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Compliance Monitor
This HTML e-mail newsletter delivers news on Medicare and Medicaid fraud and abuse, as well as recent documents and targets of the Office of Inspector General, CMS, and the Department of Justice each week. A second e-mail newsletter, Compliance Monitor Q&A, answers compliance questions from your peers.
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2001
Issue 52, June 22, 2003
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1. HHS-sanctioned committee asks for flexible transactions deadline
1. HHS-sanctioned committee asks for flexible transactions deadline 2. GAO releases new yellow...
2. GAO -
1. HHS posts semi-annual regulatory agenda
1. HHS posts semi-annual regulatory agenda 2. Recent OIG enforcement actions 3. Pay-per-view...
2. Recent OIG enforcement actio -
*HIPAA and the switchboard
*HIPAA and the switchboard *Charging for intramuscular injections
*Charging for intramuscular injections -
1. CMS final rule could mean big changes for RHCs
1. CMS final rule could mean big changes for RHCs 2. Grand Rapids hospital to pay $6.25 million...
2. Grand Rapids hospital
Issue 51, June 22, 2003
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* Can we ask a physician for more documentation?
* Can we ask a physician for more documentation? * How can we settle compliance turf battles...
* How can we settle compli -
1. OIG seeking recommendations on safe harbors, fraud alerts
1. OIG seeking recommendations on safe harbors, fraud alerts 2. New HIPAA regulations come under...
2. New HIPAA -
*Charging for treatment rooms
*Charging for treatment rooms *HIPAA-compliant electronic transactions
*HIPAA-compliant electronic transactions
Issue 50, June 22, 2003
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1. AstraZeneca pays $355 million to settle fraud allegations
1. AstraZeneca pays $355 million to settle fraud allegations 2. EMG services cause false claims...
2. EMG service
Issue 49, June 22, 2003
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* Dueling privacy notices: Forming an OHCA
* Dueling privacy notices: Forming an OHCA * Can we charge a fee for retrieving records under...
* Can we charge a fee for retrie -
1. Tom Scully to step down December 15
2. OIG boasts record year for a -
*PHI and charitable giving
*Defining legibility
Issue 48, November 1, 2003
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1. New prospective payment system for inpatient psych facilities
1. New prospective payment system for inpatient psych facilities 2. Another clean audit for HHS...
2. Anothe -
1. $13 million dollar opinion upheld
1. $13 million dollar opinion upheld 2. CMS announces participants in pilot program 3...
2. CMS announces participants in pilo
Issue 47, June 22, 2003
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* How large should our audit sample be?
* How large should our audit sample be? * How can we convince our physician to complete the...
* How can we convince our physician -
*Is working at home a threat to HIPAA compliance?
*Is working at home a threat to HIPAA compliance? *Documenting medical necessity
*Documenting medical nec
Issue 46, June 22, 2003
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1. CMS finalizes outlier rule
1. CMS finalizes outlier rule 2. Hospital CEO indicted on kickback allegations 3. Pay-per-view...
2. Hospital CEO indicted on kickback allegati -
1. CMS issues EMTALA interim guidance for surveyors
1. CMS issues EMTALA interim guidance for surveyors 2. Spinal implant salesmen indicted on $3.5...
2. Spinal implant sale -
1. CMS announces Medicare improper payment rate
1. CMS announces Medicare improper payment rate 2. UIC Medical Center agrees to $2 million...
2. UIC Medical Center agre
Issue 45, June 22, 2003
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* Protecting digital files under HIPAA
* Protecting digital files under HIPAA * Getting physician buy-in for compliance efforts * Tips...
* Getting physician buy-in for compl -
*What are the Medicare requirements for dates on physician's orders?
*What are the Medicare requirements for dates on physician's orders? *HIPAA and school records
*HIPA
Issue 44, June 4, 2003
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1. Radiology venture is A-OK with feds
1. Radiology venture is A-OK with feds 2. Documentation problems prompt $2 million settlement for...
2. Documentation problems prompt $2 -
1. CMS final rule: Beneficiaries can seek appeal for NCDs
1. CMS final rule: Beneficiaries can seek appeal for NCDs 2. Supreme Court reviewing whether...
2. Supreme Court -
*EMTALA and dedicated emergency departments
*EMTALA and dedicated emergency departments *Influenza and pneumonia vaccine standing orders
*Influenza and pneumonia vacci
Issue 43, May 4, 2003
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* Changing patient status on rejected claims
* Changing patient status on rejected claims * Should we hold exit interviews for fired...
* Should we hold exit intervie -
*Can codes for both CPR and the cardioversion be used for the same event?
*Can codes for both CPR and the cardioversion be used for the same event? *Outpatient setting: Is... -
1. Recent OIG enforcement actions Recent Medi-Cal fraud recovery pushes total re
1. Recent OIG enforcement actions Recent Medi-Cal fraud recovery pushes total restitutions for...
Issue 42, May 4, 2003
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1. Aetna settles lawsuit with physicians for $170 million
1. Aetna settles lawsuit with physicians for $170 million 2. Criminal charges filed against...
2. Criminal charg -
1.OIG has authority to perform PATH audits
1.OIG has authority to perform PATH audits 2.Florida doctor accused of fraudulently collecting...
2.Florida doctor accused of fra -
*Should a patient's name be on each page of the medical record?
*Do ph
Issue 41, May 4, 2003
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* Can we integrate our compliance and patient grievance reporting systems?
* Can we integrate our compliance and patient grievance reporting systems? * ABN-Gs and Ls...
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1.Advisory group recommends "update" to sentencing guidelines
1.Advisory group recommends "update" to sentencing guidelines 2.Tenet affiliate receives U.S...
2.Tenet affi -
*Public emergencies and HIPAA
*Public emergencies and HIPAA *Call-in Scripts and privacy notices
*Call-in Scripts and privacy notices
Issue 40, May 4, 2003
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1. GAO gauges specialty hospitals' impact
1. GAO gauges specialty hospitals' impact 2. "Facility fees" cause Florida clinics to repay $16.9...
2. "Facility fees" cause Florida -
*Sharing protected health information among providers
*Sharing protected health information among providers *Inpatient comes back as outpatient: Report...
*Inpatient comes bac -
1.Fifth Circuit court throws out CMS decision on Louisiana RHCs
1.Fifth Circuit court throws out CMS decision on Louisiana RHCs 2.Government seeking intervention...
2.Governme -
1.UMH signs "matching funds agreement"
1.UMH signs "matching funds agreement" 2.St. Louis University pays $1.8 million in settlement...
2.St. Louis University pays $1.8 mi -
*HIPAA compliance for company health plans
*HIPAA compliance for company health plans *HIPAA and return to work notices
*HIPAA and return to work notic
Issue 39, May 19, 2003
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* Hotline pros and cons
* Hotline pros and cons * Are we required to bill for every patient encounter? * Pay-per-view...
* Are we required to bill for every patient encoun -
1.OIG trying to clear confusion surrounding excessive claims
2.Children
Issue 38, May 19, 2003
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1. Billing for E&M services leads to penalty for health system affiliates
1. Billing for E&M services leads to penalty for health system affiliates 2. Bayer to pay $5...
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*Staying on top of credentialing due dates
*Staying on top of credentialing due dates *Looking for answers to cataract surgery...
*Looking for answers to cataract
Issue 37, May 19, 2003
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* Is our compliance checker wrong?
* Is our compliance checker wrong? * Can we leave answering machine messages under HIPAA...
* Can we leave answering machine messag -
1.OIG developing compliance program guidance for sponsored research
2. -
*Balancing privacy and accessibility
*When are written orders necessar -
1.Tenet Healthcare faces exclusion from federal programs
2.Griffin Hea -
*Privacy issues, incapacity, and minors
*Privacy issues, incapacity, and minors *To round or not to round: How does Medicare want...
*To round or not to round: How doe
Issue 36, May 19, 2003
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1. EMTALA settlements raise the stakes for emergency departments
1. EMTALA settlements raise the stakes for emergency departments 2. Underpayments lead to...
2. Underp -
1. OIG developing compliance program guidance for sponsored research
1. OIG developing compliance program guidance for sponsored research 2. Compliance officers take...
2. Com
Issue 35, September 3, 2003
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1. CMS to release EMTALA final rule
1. CMS to release EMTALA final rule 2. Hospital pays $1.2 million for kickbacks 3. Pay-per-view...
2. Hospital pays $1.2 million for kickb -
* Can we require uninsured patients to pay up front?
* Can we require uninsured patients to pay up front? * Can we charge patients for administrative...
* Can we charge patien
Issue 34, April 28, 2003
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1. Final OIG pharma guidance arrives
1. Final OIG pharma guidance arrives 2. OIG bulletin targets contractual joint ventures 3...
2. OIG bulletin targets contractual jo -
1. CMS extends electronic cost report requirement
1. CMS extends electronic cost report requirement 2. Analyze gaps in your information systems...
2. Analyze gaps in your
Issue 33, April 28, 2003
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* Sorting out HIPAA enforcement
* Sorting out HIPAA enforcement * Documenting tests for "high risk" patients * Pay-per-view...
* Documenting tests for "high risk" patien -
* Sorting out HIPAA enforcement
* Sorting out HIPAA enforcement * Documenting tests for "high risk" patients * Pay-per-view...
* Documenting tests for "high risk" patien -
* Will Medicare pay for routine observations?
* Will Medicare pay for routine observations? * Can we bill patients for multiple copayments...
* Can we bill patients for mu -
1. Mental health centers pay for improper billing
1. Mental health centers pay for improper billing 2. CMS expands Medicare Web site 3...
2. CMS expands Medicare W -
* Can we raffle donated tickets?
* Can we raffle donated tickets? * Are students considered business associates? * Rehab...
* Are students considered business associ
Issue 32, April 28, 2003
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1. Cost report troubles lead health system to $2.9 million settlement
1. Cost report troubles lead health system to $2.9 million settlement 2. Surgeon settles over...
2. S -
1. Tenet pays record-setting $54 million
1. Tenet pays record-setting $54 million 2. Senator Grassley questions backlog in whistleblower...
2. Senator Grassley questions back
Issue 31, April 18, 2003
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* True or false claim? Must a DME supplier meet all of the 21 supplier standards
* True or false claim? Must a DME supplier meet all of the 21 supplier standards? * Coding for... -
1. Physician pays $185,000 for overbilling
1. Physician pays $185,000 for overbilling 2. Billing for consultations versus visits 3...
2. Billing for consultations ver -
* Do we have to track all disclosures?
* Do we have to track all disclosures? * What is the time limit to adjust claims? * Security...
* What is the time limit to adjust c
Issue 30, April 18, 2003
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1. HIPAA privacy rule deadline passes
1. HIPAA privacy rule deadline passes 2. Advisory opinion: Rehab arrangement needs more than safe...
2. Advisory opinion: Rehab arrangeme -
1. Tenet indicted for physician recruitment scheme
1. Tenet indicted for physician recruitment scheme 2. Documentation improvement tips for the...
2. Documentation improve -
* How does HIPAA require facilities to shred confidential papers?
* How does HIPAA require facilities to shred confidential papers? * Change revenue code for 'N...
* Change -
1. Hospitals settle for transplant fraud
1. Hospitals settle for transplant fraud 2. How to minimize FCA penalties 3. Pay-per-view...
2. How to minimize FCA penalties -
* Are insurance companies business associates under HIPAA?
* Are insurance companies business associates under HIPAA? * Should we bill outpatients as...
* Should we bill
Issue 29, April 18, 2003
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* Working with schools in the HIPAA era
* Working with schools in the HIPAA era * Sorting out the duties of mid-level providers...
* Sorting out the duties of mid-le -
* When may we use the nurse practitioner's UPIN?
* When may we use the nurse practitioner's UPIN? * May I withhold access to a patient's medical...
* May I withhold access t -
1. Medicare Part B providers ready, but concerned about vendor compliance
1. Medicare Part B providers ready, but concerned about vendor compliance 2. Abbott Labs settles...
2 -
* Can our board view protected health information?
* Can our board view protected health information? * Should internal auditors report to our HIM...
* Should internal audito -
1. FTC cites physician network for price-fixing
1. FTC cites physician network for price-fixing 2. Twelfth HealthSouth executive pleads guilty 3...
2. Twelfth HealthSouth exec -
* Can we bill for services if a patient complains about them?
* Can we bill for services if a patient complains about them? * Do we need to send our NPP to...
* Do we need
Issue 28, April 18, 2003
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1. Governing boards get compliance help from the OIG
1. Governing boards get compliance help from the OIG 2. Former clinic VP faces fines, prison for...
2. Former clinic VP f
Issue 27, April 18, 2003
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* Billing for nutritional counseling after surgery
* Billing for nutritional counseling after surgery * Insurers, physicians, and business associate...
* Insurers, physicians,
Issue 26, April 18, 2003
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1. Chief operating officer gets prison sentence over kickbacks
1. Chief operating officer gets prison sentence over kickbacks 2. PA company sues Internet...
2. PA compa
Issue 25, March 3, 2003
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* Can we use e-mail under HIPAA?
* Can we use e-mail under HIPAA? * Disclosing financial relationships with vendors...
* Disclosing financial relationships with
Issue 24, March 3, 2003
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1. DOJ enforces Sarbanes-Oxley against HealthSouth
1. DOJ enforces Sarbanes-Oxley against HealthSouth 2. Ambulance companies get OIG advice 3...
2. Ambulance companies
Issue 23, April 3, 2003
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* Should we wait for a subpoena?
* Should we wait for a subpoena? * Coding for three procedures with unexpected results...
* Coding for three procedures with unexpe
Issue 22, March 21, 2003
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1. Pneumonia codes problematic for FL hospital
1. Pneumonia codes problematic for FL hospital 2. OIG audit finds NJ filed duplicate claims, owes...
2. OIG audit finds NJ filed
Issue 21, March 21, 2003
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* How do we perform a criminal background check?
* How do we perform a criminal background check? * ABNs, routine and not * Pay-per-view...
* ABNs, routine and not
Issue 20, March 13, 2003
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1. Hospital pays $6.2 million over cost reports
1. Hospital pays $6.2 million over cost reports 2. IG Rehnquist resigns amidst controversy 3...
2. IG Rehnquist resigns am
Issue 19, March 13, 2003
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* Can a human resources employee serve as our privacy officer?
* Can a human resources employee serve as our privacy officer? * How can our lab get proper...
* How can ou
Issue 18, March 13, 2003
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1. CMS rule to reign-in outliers
1. CMS rule to reign-in outliers 2. DME telemarketing prompts Fraud Alert 3. Pay-per-view...
2. DME telemarketing prompts Fraud Alert<
Issue 17, February 28, 2003
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* What can we do about illegible physician handwriting?
* What can we do about illegible physician handwriting? * Do we have to give our privacy notice...
* Do we have to gi
Issue 16, February 27, 2003
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1. Hospital accused of hoarding "free bed" funds
1. Hospital accused of hoarding "free bed" funds 2. Jail time, fines for Missouri home health...
2. Jail time, fines for M
Issue 15, February 27, 2003
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* What is the best way to handle a patient's credit balances?
* What is the best way to handle a patient's credit balances? * Is it a compliance issue when...
* Is it a co
Issue 14, February 20, 2003
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1. HIPAA final security rule finally arrives
1. HIPAA final security rule finally arrives 2. University settles for $800,000 3. Pay-per-view...
2. University settles for $80
Issue 13, February 20, 2003
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* Cell phones and HIPAA: A bad mix?
* Cell phones and HIPAA: A bad mix? * How do I bill for labs that don't fall under preventive...
* How do I bill for labs that don't fa
Issue 12, February 14, 2003
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1. OIG: Uniform outpatient rates could save a billion
1. OIG: Uniform outpatient rates could save a billion 2. Grassley wants congress to "check" False...
2. Grassley wants co
Issue 11, February 10, 2003
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* Should compliance officers do their own staff training?
* Should compliance officers do their own staff training? * Do I have to tell our compliance...
* Do I have to t
Issue 10, February 5, 2003
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1. OIG gives the green light to excluded parties in limited situations
1. OIG gives the green light to excluded parties in limited situations 2. FL oncologist accused...
2.
Issue 9, January 28, 2003
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* Can we use the overhead pager?
* Can we use the overhead pager? * Can we charge for set-up when the patient cancels...
* Can we charge for set-up when the patie
Issue 8, January 28, 2003
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1. MI hospital pleads guilty to criminal fraud
1. MI hospital pleads guilty to criminal fraud 2. CMS adopts quality improvement requirement 3...
2. CMS adopts quality impro
Issue 6, January 22, 2003
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1. OIG gives guidance on malpractice assistance...sort of
1. OIG gives guidance on malpractice assistance...sort of 2. Former General American employees...
2. Former Genera
Issue 5, January 17, 2003
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* To restrict or not to restrict?
* To restrict or not to restrict? * How do I properly code for outpatient group therapy...
* How do I properly code for outpatient
Issue 4, January 15, 2003
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1. South Dakota hospital pays $6 million for Stark violations
1. South Dakota hospital pays $6 million for Stark violations 2. California sues drug companies...
2. California
Issue 3, January 13, 2003
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* Can you provide some guidelines for giving gifts to physician referral sources
* Can you provide some guidelines for giving gifts to physician referral sources? * Are...
Issue 2, January 8, 2003
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1. OIG audits Rhode Island hospital over outliers
1. OIG audits Rhode Island hospital over outliers 2. Tenet adopts new outlier policy 3...
2. Tenet adopts new outl
Issue 1, January 3, 2003
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* Can we create an increased pricing structure for on-call services?
* Can we create an increased pricing structure for on-call services? * How can we secure radiology...
* How
Issue 21, May 28, 2003
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Physician faces exclusion, fines for upcoding and false claims
Physician faces exclusion, fines for upcoding and false claims
Issue 34, August 27, 2003
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Hospital must improve cardiac rehabilitation billing
Hospital must improve cardiac rehabilitation billing
Issue 20, May 20, 2003
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Adopt Sarbanes-Oxley Act provisions now
Adopt Sarbanes-Oxley Act provisions now
Issue 5, February 4, 2003
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FL oncologist accused of diluting Lupron
FL oncologist accused of diluting Lupron
Issue 48, December 5, 2003
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*Nurse documentation and diagnosis coding
*Nurse documentation and diagnosis coding *Injured staff and EMTALA
*Injured staff and EMTALA
Issue 35, September 5, 2003
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* What rules apply for non-physician staff and evaluation and management codes?<
* What rules apply for non-physician staff and evaluation and management codes? * Does Medicare...
Issue 33, July 19, 2003
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Mental health centers pay for improper billing
Mental health centers pay for improper billing
Issue 22, June 4, 2003
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Documentation problems prompt $2 million settlement for PA hospital
A Philadelphia hospital network agreed to pay nearly $2 million on May 28 to settle allegations...
Issue 18, May 7, 2003
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EMTALA settlements raise the stakes for emergency departments
Two separate settlements in the last week have turned the spotlight on the Emergency Medical...