Africanamerican voters and also africanamerican candidates . Let me share with you, jesse holland, this is from a democrat, he worked for president bill clinton as a speechwriter and he says to t Voting Rights nationwide on heading on inattention by the American People, emboldened by the recent Supreme Court case limiting the reach of the Voting Rights act, they have worked weeklyo cut voting samed is not a paradox because often the africanamerican voters are those who cast their ballots early according to a number of studies. Guest that is a paradox. You would think someone is trying to recruit voters would want to make it as easy as possible those people to vote. Now, a lot of republican opportunists will tell you that even africanamericans are concerned about voter fraud and thats one of the issues that they tried to point at when you look at voter id law. However, one of the practical effect of voter id laws obviously is that make it makest harder for some people to vote. Now, one of the things that weve been looking at is whether this effort can boomerang. If someone sees you, if so i think youre trying to take away their power to vote, that may make it even, make them even more intent to make sure they vote. So some people say that these voter id efforts could actually boomerang and bring more people to the polls to exercise their rights than they would have otherwise. So thats one of the things will have to keep our eyes on when the Elections Come around in november. Host jesse holland, thanks to much for getting it early on a monday morning and adding your perspective to these issues. We appreciated. Guest thank you. Cspan to provide live coverage of u. S. Senate floor proceedings and key Public Policy event. Every weekend booktv now for 15 years the only Television Network devoted to nonfiction books and authors. Cspan to greater by the cable tv industry and brought you as a Public Service by your local cable or satellite provider. Watch us in hd, like us on facebook and follow was on twitter. Next, House Oversight and government reform subcommittee hearing on medicare oversight and management. According to the Government Accountability office, improper payments in the Medicare Program cost taxpayers almost 50 billion in 2013. Witnesses include officials from cms, the gao, and the department of health and Human Services. This is just over two hours and 20 minutes. The meeting will come to order. Without objection pictures offers did the recess of the committee at any time. We will take this all but out of order today as we walked to this. With some of the democratic members were on the we are but we begin with Opening Statements and they can catch up. The subcommittee hearing on health care entitlements. I like to begin by stating Oversight Mission statement. We exist to secure to from the principles. First american the right to know the money washington take someone is well spent. Americans deserve an efficient and effective government that works for them to our duty on oversight and Government Reform Committee to protect these rights. Are so responsibly still government a couple because taxpayers have right to know what they get from the government but we will work tirelessly in partnership with watchdogs to the facts American People and bring genuine reform to the federal bureaucracy. This is our mission. Medicare currently pays onefifth of all Health Care Services provided nationwide making it the largest single purchaser of health care in the country. Fortunately, every year the Medicare Program wastes enormous amount of money and overpayments, fraud and unnecessary tests and procedures. According to jail, in 2013, 50 billion was lost to improper payments, an increase of 5 million in 22 but medicare feeforservice care for 36 billion of the total. Gao has related medicare as a high risk since 1990. In part to the programs successfully to this ways which makes up the a staggering 40 some of total improper payments identified by the federal government last year. Wrote with significant threat not onto the 59 beneficiaries who determine its services but also the programs finances. At present the Medicare Trust fund has been in deficit since 2008. The medicare actuaries predict the fund will be fully depleted by 2026. Cms has responsibly demand in the Program Integrity of medicare. To combat fraud, seen as works in partnership with outside organizations like the Health Care Fraud prevention enforcement act which operates the Medicare Fraud strike force to combat perpetrators who often steal identity and also by billing documents. Been submitted to a riskbased screening to identify fraudulent medicare providers and suppliers. In april 2014 seamless announced fingerprintbased background checks will be conducted on highrisk providers. Temporary enrollment moratoriums have been placed on new medicare providers, suppliers interest at high risk for fraud. C s has begun administering riskbased private Sector Technology like Predictive Analytics identify possible fraudulent claims for review. Cms also relied on oversight of contractors to combat improper payments. These contractors such as recovery audit contractors, or racs, we declined to give a overpayments and recover misspent funds. Gao undoes have found these contractors effort sometimes overlap and requirements respond to audits are not uniform. This puts a greater burden on providers. Gao ezra committed to improving consistency among contractors would improve the efficiency of post payment reviews of medicare claims. Was improper payments identified cms may take steps to reclaim identified overpayments. Providers and beneficiaries are given opportunity to appeal the determination through a lengthy appeals process. This third level of appeal is a measure by 66 administered law judges and hhs office of medicare hearing and appeal. Theres a massive backlog of over 460,000 pending appeals for alj hearings. Digitus backlog, h. S. Can probably pick up to 28 months for a hearing before an alj during which providers have their money held by the government. Not many businesses can survive having their money held for 28 months while they wait to decide if they will actually get reimbursed. Nancy griswold will testify that she was unable to appear. We will follow through on the. Today with three witnesses. Kathleen king, director of health care at Government Accountability office. Brian ritchie. Brian ritchie, acting director Inspector General or evaluation of inspection hhs office of Inspector General. And shantanu agrawal, debbie of measure and director for the center for Program Integrity at the cms to discuss how seniors can put medicare oversight and Program Integrity. I look forward to the testimony. The American People deserve a government that protects their tax dollars and use them wisely. We must do more to strengthen integrity of Government Programs over all the particularly given its enormous size and scope. Clearly, more needs to be done to improve the federal governments efforts to recover 50 billion in overpayments and other improper payments. Todays hearing will provide subcommittee with clarity about these areas. The process cannot drive up the cost of health care for seniors and reduce the options for care. I look forward to the conversation well have today. With that i recognize Ranking Member grisham. Good morning. Thank you, chairman lankford, for holding the hearing. I agree with the chairman reducing waste and fraud and abuse in the Medicare Program is critically important not only to protect taxpayer funds that as you just heard, its also include important to protect the health of our nation seniors and disabled adult population. Weve got more than 10,000 seniors aging in the Medicare Program each day this year. It is now more important than ever that we ensure the integrity of medicare funds and keep the medicare promise alive for generations of future americans. Im grateful to have mr. Ritchie on the other Departments Office of Inspector General to speak about the oigs efforts to do exactly that. The oig in conjunction with the department of justice prosecute some of the worst instances of Health Care Fraud. Providers buildings were nonexistent beneficiaries or services that were never provided, and providers to order unnecessary or in fact harmful procedures. The Health Care Fraud and abuse control, a joint program under the direction of the attorney general and the secretary to health and Human Services department is a model for interagency cooperation and coordination. In fiscal year 2013 the hcfac program recovered a record for . 3 billion in Health Care Fraud judgments and settlements. This is remarkable and i look forward to hearing from the assistant Inspector General about how this was achieved and what can be done to strengthen the Program Going forward. I also think its important to underscore what we heard that these bad actors represent a small fraction of all providers. Investment go to a providers are not fraudsters under deeply dedicated to the care of their patients. Given the size and complexity, the theme of Medicare Programs, overpayments are going to occur. Cms must be vigilant in detecting and recouping them, but will many providers are entitled to have their claims administered fairly, efficiently, and without undue delay so that they can focus on the core mission of providing care. And i have some serious concerns that the Current System of post payment audits by rac is resulting in a significant burden on some providers, particularly smaller entities. Smaller providers such as Durable Medical Equipment or dna suppliers have more difficulty complying with rac request for medical documentation and may not have the resources to, in fact, even appeal overpayment determination. A considerable backlog in the office of medicare hearings and appeals only makes these matters worse. As these providers and suppliers do not have the luxury of waiting months for their appeals to be adjudicated. I also have concerns about how rac audits may affect beneficiaries. As a representative of new mexicos first district, the issue of access to care is always paramount in my mind. If a provider or supplier is forced to cut back services or close its doors as a result of iraq audit, i think this is a loselose situation for everyone, particularly as we are working to build access to care particularly Preventive Care for these populations. Cms recently announced it will increment several changes to the rac program which will be effective with the ram contract. I look forward to hearing dr. Agrawal about cms efforts to improve the oversight of iraq in particular. I hope that you also address some of the issues we both race, the chairman and i, regarding the burden on medicare providers and with particular focus on some of those smaller providers on providers in rural and frontier states like mine. And ly on the beneficiaries who are k forward to hearingo access th. From all of the witnesses about what cms is doing to move away from that day and chase model, to a more proactive model that identifies improper payments up front, such a model would spare both providers and taxpayers from expending resources that could be much better spent on providing care which in the long run shores of medicare for future generations. With that, md back. Mr. Meadows, Opening Statement. Thank you, mr. Chairman for holding this hearing, and thank you for continuing to 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 alj backlog. And as the Ranking Member just testified, it could be extended difficult on Small Businesses. The request for a particular company in my district threatens to put them out of business, and yet all they want is a fair hearing. I shared this with the chairman and shared some of my concerns that women are, and in his Opening Statement he talked about the fact that we have a 28 month backlog. Well actually its worse than that. If you look at the real numbers that today if we hired according to the budget request for cms, if we hired all the adjudicators, it would take close to 10 years to work through this backlog. Some million, a million appeals, and if you look at the rate, actually the adjudicators have been improving their efficiency. They have been Getting Better year after year, and yet we do is we have a policy of where we are saying youre guilty until proven innocent. Now, were all against waste, fraud, and abuse, but what we must make sure of is that we do it under the rule of law and that we have laws that guide, the guidelines that are there. There is a long right now that says that if we ask, if a constituent asks for a hearing, that the law says that they should have some kind of adjudication and a decision within 90 days. And yet even according to the website for cms, were not even opening the mail for weeks and months and months and months. So its not even being put in terms of on the docket where it could be assigned to a judge for many, many months. We have got to do better than this and make sure that in this we dont take those that are innocent and put them out of business. Now, i say that because if our overturn rate was not that great, we wouldnt have a problem. But according to documents many of these appeals are being overturned by the adjudicators, over 50 of them are being overturned. So you 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. So i look forward to reading your testimony on all these things, and i thank you, mr. Chairman. Thank the chairman for all of his work and his research that its gone into this hearing this day, and hes been a leader in this. Ill be glad to be able to receive the tests were now of our thre three witnesses. Pursuant to Committee Rules all witnesses are sworn in before they testify, so if you could please raise and rise in racial right hand. And raise your right hand. [witnesses were sworn in] thank you. Let the record reflect all three witnesses answered in the affirmative. Ms. Kathleen king is right for health care at interest is Government Accountability office. Thank you for being here. Dr. Agrawal is the deputy administrator after for the center for Program Integrity at the cms and mr. Vine which is acting deputy Inspector General for evaluation inspection at the office of Inspector General at hhs. Thank you all for being here. Thanks for testament to the. Weve all received a written test and. That would be part of the public record. We now would be able be glad to receive your oral testimony. You will see the clock in front of you. Ms. King, your first. Mr. Chairman, and members of the subcommittee, thank you for inviting me to talk about our work regarding medicare and proper payments. Cms has made progress in implementing our recommendations to reduce improper payments, but there are additional actions they can take. I want to focus my remarks today on three areas, provider enrollment, prepayment claims review, and post payment claims review. With respect to provider enrollment, cms has implement it provisions of the Patient Protection and Affordable Care act to strengthen the enrollment process so that potentially fraudulent providers are presented from enrolling in medicare, and highrisk providers undergo more scrutiny before being permitted to enroll. Cms has recently imposed moratorium on the enrollment of certain types of providers and fraud hotspots and is contracted for fingerprintbased background checks for highrisk providers. However, seanez has not completed certain actions to authorize in ppaca which also be helpful in fighting fraud. It has not yet published regulations to require additional disclosures of information regarding actions previously taken against providers, such as payment suspensions, and it is not published regulations establishing the core element of compliance programs, or requirements for surety bonds for certain types of that risk providers. With respect to review of claims for payment, medicare uses prepayment for claims that should not be paid, and post payment review to recover improperly paid claims. Prepayment reviews are typically automated edits in claims Processing Systems