The cms initiative has contributed to an estimated 50,000 fewer patient deaths in hospitals and 1. 3 million hospital acquired conditions saving 12 billion over three years. Medical review strategies have resulted in over 5 billion of savings in just the last year. He are working to transform medicare into a highvalue paler with payment is based on quality and not just volume and we remain focused on preventing waste and abuse and fraud before it occurs. This is not just about cost the threatening than a Beneficiary Services and a host of other problems. Since 2011 we have been using the system to provide advanced analytics on all the feeforservice claims. The system also incorporates beneficiary complaints and works with numerous other inputs to generate and prioritize further reviews and investigations. Cms takes administrative action to stop problematic behaviors through the suspension of payments and medical review of claims and a removal from the program. As we recently reported to congress, the advanced analytic system has a dirty generated a five to one return on investment and another component is the the strength and provider and will thereby verifying the the legitimacy of new and existing medicare providers through a risk taste approach and we are screening those that pose the highest risk of the Program Using routine data checks of lifeinsurance criminal records scheduled and unscheduled site visits and fingerprinting. We have removed over 450 medicare it enrollments since 2010 and importantly denied thousands of enrollment applications, which means that these providers never gain the ability or lose the ability to in building Medicare Program. These examples have been positively acknowledged i do gao. And we are engaging with the private sector in new ways to better share information and transfer insights into action the Fraud Prevention partnership is made up of 38 private federal and state members and continues to gain membership and this has completed studies that have helped us to take substantive action and the president s fiscal year budget includes a proposal to allow both public and private partners to support this Irish Partnership by providing funds, see nss made important private sector tools in operation including prior authorization and the use of automated claims and this net hundreds of millions of dollars in savings every year. Finally we are focused on moving the Medicare Program away from feeforservice reimbursement and by paying the number and we are testing different payment models were provide all is are held accountable for the quality and cost of care and providers have a financial incentive to coordinate care for their patients. And we have sent explicit goals for this work and this includes payment models and tying 60 by the end of 20 and i ultimately care most about the health of patients, which i am reminded of daily and our Health Care System should offer in the highest quality and most appropriate care possible to ensure the wellbeing of individuals and population. Thank you for your time. Thank you. Thank you member tickets Ranking Member cummings, i appreciate the opportunity to discuss the efforts to improve our position management this includes expanding the frontiers of knowledge and capabilities and opportunities in space in here on earth. By the very nation the nasa activities are high risk and at the same time we recognize a critical importance of managing the products as effective stewards of taxpayer dollars. And this means delivering them on cost and on schedule and identifying risks as we can implement appropriate corrective action. We have made significant improvements that are already yielding results particularly with our small and medium platforms. And we have seen a significant number of products and several projects have launched within their baseline including juno and the mars atmosphere and just two weeks ago the soil moisture active mission and this includes a development of significant number of new technologies. Which present greater technical risks, but even in next greatest observatory in space that was confirmed and has exceeded its original baseline has benefited from improved process. This has remained on track to meet the new cost we have established in accordance with the new policy three years ago. It has evolved over time as a probabilistic joint cost and is Level Analysis enables us to estimate the probability of completing a project within a certain lifecycle cost and schedule based upon individual products unique technical and programmatic characteristics and a benefit to this policy is what it brings to the analysis process and this includes the cost, schedule, and technical risk and the earned Value Management capabilities. The guidance provided to the nasa community through the recently released project management handbook as well as nasa routinely reviews the earned Value Management data with regular meetings at the center of the level as well as an ad hoc meeting as it arrives. We rely on the knowledge we gain to improve our management processes including we are on track to read meet the scheduled commitment. And we appreciate the open dialogue we have had is we have improved this capability. And im confident that we are on the right track to the Improvement Program management. Thank you for the opportunity to be here. We will continue and we thank you for your patience. The committee will come to order. I thank you all for your patience with both of us we obviously got delayed and i would actually like to start with the chairman of one of our subcommittees and subcommittees on government operations. The gentleman from north carolina, mr. Meadows for five minutes. Thank you, mr. Chairman thank you for being incredibly flexible today and really i guess the underlying concern as we are celebrating and its not a very high benchmark really if you look at the components of that it is does making a real concerted effort and we look forward to all of you putting this together. Doctor, let me come to you and i will send you a text and i want to compliment you i sent you an email and i want to compliment you that on a weekend you responded via email, which was shockingly surprisingly and i just want to say thank you do you have the enrollment numbers that have been resting from cms and have they given us you . Thank you for the question, happy to be accepted. The answer is that i think we are still working on it that is an agency, that i dont have direct oversight. And that they are working on assembling those numbers. Especially for making sure of that. What youre saying is that you have not seen the numbers for the automatic reenrollment, you have never seen any totals . I have not. Its my understanding that we have those numbers and we have been trying this. I think its just confirming that the numbers are some we can stand behind, they are numbers we can release, i believe that the cms is in touch with the staff. We have been in touch they have not really been in touch from a followup. It is amazing to me that we can have the Response Time that we can did this with spanishspeaking operators and we know that down to the second and we need to get automatic remoment numbers from cms. When can we expect that . Let me go one further because i have limited time. Lets look at medicare going from 14,000 lines of code to 68,000 lines of code in terms of medicare reimbursement is that correct . Yes. We need to start going to other codes. And they will calmly at an improper payment of fraud. You know, obviously the importance, why would we go from 14000 codes to 60,000 codes and how could that make it more efficient. First let me say that the agency is adopting these codes and with the input, it was really the provider communities searching for this and the ability to really define exactly what they were seeing. Let me ask you i went through and i looked at your codes and we got codes and one in particular says if youre unexpectedly missing your big toe yet you should get a code. There are six different codes for swirls sofa by few if its the first time if it scratches you, do you not see that we have unbelievable lines of codes and this will not make it more efficient . There is one in here for spending too much time in a freezer its incredibly ridiculous of images tell you that the positions that i talked to and the hospitals i talk to are spending billions of dollars in compliance trying to figure out these codes and yet we are going to increase those by fourfold. Why would you do that . I believe there is a code for a different kind of tax and i dont imagine in my own practice using that one or one of the others. Is a mouse a rodent . I think it is. But i think we have a different code and what im saying is that if its so complicated, you make it so, kid that nobody can comply. The agency is a recipient as other agencies are. What about implementing the Program Integrity . And that includes at some point we are required to implement this and that is the codesigned itself is not something that cms is engaged in but designed to improve epidemiologic situations to make sure that it reflects what is going on in the real world and that providers have had it extensive input. I dont disagree with your point but i think that we are a recipient as other agencies that are implemented across the world my time is expired and i yield back. Thank you. We recognize the gentleman. Cms has undertaken a number of initiatives including improper payments in the Medicare Program including about how they work and how effective they are and what you see for the future. I would like to ask you about these today and this includes suppliers that have historically pose a higher risk of abuse this heightened screening process that are attempting this in the Medicare Program or revalidate this. Can you describe the different riskbased screening level designations and the various requirements that providers are subject to . Sure. Provider categories are subdivided among three risk categories and as we go up the chain of risk more screening strategies and approaches are implemented including whether they are newly enrolling or revalidate them. The highest number say they have automated background checks that will be performed for all providers to ensure adequate licensure and level criminal background or felony record that would keep it out of the program, but in addition to that, high risk providers face fingerprint background checks, a multitude of different screening approaches for the highest risk providers and that includes those that are attempting to reenroll after having a Program Integrity action taken against them in the past. The result of all of this work today we have revalidated over a million of the million and a half providers enrolled in medicare and the totality of all this work on newly enrolling and the validation is that we have removed the billing privileges of over 450,000 enrollments in medicare today. And so i can tell you that the new enrollment requirements are also allowing us more applications at the financer never actually make it into the program because they do not qualify. That is what i was about to ask you as opposed to chasing money you do some preventative things. Is that right . Yes, i think that a lot of it solidly lands in the preventative category because it really is designed to keep folks out of the program that dont belong. So if we can duck this visit and to terminate your nonoperational as a provider, you never make it into the program or if we check the licensure and determine that you are not appropriately licensed or you have a felony conviction would keep you out of the program, we deny the enrollment application. Asking about this Demonstration Program on power mobility devices, how does the agencys prior authorization demonstration of power mobility devices complement the Program Integrity assets. Thank you very question, one of the central challenges in the improper payment rate is that there is a disconnect between the medical record documentation that underlies a medical service or indicates what happened over the course of that medical interaction and the claim that comes in for that interaction and what it does is allows us to ensure that medical necessity requirements and documentation requirements are being met on the front end before the services are offered as a beneficiary. Generally the way that we approach this is to take a risk based approach and the demonstration was implemented around these mobility devices first and we have put out a proposed rule that would look to expand this and then there are others in the budget bill up to expand it to things like hyperbaric oxygen and scheduled ambulance transportation and that includes what the private sector uses everyday evaluating the service before its provided, determining that its okay and the beneficiary gets the service and the provider gets paid. The beneficiary, is it adversely affected . I think that that is an important aspect. Before the Service Provided the medical appropriateness and a medical necessity or there, it prevents it from being on the hook for a denied claim and the service was never provided. That way neither the provider is on the hook for services they provided but then im not getting paid for and the beneficiary is also not on polk of the provider will get paid for. Thank you sir. Thank you, gentlemen. We now recognize the gentleman from tennessee. Thank you mr. Chairman. Just today the hill newspaper said in an article before signing on increased spending to the highest level ever, congress should is upon this to identify and address wasteful spending and then major federal is the only narrative to submit love alone pass theirs. In another article said pentagon leaders have requested this the jet fighter that has proven to be a nasty drain on resources with no end in sight 7. 5 billion in fiscal year 2014 alone with massive cost overruns and an egregious failure. And over the years i have read so many articles about this and i sometimes wonder if there are any fiscal conservatives at the pentagon. But what do you say, how much you have an estimate as to how much we have spent on the f35 so far . And are you concerned about this that talks about wasteful spending by the pentagon . Thank you for your question, congressman. First, we are always concerned about this at the pentagon and we have a place to address spending in general. Including looking at the overhead functions and acquisition processes dont have the total number, but it has gone down below our estimate since it was rebaseline in 2010 is actually producing a pretty good airplane. And i think its stuck on old news. Do you have any rough estimate of how much we have spent so far . I met last week with hospitals in tennessee we are either going to have to close or go under or could probably be end up sold to some outofstate corporations because of the unfairness in the medicare rates and they said that the system, and they penalize these that have continually lowered beds. Have you looked into this . The difference between what hospitals are this in comparison to in these hospitals are being paid twice as much for mostly the same kind of works. What can you tell me about that. Is the cms looking into this are concerned about these discrepancies at all . I appreciate the question and we do have processes for hospitals to engage us in terms of wage discrepancies like this and i can tell you we have a very proactive approach to what we know exists and reevaluating those codes that it should really pay for valuable services that taxpayers expect that we all want the program to provide. So i think it is there is a process for doing that and we are happy to engage with hospitals and providers on these questions. Years ago a Hospital Administrator told me that he said if you dont have hospitals you dont get doctors and if you dont give doctors you dont give people. There are so many hospitals that are really struggling in the country because of these discrepancies between what they are getting in comparison to some of the wasteful inefficiency hospitals and that is something that we really need to take a look at because its very unfair and i could give you all kinds of statistics about that but i wont bother with today, but its getting to be a very serious problem in my opinion. Thank you very much, mr. Chairman. The tone is recognized for five minutes. Thank you, mr. Chairman. When i sat down, this is my first year, when i sat down to do the geo report i got sidetracked and i want to talk about some other things because one of the things that i found that i think came out today that your agency is reporting that the tax refund fraud would be 21 billion from just a couple years ago and that number stunned me. And i think its more than we spent on the entire department of agriculture, the treasury the sec, the fda, and your irs with that money and still have a couple billion dollars left over, just out of curiosity we could buy 140. And this includes tax refund fraud and thats not all the fraud thats just a tax refund fraud and that is something i want to ask you about which includes her testimony last week for the senate which senator grassley asked her some questions about the impact in this claim that the earned income tax credit for up to three years and we remember this would senator grassley. I dont know if we established what that would cost. If you had a chance to figure out what the cost of the program would be. The 21 million came from, the gao testified that we stop lester about 16 billion with a refund and only 5 billion as our estimate and its still a big number and we are worried about but it isnt 21 or 31 million going out the door with regard to the question you asked this includes the earned income tax credit, you have to have a Social Security number and so we have about 700,000 out there by those who are paying taxes but then on eligible to apply because i dont have a Social Security number. And under the new program if you get a Social Security number and you were, you will be able to apply for the earned income tax credit. If youre working for this the maximum that you can get and spend the range of about five or 600. There was such lack of clarity in the interpretation of what they said. Is this earned income tax credit only going to be available for a to legal immigrants are filed previou