Also believe it is a goodfaith proposal that i think will serve the people of our state well for many years to come. We will seek the maximum allowable time under the law for that waiver. Let me say as i close, and then i will finish the formal program but i can catch up with some of you afterwards if you want. I served 12 years in the congress and i served the better part of a year and a half i have become more convinced every day that the cure for what ails our country is going to come more from the nations state capitals than it ever will from the nations capital. At the very core of this waiver request is my belief that many of the most intractable issues facing our country, including health care, can best be solved by giving the states the freedom and flexibility to design programs that can solve the challenges the people of their state are facing in those areas. So we will continue those discussions with federal officials. Im hopeful that we will be able to expand the healthy indiana plan in a way that will serve the people of our state, will close the coverage gap but will do it in a way that continues to advance principles of empowerment, personal dignity, Consumer Driven Health care in our state and maybe be an example to other people around the country. Thank you all very much. [applause] [captions Copyright National cable satellite corp. 2014] [captioning performed by national captioning institute] next a house hearing on Medicare Fraud then q a. Live at 7 00 a. M. Your calls and comments on washington journal. Cspan brings you live coverage of president obama on memorial day participating in the annual ceremony of the tomb of the unknown soldier. Today, live beginning at 11 00 a. M. Eastern on cspan. You can take cspan wherever you go with our free cspan radio app for your smartphoner tablet. Listen to all three cspan tv channels or cspan radio any time. You can tune in menu want. Play podcasts from our signature shows like afterwards, communicators, and q a. Download your free app online for your iphone, android or blackberry. On tuesday, a House Oversight subcommittee held a hearing on Medicare Program oversight and management. According to the g. M. O. , officials from senators and the Government Accountability office from human and Health Service unless is two hours and 25 minutes. The subcommittee hearing on Energy Policy hearing called medicare mismanagement oversight from the effort to recapture misimaginationed fund. First americans have the right to know that washington takes from them is well spent. Our duty in the oversight reform government is to protect these rights. Taxpayers have a right to get from their government. We will work tireless to deliver the facts to the American People and bring general reform. This is the mission. Medicaid currently pays one fifth of all Health Care Services provided nationwide making it the largest single purchaser in the country. Unfortunately, every year the Medicaid Program wastes money on fraud and tests and procedures. In to 13, 50 billion was lost to improper payments, an increase of 5 billion in 2012. Gsm o. Has related medicare as a high risk since 1990 in part due to the programs acceptability to this waste, that makes up 77 total identified by the federal government last year. Fraud represents a significant amount to the programs finances. At presence the trust fund has been in deficit since 2008 and they predict the fund will be depleted by 2026. The services have the responsibility to maintain the integrity of medicare. Like the Health Care Prevention action team, which operates Medicare Strike forces to combater. Traders who steal identities and falsify billing documents. A riskbased screening to identify supplies. In april 2014, fingerprinted background checks will be conducted on higharise providers. C. M. S. Is admit straighting to identify fraudulent claims for review. They rely on four types of combat. These contractors such as audit contractors or review claims to identify overpayments. G. O. And others found these efforts sometimes overlap in requirements are not uniform. Providers and beneficiaries are given the opportunity to appeal. This third level is by law judges at appeals. There is currently a massive backlog of over 460pounding 460,000 appeals. It could take up to 28 months during which providers have their money held by the government. Not many businesses can survive having their businesses held for 28 months while they wait to decide if they are going to get reimbursed. Nancy griswold was to testify but she was unable to fall throw on that. We have kathleen king, director at the health care office. And the doctor, deputy administrator and Program Integrity to see how c. M. S. Can improve oversight. I look forward to their testimony. We must do more to strengthen the integrity overall particularly medicare given its enormous size and scope. Clearly, more needs to be done to recover 50 billion in overpayments. Todays hearing will provide subcommittee for clarity in these areas. It cannot drive up the expenses for seniors. Morning. Thank you, chairman lankford for holding the hearing. I agree that reducing waste and fraud and abuse in the Medicare Program is critically important not only to protect taxpayer funds but it is important to protect the health of of seniors and adult population. We have 10,000 seniors aging into the Medicaid Program each day this year. It is more than important than ever to keep the medicare promise alive for jen rievtion future americans. Im grateful to have you here on behalf of the Inspector General to speak about the o. I. G. s efforts to do that. They prosecute some of the worse instants of Health Care Fraud. Providers billing for services that were never provided and providers who order unnecessary or, in fact, harmful procedures. The Health Care Fraud and Abuse Program under the attorney general and the secretary, the health and Human Services department is a model for inner Agency Cooperation and coordination. In fiscal year 2013, the program recovered 4. 3 billion in fraughted settlements. This is remarkable. I look forward to hearing from the assistant Inspector General on how this was achieved and what can be done to strengthen the Program Going forward. These bad actors represent a small fraction of all providers. The vast majority of providers are not fraudsters and are deeply dedicated to the care of their patient. Given the size and complexity of medicare theme, overpayments are going to occur and c. M. S. Must be individual leapt in recouping them. Well meaning providers are entitled to have their claims issued fair so they can focus on the core mission of providing care. I have some serious concerns that the Current System of post payment audits, are resulting in a significant burdens on some providers, particularly smaller entities. They have more difficulty complying with requests for medical documentation and may not have the resources to even appear over payment determinations. The backlog in the office of medicare hearings and appeals only makes the matters worse as the supplies do not have the luxury to to be waiting months to have their cases adjudicated. In new mexicos First District the first access to care is paramount in my mind. If a provider or supplier is forced to cut back services as a result of an audit, thing is a loselose situation for everyone, particularly as we work to build access to care, particularly preventive care. C. M. S. Announce they will implement several changes that will be effective with the next contract. I will look forward to hearing about improving the oversight. I hope you will also address some of tissues we both raised regarding the burden on medicare providers and with a particular focus on the smaller providers or providers in rural and frontier states like mine and the impact that has on the beneficiaries who are working to access those services. I also look forward to hearing from all of the witnesses what c. M. S. Is doing to move away from the pay and chase model to a proactive mod that will identifies improper payments upfront. Such a model spares taxpayers resources that could be better spent on providing care, which in the long run shores up medicare for future expwren rations. With that, mr. Chairman, i yield back. Thank you mr. Chairman for holding this hearing. Thank you for continuing to high highlight that we need to make sure that the american taxpayers money is well protected. This particular hearing is of importance to me primarily because i have some constituents that have been caught up in this a. L. J. Backlog. As the Ranking Member just testified, it can be extremely difficult on Small Businesses. The request for a particular company in my district threatens to put them out of business, yet, all they want is a fair hearing. I shared this with the chairman and shared some of my concerns where we are and in his own Opening Statements he talked about the fact that we have a 28month backlog. Well actually, it is worse than that. If you look at the real numbers that today if we hired according to the budget request from c. M. S. , it would take 10 years to work through this bag backlog. A million appeals and they have been Getting Better year after year, yet, what we do is we have a policy of where were saying youre guilty until proven innocent. Were all against waste fraud and abuse. What we must make sure of is we do it under the rule of law and we have laws that guidelines guidelines that are there. There is a law right now that says if we ask if a constituent asks are for a hearing that the law says they should have some kind of adjudication and a decision within 90 days and, yet, according the the website for c. M. S. , were not opening the mail for weeks and months and months and months. Weve got to do better than this and in this, we dont take those who are innocent and put them out of business. I say that because if our overturn rate was not that great, we would ivet havent wouldnt have a problem. Over 50 of them are being overturned. We have over 50 of the people who are innocent, who are having to wait years for a decision and in that, we must do better and we must find a better way to address this. I look forward to hearing your testimony on all of these things and i thank you mr. Chairman. I thank you for your work and your research that has gone into this. Im glad to receive the testimony of our three witnesses. All witnesses are sworn in before they testify. Please rise and raise your right hand. You affirm that the testimony youre going to give is the truth, the whole truth and nothing but the truth. Thank you for being here. Mr. Richie is the Inspector General for evaluation at h. H. S. Thank you all for being here and thanks for your testimony today. Weve all received your written testimony. It will be part of your permanent record. We will be glad to receive your oral testimony in order to allow for discussion, i ask you to limit your opening remark to five minutes. You will see the clock in front of you. Mr. Chairman and members of the subcommittee, thank you for inviting me to talk about our work in medicare and improper payments. C. M. S. Has made progress to reduce improper payments but there is additional action they should take. I want to focus my remark on three areas, provider enrollment, prepayment claims review and post payment claims review. With respect to provider enrollment c. M. S. Implemented payment protection and Affordable Care act to strengthen the enrollment process so fraudulent providers are prevented in enrolling. C. M. S. Has performed moratorium on providers and contracted for fingerbased background checks for highrisk providers. However, c. M. S. Has not completed certain actions, which would be helpful in fighting fraud. It has not yet published regulations to require disclosures of information taken against providers, such a payment suspensions and it has not published regulations establishing the core element of compliance programs or requirements for surety bonds for certain times of atrisk providers. With respect to review of claims for payment, medicare uses prepayment review to deny payment for claims that should not be paid and post payment review to recover improperly paid claims. Prepayment reviews are typically Automated Systems that could prevent improper payment systems. For example, some prepayment edits check to see if the claim is filled out properly and that the provider is enrolled in medicare. Others check to see if the service is covered by medicare. We found some weaknesses in the use of prepayment edits and made a number of recommendations to c. M. S. To promote implementations regarding National Policies and increase widespread use with local contractors. C. M. S. Agreed with our recommendations and taken steps to implement most of them. Post payment claims reviews may be automated like prepayment reviews or complex, which means trained staff review, medical documentation to determine if the claim was proper. C. M. S. Uses four types of contractors to provide post payment respreups we recently finished work and found differences that can impede efficiency and effectiveness by increasing Administrative Burden on providers. For example the minimum number of days that contractors must give providers to respond to documentation of a service range from 3570 days. We rerecommend that we make these more efficient consistent. C. M. S. Is taking steps to implement them. We have further work on the post payment review contractors to exam if c. M. S. Has strategies to coordinate their work and if contractors comply with c. M. S. Guidelines. Less than 1 of all claims, the numbers of post payment reviews have increased. From 20112012, the number of reviews increased 1. 5 million to 2. 3 million. This is one factor contributing to a backlog and delays in revolving appeals by judges. Weve been asked to exam the appeals process, the reason for the increase, the effects on the providers and contractors, and options to streamline the process. In conclusion, because medicare is such a large and complex program, it is vulnerable to fraud and abuse. Given the level of improper payments we asked c. M. S. To use all of authority to identify and recouping improper payments. Thank you. Thank you. Thank you. Chairman lankford, Ranking Members and members of the subcommittee, thank you for the invitation to discuss the Medicare Program inintegrititiests. We share the subcommittees commitment in ensuring that taxpayer dallass are spent on legitimate services. Our program through the lens of my experience who fundamentally cares about the health of airports. Our Health Care System should offer the best health care possibly. C. M. S. Is committed to protecting taxpayer dollars by recovering wasted or fraudulent services. That helps to extend the life of the trust fund. But efforts extend beyond dollars. It is fundamentally about protecting our beneficiaries and ensuring we have the resources to provide for their care. As part of our responsibility, the taxpayers to see their resources are used appropriately, c. M. S. Has an obligation to perform audits and other youre sight tools as a part of these efforts. I would like to make three points today. First, we are having real impact in reducing waste abuse, and fraud. We reduce provider burden. Finally, we continue to improve to meet our mission. On the first point were seeing success from our efforts. Through medical review activities in fiscal 13 alone 5. 6 payments were prevented from being paid or were returned. We saved 7. 5 billion over the last several years from payment edits, which prevented bad payments being made. C. M. S. Performed medical review. Recovery auditors have recovered 7 billion to the Medicare Trust fund since the start of the program in 2010. Our antifraud activities have also had impact. Last year, they returned 4 billion to the trust fund. We have revoked over 17,000 since the passage of the Affordable Care act. We recognize they can pose burdens on providers. We strive to balance our responsibility to limit the burden these can place. We use tools such as educationallests and contractor oversight to minimize burden when we can. We engage in dialogue to improve our programs. In the next round of recovering c. M. S. Is making changes on the Program Based on feedback from stake hold theirs we believe will lead to an efficient program. We utilize other approaches such as prior authorization while granting more security to the provide community. We will listen to stake holders to make improvements to our programs. We appreciate the committees interest in ensuring that c. M. S. Is improving its efforts to know that congress and the public expect tang eligible results. In july 2013 c. M. S. Imposed moore or the ya for the first time in geographic areas that have been prone to high amounts of fraud. We invoked the privileges of Home Health Agencies in the miami area. We are also continuing to work with Law Enforcement in these hot spot areas. C. M. S. Is using private seconder tools to stop improper payments. Since june 2012, we have advanced analytics on a streaming national basis. We stopped or identified 100 many million in in inproper payments. We began to use the private sector tool to address an area of improper payments. In 2012, c. M. S. Began a demonstratio