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Archives - Kickback and Physician Self-Referral

In each CMP case resolved through a settlement agreement, the settling party has contested the OIG's allegations and denied any liability. No CMP judgment or finding of liability has been made against the settling party.

2007

12-20-2007
After it self-disclosed conduct to the OIG, TLC Health Care Services, Inc. (TLC), Texas, agreed to pay $86,327 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks. The OIG alleged that TLC's subsidiary, AccuMed Home Health of North Texas, LLP, entered into two arrangements that provided free nursing services to beneficiaries and physicians with the intent to induce Federal health care program referrals from them.
08-07-2007
After it self-disclosed conduct to the OIG, Saint Francis Hospital (St. Francis), Illinois, agreed to pay $20,000 for allegedly violating the Civil Monetary Penalties Law provisions applicable to kickbacks and beneficiary inducements. The OIG alleged that St. Francis provided free transportation to 384 outpatient orthopedic surgery patients of a physician on St. Francis's medical staff. Some of these patients were Medicare beneficiaries.
07-02-2007
Advanced Neuromodulation Systems, Inc. (ANS), Texas, agreed to pay $2,950,000 and to enter into a 3-year corporate integrity agreement to resolve its liability for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ANS offered and paid remuneration to potential and existing referral sources in exchange for referrals to ANS for the purchasing, leasing, ordering, arranging for, or furnishing of medical devices that were manufactured by ANS that were payable by a Federal health care program. Other ANS practices that raised kickback concerns included educational grants and fellowships, conferences held at resort locations, free dinners and gifts, and expenses paid to physicians under consulting agreements.
06-25-2007

HealthSouth Corporation (HealthSouth), Texas, agreed to pay $100,000 to resolve its liability for allegedly violating the Civil Monetary Penalties Law (CMPL). The OIG alleged that HealthSouth violated the CMPL by entering into certain sponsorship arrangements with a high school during the period August 1, 2001, to May 31, 2006. Dr. Jack Johnston, a significant referral source for HealthSouth, was the team physician for the high school during the relevant time period. Under the terms of the sponsorship arrangements, HealthSouth agreed to provide an athletic trainer to the high school whose salary the high school supplemented by payments to HealthSouth. The agreed upon payment amount was less than the cost of the salary and benefits of the trainer provided. The OIG alleged that HealthSouth agreed to these arrangements, in large part, to induce the high school's team physician to continue making referrals to HealthSouth. HealthSouth previously entered into a corporate integrity agreement with the OIG and as a result of the above allegations, HealthSouth agreed to adopt additional integrity obligations.

03-23-2007

Candida Catucci, M.D. and Juan Carlos Acosta, New York, agreed to pay $75,000 and to enter into a 5-year integrity agreement to resolve their liability for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the two solicited and received remuneration in exchange for referring beneficiaries for MRI and/or CT scans to a particular imaging center.

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2006

12-20-2006
After it self-disclosed conduct to the OIG, Murray-Calloway County Public Hospital Corporation d/b/a Murray-Calloway County Hospital (MCCH), Kentucky, agreed to pay $175,000 and enter into a 3-year corporate integrity agreement for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that MCCH: (1) leased space in its medical office building to physician tenants at rental rates below fair market value, and entered into such lease arrangements without written agreements; (2) entered into global billing arrangements with certain physicians without written agreements; (3) entered into Medical Directorship arrangements with certain physicians for oversight of hospital-wide operations, the vascular lab, and long-term care operations without written agreements; entered into cooperative marketing arrangements with certain physicians; and (5) failed to bill a certain physician independent practice association (IPA) for the employment benefits provided to an employee of MCCH assigned to the IPA.
05-15-2006
Lincare Holdings,Inc. & Lincare, Inc. (Lincare), Florida, agreed to pay $10 million and to enter into a 5-year integrity agreement to resolve its liabilityunder the Anti-Kickback Statute provision of the CMPL and the StarkLaw. The OIG alleged that Lincare offered and paid remuneration topotential and existing referral sources to induce referrals of patientsto Lincare for the furnishing of durable medical equipment. The remunerationincluded sporting and entertainment event tickets, gift certificates,rounds of golf, golf equipment, fishing trips, meals, advertising expenses,office equipment, and medical equipment, as well as payments pursuantto purported consulting agreements.
04-17-2006
After it self-disclosedconduct to the OIG, Vanguard of Anaheim d/b/a West Anaheim MedicalCenter (WAMC), California, agreed to pay $809,945 and to enter intoa certification of compliance agreement to resolve its liability underthe CMP provisions applicable to kickbacks. The OIG alleged that WAMChad entered into lease arrangements with 19 physicians who continuedto pay rents set by the leases after the leases had expired. Duringthe time period in which the leases were expired, the OIG further allegedthat WAMC continued to bill Medicare for services ordered or referredby the physicians.
04-14-2006
After it self-disclosedconduct to the OIG, St. Joseph's Hospital, Florida, agreedto pay $307,000 and to enter into a 3-year integrity agreement to resolve its liability under the CMP provisions applicable tokickbacks. The OIG alleged that the hospital leased space to a cardiovascularsurgeon at a rate below fair market value, paid the surgeon for administrativework that his employees performed at the hospital at a rate in excessof fair market value, and paid the surgeon's employees $165per hour to be on call which is an expense that the surgeon'spractice should have incurred.
02-16-2006
Two south Florida pulmonologists, agreed to pay $65,066 and $57,030,respectively, and enter into a 3-year Integrity Agreement to resolvetheir liability under the Anti-Kickback Statute provision of theCMPL and the Stark Law.  The OIG alleged that the doctors violated thoselaws by accepting gifts, including Miami Dolphins tickets andmeals, from a durable medical equipment (DME) supplier in exchangefor patient referrals.
01-30-2006
Caring Physicians, P.C. and two Pennsylvania physicians (respondents)agreed to pay $50,000 to resolve their liability under the Anti-Kickbackprovision of the CMPL and the Stark Law. The OIG alleged that therespondents received illegal remuneration from Home Health Corporationof America, Inc. (HHCA) in the form of monthly lease payments forrental space that was not utilized by HHCA in exchange for Medicarepatient referrals.

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2005

11-28-2005
After it self-disclosed conduct to the OIG, Inova Health Care Services d/b/a Inova Fair Oaks Hospital (Inova), Virginia, agreed to pay $713,623 and to enter into a certification of compliance agreement to resolve its liability under the CMP provisions applicable to kickbacks and stark law violations. The OIG alleged that from 1998 to 2004, Inova subleased space in one of its medical office buildings to physicians at rental rates that were below the fair market value. In one instance, the OIG further alleged that one physician failed to pay any rent from 1999 through 2004.
06-15-2005
After it self-disclosed conduct to the OIG, Medical CenterHospital, Texas, agreed to pay $333,500 to resolve its liability under theCMP provisions applicable to kickbacks. The OIG alleged that from December1, 1998 through November 30, 2001, the hospital leased space to a physiciangroup at a rate below fair market value. The error was discovered by an externalaudit performed as part of the hospital's compliance program. The originallease amount that was proposed and approved by the hospital board was substantiallyhigher than the final lease amount contained in the lease agreement.
06-13, 2005
A former Chief Executive Officer (CEO) of GoodSamaritan Hospital, Nebraska, agreed to pay $130,000 and to enterinto a 3-year integrity agreement to resolve his liability underthe CMP provisions applicable to kickbacks. The OIG alleged thatfrom September 1994 through October 1999, the former CEO providedfinancial assistance to a physician in the form of bank loan guarantees,the payment of consultant fees, and the provision of discounted pharmaceuticals,biologicals, supplies, and medical equipment to induce her referralof Medicare beneficiaries requiring cardiology care to the hospital.As a result of the former CEO'sconduct, he allegedly received annual bonuses that reflected, inpart, the referrals made by the physician to Good Samaritan Hospital.The hospital previously entered into a False Claims Act settlementrelated to this conduct.
05-24, 2005
Home Health Corporation of America (HHCA), Pennsylvania, agreed to pay $300,000and to enter into a 5-year integrity agreement to resolve its liability underthe CMP provisions applicable to kickbacks. The OIG alleged that from February1997 through May 1998, HHCA made payments in the form of loans, consulting fees,and monthly space rental payments to six physicians located in Pennsylvania andFlorida to induce their referral of Medicare beneficiaries requiring home healthservices and/or durable medical equipment that was provided by HHCA and paidfor by the Medicare program.
05-2, 2005
After it self-disclosed conduct to the OIG, St. Joseph Mercy-Oakland(SJMO), Michigan, agreed to pay $4 million to resolve its liability under theCMP provisions applicable to kickbacks and stark law violations. The OIG allegedthat SJMO entered into financial arrangements with 14 different physicians andphysician groups. The financial arrangements allegedly included office managementservices, medical equipment, lease and/or purchase agreements, loans, and incomeguarantees.
03-29-2005
PharMerica Drug Systems, Inc. and PharMerica, Inc. (collectivelyPharMerica), agreed to pay $5,975,000 and to enter into a corporate integrityagreement to resolve its liability under the CMPL provisions applicable to kickbacks.The OIG alleged that PharMerica entered into a purchase and sale agreement withthe owners of a nursing facility chain to acquire the chain's institutionalpharmacy for $7.2 million. Prior to the purchase of the pharmacy, the pharmacyhad been operational for only eight weeks and was serving a small percentageof the nursing facilities' approximately 2800 residents. PharMerica allegedlyconditioned its purchase of the pharmacy on the creation of a pharmacy servicesagreement (PSA) that contractually required the nursing facilities to orderits drugs from the pharmacy. PharMerica allegedly negotiated the PSA itselfin the month before the execution of the PSA. The OIG alleged that the PSAwas backdated to July 9, 1996 to make it appear that the pharmacy had a longeroperating history than it did.
02-15-2005
After it disclosed conduct to the OIG pursuant to the requirements of its corporate integrityagreement, Tender Loving Care Health Care Services, Inc. (TLC), a nationwide home health agency,agreed to pay $130,000 to resolve its liability under the CMP provisions applicable to false claimsand kickbacks. The OIG alleged that one of TLC's franchisees (Miami Lakes) paid commissionsto non-employees who were providing marketing services. TLC allegedly made commission paymentsfor each patient referred to TLC by the independent contractor sales representatives. The paymentswere allegedly based on the type of services utilized by the referred patients. TLC disclosed thealleged kickback violation pursuant to its corporate integrity agreement that it entered into in2000.

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2004

09-30-2004
A California physician agreed to pay $57,500 and to enter into an IntegrityAgreement to resolve his liability under the CMP provisions applicable to false claims and kickbacks.The OIG alleged that the physician received free samples of the prostate cancer drug Lupron fromTap Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and otherpayers.
09-15-2004
A Texas physician agreed to pay $38,941.92 and to enter into an IntegrityAgreement to resolve his liability under the CMP provisions applicable to false claims and kickbacks.The OIG alleged that the physician received free samples of the prostate cancer drug Lupron fromTap Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and otherpayers.
06-29-2004
A New Jersey physician agreed to pay $500,000 and enter into a five-year integrityagreement to resolve his liability under the CMP provisions for violating the Stark Law and theAnti-Kickback Statute. The physician entered into two lease agreements with a home health agency/durablemedicalequipment supplier to which the physician referred Federal health care program beneficiaries. TheOIG alleged that neither lease was commercially reasonable and that both leases were shams to disguisekickbacks paid to the physician in exchange for referrals.
03-26-2004
After it self-disclosed conduct to the OIG, Blue Grouse Health Care Center,a skilled nursing facility located in Colorado, and its medical director, agreed to pay $23,000toresolve their liability under the CMP provisions applicable to physician self-referrals. The OIGalleged that the medical director of Blue Grouse was one of the owners of an investment firm thatwas the licensed operator of Blue Grouse and also was the attending physician for some of BlueGrouse'sresidents. The OIG alleged that Blue Grouse billed Medicare for designated health services providedto its residents pursuant to the orders of the medical director.
03-05-2004
A Pennsylvania physician agreed to pay $80,000 and to enter into an integrity agreement to resolvehis liability under the CMP provisions applicable to false claims and kickbacks. The OIG allegedthat the physician received illegal remuneration from Home Health Corporation of America, Inc.(HHCA) in the form of monthly lease payments for rental space not utlilized by HHCA. In exchangefor these payments, the OIG further alleged that the physician would in turn refer Medicare beneficiariesto HHCA.

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2003

11-24-2003
A Ohio urologist agreed to pay $42,224 and to enter into an integrity agreement to resolve hisliability under the CMP provisions applicable to false claims and kickbacks. The OIG alleged thatthe urologist conspired with AstraZeneca Pharmaceuticals LP employees to receive free samples ofthe prostate cancer drug Zoladex and billed at least some of those samples to Medicare and otherpayers.
09-16-2003
After it self-disclosed conduct to the OIG, Dominican Health Services,d/b/a Holy Family Hospital (Holy Family), Washington, agreed to pay $270,000 and to maintain itsexisting compliance program and to undertake certain integrity obligations for a three-year periodto resolve its liability under the CMP provisions applicable to kickbacks. The OIG alleged thatHoly Family paid remuneration to induce referrals from an entity owned by urologists. The OIG allegedthat Holy Family entered into a series of contracts with an entity owned by urologists under whichHoly Family paid the entity in excess of fair market value for the lease of a lithotripter andcontractedlithotripsy services. The OIG alleged that Holy Family's payments were to induce Federalhealth care program referrals from the urologists who owned the entity.
08-28-2003
A Pennsylvania physician agreed to pay $140,000 and to enter into a 3-year integrity agreementto resolve his liability under the CMP provisions applicable to false claims and kickbacks. TheOIG alleged that the physician received $30,000 in kickbacks disguised as loans for improvementsto his medical office from a company. In exchange, the physician allegedly referred Medicare beneficiariesrequiring durable medical equipment items to the company.
08-20-2003
A Tennessee physician agreed to pay $71,400 and to enter into an Integrity Agreement to resolvehis liability under the CMP provisions applicable to false claims and kickbacks. The OIG allegedthat the physician received free samples of the prostate cancer drug Lupron from Tap PharmaceuticalProducts, Inc. and billed at least some of those samples to Medicare and other payers.
07-08-2003
Greenport Rescue Squad, Inc. (Greenport), an ambulance company located in New York, agreed topay $10,000 to resolve its liability under the CMP provisions applicable to kickbacks. The OIGalleged that Greenport participated in a kickback scheme that involved Greenport paying remunerationto a hospital in the form of deep discounts on all ambulance transports of inpatients for whichthe hospital was financially responsible in return for the hospital's promise to refer otherseparately-reimbursable ambulance business to Greenport. The OIG alleged that the conduct in thiscase constituted an ambulance "swapping" arrangement of the type that the OIG had identifiedas potentially illegal in OIG AdvisoryOpinion 99-2, issued February 26, 1999.
07-03-2003
A Monterey Park, California, physician agreed to pay $80,000 and to enter into an IntegrityAgreement to resolve his liability under the CMP provisions applicable to false claims and kickbacks.The OIG alleged that the physician received free samples of the prostate cancer drug Lupron fromTap Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and otherpayers.
04-22-2003
Family Health Group, and three of its member physicians, Puerto Rico, agreed to pay $200,000and enter into a 3-year integrity agreement to resolve their liability under the CMP provisionsapplicable to kickbacks and physician self referrals. The OIG alleged that Family Health Groupand its member physicians solicited and received loans from the owner of a durable medical equipment(DME) company and a pharmacy in return for Family Health Group's agreement to direct theirpatient referrals to the DME company and pharmacy.
03-18-2003
Columbia Memorial Hospital (Columbia), New York, agreed to pay $25,000 to resolve its liabilityunder the CMP provisions applicable to kickbacks. The OIG alleged that Columbia solicited and receivedremuneration from an ambulance company in the form of deep discounts on all ambulance transportsof inpatients for which the hospital was financially responsible in return for Columbia'spromise to refer other separately-reimbursable ambulance business to the ambulance company. TheOIG alleged that the conduct in this case constituted an ambulance "swapping" arrangementof the type that the OIG had identified as potentially illegal in OIGAdvisory Opinion 99-2, issuedFebruary 26, 1999.
02-19-2003
A Chula Vista, California, physician agreed to pay $64,326 and enter into an Integrity Agreement to resolve his liability under the CMP provisions applicable to false claims and kickbacks. The OIG alleged that the physician received free samples of the prostate cancer drug Lupron from TAP Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and other payors.
01-31-2003
After it self-disclosed conduct to the OIG, Inland Empire Lithotripsy, LLC (f/k/a Inland EmpireLithotripsy, Inc.) (Inland), Washington, agreed to pay $404,538 and enter into a 3-year IntegrityAgreement to resolve its liability under the CMP provisions applicable to kickbacks. The OIG allegedthat Inland, an entity owned by urologists, received payments from a hospital in excess of fairmarket value for rental of a lithotripter and provision of lithotripsy services in exchange forInland's referral of Medicare patients to the hospital. The OIG also alleged that Inlandterminated some of its physician members in retaliation for the failure of those physicians torefer a sufficient number of patients to the hospital.
01-13-2003
A Fairfield, New Jersey, physician (now retired) agreed to pay $40,000 to resolve his liability under the CMP provisions applicable to false claims and kickbacks. The OIG alleged that the physician received free samples of the prostate cancer drug Lupron from TAP Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and other payors.
01-08-2003
Cardiology Consultants, P.A., and its member physicians, all of Delaware, agreed to pay $611,250 to resolve their liability under the CMP provisions applicable to kickbacks and physician self-referrals. This cardiology group paid hourly fees to physicians who were not members of the group to monitor cardiac stress tests at the cardiology group's testing facilities. The OIG alleged that the payments to these contracting physicians were in excess of fair market value and were not commercially reasonable. In addition to the settlement payment, the group agreed to lower its monitoring fees and entered into a three-year integrity agreement.
01-08-2003
Performance Plus, Inc., a DME supplier, and its owner, both of New Jersey, agreed to pay $50,000 to resolve their liability under the CMP provisions applicable to kickbacks. The OIG alleged that Performance operated a program under which it offered and provided free devices to physicians who prescribed and ordered DME from Performance.
01-06-2003
A Pueblo, California, physician agreed to pay $95,000 and enter into an Integrity Agreement to resolve his liability under the CMP provisions applicable to false claims and kickbacks. The OIG alleged that the physician received free samples of the prostate cancer drug Lupron from TAP Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and other payors.

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2002

11-01-2002
A Glendale, California, physician agreed to pay $50,000 and enter into an Integrity Agreement to resolve his liability under the CMP provisions applicable to false claims and kickbacks. The OIG alleged that the physician received free samples of the prostate cancer drug Lupron from TAP Pharmaceutical Products, Inc. and billed at least some of those samples to Medicare and other payors.
10-03-2002
Pride Mobility Products, a Pennsylvania DME company, agreed to pay $80,000 to resolve its liability for violations of the kickback provision of the CMPL. An OIG investigation revealed that through a marketing program, the company solicited and received monthly payments from suppliers in return for referring sales leads to those suppliers. In addition to the payment under the settlement agreement, the company was also required to adopt and implement certain compliance measures.
06-12-2002
A Tampa, Florida, physician agreed to pay $63,000 and enter into a 5-year integrity agreement to resolve his liability under the kickback provision of the CMPL. The OIG alleged that in return for referrals to a clinical laboratory, the physician received monthly payments for space and medical equipment rental. The OIG alleged that the rental payments were above fair market value.
06-04-2002
A Tennessee physician agreed to pay $8,000 to resolve her liability under the CMP provisionsapplicable to kickbacks and physician self-referrals. The physician received payments from a diagnosticimaging company. The OIG alleged that the payments violated both the kickback and physician self-referralstatutes because they exceeded fair market value and varied based on the number of services referredby the physician to the diagnostic imaging company.
04-30-2002
Ultra Healthcare Services Inc., a Clearwater, Florida, mobile diagnostic and respiratory care services provider, and its owner, agreed to pay $25,000 and enter into a 5-year integrity agreement to resolve their liability under the kickback provision of the CMPL. The OIG alleged that the provider paid numerous physicians kickbacks disguised as monthly space rental payments for their referrals of Medicare business.
03-21-2002
After it self-disclosed conduct to the OIG, Pediatric Services of America, a Georgia corporation that provides nationwide home health services, agreed to pay $130,691 to resolve its liability for violations of the kickback provision of the CMPL. The OIG alleged that one of the company's subsidiaries paid kickbacks to a certain individual to induce referrals of Federal health care program patients. As part of the settlement, the company agreed to implement anti-kickback compliance measures to supplement its current compliance program.

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2001

10-31-2001
OB-GYN Associates, Inc., and four physicians,, all of Tennessee, agreed to pay $109,900 to resolve their liability under the CMP authorities for kickbacks and physician self-referrals. The physician group received payments from a diagnostic imaging company. The OIG alleged that the payments violated both the kickback and physician self-referral statutes because they exceeded fair market value and varied based on the number of services referred by the physicians to the company.
06-18-2001
A Tampa, Florida, physician agreed to pay $150,000 and enter into a 5-year integrity agreement to resolve his liability under the kickback provision of the CMPL. The OIG alleged that the physician received kickbacks from a clinical laboratory in the form of space rental payments, payments for alleged consulting work, and payments for employee salaries in return for referrals of Medicare business. The OIG alleged that the space rental and consulting fees were above fair market value.
06-18-2001
A New Port Richey, Florida, physician agreed to pay $70,000 to resolve his liability under the kickback provision of the CMPL. The OIG alleged that in return for referrals to a clinical laboratory, the physician received space rental payments in excess of fair market value and payments for employee salaries. In addition to the settlement payment, the physician agreed to a voluntary exclusion for a period of four years.
06-05-2001
A Spring Hill, Florida, physician agreed to pay $16,200 and enter into a 5-year integrity agreement to resolve his liability under the kickback provision of the CMPL. The OIG alleged that the physician received kickbacks from a clinical laboratory for alleged consulting work in return for referrals of Medicare business. The OIG alleged that the payments for the physician's consulting services were above fair market value. The settlement amount took into account the physician's financial condition.
05-24-2001
A Tampa, Florida, physician agreed to pay $30,000 and enter into a 3-year integrity agreement to resolve his liability under the kickback provision of the CMPL. The OIG alleged that in return for his referrals to a clinical laboratory, the physician received monthly payments for space and equipment rentals that exceeded fair market value.
05-23-2001
A Zephyrhills, Florida, physician agreed to pay $95,000 and enter into a 5-year integrity agreement to resolve his liability under the kickback provision of the CMPL. The OIG alleged that in return for referrals to a mobile diagnostic services provider, the physician received space rental payments that exceeded fair market value.
03-12-2001
American Medical Imaging, Inc., a diagnostic imaging company, and its owners, all of Tennessee, agreed to pay $225,000 to resolve their liability under the CMP provisions applicable to kickbacks, physician self-referrals, and false or fraudulent claims. In addition, one of the owners of the company agreed to a permanent exclusion from participation in Federal health care programs and the other owner agreed to certain integrity provisions. The company paid physicians ostensibly to rent space in the physicians' offices. The OIG alleged that the payments violated both the kickback and physician self-referral statutes because the payments exceeded fair market value and varied based on the number of services referred by the physicians to the company. In addition, the OIG alleged that the company submitted claims with inappropriate diagnosis codes chosen based on reimbursement rather than medical justification.
01-31-2001
A New York City cardiologist, agreed to pay $30,000 to resolve his liability under the kickback provision of the CMPL. The OIG alleged that the cardiologist paid cash on a per-patient basis to a primary care physician induce the referral of Medicare beneficiaries to the cardiologist for cardiac diagnostic testing.

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