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Section 1833(g)(5)(E) of the Act states that CMS shall identify and conduct targeted medical review using factors that may include the following: (1) The therapy provider has had a high claims denial percentage for therapy services under this part or is less compliant with applicable requirements under this title

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Similarly, the use of valproic acid at high doses used by patients can have noteworthy effects on the gut microbiota, altering the biosynthesis of fatty acid by different microorganisms [270]