Responsive neurostimulation (RNS) insertion in 106 Neurosurgery clinics in Americas

It is an excellent hospital, well located and with a wonderful team. We are always very well attended to, they give us quick solutions with zero bureaucracy. I have been a patient for 4 years and the service is always of the same standard. Whenever I feel something or go straight to this hospital 🏥. It has a restaurant, cafes, 24-hour bank and valet.

Considered top level. The prompt service leaves a lot to be desired. I passed on 25/Nov/23. In pain, the medical team only did a urine test. When the doctor came to talk, she had to consult a urologist with my request for medication, as I was in pain. In short, an US or CT scan would solve the problem and be accurate. But I had to go to another hospital to find out. BP Mirante for emergency care is too weak.

IS A PREMIUM?!?! JOKE!! Yesterday I was in the ER and I was outraged by the lack of structure and commitment to the patient. Only 1 attendant to open a form, 1 person doing the triage, 2 doctors attending all Emergency Rooms, patients being placed in common chairs to be medicated, only 1 nursing assistant to apply all the patients' medications and mismatched information. I thought that the fact that Mirante has premium service would never be served in this way. The doctor who attended to me prescribed the same medications I was taking at home, did he think I liked going to the ER for a walk? While I was in the medication room, I asked the person responsible for the PS, and nurse Bruna came to assist me. I informed him what was happening and he immediately took action. He transferred my care to a surgeon to analyze me, transferred me to a private place to receive the new prescribed medications, in short, he did everything possible to make my impression change. The problem is that I wouldn't have needed to complain to receive the service that should have been offered. I was extremely disappointed with BP Mirante, as it was not what I expected for this service.

It is an excellent hospital, well located and with a wonderful team. We are always very well attended to, they give us quick solutions with zero bureaucracy. I have been a patient for 4 years and the service is always of the same standard. Whenever I feel something or go straight to this hospital 🏥. It has a restaurant, cafes, 24-hour bank and valet.

Considered top level. The prompt service leaves a lot to be desired. I passed on 25/Nov/23. In pain, the medical team only did a urine test. When the doctor came to talk, she had to consult a urologist with my request for medication, as I was in pain. In short, an US or CT scan would solve the problem and be accurate. But I had to go to another hospital to find out. BP Mirante for emergency care is too weak.

IS A PREMIUM?!?! JOKE!! Yesterday I was in the ER and I was outraged by the lack of structure and commitment to the patient. Only 1 attendant to open a form, 1 person doing the triage, 2 doctors attending all Emergency Rooms, patients being placed in common chairs to be medicated, only 1 nursing assistant to apply all the patients' medications and mismatched information. I thought that the fact that Mirante has premium service would never be served in this way. The doctor who attended to me prescribed the same medications I was taking at home, did he think I liked going to the ER for a walk? While I was in the medication room, I asked the person responsible for the PS, and nurse Bruna came to assist me. I informed him what was happening and he immediately took action. He transferred my care to a surgeon to analyze me, transferred me to a private place to receive the new prescribed medications, in short, he did everything possible to make my impression change. The problem is that I wouldn't have needed to complain to receive the service that should have been offered. I was extremely disappointed with BP Mirante, as it was not what I expected for this service.

I went on 11/22/23 at 11pm something (I don't remember the exact time) with a fever of 40 and discomfort throughout the body, with vomiting. To which they answer that they only attend to emergencies. Only guard is from 8am to 9pm. How can it be that a public hospital has guard duty all day and night and this hospital, which is classified as the best, only has guard duty during certain hours. The person who assists me tells me after I complained that I required medical attention that they would attend to me but I would have to wait at least 4 hours, but that it was safer in 5 hours. With terrible abdominal and body pain, I waited 1 hour and a half and left, to which they wanted to charge me for parking and with a card only. I had cash. But at night it is only with the posnet and you charge yourself. I had to go to the Lomas de San Isidro, and upon seeing my condition, they treated me in 30 minutes, where they referred me to a room and made me Urgent studies and analysis. They treated me excellently. Let's see if the hospital commission understands that the patient does not have a stipulated time to feel bad. That is why it is a guard to attend at any time. I know that the word (Guard) has a certain schedule for whoever manages the hospital. I must clarify that the hour of parking is too expensive, the hour costs more than two liters of gasoline. And the car is left out in the open. Also Sometimes to pay for parking there is a long line and there is a delay when you are in the sun or rain without shelter. It should be subsidized. But the greed is greater. I must clarify that the professionals always treated me more than well in the Austral. The issue is They give you shifts with a delay of 2 months. There are never shifts.

The hospital has excellent doctors. The serious problem that this hospital has is access to medical appointments. A patient has follow-up checks for chronic medication and the SHIFT staff, after several attempts, respond that they do not have appointments for this month and do not know when they will open the agenda for the next one. I go through the application and it doesn't schedule an appointment for that doctor and it tells me to contact me by phone. And as best as you can during your work hours, you keep trying and spend the month with the Same answer 🤷‍♀️ It's an epic to get a turn. And an almost impossible challenge to achieve medical follow-up for treatment. How to solve it 🙏🏻? How many more patients are there in this same situation? A first level hospital has to be able to solve this urgent issue.

Excellent attention from everyone, from the security person at the entrance, to the receptionists as well as the doctors, who are super professional. They treated me quickly and gave me an accurate diagnosis. There were a lot of people in the waiting room, I thought I wasn't going anymore. But the service is fast, since there are many receptionists and many doctors serving at the same time. The building is beautiful, large, clean, with coffee machines (you can pay with MercadoPago) and some things for breakfast. Highly recommended.

Good hospital but total inflated prices, they charge so high that they reach above the TOPE of your insurance. For a small one - hour surgery, they charge 7 million CLP

“Urgencia” doesn’t move with much urgency. I’m currently in the waiting room in the respiratory area of the emergency department. My mother in law arrived in bad condition and I saw no sign of triage or prioritization based on symptoms , first come first served. NONE of the alcohol hand dispensers have alcohol, staff aren’t using alcohol gel. Not just in the emergency area but also in the other buildings I passed through. Very surprised by the experience considering the cost and reputation of the hospital. Go to Clinica San Carlos de Apoquindo UC or Clínica Alemán.

I had a severe reaction to a Lyme disease infection contracted in the USA, that manifested itself when I arrived. I was hospitalized at Clinica Los Condes for 3 days. The care was superb. Since Lyme disease does not exist in Chile, the staff coordinated their care for me in coordination with the USA CDC.

We unfortunately had a five night stay at the NICU over the Thanksgiving holiday. The staff provided excellent care to our kid and were extremely compassionate to us as parents. We were grateful for the private sleep rooms and shower, and they even had a free Thanksgiving dinner for everyone. The parent / family lounges have places to grab coffee and store food, and everything is very clean and organized. The doctors and nurses were very communicative and kept us in the loop the entire time.

Absolute terrible service , my child who has a seizure disorder and potential c- diff was made to wait in the ER for 3 and half hours plus without even being properly triaged . She didn’t receive a wrist band , at any point & we can run the cameras back , no one was alerted to her allergies , there was no band received for that as it typically is .. and she begin to have diarrhea thru the long wait due to the virus she’s had the past week and in turn she begin to get worked up and her fever returned . I asked how much longer the wait would be abd for an approximate timeline .. as I’ve observed plenty of patents come in after one in which I knew personally with less servere circumstances… literally come and go and my child was still suffering in the ER … the Nurse on duty was unaccomidating and almost seemingly unwilling to engage .. as I waited for some kind of answer on when my severely sick child would be seen . I asked if it would be more then another 30 mins and he said he couldn’t promise but shouldn’t be . Well it was . After 45 mins of them calling more then 3 patients who arrived after us .. I reluctantly decided it best to take my fevering , baby who now was covered in feces home.. as she was in her 3rd bowel movement and we had difficulty changing her in the nasty public restroom . I ultimately watched them call two more patients who had come after us exhibiting no signs of eminite health scares then I ordered our ride so I could take my child home to change her and give her medicine to help reduce fever and prevent seizure . I am pissed and very upset that my child and I spent. 3 plus hours we can’t get back in the ER after already being across the street at the Berger building for 3 hours prior this was wayy less then pleasant This is the second poor experience in this particular Emergency Dept but this is the first time it was so horribly handled that I had to leave with not only an even sicker baby then I arrived with . She still now will have to go to another ER to be seen .. because she did infact have a seizure once we got home from her fever that arose& I informed them but that did nothing to medicate the situation or get her seen. Now my kid is home fevering still sick potentially has c-diff and I am skeptical to return her to this terrible hospital because they haven’t even returned my call. I called to speak with charge nurse after filing formal complaint and was told by Jennifer in WR I could not speak to any charge nurse and then she took my information and said a nurse on duty would call back and it’s been an hour with out a returned call. This is negligence and unprofessionalism tht promoted us to leave in the first place and CHOP is looking at a pretty decent lawsuit if we do go to another practice and something is severely wrong with my child with so much documented instances of me trying to get her helper seen and have a team leader consult about next steps. This place wasted my time , cash as it’s costed money I didn’t have to travel to and from and I felt like the poor treatment was racially motivated , as as kid who came in after us was pulled to the back cuz her mother told them she was seizing but I was looking at the child. Who literally just had woke out her sleep. This place is incompetent , and of all the amazing experiences we’ve had here . Today ultimately casted a shadow on them all and I will be contacting the PA board of insurance aswell to file a formal complaint because they need to do better on managing and transparency in the ER wait times. We got there at 12:15 and didn’t receive a text saying my child’s room was ready until 4:15 pm that’s 4 freaking hours for a child who had 2 seizures in past week, has a virus, and cold and caught fever while there … when she has a history of febrile seizures … 0/10 would not recommend. Shame on u all

Very friendly staff and amazing doctors. The information desk is very helpful. The front lobby is well designed and honestly fun to be in due to it's design: there is a meandering ramp that goes up several stories with interesting interactive stops on the way. The lobbies on each floor are also all well laid out: they have great views outside and inside were designed with children and comfort in mind. The plaza out front and the cafeteria/Cafe are both relaxing places to recharge.

My brother was in this hospital because he had appendicitis and had to get surgery and He said the nurse was nice! I think this place is really nice because it's clean and Its nice looking, I know that because I was there to visit him in the hospital. I also want to thank you for saving my Brother before more consequences happened to him and that he could've died.. but thank God this hospital was there! Once again, thank you for saving him🙏🤍 Also I definitely Recommend this place if you want nice doctors and want to feel less anxious and comfortable here.👍

This hospital isn't what it used to be! It seems to be loosing patient focus and fast. We've been a CHLA family for 11 years and I think it's time to switch. My autistic son was SCHEDULED for Dental Surgery. Originally it was supposed to be at 1pm and us be here at 11am. When we got the call from the nurse last night that we needed to be here at 530 AM we were like no one told us! But we got here right on time. We'll let me tell you that they took him upstairs to Surgery PreOp it took over 4 hours to get him into the the surgery room, because he needed to be admitted after surgery and no beds were available. This hospital needs to have better planning for these types of things OBVIOUSLY there will be emergencies that come in over night THAT SHOULD'VE ALREADY BEEN ACCOUNTED FOR!!! Maybe you need more staff and more beds!!! Because to have a child basically starving because you couldn't plan Accordingly is just plainly ridiculous! Then when I spoke to the Charge Nurse in the Surgery Dept she tells me that if my autistic son has an outburst that the anesthesiologist and nurse are there to help give him something to calm down. So basically if my son has an autistic outburst they will just drug him up. I'm like realistically drugging my son just to calm him down because your hospital didn't plan accordingly is uncalled for and unnecessary! Again I am seriously contemplating switching hospitals even though my son is on the Heart Transplant List!!! -A Frustrated Autistic Heart Mom

Ok so I had open heart surgery 20 years ago. I was well cared for and was in icu for three days and then went to a step down room where I was later discharged home after only three days at the hospital. My team was so amazing and so supportive and loving. And a picture of me twenty years later.

I found some english speaking doctors here and they have an international office to help you translate if you dont speak spanish. Thank you very much Carolina 🙏

Horrible! Dont go to this clinic. The most unfriendly employees I have experienced in this Hospital. Yes I do speak spanish but once I didnt understand smth the lady just ignored me! Errors start already in front of the Clinic. Apparently they don't know the difference between a Swiss flag and a medical (red!!!) cross. So my question: is this a Swiss Clinic??? Of course not...

My mom got a well planned surgery in this Clinic. Excellent outstanding service what a relief. Fast service, very diligent and well trained all staff. Great place to get well and get some recovery. If you get sick go there you will be fine quickly. Do not visit Los Nogales clinic or La Colina. Marly is the best! Thank you all for your service! Mom is doing great. The doctor was very profesional!

They do not do their job well, 7 hours in the emergency room and do not attend and then say that they cannot attend to a patient

Undoubtedly one of my best experiences, location in the center of the city, excellent medical and administrative staff, old but well-kept infrastructure, spacious with gardens.

This opinion is directed to block 6 of the hospital, which is in an area where you can see people who consume drugs, although there is surveillance and once inside the hospital it is safer, if it is scary, at least walk to the hospital at dawn, and block 6 is opened at 6 in the morning and meanwhile everything is dark or with little light, a perfect place for homeless people, you have to travel with great caution and at least if you are patient and come from somewhere other than Medellín, it is not advisable to be in line before 6 in the morning to check in at block 6, arrive with 5 minutes left or at 6:00 am, there a guard opens the door and when you are already inside the place is much more pleasant and neat, there is a waiting room with chairs where you can wait for them to call you for the billing card, there are elevators, there is natural ventilation in that waiting room, almost all the staff there are friendly to the extent they should be. I give it a 3 star rating, for a not very pleasant event that I had to go through in there, I think that of all the possible days in which that bad event had to happen, it happened just on the day of my appointment, I don't know who it was from the fault of that negligence but thanks to a call to my eps I was able to quickly solve that difficulty so as not to continue in that unpleasant situation in that hospital block.

All staff member needs an urgent training to learn the meaning of empathy and serve to patients.

The best in town.

Omg I had to walk to the nurses station for everything from a blanket to medication. They have no tv in the rooms. They take for ever. You have to wait 6-8 hours to get something done. Just go to a regular clinic in Barranquilla they are not as nice but they get things done.

An amazing facility with an amazing level of care. Better than any US or German hospital I have ever been in. The office of international patients is very professional and thorough. Dr. Taboada is very thorough and professional. I can't recommend this hospital enough. Super experience.

I came to see if giving birth at Serena del Mar was an option. When I was given a tour of where the mothers and babies stay it was great. I was told to male an appointment to be seen by an obgyn so that they would have a history of me. The nurse took my info days before my appointment but apparently never followed through with setting up my profile. I showed up for my appointment and was never told who I would be seen by. Dr Maria Fernanda Toro Wils was upset that she had to wait on me because the staff had not created my profile. I finally went into my appointment with the doctor and she scolded me and told me she had no time we had to rush. I told her I did not understand whybinwas being treated this way when her staff was a mess. She told me she always does 40 minutes and she dedicated about 20 minutes if that. I left there feeling so upset and totally changed my mind about having my baby there. The treatment from Dr. MARIA Fernanda Toro Wils was terrible. I would not recommend her or her staff in a million years.

They neither answer their phones nor respond to emails seeking an appointment! Terrible customer service. I communicated in Spanish as well so not a language issue.

Malpractice. My grandmother was left to die. After an isquémic stroke. Proper measures were not taken within first 6 hours. Instead of ICU, she was put in a regular room. Nurses shifts had no records of prior shifts. Avoid at all costs.

I was supposed to have surgery in this clinic on 10/17/22. I arrived around 10:30 at the O.R floor, 4th floor in the building, and no one was there. The reception desk was dark with zero employees. While I sat waiting for someone to show up I looked at my paperwork handed to me at check-in, when I realized they had me as a Colombian citizen born in Barranquilla. I'm a U.S citizen. The address, phone number, and emergency contact provided by me earlier had been overlooked and ignored. I went downstairs and corrected it. Finally, the nurse showed up; she was a nice lady. There isn't anything negative to say about her. Around 3:30 a nurse assistant brings a wheelchair and wheels me into the OR. My surgeon, Dr. Carlos Cala was running late, she said. The O.R had a two way-in, bidirectional, restaurant style, swing door with small windows. At his point I had not been sedated, medicated, nor given a relaxant to prepared me for the cultural shock I was about to experience. There was, right in the middle of the room, an overwhelming sight of a surgical bed dressed in brown sheets ready for a bloodbath; and a dented, shallow bucket, right at my feet. The pan was wide enough for my feet to fit in. The N.A explained to me that she was going to bathe me with antiseptics and soap before surgery. I followed her with my gaze, noticing a disturbing sight of two soiled, worn out, filthy, and grotty, styrofoam coolers. There they kept the antiseptic and soap warm that she was about to use on me. She asked me to stand in the pan facing the door and those swinging doors started to open and close while medical staff came in and out. I was naked and a swing away to be seen by everyone sitting at the desk just outside the OR (recovery area). Then, as I’m looking around in dismay, I spotted a recording video camera IN the OR. All the feelings of humiliation, indignity, disrespect, and violation of privacy took over me at this point. I complained about this to the NA and she called the floor manager. The manager explained to me that the video was for liability reasons and to cover their backs, privacy wasn't a concern to them and video recording was a common practice. I requested an appointment with the clinic’s director and It seemed as if I threw a stone in a hornets nest. The floor manager called the anesthesiologist, Dr. Bernal, and he asked me what was the problem. All of this time I was still naked. I tried to explain to him that I felt my privacy was not being respected as I had never gone through anything like I was experiencing at that moment before and his replied was: “you should go back to the United States and get surgery there.” I don’t know what was more upsetting; the fact that this doctor represented COLOMBIA so poorly, not aspiring to anything beyond mediocrity as a professional, stepping over his Hippocratic Oath, and having a condescending tone towards a CUSTOMER (I’m a paying client in a private clinic, I reminded him), or the fact that his lack of character, dignity, and vulgar behavior, were an irrevocable proof of his unprofessionalism. When did lack of HYGIENE and violation of privacy became a common practice in healthcare?! Both, Dr. Bernal and the floor manager, proceeded to tell me to calm down and that if I wasn’t ready for surgery I could reschedule. I kept saying that I still was interested in an appt with the clinic’s manager. The floor manager kept hinting that there was not going to be a surgery if I insisted to see the director because that meant I was upset, while Dr. Bernal kept using my request as leverage pertaining to the final success and outcome of the surgery. Again, all of this time I was naked. Because I didn’t shut up and submissively obeyed, the surgery was canceled and I was scorted out of the OR while the nurse assistant was making signs behind me at everyone we were passing by (medical staff, patients, and their families around) that I was crazy. I did speak to the director days later. Even though he was nice, I opted to have my surgery elsewhere. Avoid at all cost unless you're dying.

Good service but they would have bigger watings rooms...

There is no appointment assignment because "there is no agenda." But the EPS does make the punctual collection. Edit: The clinic is still terrible. Nurse Jeimy Oviedo, from the emergency room, is extremely rude and does not even see people to take signs. Edit 2: EPS Sanitas should consider ending the contract with this IPS, THEY NEVER HAVE AN AGENDA FOR ANYTHING. If I could I would give them 0 stars.

This clinic is now Christus Sinergia, according to the 3 hours I spent on the phone line waiting for one of those who answered me and went from one line to another to tell me how many hours they offer vaccinations, they have the best specialists and the best technology but they have the worst customer service or telephone service that I have ever had to endure for 3 hours without any response, just frustrated... they should have communication with palmira-cali and not throw the ball around

It is an institution with good facilities but poor reception of both patients and communication. For them to treat you urgently is deplorable, you have to be almost dead. When scheduling appointments, they do not give complete information. Apart from the girls at the reception who are kind on the phone, but in person they believe that, being despots, they do a lot; If someone arrives unwell it is due to the actions of the entries.

Just was released yesterday after being admitted last Thursday in need of a pacemaker. My husband and I were so pleased with our experience. Dr Marlon and Dr Francisco from the cardiology department were amazing. I was treated very well. I will be forever grateful.

Such an amazing experience! I went to the emergency with a stomach issue and they immediately took me in for checks and tests. Super professional - totally recommend!

Terrible (i.e. no) pain management after severe accident. Got also pain chock due to rush in changing linnen. As I chose to be operated at my home hospital (one of the top three hospital in pelvis operations in the whole World) they got upset and delayed my ambulance flight with a day (by not filling in papers on time). You can imagine the cost of having an ambulance flight waiting for you one extra day..

Terrible service, the lady at the checkout and the guards are rude. I am calling the service number to send me my ultrasounds and exams and they leave me in the clouds without any response. I've been waiting for more than 30 minutes and before leaving I went to ask if everything arrived in the mail and they told me yes. I don't receive anything even though a clinic like that can have people with so little education.

Located in the best place, excellent clinic, precise care, they have professionals in the different branches, the issue of the exams to be performed as well, it is located in the middle of the city, one could say, easily accessible, although in the afternoon at Traffic is very complicated either because there is no parking, but everything else is fine.

60 USD for consultation. Receptionist smalltalks so I don't ask the price.

Great Service, Doctors are so respectful of patients times. Very clean hospital. Quite a different experience from other hospitals. Very pleased.

I went in with back pain. Got excellent care ,x-rays, diagnosis in less than 2 hrs.

This hospital is amazing! My husband had to attend and I was so impressed with the staff! As we do not speak Spanish, they were all very amazing and did their best to help us. They were kind, caring and detailed to ensure that we were well taken care of. Thank you so much for taking care of my husband! You are the best!

It is a hospital with very good facilities and good medical staff. It is noticeable that they are trying to improve many aspects, but they have failures at the level of internal logistics, since they frequently drop hospitalized patients hours in advance for diagnostic imaging and other tests, clarifying that in the waiting room for Imaging diagnostic rooms have air conditioning, which ends up making some patients more sick; The truth is that in this regard there is a great deal of disregard for patients and a great lack of organization on the part of the hospital. There is also a large overpopulation of patients in the emergency room that obviously exceeds the capacity of the hospital, since even in the emergency corridors there are stretchers with patients and companions who do not even have a place to sit.

The emergencies of this hospital are chaos! The disrespect towards the patient is total, you must stay 3 to 4 days in the emergency room under undignified conditions so that they give the patients a bed there is a doctor Moros who is the head of the emergency room and the man does not appear! No one provides a solution or an answer!

Rude guards that don't know medical status but won't allow access or questions to medical personnel. This goes for guards outside and inside. Doctors do not provide status to patients and send students to relay status. Students can't answer questions. Poor communication and follow up by all personnel which have led to 3 wrong diagnosis by doctors. Once realized we asked and the staff blamed the family members of making up stories and medical visit history missing information. This review is based on the past year with various family members appointments and emergencies I am basing my rating. This rating applies to various areas: emergency room, intensive care, critical area, and maternity ward.

Without a doubt it is an incredibly efficient hospital with great human warmth. The guardian service is one of the best I have known in public institutions. I hope they continue like this, the demands of their doctors and area heads make it one of the best hospitals in the country, if not THE BEST

I really say this government hospital really awesome . One week I spend here. Stuff very friendly and helpful.

The experience I have is sitting outside on the sidewalk, my wife arrived an hour before me for emergency treatment and entered without problems, since I did not enter with her I have to wait outside, the doctor tells her that only the guard can decide if I go in or not and he tells me that only the doctor... well, there is my wife feeling very bad and unable to accompany her. I thought patients had the right to a companion... terrible!

It seems to be the best among the many hospitals in Monterrey for health check-ups. All hospitals are friendly... I was satisfied with the most detailed check. I was able to see the doctor more comfortably than at other general hospitals. The food in the last week was tastier than any other hospital.

Great hospital. Better service than some hospital in the US.

No good guadlupe mendodoza ,I no pay you

Good attention

They take good care of patients, they are treated as they should be. The facilities are well maintained. The parking lot is ample.

Madhouse, worst service at ER

Please remove Cynthia Solís (plastic) from this hospital. My family and I were her patients and she almost killed one of us. She is ignorant, an extreme danger to patients and commits medical malpractice for which she is currently under investigation.

My second time here in the past month…this is one of the best Hospitals I’ve ever been in. Excellent staff, World class service. No problems whatsoever like the other reviews. Blue Cross insurance was accepted and I was taken care of around the clock. HIGHLY RECOMMENDED.

Went in to get an abscess removed on three different visits. I was scheduled at 10am but the room wasn't available until 8pm. Told to wait. I luckily asked for a written cost estimate and was told 58,000 PESOS (not including blood work, ultrasound and "hospital fees"). I said "no" and before I left, I paid the receptionist the 2,000 peso consult fee which she strangely handed over to one of the doctors. I never got a receipt for the two times that I paid. I went down the street and had the abscess removed for 2,000 pesos. BE SURE TO GET A WRITTEN COST ESTIMATE BEFORE ANY PROCEDURE. GO ELSEWHERE- THIS PLACE IS A RIP OFF! 30x more than the competition. Shady billing, accounting, payment, no receipts and handing cash to doctors?