUs did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. </font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In October 2016, the FASB issued ASU No. 2016-16, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory</font><font style="font-family:inherit;font-size:10pt;">. The amendments in this ASU allow entities to recognize the income tax consequences of an intra-entity transfer of an asset other than inventory when the transfer occurs. The current guidance does not allow recognition until the asset has been sold to an outside party. The amendments in this ASU are effective for the Company beginning on January 1, 2018 and are to be applied on a modified retrospective basis. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. </font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In August 2017, the FASB issued ASU No. 2017-12, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. </font><font style="font-family:inherit;font-size:10pt;">The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in the new ASU are effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU is not expected to have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2019. </font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In February 2018, the FASB issued ASU No. 2018-02, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Income Statement - Reporting Comprehensive Income (Topic 220), Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income</font><font style="font-family:inherit;font-size:10pt;">, which allows for the reclassification of certain income tax effects related to the 2017 Tax Act between “Accumulated other comprehensive income” and “Retained earnings.” This ASU relates to the requirement that adjustments to deferred tax liabilities and assets related to a change in tax laws or rates be included in “Income from continuing operations”, even in situations where the related items were originally recognized in “Other comprehensive income” (rather than in “Income from continuing operations”). The amendments in this ASU are effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. The Company elected to early adopt this ASU on January 1, 2018 and applied the change in the period of adoption. The adoption of this ASU resulted in the reclassification of an immaterial amount of deferred tax effects from accumulated other comprehensive income to retained earnings via a cumulative change in accounting principle effective January 1, 2018. See Note </font><font style="font-family:inherit;font-size:10pt;">14</font><font style="font-family:inherit;font-size:10pt;"> for more details.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In August 2018, the FASB issued ASU No. 2018-13, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">Fair Value Measurement (Topic 820): Disclosure Framework -Changes to the Disclosure Requirements for Fair Value Measurement</font><font style="font-family:inherit;font-size:10pt;">. The applicable amendments in this ASU remove requirements for disclosures concerning transfers between fair value measurement Levels 1, 2 and 3 and disclosures concerning valuation processes for Level 3 fair value measurements. The applicable amendments in this ASU also add a requirement to separately disclose the changes in unrealized gains and losses included in other comprehensive income for the reporting period for Level 3 items measured at fair value on a recurring basis, and require disclosure of the range and weighted average of significant unobservable inputs used to develop Level 3 fair value measurements. The amendments in this ASU are effective for the Company beginning on January 1, 2020 and its new requirements are to be applied on a prospective basis. The adoption of this ASU is not expected to have a material impact on the Company’s consolidated financial statements.</font></div></div>
	us-gaap	Loss Contingency Disclosures LossContingencyDisclosures	<div style="font-family:Times New Roman;font-size:10pt;"><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">Contingencies</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of: (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors.</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">The Company operates in a highly regulated industry and is a party to various lawsuits, claims, </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">qui tam</font><font style="font-family:inherit;font-size:10pt;"> suits, governmental investigations and audits (including investigations resulting from its obligation to self-report suspected violations of law) and other legal proceedings. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of </font><font style="font-family:inherit;font-size:10pt;">September 30, 2018</font><font style="font-family:inherit;font-size:10pt;">, and December 31, 2017, the Company’s total recorded accruals, including DMG, with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject.</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;font-weight:bold;">Inquiries by the Federal Government and Certain Related Civil Proceedings</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2015 U.S. Office of Inspector General (OIG) Medicare Advantage Civil Investigation</font><font style="font-family:inherit;font-size:10pt;">: In March 2015, JSA HealthCare Corporation (JSA), a subsidiary of DMG, received a subpoena from the OIG for the U.S. Department of Health and Human Services (HHS) requesting documents and information for the period from January 1, 2008 through December 31, 2013, for certain MA plans for which JSA provided services. It also requested information regarding JSA’s communications about patient diagnoses as they related to certain MA plans generally, and more specifically as related to two Florida physicians with whom JSA previously contracted. </font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In addition to the subpoena described above, in June 2015, the Company received a civil subpoena from the OIG covering the period from January 1, 2008 through the present and seeking production of a wide range of documents relating to the Company’s and its subsidiaries’ (including DMG and its subsidiary JSA) provision of services to MA plans and related patient diagnosis coding and risk adjustment submissions and payments. The Company believes that the request was part of a broader industry investigation into MA patient diagnosis coding and risk adjustment practices and potential overpayments by the government. The information requested included information related to patient diagnosis coding practices for a number of conditions, including potentially improper historical DMG coding for a particular condition. With respect to that condition, the guidance related to that coding issue was discontinued following the Company’s November 1, 2012, acquisition of HealthCare Partners (now known as the Company's DMG business), and the Company notified Centers for Medicare and Medicaid Services (CMS) in April 2015 of the coding practice and potential overpayments. In that regard, the Company identified certain additional coding practices which may have been problematic, some of which were the subject of the previously disclosed and dismissed</font><font style="font-family:inherit;font-size:10pt;font-style:italic;"> Swoben Private Civil Suit</font><font style="font-family:inherit;font-size:10pt;">.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">The Company entered into a settlement agreement with the Department of Justice (DOJ) and OIG to resolve these matters on </font><font style="font-family:inherit;font-size:10pt;">September 28, 2018</font><font style="font-family:inherit;font-size:10pt;">. As previously disclosed, an escrow established in connection with the Company's acquisition of HealthCare Partners in 2012 held back a portion of the purchase price to the prior owners of HealthCare Partners as security for the indemnification rights of the Company. The settlement amount of </font><font style="font-family:inherit;font-size:10pt;">$270,000</font><font style="font-family:inherit;font-size:10pt;"> was paid with these escrowed funds.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2016 U.S. Attorney Texas Investigation</font><font style="font-family:inherit;font-size:10pt;">: In early February 2016, the Company announced that its pharmacy services wholly-owned subsidiary, DaVita Rx, LLC, (DaVita Rx) received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office for the Northern District of Texas. The government is conducting a federal False Claims Act (FCA) investigation concerning allegations that DaVita Rx presented or caused to be presented false claims for payment to the government for prescription medications, as well as into the Company’s relationships with pharmaceutical manufacturers. The CID covers the period from January 1, 2006 through the present. In the spring of 2015, the Company initiated an internal compliance review of DaVita Rx during which it identified potential billing and operational issues, including potential write-offs and discounts of patient co-payment obligations, and credits to payors for returns of prescription drugs related to DaVita Rx. The Company notified the government in September 2015 that it was conducting this review of DaVita Rx and began providing regular updates of its review. Upon completion of its review, the Company filed a self-disclosure with the OIG in February 2016 and has been working to address and update the practices it identified in the self-disclosure, some of which overlap with information requested by the U.S. Attorney’s Office. The OIG informed the Company in February 2016 that its submission was not accepted. They indicated that the OIG is not expressing an opinion regarding the conduct disclosed or the Company’s legal positions. In connection with the Company’s ongoing efforts working with the government the Company learned that a </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">qui tam</font><font style="font-family:inherit;font-size:10pt;"> complaint had been filed covering some of the issues in the CID and the Company’s self-disclosure. In December 2017, the Company finalized and executed a settlement agreement with the government and relators in the </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">qui tam</font><font style="font-family:inherit;font-size:10pt;"> matter and that included total monetary consideration of </font><font style="font-family:inherit;font-size:10pt;">$63,700</font><font style="font-family:inherit;font-size:10pt;">, as previously announced, of which </font><font style="font-family:inherit;font-size:10pt;">$41,500</font><font style="font-family:inherit;font-size:10pt;"> was an incremental cash payment and </font><font style="font-family:inherit;font-size:10pt;">$22,200</font><font style="font-family:inherit;font-size:10pt;"> was for amounts previously refunded, and all of which was previously accrued. The government’s investigation into certain of the Company's relationships with pharmaceutical manufacturers is ongoing, and in July 2018 the government served an HHS-OIG subpoena seeking additional documents and information relating to those relationships. The Company is continuing to cooperate with the government in this investigation.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2017 U.S. Attorney Massachusetts Investigation</font><font style="font-family:inherit;font-size:10pt;">: In January 2017, the Company was served with an administrative subpoena for records by the U.S. Attorney’s Office, District of Massachusetts, relating to an investigation into possible federal health care offenses. The subpoena covers the period from January 1, 2007 through the present, and seeks documents relevant to charitable patient assistance organizations, particularly the American Kidney Fund, including documents related to efforts to provide patients with information concerning the availability of charitable assistance. The Company is continuing to cooperate with the government in this investigation.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2017 U.S. Attorney Colorado Investigation</font><font style="font-family:inherit;font-size:10pt;">: In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal health care offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries, including DMG, DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In August 2018, the Company received a CID from the DOJ. The CID was issued pursuant to the FCA and covers the period from January 2005 through the present. In connection with the resolution of the </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">2015 U.S. OIG Medicare Advantage Civil Investigation</font><font style="font-family:inherit;font-size:10pt;"> referred to above, the Company resolved possible claims relating to DMG in this investigation. The Company is continuing to cooperate with the government in this investigation. </font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2017 U.S. Attorney Florida Investigation</font><font style="font-family:inherit;font-size:10pt;">: In November 2017, the U.S. Attorney’s Office, Southern District of Florida informed the Company of an investigation it was conducting into possible federal healthcare offenses involving the Company's wholly-owned subsidiary, Lifeline. The Company is continuing to cooperate with the government in this investigation.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2018 U.S. Attorney Florida Investigation</font><font style="font-family:inherit;font-size:10pt;">: In March 2018, DaVita Labs received two CIDs from the U.S. Attorney’s Office, Middle District of Florida that were identical in nature but directed to the two different labs. According to the face of the CIDs, the U.S. Attorney’s Office is conducting an investigation as to whether the Company’s subsidiary submitted claims for blood, urine, and fecal testing, where there were insufficient test validation or stability studies to ensure accurate results, in violation of the FCA. In October 2018, DaVita Labs received a subpoena from the OIG in connection with this matter requesting certain patient records linked to clinical laboratory tests. The Company is continuing to cooperate with the government in this investigation.</font></div><div style="line-height:174%;padding-top:13px;text-align:center;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">* * </font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and on-going discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies and/or private civil </font><font style="font-family:inherit;font-size:10pt;font-style:italic;">qui tam</font><font style="font-family:inherit;font-size:10pt;"> complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, possible criminal penalties, any of which could have a material adverse effect on the Company.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;font-weight:bold;">Shareholder and Derivative Claims</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">Peace Officers’ Annuity and Benefit Fund of Georgia Securities Class Action Civil Suit</font><font style="font-family:inherit;font-size:10pt;">: On February 1, 2017, the Peace Officers’ Annuity and Benefit Fund of Georgia filed a putative federal securities class action complaint in the U.S. District Court for the District of Colorado against the Company and certain executives. The complaint covers the time period of August 2015 to October 2016 and alleges, generally, that the Company and its executives violated</font><font style="font-family:inherit;font-size:10pt;font-style:italic;font-weight:bold;"> </font><font style="font-family:inherit;font-size:10pt;">federal securities laws concerning the Company’s financial results and revenue derived from patients who received charitable premium assistance from an industry-funded non-profit organization. The complaint further alleges that the process by which patients obtained commercial insurance and received charitable premium assistance was improper and "created a false impression of DaVita’s business and operational status and future growth prospects." In November 2017, the court appointed the lead plaintiff and an amended complaint was filed on January 12, 2018. On March 27, 2018, the Company and various individual defendants filed a motion to dismiss. Briefing on the motion is complete. The plaintiffs filed an opposition to the motion to dismiss on June 6, 2018. The Company filed a reply in support of the motion on July 19, 2018. The Company disputes these allegations and intends to defend this action accordingly.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">In re DaVita Inc. Stockholder Derivative Litigation</font><font style="font-family:inherit;font-size:10pt;">: On August 15, 2017, the U.S. District Court for the District of Delaware consolidated three previously disclosed shareholder derivative lawsuits: the Blackburn Shareholder action filed on February 10, 2017, the Gabilondo Shareholder action filed on May 30, 2017, and the City of Warren Police and Fire Retirement System Shareholder action filed on June 9, 2017. The complaint covers the time period from 2015 to present and alleges, generally, breach of fiduciary duty, unjust enrichment, abuse of control, gross mismanagement, corporate waste, and misrepresentations and/or failures to disclose certain information in violation of the federal securities laws in connection with an alleged practice to direct patients with government-subsidized health insurance into private health insurance plans to maximize the Company’s profits. An amended complaint was filed in September 2017, and on December 18, 2017, the Company filed a motion to dismiss and a motion to stay proceedings in the alternative. The plaintiffs filed an opposition to the motion to dismiss on March 9, 2018. On June 25, 2018, the U.S. District Court for the District of Delaware granted the Company’s motion to stay proceedings and stayed the case until January 7, 2019, the date of the next status conference. The Company disputes these allegations and intends to defend this action accordingly.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;font-weight:bold;">Other Proceedings</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">White, Kathleen, et al. v. DaVita Healthcare Partners, Inc., Civil Action No. 15-cv-2106, U.S. District Court for the District of Colorado</font><font style="font-family:inherit;font-size:10pt;">: Three actions (Menchaca v. DaVita Healthcare Partners, Inc., Saldana v. DaVita Healthcare Partners, Inc. and Hardin v. DaVita Healthcare Partners, Inc.) were consolidated in December 2016 into one action in U.S. District Court for the District of Colorado. In all three actions, the plaintiffs brought claims for wrongful death based on allegations related to Granuflo®, a product used as a component of the dialysis process. The Menchaca and Saldana actions arose out of the treatment of patients in California, while the Hardin action arose out of the treatment of a patient in Illinois. On </font><font style="font-family:inherit;font-size:10pt;">June 27, 2018</font><font style="font-family:inherit;font-size:10pt;">, the jury returned a verdict in favor of the plaintiffs, collectively awarding </font><font style="font-family:inherit;font-size:10pt;">$8,500</font><font style="font-family:inherit;font-size:10pt;"> in compensatory damages and </font><font style="font-family:inherit;font-size:10pt;">$375,000</font><font style="font-family:inherit;font-size:10pt;"> in punitive damages. Judgment on this verdict was not entered. On November 1, 2018, the parties filed a joint motion notifying the court that they have arrived at a settlement of the three actions. The resolution of all three of the consolidated actions, collectively, is for </font><font style="font-family:inherit;font-size:10pt;">$25,500</font><font style="font-family:inherit;font-size:10pt;">, and requires the filing of a stipulation of dismissal with prejudice in each case. The court has now ordered the parties to file these stipulations of dismissal by November 30, 2018. The Company believes it is probable that it will be able to recover the settlement amount from insurers, indemnitors, and the like; however, the Company can make no assurances that it will recover the full amount. </font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">In addition to the foregoing, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters.</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;font-weight:bold;">Resolved Matters</font></div><div style="line-height:120%;padding-top:13px;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">2011 Suit against the U.S. Department of Veterans Affairs</font><font style="font-family:inherit;font-size:10pt;">: As previously disclosed, the Company had a pending lawsuit in the U.S. Court of Federal Claims against the federal government which was originally filed in May 2011. The lawsuit related to the U.S. Department of Veterans Affairs (VA) underpayment of dialysis services the Company provided from 2005 through 2011 to veterans pursuant to VA regulations. In the first quarter of 2017, the Company received a payment of </font><font style="font-family:inherit;font-size:10pt;">$538,000</font><font style="font-family:inherit;font-size:10pt;"> related to the settlement with the VA. The Company's consolidated entities recognized a net gain of </font><font style="font-family:inherit;font-size:10pt;">$527,000</font><font style="font-family:inherit;font-size:10pt;"> on this settlement. The Company's nonconsolidated and managed entities recognized a gain of </font><font style="font-family:inherit;font-size:10pt;">$9,000</font><font style="font-family:inherit;font-size:10pt;">, of which the Company's equity investment share was </font><font style="font-family:inherit;font-size:10pt;">$3,000</font><font style="font-family:inherit;font-size:10pt;">. The net effect was a net increase of </font><font style="font-family:inherit;font-size:10pt;">$530,000</font><font style="font-family:inherit;font-size:10pt;"> to the Company's operating income.</font></div><div style="line-height:120%;padding-top:13px;text-align:center;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"> * *</font></div><div style="line-height:120%;padding-top:13px;text-align:left;text-indent:36px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Other than as described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note </font><font style="font-family:inherit;font-size:10pt;">10</font><font style="font-family:inherit;font-size:10pt;"> to these condensed consolidated financial statements, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, or otherwise harm the Company’s business, financial results or reputation.</font></div></div>

Files In Submission

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0000927066-18-000196-index.html	Edgar Link	pending
0000927066-18-000196.txt	Edgar Link	pending
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$DVA
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2018 Q4 Form 10-Q Financial Statement

#000092706618000196 Filed on November 07, 2018

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$DVA DAVITA INC. Stock $dva

2018 Q4 Form 10-Q Financial Statement

#000092706618000196 Filed on November 07, 2018

Income Statement

Balance Sheet

Cashflow Statement

Facts In Submission

Files In Submission

$DVA
DAVITA INC. Stock $dva