An Overview of Proposals to Establish an Independent Commission or Entity in Medicare
Report issued by the Congressional Research Service finds that determining the appropriate scope of authority, responsibilities, level of independence, and funding for a new policymaking body present the most pressing challenges. Nov. 13, 2009. 15 pp.
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United States v. Kaiser NW, D. Ore.
Settlement agreement with the United States requires Kaiser NW to pay more than $1.8 million to resolve allegations that it violated the False Claims Act by submitting uncertified bills for hospice services to Medicare. Nov. 12, 2009. 12 pp.
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Iowa v. Abbot Laboratories, S.D. Iowa, No. 07-00461
Settlement agreement with the United States calls for eight drug manufacturers to pay a total of $4.3 million to resolve allegations that they had reported false drug prices so as to increase reimbursements under Iowa’s Medicaid program. Nov. 12, 2009. 17 pp.
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Settlement Agreement Between United States and Ivax Pharmaceuticals Resolves Allegations of Kickbacks from Omnicare
Settlement agreement with the United States requires Ivax Pharmaceuticals, based in Weston, Fla., to pay $14 million for allegedly receiving kickbacks from Omnicare in exchange for drug purchases. Nov. 3, 2009. 17 pp.
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United States ex rel. Kammerer v. Omnicare Inc., D. Mass., No. 1:05-cv-11519-RGS
Settlement agreement with the United States requires Omnicare Inc., the nation’s largest nursing home pharmacy, to pay $98 million to resolve allegations that the pharmacy engaged in kickback schemes with drug manufacturers and nursing homes. Nov. 3, 2009. 22 pp.
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United States ex rel. Moilan v. McAllen Hospitals, L.P., S.D. Tex., No. M-05-cv-263
Settlement with the United States requires the McAllen Hospitals, a Texas hospital group, to pay $27.5 million to resolve charges in a whistleblower lawsuit that it paid illegal compensation to doctors to induce them to refer patients to hospitals within the group in violation of the False Claims Act, the anti-kickback statute, and the Stark self-referral law. Oct. 30, 2009. 22 pp.
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South Carolina v. Eli Lilly and Co., S.C. Cir. Ct., No. 2007-CP-42-1855
Settlement agreement with the state of South Carolina requires Eli Lilly and Co. to pay $45 million to settle allegations the company fraudulently marketed the drug Zyprexa. Oct. 23, 2009. 25 pp.
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Settlement Agreement Between United States and Omni Home Care Resolves Claims of Failure to Collect Doctor Approvals
Settlement agreement with the United States requires Omni Home Care, an HHA in Evansville, Ind., and its parent company Omni Home Health, to pay almost $2 million to resolve allegations it violated the False Claims Act by failing to obtain certain required physician approvals before submitting its bills to Medicare. Oct. 20, 2009. 12 pp.
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United States ex rel. Ven-A-Care v. Mylan Pharmaceuticals, D.N.H., No. 06-cv-231
Settlement with federal and state regulators requires Mylan Pharmaceuticals, UDL Laboratories (part of Mylan), AstraZeneca Pharmaceuticals, and Ortho-McNeil Pharmaceutical, to pay $124 million to resolve allegations that they violated the False Claims Act by failing to pay appropriate drug rebates to state Medicaid programs. Oct. 19, 2009. 20 pp.
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Identity Theft Red Flags – A Health Insurer’s Compliance Obligations
Special report written by Jack Rovner and Kathy Roe, founding principals of The Health Law Consultancy, discusses the obligations of health insurers to protect patients from medical identity theft. Oct. 15, 2009. 8 pp.
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United States Settlement With Michael Bakst Resolves CMP, Stark Violations
Settlement with the United States requires Michael Bakst, the former executive director of Community Memorial Hospital of Ventura, Calif., to pay $64,000 to resolve allegations that he violated the civil monetary penalties law and the Stark law. Oct. 5, 2009. 6 pp.
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United States ex rel. Bates v. (Under Seal), W.D.N.Y., Docket Number Unavailable
Settlement agreement with the United States requires six hospitals in Indiana and Alabama to pay more than $8 million to resolve allegations that they submitted false claims to Medicare. Sept. 29, 2009. 96 pp.
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United States /University of Medicine and Dentistry of New Jersey (UMDNJ) Settlement Agreement Over Kickbacks to Cardiologists
Settlement agreement with the United States requires the University of Medicine and Dentistry of New Jersey to pay $8.3 million to resolve charges that it paid kickbacks to cardiologists in an effort to increase the number of heart procedures performed at the hospital. Sept. 29, 2009. 14 pp.
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The Market Structure of the Health Insurance Industry
Report issued by the Congressional Research Service discusses how the current health insurance market structure affects the two policy goals of expanding health insurance coverage and containing health care costs. Sept. 28, 2009. 58 pp.
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Heightened Enforcement of Privacy and Security Laws Creates New Liability and Compliance Challenges for Providers and Business Associates
Terese A. Mosher Beluris and Benjamin A. Durie, with McDermott Will & Emery LLP, and Amber Gosney, a student at Southwestern Law School, write that the expansion of privacy and security laws and the increase in government resources toward enforcing HIPAA are likely to continue as the government seeks to promote widespread access to electronically stored health information for legitimate medical purposes. Sept. 24, 2009. 9 pp.
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Health Care Delivery System Reform Provisions in the Baucus Bill: A Substantive Set of Provisions
Analysis written by Douglas A. Hastings, partner and chair at Epstein Becker & Green PC, addresses provisions contained within the America’s Health Future Act of 2009 that reform the health care delivery system with a focus on quality. Sept. 24, 2009. 5 pp.
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The Recession’s Effect on Health Care Fraud: The Challenge of Maintaining Effective Compliance in a Down Market
Special analysis written by health care attorneys Brian D. Roark and Mary Beth Fortugno of Bass, Berry & Sims PLC, considers the effect of the economic downturn on health care providers’ ability to maintain effective compliance measures in the current environment of increased oversight and enforcement. Sept. 23, 2009. 5 pp.
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United States Settlement Agreement with New Jersey Cardiologists Resolves Kickback Allegations
Settlement agreement with the United States requires three New Jersey cardiologists to pay a total of $960,000 to settle claims that they accepted salaries from the University of Medicine and Dentistry of New Jersey in exchange for referring patients to the hospital for cardiac procedures. Sept. 17, 2009. 37 pp.
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United States - Pfizer Settlement Over Illegal Marketing Scheme
Settlement agreement with the United States requires drug giant Pfizer to pay a record $1.2 billion criminal fine for illegally marketing the anti-inflammatory drug Bextra for uses the Food and Drug Administration specifically had declined to approve because of safety concerns. Sept. 2, 2009. 48 pp.
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United States v. Odell, D. Nev., No. 2: 09-cv-01037-RLH-GWF
Settlement agreement with the United States requires the Advanced Spine and Pain Management Center, a Las Vegas pain management center, and five of its health care professionals to pay $167,096 to resolve allegations of health care fraud to the Medicare program. Sept. 2, 2009. 14 pp.
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Settlement Agreement between United States and Covenant Medical Center over False Billing Claims
Settlement with the United States requires the Covenant Medical Center in Waterloo, Iowa, to pay $4.5 million to resolve allegations that it violated the False Claims Act by submitting false claims to Medicare. Aug. 25, 2009. 12 pp.
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United States and Willowcrest Nursing Home Reach Settlement Agreement Over Quality of Care Issues
United States and Willowcrest Nursing Home Reach Settlement Agreement Over Quality of Care Issues. Settlement agreement between the United States and Willowcrest Nursing Home and Willow Terrace, two affiliated long-term care facilities in Philadelphia, requires the companies to pay $425,072 and hire a full-time physician assistant or nurse practitioner for at least three years to monitor and treat residents. Aug. 19, 2009. 44 pp.
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United States and Walgreen Louisiana Co. Reach Settlement over Violation of CMP Law
Settlement between the Department of Health and Human Service Office of Inspector General and the Walgreen Louisiana Co. (Walgreens) calls for the company to pay almost $1 million for allegedly violating the Civil Monetary Policies law by employing an individual that Walgreen knew or should have known was excluded from participation in federal health care programs. Aug. 17, 2009. 6 pp.
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Texas ex rel. Ven-A-Care of the Florida Keys Inc. v. Alpha Therapeutic Corp., Tex. Dist. Ct., No. GV-00-0461
Settlement with the state of Texas requires Alpha Therapeutic Corp. to pay $1.2 million to settle allegations the company improperly reported its drug prices leading to Medicaid overpayments. Aug. 13, 2009. 17 pp.
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Coverage Denied: How the Current Health Insurance System Leaves Millions Behind
Report published by the Department of Health and Human Services states insurance companies use pre-existing conditions to deny coverage and rescind coverage in the wake of an expensive illness diagnosis. The report states that health reform legislation currently being developed would prevent these practices from happening. Aug. 11, 2009. 4 pp.
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CBO Letter to Congressman Says Expanded Prevention Services Would Cause Increase in Health Spending
Letter from the Congressional Budget Office to Rep. Nathan Deal (R-Ga.), ranking member of the House Energy and Commerce Subcommittee on Health, states that in most cases the expanded use of preventive services would increase federal health care spending. Aug. 7, 2009. 7 pp.
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In re Vytorin/Zetia Marketing, Sales Practices and Products Liability Litigation, D.N.J., MDL No. 1938, No. 08-cv-00285
Settlement reached with plaintiffs requires drug manufacturers Merck & Co. and Schering-Plough Corp. to pay $41.5 million to resolve class action litigation over their cholesterol-lowering drugs Zetia and Vytoring. Aug. 5, 2009. 92 pp.
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Sen. Rockefeller Letter to CIGNA Re. “Purging” of Small Business Health Policies
Letter from Sen. John D. Rockefeller IV (D-W.Va.) asks health insurer CIGNA to respond to allegations that the company “purged” the policies of small businesses if their claims costs ran too high. Aug. 5, 2009. 3 pp.
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New England Carpenters Health Benefits Fund v. First DataBank, D. Mass., No. 05-11148-PBS
Memorandum and order issued by a Massachusetts federal court gives final approval to a $350 million settlement between San Francisco-based pharmaceutical distribution company McKesson Corp. and private parties over claims the company allegedly improperly inflated the prices of its drugs. Aug. 3, 2009. 6 pp.
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United States ex rel. Reimche v. Tulare Local Health Care District, C.D. Cal., No. CV 08-00543 CAS (Jcx)
Agreement with the United States requires the Tulare (Calif.) Local Healthcare District to pay $2.4 million plus interest to settle a whistleblower’s allegations that the district paid kickbacks to physicians from 2001 through 2007 in the form of debt forgiveness and below-market rentals and purchase prices for office space in exchange for the doctors’ referrals of Medicare patients. July 27, 2009. 19 pp.
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Illinois v. Abbott Laboratories Inc., Ill. Cir. Ct., No. 05CH 2474
Settlement agreement with the state of Illinois requires Baxter Healthcare Corp. to pay $6.8 million to resolve allegations that the pharmaceutical company inflated wholesale prices used in setting Medicaid reimbursement rates. July 27, 2009. 14 pp.
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State, New York City Agreement with United States to Resolve False Medicaid Claims
Settlement agreement with the United States requires New York state and New York City to pay $450 million to settle allegations that officials knowingly submitted, or caused to be submitted, false claims for reimbursement for school-based health care services provided to Medicaid-eligible children from 1990 to 2001. July 21, 2009. 26 pp.
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Strasen v. Allstate Insurance Co., Ill. Cir. Ct., No. 99-L-1040
A preliminary nationwide class action settlement entered into by insurance giant Allstate Corp. resolves allegations that its medical billing and review systems incorrectly calculated reimbursements for automobile and homeowner claims for 20 years. July 16, 2009. 39 pp.
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In re Schering-Plough Corp., Tex. Dist. Ct., No. 09-08811
Settlement agreement requires Merck & Co. and Schering Plough Corp. to pay $5.4 million to 35 states and the District of Columbia to resolve allegations that they delayed the release of negative clinical trial results for their cholesterol-lowering drug Vytorin. July 15, 2009. 38 pp.
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United States ex rel. Michael Flanery v. DeCandido, M.D. Fla., No. 8:05-CV-70-T-27-MAP
Settlement agreement with the United States requires Gabriel DeCandido, a Florida physician, to pay $1.7 million to resolve civil allegations of Medicare billing fraud brought in a whistleblower lawsuit. July 15, 2009. 8 pp.
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United States ex rel. Doe v. Endoscopic Technologies Inc., S.D. Tex., No. H-07-2705
Settlement with the United States requires Endoscopic Technologies Inc., also know as “Estech,” to pay $1.4 million to resolve allegations the company unlawfully marketed its surgical ablation devices to treat atrial fibrillation – a use for which it had not received approval from FDA. July 14, 2009. 38 pp.
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In re. Ind. License of Walgreen Co., Ind. Pharm. Bd., No. 2007-IB0-0034; In re. Ind. License of CVS Pharmacy, Ind. Pharm. Bd., No. 2007-IBP-0026.
Two agreements approved by the Indiana Board of Pharmacy requires CVS/pharmacy and Walgreens to put in place new employee training and information management policies to safeguard customers’ personal information. July 13, 2009. 45 pp.
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United States Settlement Agreement with Yale-New Haven Hospital to Resolve Allegations of False Billing
Settlement agreement with the United States requires the Yale-New Haven Hospital to pay $885,953 to settle charges that it billed the Medicare program for medically unnecessary inpatient hospital admissions for patients receiving certain types of radiation treatment. July 1, 2009. 10 pp.
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United States ex rel. Mayer v. Johns Hopkins Bayview Medical Center, D. Md., No. 1:07-cv-02011-WDQ
Settlement agreement with the United States requires the Johns Hopkins Bayview Medical Center to pay $2.75 million to resolve allegations it submitted false claims to federal health care programs that were reimbursed on inflated rates. June 30, 2009. 17 pp.
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New York State Department of Insurance Issues Proposal to Codify Reimbursement System Reforms
Proposed rule issued by the New York state Department of Insurance would require health and accident insurers and HMOs to use an independent source for establishing usual-and-customary rates and adopt a set of standards laid out in settlement agreements with the state. June 18, 2009. 4 pp.
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United States ex rel. Mayes v. Kindred Healthcare Inc., E.D. Tenn., No. 3:05-CV-89
Settlement agreement with the United States requires Louisville, Ky.-based Kindred Healthcare Inc. to pay more than $1.3 million to settle charges that it overbilled Medicaid for pharmaceuticals. June 10, 2009. 15 pp.
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United States ex rel. Simring v. University of Medicine and Dentistry, D.N.J., No. 2:04-cv-03530-JWB-GDH.
Settlement agreement with the United States requires the University of Medicine and Dentistry of New Jersey to pay $2 million to resolve federal civil allegations of double billing Medicaid for outpatient physician services. June 9, 2009. 17 pp.
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United States v. Seradge, W.D. Okla., No. 00-0317
Settlement agreement with the United States calls for Dr. Houshang Seradge, associated clinics, and health care professionals, to pay $3.5 million to settle allegations of knowingly submitting false claims to Medicare, Medicaid, TRICARE, and FEHBP. June 8, 2009. 25 pp.
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United States ex rel. Eisenstein v. New York City, U.S., No. 08-660
Ruling by the United States Supreme Court holds that whistleblowers and defendants seeking to appeal decisions in False Claims Act qui tam actions in which the government declines intervention must file a notice of appeal within 30 days from the entry of judgment. June 8, 2009. 9 pp.
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United States Settlement Agreement with Aventis Pharmaceutical to Resolve Charges of Misreporting Drug Prices
Settlement agreement with the United States calls for Aventis Pharmaceutical Inc. to pay $95.5 million to settle allegations that violated the False Claims Act by misreporting drug prices for steroid-based anti-inflammatory nasal sprays. May 28, 2009. 18 pp.
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United States ex rel. Hobbs v. Medquest Associates Inc., M.D. Tenn., No. 3: 06-1169
Complaint filed in a Tennessee federal court by federal prosecutors alleges MedQuest Associates, a Georgia-based medical imaging company, improperly billed Medicare for certain diagnostic tests conducted at several imaging centers. May 22, 2009. 31 pp.
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United States ex rel. Bates v. (Under Seal), W.D.N.Y., docket number unavailable
Settlement agreement with the United States requires three HealthEast Care System hospitals to pay $2.28 million to resolve allegations that they submitted false claims to Medicare for services related to treating spinal fractures. May 21, 2009. 21 pp.
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WellCare Health Plans Inc. Enters Deferred Prosecution Agreement Over Florida Medicaid Fraud
Deferred prosecution agreement with the United States requires WellCare Health Plans Inc. to pay $80 million to resolve a federal charge the company defrauded Florida’s Medicaid and the Florida Healthy Kids programs by inflating expenditure information. May 5, 2009. 28 pp.
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United States ex rel. Kruszewski v. Southwood Psychiatric Hospital, E.D. Pa., No. 05-cv-1839
Settlement agreement with the United States requires a Pennsylvania inpatient psychiatric hospital for children to pay $150,000 and implement systemic improvements at three of its facilities. April 22, 2009. 62 pp.
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United States Settlement Agreement with Lahey Clinic Hospital to Resolve False Billing Claims
Settlement agreement with the United States calls for the Lahey Clinic Hospital in Burlington, Mass., to pay $843,897 to settle allegations that it improperly submitted multiple billings to Medicare from 2001 to 2005. April 21, 2009. 9 pp.
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United States Settlement Agreement with Quest Diagnostics to Resolve Charges of Selling Misbranded Test Kits
Settlement agreement with the United States requires New Jersey-based Quest Diagnostics Inc. to pay $302 million to the government to resolve civil and criminal charges that its subsidiary, Nichols Institute Diagnostics (NID), sold misbranded test kits. April 15, 2009. 25 pp.
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United States Settlement Agreement With Methodist Hospital to Resolve False Claim Allegations
Settlement agreement with the United States requires Methodist Hospital, based in Houston, Tex., to pay $9.9 million to resolve allegations it submitted false claims to Medicare for enhanced reimbursements. Mar. 26, 2009. 11 pp.
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California ex rel. Hunter Laboratories LLC v. Quest Diagnostics Inc., Cal. Super. Ct., Case No. CIV 450691.
Announcement by California Attorney General Edmund G. Brown Jr. (D) states that his office has joined a lawsuit against seven medical testing laboratories to recover hundreds of millions of dollars in alleged illegal overcharges to Medi-Cal, California’s Medicaid program. Mar. 20, 2009. 32 pp.
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United States v. San Mateo County, N.D. Cal., No. CV-06-4859-SI
Settlement agreement with the United States calls for San Mateo County, Calif., to pay $6.8 million to resolve allegations that the San Mateo Medical Center submitted false claims to boost its payments from the federal Medicare and Medicaid programs. Mar. 10, 2009. 19 pp.
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New York State Settlements With Excellus Health Plan and Capital District Physicians’ Health Plan Over Use of Ingenix Database
Settlement agreements announced by New York Attorney General Andrew M. Cuomo (D) call for Excellus Health Plan and Capital District Physicians’ Health Plan to contribute funding for a new independent database but also agreed to re-process claims and reimburse customers for previously underpaid out-of-network charges. Mar. 5, 2009. 33 pp.
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American Medical Ass’n v. Aetna Health Inc., D.N.J., No. 09-cv-579-FSH-PS; American Medical Ass’n v. Connecticut General Life Insurance Co., D.N.J., No. 09-cv-578-FSH-PS
Separate class actions filed in a New Jersey federal court by the American Medical Association, five state medical societies, and two surgeons, allege Aetna Health Inc. and CIGNA used a flawed database to knowingly underpay out-of-network providers. Feb. 9, 2009. 140 pp.
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