Most often, House Officers moonlight at hospitals or health centers unaffiliated with the University of Michigan Health System. The services provided by House Officers to patient(s) at the University of Michigan as part of their GME program are reimbursed to the institution as direct GME payments, and the House Officer may therefore not receive extra remuneration for caring for patients in this situation. This policy not only affects the University of Michigan services connected to that particular GME program, but also services at other institutions that have signed affiliation agreements with that particular GME program. However, services provided by House Officers that are not related to their ACGME-approved program, including those within the University of Michigan Health system, are eligible for moonlighting payments. For example, a University of Michigan surgery resident could be permitted to moonlight at the St. Joseph's Hospital emergency room, as that is not part of their training program. A University of Michigan pathology resident could likewise moonlight in a University of Michigan ICU. These services are permissible, provided that services performed can be separately identified from those services that are required as part of the House Officer's approved GME program. Internal moonlighting opportunities are to be coordinated by an individual identified by the Department who is not a House Officer or a part of the operation of the educational programs within the Department.