Medpace (MEDP) 10-Q 25 Apr 23 2023 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2023	Apr. 21, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2023
Document Transition Report	false
Entity File Number	001-37856
Entity Registrant Name	Medpace Holdings, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	32-0434904
Entity Address, Address Line One	5375 Medpace Way
Entity Address, City or Town	Cincinnati
Entity Address, State or Province	OH
Entity Address, Postal Zip Code	45227
City Area Code	513
Local Phone Number	579-9911
Title of 12(b) Security	Common Stock $0.01 par value
Trading Symbol	MEDP
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		30,499,074
Entity Central Index Key	0001668397
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 46,922	$ 28,265
Accounts receivable and unbilled, net (includes $7.7 million with related parties at March 31, 2023 and December 31, 2022, respectively)	257,746	253,404
Prepaid expenses and other current assets	62,954	52,293
Total current assets	367,622	333,962
Property and equipment, net	113,755	109,849
Operating lease right-of-use assets	143,309	139,068
Goodwill	662,396	662,396
Intangible assets, net	37,458	38,008
Deferred income taxes	49,157	48,083
Other assets	22,026	21,129
Total assets	1,395,723	1,352,495
Current liabilities:
Accounts payable (includes $0.4 million and $0.3 million with related parties at March 31, 2023 and December 31, 2022, respectively)	37,110	33,069
Accrued expenses	201,201	210,125
Advanced billings (includes $11.6 million and $8.8 million with related parties at March 31, 2023 and December 31, 2022, respectively)	466,040	462,729
Short-term debt	115,000	50,000
Other current liabilities (includes $12.5 million with related parties at March 31, 2023 and December 31, 2022, respectively)	62,538	47,547
Total current liabilities	881,889	803,470
Operating lease liabilities	142,689	138,867
Deferred income tax liability	1,090	1,070
Other long-term liabilities	22,793	22,701
Total liabilities	1,048,461	966,108
Commitments and contingencies (see Note 11)
Shareholders’ equity:
Preferred stock - $0.01 par-value; 5,000,000 shares authorized; no shares issued and outstanding at March 31, 2023 and December 31, 2022, respectively	0	0
Common stock - $0.01 par-value; 250,000,000 shares authorized at March 31, 2023 and December 31, 2022, respectively; 30,623,655 and 31,091,694 shares issued and outstanding at March 31, 2023 and December 31, 2022, respectively	306	309
Treasury stock - 70,573 and 71,573 shares at March 31, 2023 and December 31, 2022, respectively	(12,322)	(12,497)
Additional paid-in capital	778,691	770,794
Accumulated deficit	(408,099)	(359,827)
Accumulated other comprehensive loss	(11,314)	(12,392)
Total shareholders’ equity	347,262	386,387
Total liabilities and shareholders’ equity	$ 1,395,723	$ 1,352,495

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($) $ in Millions	Mar. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, unbilled services with related parties	$ 7.7	$ 7.7
Accounts payable includes related parties	0.4	0.3
Advanced billings with related parties	11.6	8.8
Other liabilities, related parties, current	$ 12.5	$ 12.5
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock shares authorized (in shares)	5,000,000	5,000,000
Preferred stock shares issued (in shares)	0	0
Preferred stock shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock shares authorized (in shares)	250,000,000	250,000,000
Common stock shares issued (in shares)	30,623,655	31,091,694
Common stock shares outstanding (in shares)	30,623,655	31,091,694
Treasury stock (in shares)	70,573	71,573

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenue, net (includes $15.8 million and $13.3 million with related parties for the three months ended March 31, 2023 and 2022, respectively.	$ 434,074	$ 330,947
Operating expenses:
Total direct costs	303,885	232,270
Selling, general and administrative	38,027	29,366
Depreciation	5,408	4,270
Amortization	550	838
Total operating expenses	347,870	266,744
Income from operations	86,204	64,203
Other (expense) income, net:
Miscellaneous income, net	687	1,067
Interest (expense) income, net	(861)	54
Total other (expense) income, net	(174)	1,121
Income before income taxes	86,030	65,324
Income tax provision	13,136	4,013
Net income	$ 72,894	$ 61,311
Net income per share attributable to common shareholders:
Earnings per share, basic (in dollars per share)	$ 2.35	$ 1.75
Earnings per share, diluted (in dollars per share)	$ 2.27	$ 1.69
Weighted average common shares outstanding:
Weighted average number of shares outstanding, basic (in shares)	31,008	34,918
Weighted average number of shares outstanding, diluted (in shares)	32,155	36,364
Direct Costs
Operating expenses:
Total direct costs	$ 151,068	$ 125,434
Reimbursable Out of Pocket Costs
Operating expenses:
Total direct costs	$ 152,817	$ 106,836

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Operations (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Statement [Abstract]
Revenue with related parties	$ 15.8	$ 13.3

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Statement of Comprehensive Income [Abstract]
Net income	$ 72,894	$ 61,311
Other comprehensive income
Foreign currency translation adjustments, net of taxes	1,078	(1,542)
Comprehensive income	73,972	59,769
Foreign currency translation adjustments, net of taxes	1,078	(1,542)
Accumulated Other Comprehensive Income (Loss)
Other comprehensive income
Foreign currency translation adjustments, net of taxes	1,078	(1,542)
Foreign currency translation adjustments, net of taxes	$ 1,078	$ (1,542)

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Shareholders' Equity (Unaudited) - USD ($) $ in Thousands	Total	Common Stock	Treasury Stock	Additional Paid-in Capital	(Accumulated Deficit) Retained Earnings	Accumulated Other Comprehensive Loss
Shareholders' equity, beginning balance at Dec. 31, 2021	$ 952,928	$ 360	$ (5,427)	$ 727,857	$ 234,984	$ (4,846)
Net income	61,311				61,311
Foreign currency translation	(1,542)					(1,542)
Stock-based compensation expense	4,372			4,372
Stock options exercised	13,897	3		13,894
Repurchases of common stock	(425,950)	(27)	(14,243)		(411,680)
Retirement of treasury stock	0		5,427		(5,427)
Shareholders' equity, ending balance at Mar. 31, 2022	605,016	336	(14,243)	746,123	(120,812)	(6,388)
Shareholders' equity, beginning balance at Dec. 31, 2022	386,387	309	(12,497)	770,794	(359,827)	(12,392)
Net income	72,894				72,894
Foreign currency translation	1,078					1,078
Stock-based compensation expense	5,438			5,438
Stock options exercised	2,463	4		2,459
Repurchases of common stock	(120,998)	(7)			(120,991)
Re-issuance of treasury stock	0		175		(175)
Shareholders' equity, ending balance at Mar. 31, 2023	$ 347,262	$ 306	$ (12,322)	$ 778,691	$ (408,099)	$ (11,314)

Condensed Consolidated Statem_5

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 72,894	$ 61,311
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation	5,408	4,270
Amortization	550	838
Stock-based compensation expense	5,438	4,372
Noncash lease expense	4,757	4,537
Deferred income tax benefit	(1,063)	(713)
Other	(1,455)	(420)
Changes in assets and liabilities:
Accounts receivable and unbilled, net	(4,344)	(38,224)
Prepaid expenses and other current assets	(10,205)	(5,547)
Accounts payable	4,457	(1,041)
Accrued expenses	(9,364)	(3,651)
Advanced billings	3,311	22,580
Lease liabilities	(5,284)	(3,542)
Other assets and liabilities, net	14,976	1,486
Net cash provided by operating activities	80,076	46,256
CASH FLOWS FROM INVESTING ACTIVITIES:
Property and equipment expenditures	(9,513)	(9,257)
Other	10	(1,951)
Net cash used in investing activities	(9,503)	(11,208)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from stock option exercises	2,463	13,867
Repurchases of common stock	(120,146)	(425,950)
Proceeds from revolving loan	90,000	49,500
Payments on revolving loan	(25,000)	(49,500)
Net cash used in financing activities	(52,683)	(412,083)
EFFECT OF EXCHANGE RATES ON CASH, CASH EQUIVALENTS, AND RESTRICTED CASH	767	(1,426)
INCREASE (DECREASE) IN CASH, CASH EQUIVALENTS, AND RESTRICTED CASH	18,657	(378,461)
CASH, CASH EQUIVALENTS, AND RESTRICTED CASH — Beginning of period	28,265	461,304
CASH, CASH EQUIVALENTS, AND RESTRICTED CASH — End of period	46,922	82,843
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION —
Acquisition of property and equipment—non-cash	$ 7,216	$ 7,375

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation Description of Business Medpace Holdings, Inc. (together with its subsidiaries, “Medpace” or the “Company”), a Delaware corporation, is a global provider of clinical research-based drug and medical device development services. The Company partners with pharmaceutical, biotechnology, and medical device companies in the development and execution of clinical trials. The Company’s drug development services focus on full service Phase I-IV clinical development services and include development plan design, project management, regulatory affairs, clinical monitoring, data management and analysis, pharmacovigilance new drug application submissions, post-marketing clinical support, laboratory services, clinical human pharmacology, imaging services, and electrocardiography reading support for clinical trials. The Company’s operations are principally based in North America, Europe, and Asia. Unaudited Interim Financial Information The interim condensed consolidated financial statements include the accounts of the Company, are prepared in conformity with U.S. generally accepted accounting principles (“GAAP”), and are unaudited. In the opinion of the Company’s management, all adjustments of a normal recurring nature necessary for a fair presentation have been reflected. Certain financial information that is normally included in annual financial statements prepared in accordance with GAAP, but that is not required for interim reporting purposes, has been omitted. The preparation of the interim condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the interim condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results and outcomes could differ from management’s estimates and assumptions. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the Company’s audited consolidated financial statements and related notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022. Share Repurchases In 2018, the Board of Directors approved a stock repurchase program which has been amended several times to increase the aggregate amount of the stock repurchase authorization. During the three months ended March 31, 2022, the Company repurchased 2,745,865 shares for $425.9 million. In the fourth quarter of 2022, the Board approved a new stock repurchase program of up to $500.0 million. During the three months ended March 31, 2023, the Company repurchased 654,787 shares for $120.1 million. As of March 31, 2023, we have remaining authorization of $332.7 million under the new repurchase program.

Net Income Per Share

Net Income Per Share	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Net Income Per Share	Net Income Per Share Basic and diluted earnings or loss per share (“EPS”) are computed using the two-class method, which is an earnings allocation that determines EPS for each class of common stock and participating securities according to dividends declared and participation rights in undistributed earnings. The Company’s Restricted Stock Awards (“RSA”) are considered participating securities because they are legally issued at the date of grant and holders are entitled to receive non-forfeitable dividends during the vesting term. The computation of diluted EPS includes additional common shares, such as unvested Restricted Stock Units (“RSU”) and stock options with exercise prices less than the average market price of the Company’s common stock during the period (“in-the-money options”), which would be considered outstanding. This assumes that additional shares would have to be issued in cases where the exercise price of stock options is less than the value of the common stock being acquired because the cash proceeds received from the stock option holder would not be sufficient to acquire that same number of shares. The Company does not compute diluted EPS in cases where the inclusion of such additional shares would be anti-dilutive in effect. The following table sets forth the computation of basic and diluted earnings per share for the three months ended March 31, 2023 and 2022 (in thousands, except for earnings per share): Three Months Ended 2023 2022 Weighted-average shares: Common shares outstanding 31,008 34,918 RSAs 21 21 Total weighted-average shares 31,029 34,939 Earnings per common share—Basic Net income $ 72,894 $ 61,311 Less: Undistributed earnings allocated to RSAs (49) (36) Net income available to common shareholders—Basic $ 72,845 $ 61,275 Net income per common share—Basic $ 2.35 $ 1.75 Basic weighted-average common shares outstanding 31,008 34,918 Effect of diluted shares 1,147 1,446 Diluted weighted-average shares outstanding 32,155 36,364 Net income per common share—Diluted $ 2.27 $ 1.69 During the three months ended March 31, 2023 and 2022, the Company had (in thousands) 10 and 264 stock options, respectively, that were excluded due to the exercise price exceeding the average fair value of the Company’s common stock during the period.

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements The Company follows accounting guidance related to fair value measurements that defines fair value, establishes a framework for measuring fair value, and establishes a hierarchy for inputs used in measuring fair value. This hierarchy maximizes the use of “observable” inputs and minimizes the use of unobservable inputs by requiring that the most observable inputs be used when available. The hierarchy specifies three levels based on the inputs, as follows: Level 1: Valuations based on quoted prices in active markets for identical assets or liabilities. Level 2: Valuations based on directly observable inputs or unobservable inputs corroborated by market data. Level 3: Valuations based on unobservable inputs supported by little or no market activity representing management’s determination of assumptions of how market participants would price the assets or liabilities. The fair value of financial instruments such as cash and cash equivalents, accounts receivable and unbilled, net, accounts payable, accrued expenses and advanced billings approximate their carrying amounts due to their short term maturities. The Company does not have material recurring fair value measurements as of March 31, 2023. There were no transfers between Level 1, Level 2 or Level 3 during the three months ended March 31, 2023 or March 31, 2022.

Contract Assets and Contract Li

Contract Assets and Contract Liabilities	3 Months Ended
	Mar. 31, 2023
Revenue from Contract with Customer [Abstract]
Contract Assets and Contract Liabilities	Contract Assets and Contract Liabilities Contract assets and liabilities are reflected in the Company’s condensed consolidated balance sheets within the accounts reflected below. Contract Assets Accounts receivable represent amounts due from the Company’s customers who are concentrated primarily in the pharmaceutical, biotechnology, and medical device industries. Unbilled represents revenue recognized to date that has not been billed or is not yet contractually billable to the customer. In general, amounts become billable upon the achievement of negotiated contractual events, in accordance with predetermined payment schedules or when a reimbursable expense has been incurred. Amounts classified to unbilled are those billable to customers within one year from the respective balance sheet date. Accounts receivable and unbilled, net consisted of the following (in thousands): As of March 31, December 31, Accounts receivable $ 215,983 $ 213,169 Unbilled receivables 41,933 40,405 Less: allowance for doubtful accounts (170) (170) Total accounts receivable and unbilled, net $ 257,746 $ 253,404 Contract Liabilities Advanced billings represent cash received from customers, or billed amounts per an agreed upon payment schedule, in advance of services being performed or revenue being recognized. Advanced billings consisted of the following (in thousands): As of March 31, December 31, Advanced billings $ 466,040 $ 462,729 As of March 31, 2023, we had approximately $2.9 billion of performance obligations remaining to be performed for active projects.

Intangible Assets, Net

Intangible Assets, Net	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets, Net	Intangible Assets, Net Intangible assets, net consisted of the following (in thousands): As of March 31, December 31, Intangible assets: Finite-lived intangible assets: Carrying amount: Customer relationships 145,051 145,051 Accumulated amortization: Customer relationships (139,239) (138,689) Total finite-lived intangible assets, net 5,812 6,362 Trade name (indefinite-lived) 31,646 31,646 Total intangible assets, net $ 37,458 $ 38,008 As of March 31, 2023, estimated amortization expense of the Company’s intangible assets for each of the next five years and thereafter is as follows (in thousands): Amortization Remainder of 2023 $ 1,649 2024 1,443 2025 946 2026 620 2027 577 2028 577 $ 5,812

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2023
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consisted of the following (in thousands): As of March 31, December 31, Employee compensation and benefits $ 50,598 $ 71,197 Project related reimbursable expenses 139,052 128,416 Other 11,551 10,512 Total accrued expenses $ 201,201 $ 210,125

Short-term Debt

Short-term Debt	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Short-term Debt	Short-term Debt Short-term debt consisted of the following (in thousands): As of March 31, December 31, Revolving credit facility $ 115,000 $ 50,000 Short-term debt $ 115,000 $ 50,000 Principal payments on Short-term debt are due as follows (in thousands): 2023 (remaining) — 2024 115,000 Total $ 115,000 The estimated fair value of the Company’s debt based on Level 2 inputs using the market approach, which is primarily based on rates at which the debt is traded among financial institutions, approximates the carrying value as of March 31, 2023 and December 31, 2022. On September 30, 2019 (the “Closing Date”), the Company obtained an unsecured credit facility in an aggregate principal amount up to $50.0 million (as amended from time to time, the “Credit Facility”) through its wholly owned subsidiaries, Medpace, Inc., as borrower (the “Borrower”), and Medpace IntermediateCo, Inc., as guarantor (the “Guarantor”). On the Closing Date, the Borrower and lender entered into a Loan Agreement (as it may be amended from time to time, the “Loan Agreement”) providing for the Credit Facility, and the Guarantor executed a Guaranty Agreement providing for its guarantee of the payment and performance of the obligations under the Loan Agreement. On March 15, 2022, the Company entered into Amendment No. 4 to the Loan Agreement, which increased the aggregate principal amount that may be borrowed under the facility’s line of credit to up to $250.0 million. On March 31, 2023, the Company entered into Amendment No. 5 to the Loan Agreement, which changed the aggregate principle amount that may be borrowed under the facility’s line of credit to up to $150.0 million, adjusted the interest rate and fee charged on the credit facility and extended the expiration date of revolving credit note to March 29, 2024. The Credit Facility bears interest at a rate of the sum of The Secured Overnight Financing Rate (SOFR) plus 125 basis points (1.25%) or the highest of the Prime Rate, the sum of the Overnight Bank Funding Rate plus 50 basis points (0.50%) and the sum of Daily Simple SOFR plus 100 basis points (1.00%). As of March 31, 2023, the Credit Facility interest rate was 6.0%. The Loan Agreement contains other customary loan terms, representations and warranties, and affirmative and negative covenants, in each case, subject to customary limitations, exceptions and exclusions. The Loan Agreement contains certain events of default, including, among others, non-payment of principal or interest and breach of the covenants. As of March 31, 2023, there were $0.2 million in letters of credit outstanding related to certain operating lease obligations, which are secured by the Credit Facility.

Leases

Leases	3 Months Ended
	Mar. 31, 2023
Leases [Abstract]
Leases	Leases The Company enters into leases for real estate and equipment. Real estate leases are for our corporate office space and laboratories around the world. Real estate leases have remaining lease terms of less than 1 year to 17 years. Many of the Company’s leases include options to extend the leases on a month to month basis or for set periods for up to 20 years. Many leases also include options to terminate the leases within 1 year or per other contractual terms. The components of lease expense were as follows (in thousands): Three Months Ended March 31, 2023 2022 Operating lease cost $ 6,681 $ 6,500 Variable lease cost 2,337 2,016 Supplemental cash flow information related to the leases was as follows (in thousands): Three Months Ended March 31, 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 5,350 $ 3,806 Right-of-use assets obtained in exchange for lease obligations: Operating leases 8,419 17,745 Supplemental balance sheet information related to the leases was as follows (in thousands): As of March 31, December 31, Operating lease right-of-use assets - related parties $ 87,600 $ 86,356 Operating lease right-of-use assets - non-related parties 55,709 52,712 Operating lease right-of-use assets $ 143,309 $ 139,068 Other current liabilities - related parties 5,305 5,409 Other current liabilities - non-related parties 13,934 13,863 Other current liabilities $ 19,239 $ 19,272 Operating lease liabilities - related parties 94,901 93,393 Operating lease liabilities - non-related parties 47,788 45,474 Operating lease liabilities 142,689 138,867 Total operating lease liabilities $ 161,928 $ 158,139 Weighted Average Remaining Lease Term (years) Operating leases 10.8 11.1 Weighted Average Discount Rate Operating leases 5.4 % 5.2 % Lease payments due related to lease liabilities as of March 31, 2023 were as follows (in thousands): Related Party Operating Leases Non-Related Parties Operating Leases Total Operating Leases Remainder of 2023 $ 8,406 $ 11,657 $ 20,063 2024 11,412 14,444 25,856 2025 11,607 12,270 23,877 2026 11,807 10,147 21,954 2027 10,839 7,381 18,220 Later years 100,278 12,262 112,540 Total lease payments 154,349 68,161 222,510 Less: imputed interest (54,143) (6,439) (60,582) Total $ 100,206 $ 61,722 $ 161,928

Shareholder's Equity and Stock-

Shareholder's Equity and Stock-Based Compensation	3 Months Ended
	Mar. 31, 2023
Equity [Abstract]
Shareholder's Equity and Stock-Based Compensation	Shareholder’s Equity and Stock-Based CompensationThe Company granted 26,668 awards to employees under the 2016 Incentive Award Plan during the three months ended March 31, 2023, consisting of 25,418 RSU and 1,250 stock option awards having four year vesting schedules. The Company granted an additional 573 stock option awards to non-employee directors under the 2016 Incentive Award Plan, during the three months ended March 31, 2023. These awards are scheduled to vest on the earlier of (a) the day immediately preceding the date of the first annual meeting following the date of grant and (b) the first anniversary of the date of grant, subject to the non-employee director continuing in service through the applicable vesting date. Award Activity The following table sets forth the Company’s stock option activity: Three Months Ended March 31, 2023 Stock Options Weighted Average Outstanding - beginning of period 1,629,148 $ 89.71 Granted 1,823 $ 213.41 Exercised (67,988) $ 36.24 Cancelled/Forfeited/Expired (3,000) $ 166.73 Outstanding - end of period 1,559,983 $ 92.03 Exercisable - end of period 1,053,267 $ 62.06 The following table sets forth the Company’s RSA/RSU activity: Three Months Ended Shares/Units Outstanding and unvested - beginning of period 523,377 Granted 25,418 Vested (118,760) Forfeited (6,934) Outstanding and unvested - end of period 423,101 Cumulative vested shares - end of period 2,348,676 Stock-based compensation expense recognized in the condensed consolidated statements of operations related to all outstanding stock based compensation awards is summarized below (in thousands): Three Months Ended March 31, 2023 2022 Total direct costs $ 2,940 $ 2,440 Selling, general and administrative 2,498 1,932 Total stock-based compensation expense $ 5,438 $ 4,372

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income TaxesThe Company’s effective income tax rate was 15.3% and 6.1% for the three months ended March 31, 2023 and 2022, respectively. The Company's effective income tax rate for the three months ended March 31, 2023 varied from the U.S. statutory rate of 21% due to the impact of the state taxes, which was favorably offset by excess tax benefits recognized from share-based compensation and tax benefits related to Foreign Derived Intangible Income (FDII).

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings The Company is involved in legal proceedings from time to time in the ordinary course of its business, including employment claims and claims related to other business transactions. The Company cannot predict with certainty the outcome of such proceedings, but it believes that adequate reserves have been recorded and losses already recognized with respect to such proceedings, which were immaterial as of March 31, 2023 and December 31, 2022. There is a reasonable possibility that a loss exceeding amounts already recognized may be incurred related to these actions; however, the Company believes that such potential losses were immaterial as of March 31, 2023. Purchase Commitments

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2023
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions Employee Loans The Company periodically extends short term loans or advances to employees, typically upon commencement of employment. Total receivables as a result of these employee advances of $0.3 million existed at March 31, 2023 and December 31, 2022, respectively, and are included in the Prepaid expenses and other current assets and Other assets line items of the condensed consolidated balance sheets, respectively, depending on the contractual repayment date. Service Agreement LIB Therapeutics LLC and subsidiaries (“LIB”) Certain executives and employees of the Company, including the chief executive officer, are members of LIB’s board of managers. The Company entered into a MSA dated November 24, 2015 with LIB, a company that engages in research, development, marketing and commercialization of pharmaceutical drugs. Subsequently, the Company and LIB have entered into several task orders for the Company to perform clinical trial related services. The Company recognized total revenue from LIB of $13.3 million and $7.4 million during the three months ended March 31, 2023 and 2022, respectively, in the Company’s condensed consolidated statements of operations. As of March 31, 2023 and December 31, 2022, respectively, the Company had Advanced billings from LIB of $10.1 million and $7.4 million in the condensed consolidated balance sheets. In addition, as of March 31, 2023 and December 31, 2022, respectively, the Company had Accounts receivable and unbilled, net from LIB of $6.3 million and $5.5 million in the condensed consolidated balance sheets. The Company had Other current liabilities with LIB of $12.5 million in the consolidated balance sheets at March 31, 2023 and December 31, 2022. CinRX Pharma, subsidiaries and affiliates (“CinRx”) Certain executives and employees of the Company, including the chief executive officer, are members of CinRx’s board of managers and/or have equity investments in CinRx, a biotech company. The Company and CinRx have entered into several task orders for the Company to perform clinical trial related services. The Company recognized total revenue from CinRx of $2.5 million and $5.8 million during the three months ended March 31, 2023 and 2022, respectively, in the Company’s condensed consolidated statements of operations. As of March 31, 2023 and December 31, 2022, respectively, the Company had Advanced billings from CinRx of $1.4 million in the condensed consolidated balance sheets. As of March 31, 2023 and December 31, 2022 the Company had Accounts receivable and unbilled, net from CinRx of $1.4 million and $2.2 million, respectively, in the condensed consolidated balance sheets. Certain affiliates of CinRx included in previous reported quarters are no longer disclosed due to changes in the affiliate relationship. Leased Real Estate Campus Headquarters Leases The Company entered into an operating lease for the occupancy of office space in a building in Cincinnati, Ohio with an entity that is wholly owned by the chief executive officer of the Company. The Company has evaluated its relationship with the related party and concluded that the related party is not a variable interest entity because the Company has no direct ownership interest or relationship other than the lease. The lease was renewed in the first quarter of fiscal year 2023 for a term of ten years through December 2032 with a renewal option for one 10-year term at prevailing market rates. The Company pays rent, taxes, insurance, and maintenance expenses that arise from the use of the property. Annual base rent for its corporate headquarters allows for adjustments to the rental rate annually for increases in the consumer price index. Operating lease cost recognized for the three months ended March 31, 2023 and 2022 was $0.6 million, respectively. The operating lease cost was allocated between Total direct costs and Selling, general and administrative in the condensed consolidated statements of operations. The Operating lease right-of-use assets at March 31, 2023 and December 31, 2022 were $20.6 million and $18.2 million, respectively, in the condensed consolidated balance sheets. The current and long-term portions of the lease liabilities at March 31, 2023 were $1.4 million and $19.3 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the condensed consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2022 were $1.5 million and $16.7 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the condensed consolidated balance sheets. In 2018, Medpace, Inc. entered into a multi-year lease agreement governing future occupancy of additional office space in Cincinnati, Ohio with an entity that is wholly owned by the Company’s chief executive officer and certain members of his immediate family. The Company began to occupy the premises in the second quarter of fiscal year 2020. The lease expires in 2040 and the Company has two 10-year options to extend the term of the lease. The Company pays rent, taxes, insurance, and maintenance expenses that arise from the use of the property. Annual base rent for the corporate headquarters allows for adjustments to the rental rate annually for increases in the consumer price index. The Company has determined that the lease is an operating lease. Operating lease cost recognized for the three months ended March 31, 2023 and 2022 was $1.4 million, respectively. The operating lease cost was allocated between Total direct costs and Selling, general and administrative in the condensed consolidated statements of operations. The Operating lease right-of-use assets at March 31, 2023 and December 31, 2022 were $53.1 million and $53.5 million, respectively, in the condensed consolidated balance sheets. The current and long-term portions of the lease liabilities at March 31, 2023 were $1.1 million and $64.5 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the condensed consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2022 were $1.1 million and $64.8 million, respectively and were recognized in Other current liabilities and Operating lease liabilities in the condensed consolidated balance sheets. The Company entered into two multi-year lease agreements governing the occupancy of space of two buildings in Cincinnati, Ohio with an entity that is wholly owned by the Company’s chief executive officer and certain members of his immediate family. The Company assumed occupancy in 2012 and the leases expire in 2027 with the Company having one 10-year option to extend the lease term. The Company pays rent, taxes, insurance, and maintenance expenses that arise from the use of the property. Annual base rent for the corporate headquarters allows for adjustments to the rental rate annually for increases in the consumer price index. The Company has determined that the leases are operating leases. Operating lease cost recognized for the three months ended March 31, 2023 and 2022 was $0.9 million. The operating lease cost was allocated between Total direct costs and Selling, general and administrative in the condensed consolidated statements of operations. The Operating lease right-of-use assets at March 31, 2023 and December 31, 2022 were $13.9 million and $14.6 million, respectively, in the condensed consolidated balance sheets. The current and long-term portions of the lease liabilities at March 31, 2023 were $2.8 million and $11.1 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the condensed consolidated balance sheets. The current and long-term portions of the lease liabilities at December 31, 2022 were $2.8 million and $11.9 million, respectively, and were recognized in Other current liabilities and Operating lease liabilities in the condensed consolidated balance sheets. Travel Services The Company incurs expenses for travel services for company executives provided by private aviation charter companies which is a company controlled by the chief executive officer of the Company (each a “private aviation charter”). The Company may contract directly with the private aviation charter for the use of its aircraft or indirectly through a third party aircraft management and jet charter company (the “Aircraft Management Company”). The travel services provided are primarily for business purposes, with certain personal travel paid for as part of the executives’ compensation arrangements. The Aircraft Management Company also makes the private aviation charter aircraft available to third parties. The Company incurred travel expenses of $0.4 million during the three months ended March 31, 2023 and 2022, respectively. These travel expenses are recorded in Selling, general and administrative in the Company’s condensed consolidated statements of operations. As of March 31, 2023 and December 31, 2022, the Company had Accounts payable to the Aircraft Management Company of $0.3 million, respectively, in the condensed consolidated balance sheets.

Entity Wide Disclosures

Entity Wide Disclosures	3 Months Ended
	Mar. 31, 2023
Entity Wide Disclosures [Abstract]
Entity Wide Disclosures	Entity Wide Disclosures Revenue by Category The following table disaggregates our revenue by major source (in thousands): Three Months Ended 2023 2022 Therapeutic Area Oncology $ 141,951 $ 105,213 Other 87,104 70,417 Metabolic 86,840 48,116 Cardiology 46,617 37,396 Central Nervous System 38,697 38,487 AVAI 32,865 31,318 Total revenue $ 434,074 $ 330,947

Basis of Presentation (Policies

Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Unaudited Interim Financial Information	Unaudited Interim Financial InformationThe interim condensed consolidated financial statements include the accounts of the Company, are prepared in conformity with U.S. generally accepted accounting principles (“GAAP”), and are unaudited. In the opinion of the Company’s management, all adjustments of a normal recurring nature necessary for a fair presentation have been reflected. Certain financial information that is normally included in annual financial statements prepared in accordance with GAAP, but that is not required for interim reporting purposes, has been omitted. The preparation of the interim condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the interim condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results and outcomes could differ from management’s estimates and assumptions. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the Company’s audited consolidated financial statements and related notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022.
Share Repurchases	Repurchases under the share repurchase program are executed in the open market or negotiated transactions under trading plans put in place pursuant to Rule 10b5-1. The Company constructively retired the repurchased shares associated with these approved share repurchases, except for a small portion which were retained as Treasury Shares on the condensed consolidated statements of shareholders' equity. Retired share repurchase amounts paid in excess of par value are reflected within Accumulated deficit/Retained earnings in the Company’s condensed consolidated balance sheets.

Net Income Per Share (Tables)

Net Income Per Share (Tables)	3 Months Ended
	Mar. 31, 2023
Earnings Per Share [Abstract]
Schedule of Reconciliation of Denominators and Additional Shares That Are Excluded From the Calculation of EPS	The following table sets forth the computation of basic and diluted earnings per share for the three months ended March 31, 2023 and 2022 (in thousands, except for earnings per share): Three Months Ended 2023 2022 Weighted-average shares: Common shares outstanding 31,008 34,918 RSAs 21 21 Total weighted-average shares 31,029 34,939 Earnings per common share—Basic Net income $ 72,894 $ 61,311 Less: Undistributed earnings allocated to RSAs (49) (36) Net income available to common shareholders—Basic $ 72,845 $ 61,275 Net income per common share—Basic $ 2.35 $ 1.75 Basic weighted-average common shares outstanding 31,008 34,918 Effect of diluted shares 1,147 1,446 Diluted weighted-average shares outstanding 32,155 36,364 Net income per common share—Diluted $ 2.27 $ 1.69

Contract Assets and Contract _2

Contract Assets and Contract Liabilities (Tables)	3 Months Ended
	Mar. 31, 2023
Revenue from Contract with Customer [Abstract]
Summary of Company's Contract Asset and Contract Liability	Accounts receivable and unbilled, net consisted of the following (in thousands): As of March 31, December 31, Accounts receivable $ 215,983 $ 213,169 Unbilled receivables 41,933 40,405 Less: allowance for doubtful accounts (170) (170) Total accounts receivable and unbilled, net $ 257,746 $ 253,404 Advanced billings consisted of the following (in thousands): As of March 31, December 31, Advanced billings $ 466,040 $ 462,729

Intangible Assets, Net (Tables)

Intangible Assets, Net (Tables)	3 Months Ended
	Mar. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets, Net	Intangible assets, net consisted of the following (in thousands): As of March 31, December 31, Intangible assets: Finite-lived intangible assets: Carrying amount: Customer relationships 145,051 145,051 Accumulated amortization: Customer relationships (139,239) (138,689) Total finite-lived intangible assets, net 5,812 6,362 Trade name (indefinite-lived) 31,646 31,646 Total intangible assets, net $ 37,458 $ 38,008
Schedule of Estimated Amortization Expense of Intangible Assets	As of March 31, 2023, estimated amortization expense of the Company’s intangible assets for each of the next five years and thereafter is as follows (in thousands): Amortization Remainder of 2023 $ 1,649 2024 1,443 2025 946 2026 620 2027 577 2028 577 $ 5,812

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2023
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consisted of the following (in thousands): As of March 31, December 31, Employee compensation and benefits $ 50,598 $ 71,197 Project related reimbursable expenses 139,052 128,416 Other 11,551 10,512 Total accrued expenses $ 201,201 $ 210,125

Short-term Debt (Tables)

Short-term Debt (Tables)	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Schedule of Short-term Debt	Short-term debt consisted of the following (in thousands): As of March 31, December 31, Revolving credit facility $ 115,000 $ 50,000 Short-term debt $ 115,000 $ 50,000
Schedule of Principal Payments on Short-term Debt	Principal payments on Short-term debt are due as follows (in thousands): 2023 (remaining) — 2024 115,000 Total $ 115,000

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2023
Leases [Abstract]
Summary of Components of Lease Expense	The components of lease expense were as follows (in thousands): Three Months Ended March 31, 2023 2022 Operating lease cost $ 6,681 $ 6,500 Variable lease cost 2,337 2,016
Summary of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to the leases was as follows (in thousands): Three Months Ended March 31, 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 5,350 $ 3,806 Right-of-use assets obtained in exchange for lease obligations: Operating leases 8,419 17,745
Summary of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to the leases was as follows (in thousands): As of March 31, December 31, Operating lease right-of-use assets - related parties $ 87,600 $ 86,356 Operating lease right-of-use assets - non-related parties 55,709 52,712 Operating lease right-of-use assets $ 143,309 $ 139,068 Other current liabilities - related parties 5,305 5,409 Other current liabilities - non-related parties 13,934 13,863 Other current liabilities $ 19,239 $ 19,272 Operating lease liabilities - related parties 94,901 93,393 Operating lease liabilities - non-related parties 47,788 45,474 Operating lease liabilities 142,689 138,867 Total operating lease liabilities $ 161,928 $ 158,139 Weighted Average Remaining Lease Term (years) Operating leases 10.8 11.1 Weighted Average Discount Rate Operating leases 5.4 % 5.2 %
Schedule of Lease Payments Due Related To Lease Liabilities	Lease payments due related to lease liabilities as of March 31, 2023 were as follows (in thousands): Related Party Operating Leases Non-Related Parties Operating Leases Total Operating Leases Remainder of 2023 $ 8,406 $ 11,657 $ 20,063 2024 11,412 14,444 25,856 2025 11,607 12,270 23,877 2026 11,807 10,147 21,954 2027 10,839 7,381 18,220 Later years 100,278 12,262 112,540 Total lease payments 154,349 68,161 222,510 Less: imputed interest (54,143) (6,439) (60,582) Total $ 100,206 $ 61,722 $ 161,928

Shareholder's Equity and Stoc_2

Shareholder's Equity and Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2023
Equity [Abstract]
Share-Based Payment Arrangement, Activity	The following table sets forth the Company’s stock option activity: Three Months Ended March 31, 2023 Stock Options Weighted Average Outstanding - beginning of period 1,629,148 $ 89.71 Granted 1,823 $ 213.41 Exercised (67,988) $ 36.24 Cancelled/Forfeited/Expired (3,000) $ 166.73 Outstanding - end of period 1,559,983 $ 92.03 Exercisable - end of period 1,053,267 $ 62.06
Schedule of RSA/RSU Activity	The following table sets forth the Company’s RSA/RSU activity: Three Months Ended Shares/Units Outstanding and unvested - beginning of period 523,377 Granted 25,418 Vested (118,760) Forfeited (6,934) Outstanding and unvested - end of period 423,101 Cumulative vested shares - end of period 2,348,676
Summary of Stock-Based Compensation Expense Recognized in Statements of Operations Related to All Outstanding Stock Based Compensation Awards	Stock-based compensation expense recognized in the condensed consolidated statements of operations related to all outstanding stock based compensation awards is summarized below (in thousands): Three Months Ended March 31, 2023 2022 Total direct costs $ 2,940 $ 2,440 Selling, general and administrative 2,498 1,932 Total stock-based compensation expense $ 5,438 $ 4,372

Entity Wide Disclosures (Tables

Entity Wide Disclosures (Tables)	3 Months Ended
	Mar. 31, 2023
Entity Wide Disclosures [Abstract]
Summary of Revenue by Major Source	The following table disaggregates our revenue by major source (in thousands): Three Months Ended 2023 2022 Therapeutic Area Oncology $ 141,951 $ 105,213 Other 87,104 70,417 Metabolic 86,840 48,116 Cardiology 46,617 37,396 Central Nervous System 38,697 38,487 AVAI 32,865 31,318 Total revenue $ 434,074 $ 330,947

Basis of Presentation - Narrati

Basis of Presentation - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Basis Of Presentation [Line Items]
Repurchases of shares, value	$ 120,146	$ 425,950
Share Repurchase Program
Basis Of Presentation [Line Items]
Repurchases of shares (in shares)		2,745,865
Repurchases of shares, value		$ 425,900
2022 Share Repurchase Program
Basis Of Presentation [Line Items]
Repurchases of shares (in shares)	654,787
Repurchases of shares, value	$ 120,100
Remaining amount of repurchase program	$ 332,700
2022 Share Repurchase Program | Maximum
Basis Of Presentation [Line Items]
Stock repurchase program, authorized amount			$ 500,000

Net Income Per Share - Schedule

Net Income Per Share - Schedule of Reconciliation of Denominators and Additional Shares that are Excluded from the Calculation of EPS (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Weighted-average shares:
Basic weighted-average common shares outstanding (in shares)	31,008	34,918
Weighted average number of common and restricted shares outstanding basic (in shares)	31,029	34,939
Earnings per common share—Basic
Net income	$ 72,894	$ 61,311
Net income available to common shareholders—Basic	$ 72,845	$ 61,275
Net income per common share, basic (in dollars per share)	$ 2.35	$ 1.75
Basic weighted-average common shares outstanding (in shares)	31,008	34,918
Effect of diluted shares (in shares)	1,147	1,446
Diluted weighted-average shares outstanding (in shares)	32,155	36,364
Net income per common share, diluted (in dollars per share)	$ 2.27	$ 1.69
RSAs
Weighted-average shares:
Basic weighted-average common shares outstanding (in shares)	21	21
Earnings per common share—Basic
Less: Undistributed earnings allocated to RSAs	$ (49)	$ (36)
Basic weighted-average common shares outstanding (in shares)	21	21
Common Stock
Weighted-average shares:
Basic weighted-average common shares outstanding (in shares)	31,008	34,918
Earnings per common share—Basic
Basic weighted-average common shares outstanding (in shares)	31,008	34,918

Net Income Per Share - Addition

Net Income Per Share - Additional Information (Details) - shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Stock Options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of diluted EPS	10,000	264,000

Contract Assets and Contract _3

Contract Assets and Contract Liabilities - Summary of Accounts Receivable and Unbilled, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Accounts receivable	$ 215,983	$ 213,169
Unbilled receivables	41,933	40,405
Less: allowance for doubtful accounts	(170)	(170)
Total accounts receivable and unbilled, net	$ 257,746	$ 253,404

Contract Assets and Contract _4

Contract Assets and Contract Liabilities - Summary of Advanced Billings (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Advanced billings	$ 466,040	$ 462,729

Contract Assets and Contract _5

Contract Assets and Contract Liabilities - Additional Information (Details) $ in Billions	Mar. 31, 2023 USD ($)
Revenue from Contract with Customer [Abstract]
Performance obligations remaining to be performed	$ 2.9

Intangible Assets, Net - Schedu

Intangible Assets, Net - Schedule of Intangible Assets, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Accumulated amortization:
Total finite-lived intangible assets, net	$ 5,812	$ 6,362
Trade name (indefinite-lived)	31,646	31,646
Total intangible assets, net	37,458	38,008
Customer Relationships
Finite-lived intangible assets:
Finite-lived intangible assets, gross	145,051	145,051
Accumulated amortization:
Total accumulated amortization	$ (139,239)	$ (138,689)

Intangible Assets, Net - Sche_2

Intangible Assets, Net - Schedule of Estimated Amortization Expense of Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2023	$ 1,649
2024	1,443
2025	946
2026	620
2027	577
2028	577
Total finite-lived intangible assets, net	$ 5,812	$ 6,362

Accrued Expenses - Schedule of

Accrued Expenses - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Employee compensation and benefits	$ 50,598	$ 71,197
Project related reimbursable expenses	139,052	128,416
Other	11,551	10,512
Total accrued expenses	$ 201,201	$ 210,125

Short-term Debt - Schedule of D

Short-term Debt - Schedule of Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Short-Term Debt [Line Items]
Short-term debt	$ 115,000	$ 50,000
Credit facility
Short-Term Debt [Line Items]
Short-term debt	$ 115,000	$ 50,000

Short-term Debt - Schedule of P

Short-term Debt - Schedule of Principal Payments on Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
2023 (remaining)	$ 0
2024	115,000
Short-term debt	$ 115,000	$ 50,000

Short-term Debt - Narrative (De

Short-term Debt - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 15, 2022	Sep. 30, 2019
Debt Instrument [Line Items]
Outstanding letters of credit	$ 0.2
Credit facility
Debt Instrument [Line Items]
Aggregate principal amount borrowed under line of credit facility	$ 150	$ 250
Line of credit facility, interest rate at period end	6%
Credit facility | The Secured Overnight Financing Rate
Debt Instrument [Line Items]
Debt instrument, basis points	1.25%
Credit facility | Overnight Bank Funding Rate
Debt Instrument [Line Items]
Debt instrument, basis points	0.50%
Credit facility | Daily Simple SOFR
Debt Instrument [Line Items]
Debt instrument, basis points	1%
Maximum | Credit facility
Debt Instrument [Line Items]
Debt instrument, principal amount			$ 50

Leases - Narrative (Details)

Leases - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2023 USD ($)
Lessee Lease Description [Line Items]
Lease not yet commenced, future payments	$ 0.3
Minimum | Real Estate
Lessee Lease Description [Line Items]
Remaining lease term, operating lease	1 year
Maximum | Real Estate
Lessee Lease Description [Line Items]
Remaining lease term, operating lease	17 years
Maximum | Real Estate and Equipment
Lessee Lease Description [Line Items]
Lease renewal term, operating lease	20 years
Operating lease, options to terminate lease term	1 year

Leases - Summary of Components

Leases - Summary of Components of Lease Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Leases [Abstract]
Operating lease cost	$ 6,681	$ 6,500
Variable lease cost	$ 2,337	$ 2,016

Leases - Summary of Supplementa

Leases - Summary of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 5,350	$ 3,806
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 8,419	$ 17,745

Leases - Summary of Supplemen_2

Leases - Summary of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating lease right-of-use assets - related parties	$ 87,600	$ 86,356
Operating lease right-of-use assets - non-related parties	55,709	52,712
Operating lease right-of-use assets	143,309	139,068
Other current liabilities - related parties	5,305	5,409
Other current liabilities - non-related parties	13,934	13,863
Other current liabilities	$ 19,239	$ 19,272
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Other current liabilities (includes $12.5 million with related parties at March 31, 2023 and December 31, 2022, respectively)	Other current liabilities (includes $12.5 million with related parties at March 31, 2023 and December 31, 2022, respectively)
Operating lease liabilities - related parties	$ 94,901	$ 93,393
Operating lease liabilities - non-related parties	47,788	45,474
Operating lease liabilities	142,689	138,867
Total operating lease liabilities	$ 161,928	$ 158,139
Weighted Average Remaining Lease Term (years)
Operating leases	10 years 9 months 18 days	11 years 1 month 6 days
Weighted Average Discount Rate
Operating leases	5.40%	5.20%

Leases - Schedule of Lease Paym

Leases - Schedule of Lease Payments Due Related To Lease Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Operating Lease Liabilities Payments Due [Line Items]
Remainder of 2023	$ 20,063
2024	25,856
2025	23,877
2026	21,954
2027	18,220
Later years	112,540
Total lease payments	222,510
Less: imputed interest	(60,582)
Total	161,928	$ 158,139
Non-Related Party
Operating Lease Liabilities Payments Due [Line Items]
Remainder of 2023	11,657
2024	14,444
2025	12,270
2026	10,147
2027	7,381
Later years	12,262
Total lease payments	68,161
Less: imputed interest	(6,439)
Total	61,722
Related Party
Operating Lease Liabilities Payments Due [Line Items]
Remainder of 2023	8,406
2024	11,412
2025	11,607
2026	11,807
2027	10,839
Later years	100,278
Total lease payments	154,349
Less: imputed interest	(54,143)
Total	$ 100,206

Shareholder's Equity and Stoc_3

Shareholder's Equity and Stock-Based Compensation - Additional Information (Details)	3 Months Ended
	Mar. 31, 2023 shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options, granted (in shares)	1,823
2016 Incentive Award Plan | Granted to Employees
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Awards granted to employees (in shares)	26,668
2016 Incentive Award Plan | Stock Options | Non Employee Directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options, granted (in shares)	573
2016 Incentive Award Plan | Vesting After Four Years | Restricted Stock Units (RSU)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)	25,418
Award vesting period	4 years
2016 Incentive Award Plan | Vesting After Four Years | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options, granted (in shares)	1,250
Award vesting period	4 years

Shareholder's Equity and Stoc_4

Shareholder's Equity and Stock-Based Compensation - Schedule of Stock Option Activity (Details)	3 Months Ended
	Mar. 31, 2023 $ / shares shares
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Outstanding [Roll Forward]
Number of stock options, outstanding - beginning of period (in shares) | shares	1,629,148
Number of stock options, granted (in shares) | shares	1,823
Number of stock options, exercised (in shares) | shares	(67,988)
Number of stock options, cancelled/forfeited/expired (in shares) | shares	(3,000)
Number of stock options, outstanding - end of period (in shares) | shares	1,559,983
Number of stock options, exercisable (in shares) | shares	1,053,267
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Abstract]
Weighted average exercise price, outstanding - beginning of period (in dollars per share) | $ / shares	$ 89.71
Weighted average exercise price, granted (in dollars per share) | $ / shares	213.41
Weighted average exercise price, exercised (in dollars per share) | $ / shares	36.24
Weighted average exercise price, cancelled/forfeited/expired (in dollars per share) | $ / shares	166.73
Weighted average exercise price, outstanding - end of period (in dollars per share) | $ / shares	92.03
Weighted average exercise price, exercisable - end of period (in dollars per share) | $ / shares	$ 62.06

Shareholder's Equity and Stoc_5

Shareholder's Equity and Stock-Based Compensation - Schedule of RSA/RSU Activity (Details) - RSA/RSU	3 Months Ended
	Mar. 31, 2023 shares
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested - beginning of period (in shares)	523,377
Granted (in shares)	25,418
Vested (in shares)	(118,760)
Forfeited (in shares)	(6,934)
Outstanding and unvested - end of period (in shares)	423,101
Cumulative vested shares - end of period (in shares)	2,348,676

Shareholder's Equity and Stoc_6

Shareholder's Equity and Stock-Based Compensation - Summary of Stock-Based Compensation Expense Recognized in Statements of Operations Related to All Outstanding Stock Based Compensation Awards (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 5,438	$ 4,372
Total Direct Costs
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation expense	2,940	2,440
Selling, General and Administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 2,498	$ 1,932

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Effective income tax rate	15.30%	6.10%
U.S. statutory rate	21%

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2023 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Minimum purchase commitments for project related supplies	$ 17.1

Related Party Transactions - Na

Related Party Transactions - Narrative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($) renewal_option Agreement building	Mar. 31, 2022 USD ($)	Dec. 31, 2022 USD ($)
Related Party Transaction [Line Items]
Revenue with related parties	$ 15,800	$ 13,300
Advanced billings	11,600		$ 8,800
Accounts receivable and unbilled, net	7,700		7,700
Current liabilities with related parties	12,500		12,500
Operating lease cost recognized	6,681	6,500
Operating lease right-of-use assets	143,309		139,068
Current portion of lease liability	19,239		19,272
Long-term portion of lease liabilities	142,689		138,867
Accounts payable includes related parties	400		300
Employee Loans | Prepaid Expenses, Other Current Assets, and Other Assets
Related Party Transaction [Line Items]
Employee advances receivables	300		300
Service Agreement | LIB
Related Party Transaction [Line Items]
Advanced billings	10,100		7,400
Accounts receivable and unbilled, net	6,300		5,500
Service Agreement | LIB | Total revenue
Related Party Transaction [Line Items]
Revenue with related parties	13,300	7,400
Service Agreement | CinRx Pharma and Subsidiaries
Related Party Transaction [Line Items]
Advanced billings	1,400		1,400
Accounts receivable and unbilled, net	1,400		2,200
Service Agreement | CinRx Pharma and Subsidiaries | Total revenue
Related Party Transaction [Line Items]
Revenue with related parties	$ 2,500	5,800
Leased Real Estate | Chief Executive Officer
Related Party Transaction [Line Items]
Term of lease	10 years
Number of lease renewal, 10-year option | renewal_option	1
Lease term upon renewal	10 years
Operating lease right-of-use assets	$ 20,600		18,200
Current portion of lease liability	1,400		1,500
Long-term portion of lease liabilities	19,300		16,700
Leased Real Estate | Chief Executive Officer | Direct Costs and Selling, General And Administrative
Related Party Transaction [Line Items]
Operating lease cost recognized	$ 600	600
Leased Real Estate | Chief Executive Officer And Immediate Family | Office Space
Related Party Transaction [Line Items]
Number of lease renewal, 10-year option | renewal_option	2
Lease term upon renewal	10 years
Operating lease right-of-use assets	$ 53,100		53,500
Current portion of lease liability	1,100		1,100
Long-term portion of lease liabilities	$ 64,500		64,800
Leased Real Estate | Chief Executive Officer And Immediate Family | Building
Related Party Transaction [Line Items]
Number of lease renewal, 10-year option | renewal_option	1
Lease term upon renewal	10 years
Operating lease right-of-use assets	$ 13,900		14,600
Current portion of lease liability	2,800		2,800
Long-term portion of lease liabilities	$ 11,100		11,900
Number of lease agreements | Agreement	2
Number of buildings | building	2
Leased Real Estate | Chief Executive Officer And Immediate Family | Direct Costs and Selling, General And Administrative | Office Space
Related Party Transaction [Line Items]
Operating lease cost recognized	$ 1,400	1,400
Leased Real Estate | Chief Executive Officer And Immediate Family | Direct Costs and Selling, General And Administrative | Building
Related Party Transaction [Line Items]
Operating lease cost recognized	900	900
Travel Services
Related Party Transaction [Line Items]
Accounts payable includes related parties	300		300
Travel Services | Chief Executive Officer
Related Party Transaction [Line Items]
Travel expenses with related party	400	$ 400
Related Party Service Agreements | LIB
Related Party Transaction [Line Items]
Current liabilities with related parties	$ 12,500		$ 12,500

Entity Wide Disclosures - Summa

Entity Wide Disclosures - Summary of Revenue by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disaggregation Of Revenue [Line Items]
Total revenue	$ 434,074	$ 330,947
Oncology
Disaggregation Of Revenue [Line Items]
Total revenue	141,951	105,213
Other
Disaggregation Of Revenue [Line Items]
Total revenue	87,104	70,417
Metabolic
Disaggregation Of Revenue [Line Items]
Total revenue	86,840	48,116
Cardiology
Disaggregation Of Revenue [Line Items]
Total revenue	46,617	37,396
Central Nervous System
Disaggregation Of Revenue [Line Items]
Total revenue	38,697	38,487
AVAI
Disaggregation Of Revenue [Line Items]
Total revenue	32,865	31,318
Total revenue
Disaggregation Of Revenue [Line Items]
Total revenue	$ 434,074	$ 330,947