HIPAA Breach News

Medical Informatics Engineering Settles HIPAA Breach Case for $100,000

Medical Informatics Engineering, Inc (MIE) has settled its HIPAA violation case with the HHS’ Office for Civil Rights for $100,000.

MIE, an Indiana-based provider of electronic medical record software and services, experienced a major data breach in 2015 at its NoMoreClipboard subsidiary.

Hackers used a compromised username and password to gain access to a server that contained the protected health information (PHI) of 3.5 million individuals. The hackers had access to the server for 19 days between May 7 and May 26, 2015. 239 of its healthcare clients were impacted by the breach.

OCR was notified about the breach on July 23, 2015 and launched an investigation to determine whether it was the result of non-compliance with HIPAA Rules.

OCR discovered MIE had failed to conduct an accurate and through risk analysis to identify all potential risks to the confidentiality, integrity, and availability of PHI prior to the breach – A violation of the HIPAA Security Rule 45 C.F.R. § 164.308(a)(l)(ii)(A).

As a result of that failure, there was an impermissible disclosure of 3.5 million individual’s PHI, in violation of 45 C.F.R. § 164.502(a).

MIE chose to settle the case with OCR with no admission of liability. In addition to paying a financial penalty, MIE has agreed to adopt a corrective action plan that requires a comprehensive, organization-wide risk analysis to be conducted and a risk management plan to be developed to address all identified risks and reduce them to a reasonable and acceptable level.

“Entities entrusted with medical records must be on guard against hackers,” said OCR Director Roger Severino. “The failure to identify potential risks and vulnerabilities to ePHI opens the door to breaches and violates HIPAA.”

While the settlement releases MIE from further actions by OCR over the above violations of HIPAA Rules, MIE is not out of the woods yet. In December 2018, a multi-state lawsuit was filed against MIE by 12 state attorneys general over the breach.

The lawsuit alleged there was a failure to implement adequate security controls, that known vulnerabilities had not been corrected, encryption had not been used, security awareness training had not been provided to staff, and there were post-breach failures at MIE. That lawsuit has yet to be resolved. It could well result in a further financial penalty for MIE.

This is OCR’s second financial penalty of 2019. Earlier this month, a $3,000,000 settlement was agreed with Touchstone Medical Imaging to resolve multiple HIPAA violations, several of which were related to the delayed response to a data breach.

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Boxes of Records of Today’s Vision Patients and Employees Discovered in Texas Dumpster

Thousands of medical records have been found abandoned in a publicly accessible dumpster in Texas. The boxes contain records of Today’s Vision patients and employees and include paperwork containing highly sensitive information.

Today’s Vision has more than 50 independently owned and operated optometry clinics throughout Texas. Most of the records appear to have come from Today’s Vision in Willowbrook in northwest Houston. The Willowbrook location is no longer operational and was sold to MyEyeDr three months ago.

Dr. Donald Glenz owned and ran both the Willowbrook and Tomball Today’s Vision offices, prior to the sale to MyEyeDr in February. Dr. Glenz is unaware how the files came to be dumped and who is responsible. Dr. Glenz told KPRC that the incident is being investigated to determine who was responsible. Prior to any records being deleted they are usually shredded in accordance with HIPAA requirements but that did not occur in this instance. Today’s Vision executive director Greg Watson described the discovery as ‘disturbing.’

The incident is also being investigated by MyEyeDr and the Department of Health and Human Services is working closely with the police department and is investigating the HIPAA violation.

Over 20 boxes of records were discovered in a dumpster behind the strip mall in Tomball, which is several miles away from the offices where the records were held. The boxes have been recovered by Tomball Police department and are being securely stored.

The records appear to relate to patients who received vision services between 1997 and 2013 and staff who served at Willowbrook location in the same time period.

The types of information in the paperwork include names, addresses, phone numbers, payment information, insurance information, limited health histories, and Social Security numbers. Employee information includes work related information such as resumes, immigration status, vacation requests, payment information, and some personal information.

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PHI of 1.5 Million Individuals Exposed Online by Inmediata

In April, Inmediata, a provider of clearinghouse services to healthcare organizations, announced that the protected health information of certain patients had been exposed online as a result of a misconfigured setting on an internal web page.

The incident has now been reported to the Department of Health and Human Services’ Office for Civil Rights. The breach report indicates 1,565,338 individuals had their PHI exposed. That makes the data breach the largest to be reported in 2019.

The information had been made available to employees through an internal web page, but the failure to configure that page correctly allowed the data to be made accessible over the internet without the need for authentication. The page was indexed by Google and patient information could be found through online searches.

The information had been provided by hospitals, health plans, and independent physicians and included names, addresses, dates of birth, gender, claims data and, for a small number of patients, Social Security numbers.

Inmediata immediately deactivated the web page when it was discovered that patient information had been exposed and a computer forensics firm was retained to conduct an investigation to determine whether any patient information had been accessed by unauthorized individuals during the time it was available online.

While the investigation did not uncover any evidence to suggest that information had been accessed or copied by unauthorized individuals, it was not possible to rule out unauthorized data access entirely.

Immediata started sending breach notification letters to affected individuals on April 22, 2019. As if suffering such a large data breach was not bad enough, there were further impermissible disclosures of protected information in the breach response.

Individuals reported receiving breach notification letters addressed to other individuals. In addition, several individuals complained that it was not made clear who the company was and why it had their personal information.

You can read more about the mailing error on this link.

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Phishing Attack on Hematology Oncology Associates Sees Multiple Email Accounts Breached

The email accounts of several employees of Medford, OR-based Hematology Oncology Associates. P.C. have been compromised as a result of responses to phishing emails. The phishing attack was detected on March 19, 2018, although the investigation revealed the first account was breached on December 18, 2018. Further accounts were compromised up until February 22, 2019.

Third-party computer forensics experts were retained to investigate the breach, but it was not possible to determine which, if any, emails and attachments had been opened by the attackers.

The breach investigation was concluded on April 20 and confirmed that some of the emails and attachments in the compromised accounts contained patients’ protected health information.

A password reset has been performed to prevent further unauthorized access and additional security awareness training will be provided to employees.

The breach has been reported to the HHS’ Office for Civil Rights and state attorneys general and affected individuals have been offered free membership to Experian’s IdentityWorks credit monitoring and identity theft protection services.

It is currently unclear how many people have been affected by the breach.

Former Penn Medicine Employee Accused of Accessing and Misusing Patient Information

A former medical assistant at Penn Medicine has been accused of accessing patient information without authorization and misusing the information of at least one patient.

The contract employee had been hired through a staffing agency and worked at Penn Medicine between February and April 2019. Penn Medicine learned on April 29, 2019 that the employee had accessed patient information without any legitimate work reason for doing so.

The types of information that could have been viewed included names, demographic information, clinical information and, for certain patients, Social Security numbers. In total, the former employee had accessed 900 patient records during the 3 months of employment.

Penn Medicine spokesperson Lauren Steinfeld issued a statement saying Penn Medicine is aware of one patient whose PHI had been misused, although the nature of that misuse was not disclosed.

All 900 patients have now been notified about the privacy breach. Penn Medicine is also reviewing its use of contractors and staffing agencies and will be taking steps to ensure all employees maintain high professional standards.

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Another Phishing Attack Reported by Cancer Treatment Centers of America

Cancer Treatment Centers of America (CTCA) has discovered the email account of an employee of its Southeastern Regional Medical Center has been compromised as a result of a response to a phishing email.

The email account breach occurred on March 10, 2019 after the employee disclosed network login credentials when responding to a seemingly legitimate internal email. CTCA discovered the breach the following day and secured the account by changing the password.

The account was accessible for less than two days, but during that time it is possible that information in emails and email attachments may have been viewed. The third-party computer forensics firm that was retained to conduct an investigation and found no evidence to suggest any patient health information was viewed, but it was not possible to rule out PHI access or data theft.

The compromised email account contained names, addresses, medical record numbers, government ID numbers, health insurance information, and some medical information. No Social Security numbers or financial information were exposed.

Individuals affected by the breach are being notified and have been told to be alert to the possibility of misuse of their personal information and to carefully monitor their explanation of benefits statements and other account statements for unfamiliar charges or items.

This is the second successful phishing attack on CTCA to be reported in the past 6 months. In December 2018, an employee’s email account was compromised which contained the protected health information of 41,948 patients.

The breach occurred on May 2, 2018, CTCA was informed about the breach on September 26, 2018, and the breach was announced in early December. In that incident, the account was accessible for less than a day.

In response to the latest incident, further email security enhancements are being evaluated and CTCA is continuing to reinforce security awareness training and is ensuring employees know how to recognize phishing emails.

It is currently unclear how many individuals have been affected by the latest breach. The security breach has been reported to the Vermont Attorney General, but the incident has not yet appeared on the HHS’ Office for Civil Rights breach portal.

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April 2019 Healthcare Data Breach Report

April was the worst ever month for healthcare data breaches. More data breaches reported than any other month since the Department of Health and Human Services’ Office for Civil Rights started publishing healthcare data breach reports in October 2009. In April, 46 healthcare data breaches were reported, which is a 48% increase from March and 67% higher than the average number of monthly breaches over the past 6 years.

While breach numbers are up, the number of compromised healthcare records is down. In April 2019, 694,710 healthcare records were breached – A 23.9% reduction from March.  While the breaches were smaller in March, the increase in breaches is of great concern, especially the rise in the number of healthcare phishing attacks.

Largest Healthcare Data Breaches in April 2019

Two 100,000+ record data breaches were reported in April. The largest breach of the month was reported by the business associate Doctors Management Services – A ransomware attack that exposed the records of 206,695 patients.

The ransomware was deployed 7 months after the attacker had first gained access to its systems. The initial access was gained via Remote Desktop Protocol (RDP) on a workstation.

The second largest data breach was reported by the healthcare provider Centrelake Medical Group. The breach resulted in the exposure of 197,661 patients’ PHI and was also a ransomware attack that prevented patient information from being accessed. While the delay between access to the servers being gained and the ransomware being deployed was not as long, it also appeared that the attacker had been exploring the network prior to deploying the malicious software. Access to the server was gained 6 weeks prior to the ransomware being deployed. Ransomware was also used in the attack on ActivYouth Orthopaedics.

Covered Entity Entity Type Records Exposed Breach Type Location of Breached PHI
Doctors Management Services, Inc. Business Associate 206695 Hacking/IT Incident Network Server
Centrelake Medical Group, Inc. Healthcare Provider 197661 Hacking/IT Incident Network Server
Gulf Coast Pain Consultants, LLC d/b/a Clearway Pain Solutions Institute Healthcare Provider 35000 Unauthorized Access/Disclosure Electronic Medical Record
EmCare, Inc. Healthcare Provider 31236 Hacking/IT Incident Email
Kim P. Kornegay, DMD Healthcare Provider 27000 Theft Desktop Computer, Electronic Medical Record, Paper/Films
Pediatric Orthopedic Specialties, PA, dba ActivYouth Orthopaedics Healthcare Provider 24176 Hacking/IT Incident Network Server
Health Recovery Services, Inc. Healthcare Provider 20485 Unauthorized Access/Disclosure Network Server
Baystate Health Healthcare Provider 11658 Hacking/IT Incident Email
Riverplace Counseling Center, Inc. Healthcare Provider 11639 Hacking/IT Incident Network Server
Minnesota Department of Human Services Healthcare Provider 10263 Hacking/IT Incident Email

Causes of April 2019 Healthcare Data Breaches

Hacking/IT incidents outnumbered unauthorized access/disclosure incidents by 2 to 1 in April. 28 of the reported breaches of 500 or more records were due to hacking/IT incidents. There were 14 unauthorized access/disclosure incidents, two cases of theft of PHI, one reported case of loss of paperwork, and one case of improper disposal of PHI.

While 2018 saw a decline in the number of ransomware attacks across all industry sectors, the number of ransomware attacks is increasing once again, and healthcare is the most attacked industry. Remote Desktop Protocol often exploited to gain access to servers and workstations to deploy ransomware.

In May, a Forescout study revealed that the use of vulnerable protocols is common in the healthcare industry. Risk can be reduced by disabling these protocols, and if RDP must be used, to only use RDP with a VPN.

Phishing attacks also increased considerably in April, which highlights just how vulnerable healthcare organizations are to this type of attack. Advanced anti-phishing and anti-spam solutions can reduce the volume of malicious emails that reach inboxes and combined with regular security awareness training, risk can be reduced.

The use of multi-factor authentication is also important. In the event of credentials being compromised, MFA will prevent those credentials from being used to gain access to PHI. MFA is not infallible, but it can ensure risk is reduced to a reasonable and acceptable level. According to Verizon, most credential theft incidents would not have resulted in a data breach if MFA been implemented.

Hacking/IT incidents resulted in the highest number of compromised records in April 2019 – 384,219 records or 55% of all compromised records in April. The mean breach size was 13,722 records and the median breach size was 4,008 records.

Unauthorized access/disclosure incidents resulted in the exposure of 264,016 records or 38% of the month’s total. While hacking incidents usually result in more records being compromised, these incidents were more severe and had a mean breach size of 18,858 records. The median breach size was 3,193 records.

31,810 records were exposed to loss or theft – 4.6% of the month’s total. The mean breach size was 10,603 records and the median breach size was 4,000 records.

April 2019 healthcare data breaches - breach cause

Location of Breached Protected Health Information

Email was the most common location of breached PHI in April. Email was involved in 22 data breaches – 47.8% of all breaches in April 2019. While this category includes misdirected emails, the majority of email breaches were due to phishing attacks.

Network servers were involved in 11 breaches – 23.9% of the month’s breaches – which include malware and ransomware attacks.

Physical records such as paperwork, charts, and films were involved in 6 breaches – 13% of the month’s total.

April 2019 healthcare data breaches - location of PHI

April Breaches by Covered Entity Type

April was a relatively good month for business associates of covered entities with only two breaches reported and one further breach having some business associate involvement, although a business associate breach was the largest breach of the month.

6 health plans reported breaches in April and the remaining 38 breaches were reported by healthcare providers.

April 2019 healthcare data breaches by covered entity type

April 2019 Healthcare Data Breaches by State

Data breaches were reported by entities based in 21 states in April. California and Texas were the worst affected, with each state having 5 breaches. Florida, Minnesota, and Ohio each had four breaches, and there were 3 breaches reported by entities in Illinois.

Idaho, Massachusetts, New York, Oregon, Tennessee, and Washington each had 2 breaches and one breach was reported in each of Alabama, Delaware, Louisiana, North Carolina, New Jersey, Pennsylvania, South Dakota, Utah, and West Virginia.

HIPAA Enforcement Activity in April 2019

There were no financial penalties issued by the HHS’ Office for Civil Rights or state Attorneys General in 2019. The first OCR financial penalty of 2019 was issued in May – A $3,000,000 penalty for Touchstone Medical Imaging for the delayed response to a data breach in which the records of 307,839 patients were exposed.

In addition to the delayed response, there was a failure to issue breach notifications in a reasonable time frame, a failure to notify the media about the breach, two BAAs failures, insufficient access rights, and a risk analysis failure.

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Medical Oncology Hematology Consultants Notifies Patients about June 2018 Data Breach

Medical Oncology Hematology Consultants (MOHC), a Newark, DE-based cancer treatment center, is alerting certain patients that some of their protected health information (PHI) has been exposed as a result of an email security breach.

According to the substitute breach notice on the MOHC website, an email account was compromised between June 7 and June 8, 2018. It is unclear when MOHC learned of the breach, but its ‘extensive investigation’ concluded on March 14, 2019 that the breach had resulted in the exposure of patient information.

Third party computer forensics experts were engaged to conduct the investigation, which involved extensive coordination with the company that hosts its email environment. Data access and theft could not be ruled out, although no reports have been received to suggest any patient information has been misused.

Names, dates of birth, Social Security numbers, government ID numbers, financial account information, and health and medical information were exposed. All patients affected by the breach have been notified and offered 12 months of membership to credit monitoring and associated services at no cost.

Steps have been taken to improve email security including the use of a new, secure portal for the delivery of emails from external sources, additional malware blocking measures, a suspicious email reporting system, encryption of outgoing emails, and the provision of further security awareness training to employees. Notifications have also been set up to alert employees if they are attempting to send emails containing unencrypted sensitive information.

This is the second large data breach to be reported by MOHC in the past 2 years. In September 2017, MOHC announced that it was the victim of a ransomware attack that impacted 19,000 patients.

It is currently unclear how many patients have been affected by the latest security breach.

Health Net of California Mailing Error Results in Impermissible Disclosure of PHI

Health Net of California has discovered a coding error on a mailing has resulted in the impermissible disclosure of subscribers’ PHI.

The coding error was introduced on a mail merge which caused letters to be misaligned. As a result, the PHI of subscribers was printed on letters that were mailed to other subscribers. The coding error occurred on March 1 and affected mailings up until March 12, 2019.

As a result of the error, the following data elements were impermissibly disclosed: Name, date of birth, Health Net ID number, health plan name, group number, dependents’ names and ages, primary care physician’s name and address, and the last four digits of dependents’ social security numbers.

Health Net of California identified and corrected the coding error and has implemented additional procedures for future mailings, including several testing scenarios and the use of a checklist to make sure errors are found and corrected prior to letters being mailed.

It is currently unclear how many subscribers have been affected.

American Medical Response Alerts Patients About Email Breach

American Medical Response, a Greenwood Village, CO-based provider of emergency and patient relocation services, has discovered an unauthorized individual has gained access to the PHI of 4,300 patients who had previously used its ambulance service.

The information was contained in employee email accounts that were compromised as a result of a phishing attack. The compromised email accounts contained names, addresses, dates of birth, Social Security numbers, health insurance identifiers, and diagnostic and treatment information. The breach was limited to email accounts and no other systems or databases were subjected to unauthorized access.

While patients’ protected health information was potentially accessed, no reports have been received to suggest any patient information has been misused.

All patients affected by the breach have been notified by mail and have been offered complimentary credit monitoring services. American Medical Response has implemented additional security measures to reduce the risk of further email account breaches and employees have been provided with additional security awareness training.

Bloodworks Northwest Notifies Patients of PHI Exposure

The Seattle, WA-based blood bank and medical research institute, Bloodworks Northwest, is alerting 1,893 patients that some of their PHI has been exposed and potentially stolen.

On March 13, 2019, Bloodworks discovered a list containing patients’ names, dates of birth, and medical diagnoses had gone missing from an employee’s desk. Despite a search being performed, the list could not be located.

Peculiarly, the Notice of Data Privacy Event on the Bloodworks website says “While we are unaware of any misuse of the personal information in the impacted email account, we encourage you to remain vigilant against incidents of identity theft and fraud, to review your account statements, and to monitor your credit reports for suspicious activity.”

It is unclear whether this is an error or if an email account was also compromised. The breach report submitted to the HHS’ Office for Civil Rights suggests the breach solely involved the loss of paperwork.

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Medical Oncology Hematology Consultants Notifies Patients about June 2018 Data Breach

Medical Oncology Hematology Consultants (MOHC), a Newark, DE-based cancer treatment center, is alerting certain patients that some of their protected health information (PHI) has been exposed as a result of an email security breach.

According to the substitute breach notice on the MOHC website, an email account was compromised between June 7 and June 8, 2018. It is unclear when MOHC learned of the breach, but its ‘extensive investigation’ concluded on March 14, 2019 that the breach had resulted in the exposure of patient information.

Third party computer forensics experts were engaged to conduct the investigation, which involved extensive coordination with the company that hosts its email environment. Data access and theft could not be ruled out, although no reports have been received to suggest any patient information has been misused.

Names, dates of birth, Social Security numbers, government ID numbers, financial account information, and health and medical information were exposed. All patients affected by the breach have been notified and offered 12 months of membership to credit monitoring and associated services at no cost.

Steps have been taken to improve email security including the use of a new, secure portal for the delivery of emails from external sources, additional malware blocking measures, a suspicious email reporting system, encryption of outgoing emails, and the provision of further security awareness training to employees. Notifications have also been set up to alert employees if they are attempting to send emails containing unencrypted sensitive information.

This is the second large data breach to be reported by MOHC in the past 2 years. In September 2017, MOHC announced that it was the victim of a ransomware attack that impacted 19,000 patients.

It is currently unclear how many patients have been affected by the latest security breach.

Health Net of California Mailing Error Results in Impermissible Disclosure of PHI

Health Net of California has discovered a coding error on a mailing has resulted in the impermissible disclosure of subscribers’ PHI.

The coding error was introduced on a mail merge which caused letters to be misaligned. As a result, the PHI of subscribers was printed on letters that were mailed to other subscribers. The coding error occurred on March 1 and affected mailings up until March 12, 2019.

As a result of the error, the following data elements were impermissibly disclosed: Name, date of birth, Health Net ID number, health plan name, group number, dependents’ names and ages, primary care physician’s name and address, and the last four digits of dependents’ social security numbers.

Health Net of California identified and corrected the coding error and has implemented additional procedures for future mailings, including several testing scenarios and the use of a checklist to make sure errors are found and corrected prior to letters being mailed.

It is currently unclear how many subscribers have been affected.

American Medical Response Alerts Patients About Email Breach

American Medical Response, a Greenwood Village, CO-based provider of emergency and patient relocation services, has discovered an unauthorized individual has gained access to the PHI of 4,300 patients who had previously used its ambulance service.

The information was contained in employee email accounts that were compromised as a result of a phishing attack. The compromised email accounts contained names, addresses, dates of birth, Social Security numbers, health insurance identifiers, and diagnostic and treatment information. The breach was limited to email accounts and no other systems or databases were subjected to unauthorized access.

While patients’ protected health information was potentially accessed, no reports have been received to suggest any patient information has been misused.

All patients affected by the breach have been notified by mail and have been offered complimentary credit monitoring services. American Medical Response has implemented additional security measures to reduce the risk of further email account breaches and employees have been provided with additional security awareness training.

Bloodworks Northwest Notifies Patients of PHI Exposure

The Seattle, WA-based blood bank and medical research institute, Bloodworks Northwest, is alerting 1,893 patients that some of their PHI has been exposed and potentially stolen.

On March 13, 2019, Bloodworks discovered a list containing patients’ names, dates of birth, and medical diagnoses had gone missing from an employee’s desk. Despite a search being performed, the list could not be located.

Peculiarly, the Notice of Data Privacy Event on the Bloodworks website says “While we are unaware of any misuse of the personal information in the impacted email account, we encourage you to remain vigilant against incidents of identity theft and fraud, to review your account statements, and to monitor your credit reports for suspicious activity.”

It is unclear whether this is an error or if an email account was also compromised. The breach report submitted to the HHS’ Office for Civil Rights suggests the breach solely involved the loss of paperwork.

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UMC Physicians Discovers Patient Information Was Uploaded to Unapproved and Unsecured Cloud Service

The Lubbock, TX-based medical group UMC Physicians is alerting patients of UMC Southwest Gastroenterology that some of their protected health information has been exposed as a result of errors of judgement by two of its employed providers.

Those providers had each set up a Google shared drive which was used to track follow up tasks related to the provision of care to patients. While the shared drives were set up with good intentions and were intended to help improve the care provided to patients, the providers used an unapproved cloud storage solution and patient data was inadvertently stored on an unsecured network.

UMC Physicians discovered the policy violation on March 12, 2019 and launched an investigation to determine which patients’ protected health information had been exposed. During the course of that investigation, UMC Physicians determined that one of the providers had also been forwarding emails containing patient information to an unsecured Gmail account.

The types of information that had been stored on the unsecured network and emailed to the Gmail account included names, addresses, telephone numbers, medical record numbers, dates of birth, dates of service, health insurance carriers, diagnoses, and medical procedures performed. Highly sensitive information such as Social Security numbers, insurance policy numbers, and financial information were not exposed.

In response to the discovery, UMC Physicians has provided additional training to employees on the use of approved cloud storage solutions and technical controls will be implemented to prevent unauthorized cloud storage solutions from being used in the future.

No evidence has been found to suggest patient information has been accessed by unauthorized individuals nor have any reports been received to indicate there has been misuse of patient information. All patients whose protected health information has been exposed have been notified of the breach by mail.

It is currently unclear exactly how many patients have been affected.

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