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A doctor in Key Biscayne, Fla., became the unwitting pawn in a Medicare scheme involving forged prescriptions that cost the government $7 million. (iStockphoto)

How A Fanny Pack Mix-Up Revealed A Medicare Drug Scam

by Charles Ornstein
Jul 11, 2014 (ProPublica)

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The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.

Now it's led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.

Last year, ProPublica chronicled how lax oversight had led to rampant waste and fraud in Medicare's prescription drug program, known as Part D. As part of that series, we wrote about Dr. Carmen Ortiz-Butcher, a kidney specialist whose Part D prescriptions soared from $282,000 in 2010 to $4 million the following year. The value of her prescriptions rose to nearly $5 million in 2012, the most recent year available.

But no one in Medicare bothered to ask her about the seemingly huge change in her practice, Ortiz-Butcher's attorney said. She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. But instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. Ortiz-Butcher immediately alerted authorities.

Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show.

In February, the U.S. Attorney's office for the Southern District of Florida charged Maria De Armas Suero, who had been a secretary at Ortiz-Butcher's Island Clinic from March 2011 to September 2013, with 11 counts of conspiracy, fraud and aggravated identity theft.

Suero subsequently agreed to plead guilty to two counts of conspiracy and identity theft. In a recounting of her wrongdoing, called a factual proffer, she acknowledged using Ortiz-Butcher's paper prescriptions to "create fraudulent scripts for numerous Medicare beneficiaries ...The prescriptions falsely represented that the Medicare beneficiary was seen by [Ortiz-Butcher] and that the listed prescriptions were medically necessary."

Suero acknowledged that she was paid $100 for each prescription she generated. Local pharmacies then billed Medicare for filling the prescriptions, which were sometimes never dispensed. The false claims resulted in losses to Medicare of at least $2.5 million, the proffer said.

In March, the U.S. Attorney charged another secretary at the same clinic, Milagros Matias Ortiz, with two counts of conspiracy to commit health care fraud and aggravated identity theft. She also has pleaded guilty, acknowledging in her proffer that she created false prescriptions from March 2011 to August 2012. She was paid $50 for each prescription.

Ortiz and Suero are set to be sentenced this month. Suero's lawyer, Rene Palomino Jr., said the doctor had no knowledge of what was going on. "Believe me if she had any knowledge about this, her name would have been in an indictment," he said.

Ortiz' lawyer, Joseph Tesmond, said his client has "accepted responsibility" for her "very minor role in this." He said she continued working at the clinic after she withdrew from the scheme, resigning in March before she was charged.

"She has been cooperating with the government since the beginning," Tesmond said. "The first time that they came to speak to her, she spoke to them at length without [legal] representation."

In May, prosecutors also charged a pharmacy owner, Luisa Isabel Vega, with conspiracy and fraud relating to Medicare claims linked to Ortiz-Butcher. Vega's AB Pharmacy in Miami was overpaid $4.2 million by Medicare from April 2011 to November 2013, according to the indictment.

In an affidavit, Daniel Crespi, a special agent with the Health and Human Services Inspector General's office, said several Medicare beneficiaries whose prescriptions were supposedly filled by AB Pharmacy denied receiving most or all of the medications. "The beneficiaries further admitted that they had been paid kickbacks by patient recruiters for allowing AB Pharmacy to submit fraudulent claims to Medicare utilizing their personal information," Crespi wrote.

Crespi's affidavit says he interviewed a physician (ProPublica data shows it was Ortiz-Butcher) who purportedly sent prescriptions for 181 Medicare patients to AB Pharmacy, but it turned out that only 17 of them were actually patients of hers. "The physician concluded that his/her signature on the prescriptions were being forged and fraudulently utilized at AB Pharmacy."

Medicare data show that 7,613 prescriptions attributed to Ortiz-Butcher were filled at AB Pharmacy in 2012, more than any other doctor.

The second highest Medicare prescriber for AB Pharmacy was Miami physician Aurelio Ortiz, whose tab jumped from $2.1 million in 2010 to $8.7 million the next year. (It was $8.4 million in 2012). His most-prescribed drugs, like Ortiz-Butcher's, read like a shopping list of the brand-name pills that are most valued in scams. In an interview last year, Ortiz couldn't recall whether the prescriptions were his, but later said he'd been aware that some bogus prescriptions had been written using his name. (He has not been charged.)

Vega, the pharmacy's owner, has pleaded not guilty. Her lawyer declined to comment, saying the case is pending.

A spokeswoman for the U.S. Attorney's office said other cases related to prescriptions attributed to Ortiz-Butcher are under investigation. Criminal cases also were brought against officials at two other pharmacies that filled the doctor's prescriptions, though they began before she uncovered the scam.

"The Suero and Ortiz cases are somewhat unique because we charged the individuals creating the fraudulent scripts," spokeswoman Michelle Alvarez wrote by email. "Most of our cases focus on those who are more directly involved in billing Part D, i.e. pharmacy owners, and those who recruit and pay patients needed to bill the Part D program."

The larger question may be why Medicare didn't spot the spike in Ortiz-Butcher's supposed prescribing and inquire about it.

Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said he can't discuss individual cases but said the agency has beefed up its oversight of the prescription drug program, including its use of proactive data analysis. The agency recently issued a new regulation giving itself the authority for the first time to kick abusive prescribers out of Medicare.

In a brief interview, Ortiz-Butcher said she was happy the case was being investigated and acted upon, but the effect on her has been profound.

"When you trust people in your life to work with you, and that trust is violated, it leaves a sense of emptiness that's insurmountable and also makes it very difficult to trust again," she said. "That's pretty much where I'm at right now."

Copyright 2014 ProPublica. To see more, visit http://www.propublica.org/.

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A drawing of two clinking martini glasses. ( NPR)

Pop Culture Happy Hour: Bucket Lists And Summertime, Live In D.C.

Jul 11, 2014 (ProPublica)

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We haven't even gotten to Episode 200 of Pop Culture Happy Hour — that's running next week, when we present the second part of this June 24 live show — and we've already got a special announcement about our next live appearance. On July 24 at 2 p.m. PT, Linda Holmes, Glen Weldon and I will storm the San Diego Comic Con for a live panel discussion with a special guest: my dear mother, Maggie Thompson. Mom, a comics-industry veteran who blogs for the San Diego Comic Con website, is an honored guest at this year's festival, and she invited the three of us to join her for one of her many panels.

More information on the event is available here, so if you're attending SDCC, be sure to put us on your calendar! We'll bring PCHH buttons and stickers to give away — and, for the sake of the many Southern Californians who can't or won't make it to Comic Con, we'll also do an informal public meet-and-greet on the morning of July 26. For more information on that event as plans are firmed up, follow Linda, Glen and me at the Twitter handles below.

As for this week's episode, the three of us stare down a lovely and enthusiastic crowd — the same folks who sold out NPR's Studio 1 in less than two minutes — with the help of our dear pal, All Things Considered co-host Audie Cornish. After shamelessly goosing the crowd to cheer when they hear our names, we kick off the festivities with a discussion of pop-culture bucket lists. This, it turns out, includes not only things we hope to do before we die, but also things we promise never to do in all the years we hope to have remaining.

Then it's on to a discussion of summer entertainment: Besides the season in which a piece of entertainment is released, what makes certain pop culture summery? We discuss populism, freedom, abandon, the cultural calendar, beach reads, movies in which aircraft carriers smash into buildings, the music of a perfect pop band and a joyous legend, and much more.

Finally, as always, we close with what's making us happy. I shout out some PCHH veterans we love, and am already losing my mind about a movie coming out in June 2015. Glen is thrilled about the return of a wonderful comedy series. Audie has her eye on a 2015 movie of her own. And Linda recommends a documentary short, a play making its way across the country, and the new issue of a legendary magazine.

Next week: Episode 200! In which we embark upon a series of quizzes and take a few questions from the audience.

Quiz answers: 1) Winnie-the-Pooh. 2) South Park. 3) "This is Sparta!" 4) Honoré de Balzac. 5) Benny and Joon. 6) Wonder Woman. 7) ABC Family. 8) America's Most Wanted. 9) Tony Hawk (a 900 is a skateboarding trick where the skateboarder does two and a half spins in the air). 10) Rent ("Seasons of Love").

We're always happy to hear from you, so find us on Facebook or follow us on Twitter: me, Linda, Glen, Audie, producers Jessica and Lauren, and our pal Mike Katzif.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Take The Ask Me Another Quiz

In honor of our 200th episode, we asked our dear pal — Ask Me Another puzzlemaster Art Chung, to whom we are resoundingly grateful — to whip up a quiz that we could pass out to the audience before the show. Here's his handiwork: 1) What children's book character lives in The Hundred Acre Wood? 2) What TV series' 200th episode featured Tom Cruise threatening to sue the town unless he got to meet the prophet Muhammad? 3) In the action movie 300, Leonidas kicks a man into a well and yells what three-word catchphrase? 4) In Francois Truffaut's classic film The 400 Blows, a 13-year-old named Antoine gets in trouble at school for plagiarizing what French writer? 5) Although it was released in 1989, the Proclaimers song "I'm Gonna Be (500 Miles)" didn't become a hit until four years later, thanks to its use in what Johnny Depp film? 6) In 2010, the 600th issue of what comic book character's signature series introduced a costume change, giving her a red top, black pants and an unfortunate blue half-jacket? 7) Because of contractual obligations stipulated by Pat Robertson when he sold his cable company, The 700 Club must air twice a day on what basic-cable network? 8) From 1995 until 2012, eagle-eyed viewers called 1-800-CRIMETV to contact what long-running television show? 9) In 2011, who tweeted, "I'm 43 and I did a 900 today"? 10) Finally, since there are no good trivia questions about "ten hundred," what Broadway musical features a song that begins, "Five hundred twenty-five thousand six hundred minutes / Five hundred twenty-five thousand moments so dear"?

Missing some content? Check the source: NPR
Copyright(c) 2014, NPR
Weingarten says people need to talk more about how to "attract, retain, support and nurture great teaching for kids at risk." (AP)

Q&A: A Union Leader On Tenure, Testing And The Common Core

Jul 11, 2014 (ProPublica)

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Eric Westervelt

The American Federation of Teachers (AFT) is holding its annual convention in Los Angeles through this weekend. For the AFT's more than 3,500 national delegates descending on LA, there is a lot on their plate and big challenges ahead for the nation's second-largest teachers' union: the Common Core, tenure and fierce debate about testing, to name a few. We reached out to the AFT's President, Randi Weingarten, and NPR Ed's Eric Westervelt got her on the phone from the floor of the LA Convention Center.

What do you think the mood is of your members coming into this? Because one could look at it and say: Look, you've got tensions over Common Core implementation, testing and accountability. And now the big ruling in California on tenure and dismissal. I could see members saying, "we've taken it on the chin a bit in the last year. We're not feeling so great."

"Public education and educators have taken it on the chin not just last year but for several years. And so no doubt there will be frustration at this convention. But this is what I see about our members: There's tenacity and resilience and a relentlessness about the fight back. And the other side: the anti-union, anti-public education, anti-worker forces want to defeat us and want to demoralize us. And what I'm seeing at least from the activists I've bumped into is that they want to fight back and they want to fight forward. That means being solution-driven. It means being community involved. It means members have to be engaged and empowered. And frankly it means being a little badass. It's giving people a voice because so many times they don't have one."

On the Common Core, you've said you and your members like the promise. But you're worried about implementation and are frustrated about it. What, specifically, do you think your members want you as a leader to do now about Common Core implementation?

"Good question. Well first our members range from people who don't believe in standards at all to people who think standards are really important, including these new standards. You have the full range. Where there is real consensus is that they should be de-linked from testing. In all places where Core is being implemented you need to de-link high-stakes testing and you need to stop with the profit motive. We should follow what all the other countries which out-compete us do: none of them test every single student every year in every grade. They may have two or three standardized tests throughout the experience of a youngster. But there is none of this toxic, obsessive test fixation that we have in the United States today that reduces students to test scores and teachers to algorithms."

I want to ask about the Vergara case . Do you think that pushback and fight back you talk about belongs in the courtroom, or is there still room for non-courtroom discussions — in California and beyond — about tenure, dismissal and coming up with different forms of accountability and measurement?

"What's disappointing to me [about the ruling] is that we have solved this in so many different jurisdictions. And that's part of the reason that you're seeing in some of the copycat cases that have already been filed, like in New York, lots of people are saying 'not so fast.' The American Association of School Administrators, the school superintendents, and [the AFT] have worked out a whole protocol on ensuring that you have both fairness and quality and that the two are not in conflict with each other. How do you ensure that due process is really about fairness? How do you ensure that you have zero-tolerance for sexual misconduct while at the same time protecting against false allegations? How do you ensure that you help prepare, support and nurture a teacher? But if they can't do their job, and you've helped them, then they shouldn't be there. You can see throughout the country a lot of this work has been done by our locals, by state legislators and others. And what's sad is that none of this was discussed in the Vergara case and the aftermath. And the other thing that hasn't been discussed in Vergara is the real issues: how do you attract, retain, support and nurture great teaching for kids at risk? How do you turn around schools that need to be fixed? And not one second in the Vergara case was dedicated to that. And so that's why you have to have these discussions not only in the courthouse but in the court of public opinion, at the bargaining table, at the ballot box and in legislatures throughout the country."

Your counterpart at the NEA, at their recent annual meeting, called for the Secretary of Education, Arne Duncan, to step down. It passed. Do you personally endorse that and would you support that as a resolution at your convention?

"This is now in the hands of our membership. We have a special order of business that's going to the floor of the convention that actually has a broader injunction here: That's that we will fight for the election and appointment of policymakers who stand on the side of working people, their families and their communities. And we'll hold them accountable. It sends a message: You either stand with working people — stand with students and communities and educators — or you don't. I understand the sentiment of the NEA membership. There is a deep frustration. It's the same frustration and impulse that led me to write [Duncan] an open letter and criticize him. But this is about broader policy. So if the members of the convention floor want to amend the resolution and make it specific, that will be their right to do."

But the question was about you specifically: Has he lost your confidence and in terms of accountability, should he go?

"Look I've called him out. And that's what I thought was important for me to do. This is a matter of making sure it's in a broader sense about any elected or appointed official. But we've created a vehicle that if people want to amend on the floor, they can amend it on the floor."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Take The Ask Me Another Quiz

In honor of our 200th episode, we asked our dear pal — Ask Me Another puzzlemaster Art Chung, to whom we are resoundingly grateful — to whip up a quiz that we could pass out to the audience before the show. Here's his handiwork: 1) What children's book character lives in The Hundred Acre Wood? 2) What TV series' 200th episode featured Tom Cruise threatening to sue the town unless he got to meet the prophet Muhammad? 3) In the action movie 300, Leonidas kicks a man into a well and yells what three-word catchphrase? 4) In Francois Truffaut's classic film The 400 Blows, a 13-year-old named Antoine gets in trouble at school for plagiarizing what French writer? 5) Although it was released in 1989, the Proclaimers song "I'm Gonna Be (500 Miles)" didn't become a hit until four years later, thanks to its use in what Johnny Depp film? 6) In 2010, the 600th issue of what comic book character's signature series introduced a costume change, giving her a red top, black pants and an unfortunate blue half-jacket? 7) Because of contractual obligations stipulated by Pat Robertson when he sold his cable company, The 700 Club must air twice a day on what basic-cable network? 8) From 1995 until 2012, eagle-eyed viewers called 1-800-CRIMETV to contact what long-running television show? 9) In 2011, who tweeted, "I'm 43 and I did a 900 today"? 10) Finally, since there are no good trivia questions about "ten hundred," what Broadway musical features a song that begins, "Five hundred twenty-five thousand six hundred minutes / Five hundred twenty-five thousand moments so dear"?

Missing some content? Check the source: NPR
Copyright(c) 2014, NPR
Tenor Carlo Bergonzi as Radames in Verdi's Aida in 1956, the year of his Metropolitan Opera debut. (Metropolitan Opera Archives)

A Voice Of Velvet And Bronze: Carlo Bergonzi At 90

Jul 11, 2014 (ProPublica)

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Carlo Bergonzi endures. Not only is the Italian tenor approaching his 90th birthday (on July 13) but for decades he sang with tireless warmth and precision, representing a certain old school approach to carefully cultivating one's vocal resources.

Bergonzi may not have been as loud or intimidating as his Italian rivals (especially Mario del Monaco and Franco Corelli), but he outlasted them all, singing at Milan's La Scala for 20 years and at New York's Metropolitan Opera for more than 30. At age 68 he gave a farewell recital at London's Covent Garden, and at 75 he returned to New York to sing the punishing title role in Verdi's Otello. (Although he had to drop out after the second act, reportedly due to irritation from the air conditioning, his voice sounded remarkably well-preserved for its age.)

Bergonzi was born in Vidalenzo, in northern Italy, just a few miles from Verdi's birthplace. The youngster who made Parmesan cheese with his father could hardly have predicted that eventually he would become one of the most important interpreters of Verdi's music in the 20th century.

John Steane, in his book The Grand Tradition: Seventy Years of Singing on Record, 1900 to 1970, describes Bergonzi's "inner fire and outgoing command" in Verdi roles. "More than any other Italian tenor on record," Steane writes, "he combines power, beauty, intensity and elegance."

With a sturdy Italianate mix of velvet and bronze, Bergonzi's voice seemed tailor-made for most of Verdi's heroic roles. But Bergonzi also excelled in quick-tempered protagonists of the verismo style in Cavalleria Rusticana and Pagliacci and the romantic leads of Puccini's La bohème and Madama Butterfly. Some of his burnished tone comes from the fact that he made his 1948 debut as a baritone. He then retrained himself and resurfaced three years later as a tenor.

When discussing singers, opera fans often talk about musical "line." Does it flow? Is there a wobble or is the tone steady and focused? Does diction get in the way? With Bergonzi the line was supremely musical — smooth, stable and expressively phrased. There's hardly a better example than the video above, a night scene near the close of Donizetti's Lucia di Lammermoor, filmed in Tokyo in 1967. Afterward, Bergonzi received almost seven minutes of applause and 11 curtain calls. All richly deserved.

In retirement, Bergonzi turned to teaching and food. He started an academy specializing in Verdi's music and founded I Due Foscari, a restaurant and hotel (now run by his son) located in Busseto and named after Verdi's sixth opera.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Take The Ask Me Another Quiz

In honor of our 200th episode, we asked our dear pal — Ask Me Another puzzlemaster Art Chung, to whom we are resoundingly grateful — to whip up a quiz that we could pass out to the audience before the show. Here's his handiwork: 1) What children's book character lives in The Hundred Acre Wood? 2) What TV series' 200th episode featured Tom Cruise threatening to sue the town unless he got to meet the prophet Muhammad? 3) In the action movie 300, Leonidas kicks a man into a well and yells what three-word catchphrase? 4) In Francois Truffaut's classic film The 400 Blows, a 13-year-old named Antoine gets in trouble at school for plagiarizing what French writer? 5) Although it was released in 1989, the Proclaimers song "I'm Gonna Be (500 Miles)" didn't become a hit until four years later, thanks to its use in what Johnny Depp film? 6) In 2010, the 600th issue of what comic book character's signature series introduced a costume change, giving her a red top, black pants and an unfortunate blue half-jacket? 7) Because of contractual obligations stipulated by Pat Robertson when he sold his cable company, The 700 Club must air twice a day on what basic-cable network? 8) From 1995 until 2012, eagle-eyed viewers called 1-800-CRIMETV to contact what long-running television show? 9) In 2011, who tweeted, "I'm 43 and I did a 900 today"? 10) Finally, since there are no good trivia questions about "ten hundred," what Broadway musical features a song that begins, "Five hundred twenty-five thousand six hundred minutes / Five hundred twenty-five thousand moments so dear"?

Missing some content? Check the source: NPR
Copyright(c) 2014, NPR
And Tango Makes Three, co-written by Justin Richardson and Peter Parnell, illustrated by Henry Cole. (AP)

Book News: Singapore Pulls 2 Children's Books With Gay Couples From Libraries

by Annalisa Quinn
Jul 11, 2014 (ProPublica)

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The daily lowdown on books, publishing, and the occasional author behaving badly.

  • Authorities in Singapore, where gay sex is illegal, have withdrawn two children's books about gay couples from libraries. In a statement, the National Library Board suggested that gayness and family values are incompatible: "Young children are among our libraries' most frequent visitors. Many of them browse books in our children's sections on their own. As such, NLB takes a pro-family and cautious approach in identifying titles for our young visitors." The two books are And Tango Makes Three, inspired by two real male penguins who hatched an egg together, and The White Swan Express, about four couples — one of which is a lesbian couple — who travel to China to adopt baby girls. The books will be pulped, according to Time.
  • For NPR's It's All Politics blog, Frank James writes about using the Bible as a political tool: "Here are two rules of American politics: Never let an opponent's attacks go unanswered, and if you're running in the South and have a good reason to be pictured holding a Bible, go for it."
  • In the Virginia Quarterly Review, Roxana Robinson writes about the painful fragility of her concentration and the importance of having a room of one's own: "Writing is a bit like inflating a vast oxygen tent contained by a thin filmy membrane. Each time I write I have to breathe life into this, slowly blowing it larger and larger, making it more and more substantial, giving it shape. The sound of anyone's voice, an approaching step, arrests me. I waver, and the whole filmy construct trembles, shudders, and then deflates, sliding into nothingness. It's gone."
  • Irish writer Colin Barrett has won the EUR25,000 ($34,000) Frank O'Connor International Short Story Award for his collection Young Skins. Alison MacLeod, a novelist and one of the prize judges, said of Barrett in a statement: "His vision is sharp, his wit is sly, and the stories in this collection come alive with that ineffable thing — soul." Previous winners include Edna O'Brien and Haruki Murakami. Young Skins will be published in the U.S. next March by Grove Atlantic.
Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Take The Ask Me Another Quiz

In honor of our 200th episode, we asked our dear pal — Ask Me Another puzzlemaster Art Chung, to whom we are resoundingly grateful — to whip up a quiz that we could pass out to the audience before the show. Here's his handiwork: 1) What children's book character lives in The Hundred Acre Wood? 2) What TV series' 200th episode featured Tom Cruise threatening to sue the town unless he got to meet the prophet Muhammad? 3) In the action movie 300, Leonidas kicks a man into a well and yells what three-word catchphrase? 4) In Francois Truffaut's classic film The 400 Blows, a 13-year-old named Antoine gets in trouble at school for plagiarizing what French writer? 5) Although it was released in 1989, the Proclaimers song "I'm Gonna Be (500 Miles)" didn't become a hit until four years later, thanks to its use in what Johnny Depp film? 6) In 2010, the 600th issue of what comic book character's signature series introduced a costume change, giving her a red top, black pants and an unfortunate blue half-jacket? 7) Because of contractual obligations stipulated by Pat Robertson when he sold his cable company, The 700 Club must air twice a day on what basic-cable network? 8) From 1995 until 2012, eagle-eyed viewers called 1-800-CRIMETV to contact what long-running television show? 9) In 2011, who tweeted, "I'm 43 and I did a 900 today"? 10) Finally, since there are no good trivia questions about "ten hundred," what Broadway musical features a song that begins, "Five hundred twenty-five thousand six hundred minutes / Five hundred twenty-five thousand moments so dear"?

Missing some content? Check the source: NPR
Copyright(c) 2014, NPR

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