Good morning everyone. Welcome to the newly refurbished oversight investigation room. This is the first one of 115th congress. Welcome here and welcome our Witnesses Today. Welcome back to my friend and colleague. This is our medicaid oversight hearing on ways to strengthen the program. The Sub Committee convenes to examine patient and Affordable Care act. Medicaid and Medicaid Expansion. It provides Health Care Coverage for over 70 million americans and accounts for more than 15 of health dacare spending in th United States. The federal share and medicaid spending is expected to rise from 371 billion in 2016 to 624 billion in 2026, ten years. At a time when Medicaid Program costs are skyrocketing it makes sense to ask is it adequately serving our most vulnerable populations . 20 and 40 cents of value for each the government spends on their behalf. Further, reports by nonpartisan watchdogs, two of which are here today show that the Program Remains a target for waste, fraud and abuse. Because of the size and scale improper payments including payments or for services not provided are extremely high. For these reasons med dicaid ha been designated as a high risk program. Despite the longstanding problems the patient expanded medicaid to a whole new population. 32 states medicaid benefits have been opened up under the age of 65 and make less than 133 of the Poverty Level. Since open enrollment began in october 2013 roughly 11 million have signed up under the new eligibility per ram tam ters. It means they have enrolled instead of purchasing private health care. The costs have been far more expensive than predicted. A report found that the average cost of expansion was nearly 50 higher than projected. Medicaid expansion costs 6,366 in fiscal year 2015, which is 49 higher than the agency predicted the year prior. It means not only are expansions but the costs are difficult to predict. The vast majority of expenses. Unfortunately reports show states and federal government cannot effectively oversee Medicaid Expansion. The jail found determination that could lead to misspending of funds. They found troubling evidence that they failed to recommend requiremen requirements. We knowledged there are serious weaknesses and we recognize the responsibility of the federal government to previed a safety net. It means ensuring it is to help improve outcomes and serves the medicaid population. We want this to work, not hinder services. I hope we can support its strengths, knowledge problems and together find some solutions. Tomorrow the health Sub Committee will discuss to strengthen medicaid. As we move forward we must be careful not to repeat problems that already exist in the programs. We have a lot of work do. I would like to thank witnesses for appearing today. Thank you very much, mr. Chairman. It is good to be back for another session of congress. We have two new members on our side of the aisle this year. I am so happy to welcome them. Dr. Ruiz is here with us. He is an actual emergency room doctor. He will be able to bring us so much great perspective on issues like this hearing and other hearings. Scott peters who is not here at this moment, im pleased he is here. He and i comprised twothirds of the nyu law graduate to congress. Im happy we are loading up this committee with law grads. I think i would be deceiving myself if i thought todays hearing was intended to actually strengthen the Medicaid Program. I hope its not so. I fear that this discussion about medicaid is intended to lay the ground work for drastic cuts to the program and eventually to repeal the Affordable Care acts historic Medicaid Expansion. I would like to talk about what Medicaid Expansion has accolished for the American People. Today more than 70 million low income americans including sen kbr seniors have access to contrary to what they think it delivers this care efficiently and effectively. The cost per beneficiary are substantially lower than for private insurance and have been growing more slowly per beneficiary. It has shown it helped improve access to primary and Preventive Care and by helping americans manage and treat serious disease. In fact the Medicaid Program literally saves lives. Research reported that previous expansions for lowincome adults actually reduced deaths by 6. 1 . The acas historic Medicaid Expansion helped states build on this record of success and provide insurance to millions of americans who otherwise would not have had access to health care. Last year and we need to think about this. More than 12 million low income adults had Health Care Coverage because of the Medicaid Expansion. This is astonishing. Combined with other important provisions this has helped drive the uninsured rate to the lowest level in our country east his rhode island it history. It is not people that shifted from private insurance. This is people who had no insurance and were using Emergency Rooms as their primary care facilities. In colorado the rate of the uninsured was cut in half and through the expansion of medicaid. Aside from the benefits that have accrued to the people medicaid has actually resulted in tremendous savings from the states. They have seen their uncompensated care burden drop since the aca became law. Denver Health Medical center reported to my office their uncompensated care claims fell by 30 . This is real savings. Also we know that medicaid is helping people get access to Vital Health Care services. I had a listening session last week in denver about the aca. I had 200 people show up at this listening session. Most of the people who told their stories talked about how they were employed but they couldnt afford private insurance. Due to Medicaid Expansion they now had drug treatment services. They had services for catastrophic accidents they had had and on and on. It got to the point where i literally had to take a packet of kleenex out of my purse and put it on the podium because we were in tears listening to these story. This is what the majority wants to take away and this is what we are talking about. We can all talk about eliminating waste, fraud and abuse in the program. We are all for that. I would support that 100 . Taking away Vital Health Care for so many millions of americans is wrong. We must fight against taking that important benefit away. I yield back. You yield back and we dont have anybody else on our side that wants to give an Opening Statement. I think mr. Walden will come back later. Thank you. It is great to be back in our room here today. It looks really nice. For seven years now Congressional Republicans have railed against the Affordable Care act with a city drum beat of repeal and replace. For seven years they sabotaged implementation of the law. Republicans are misleading the public with falsehoods that the law is failing. It could not be further from the truth. The truth is after seven years of claiming they could do better they have no lan. The Sub Committee should be evaluating how it would impact the people. They are holding another hearing to highlight ongoing opposition to the Medicaid Expansion despite evidence it has made it affordable and available for the first time to 12 Million People nationwide. Tomorrow and thursday they are Holding Hearings on what republicans consider the first pieces of the Gop Health Care replacement plan. The fact is none of these bills will prevent 30 million from losing Health Care Coverage. None will reduce chaos in Health Care System that will result in republicans successfully appeal. Republicans are creating instability in the individual market. This will ultimately result in higher premiums and will endanger health and welfare of americans. The republican made chaos has already begun. Of course we are seeing the same thing but the president S Immigration executive orders, i just hope that at some point our gop colleagues join us against what i consider reckless actions and oppose President Trumps actions. Congressional continue to ask them to trust them and they have a plan that some how everything will be okay. They repeatedly assured the American Public no one will lose covera coverage, a claim they also continue to make. Recently released audio at a closed door meeting from the republican retreat last week confirms they simply have no plan. At that meeting republicans admitted repealing the Affordable Care act could we vis rate coverage now covered through state and federal marketplaces as bewell as thoug covered under medicaid expans n expansion. One said we better be prepared to live with the market we created. They tried to claim it is already collapsing under its own weight and it will rescue the American People from obamacare. It could not be further from the truth. Americans today have Better Health coverage and Health Care Thanks to the Affordable Health care act. It helped improve the quality and affordability of millions of health care. If they took blinders off they should realize they should not be repealed. I say this because i dont care about the idealology. The fact of the matter is real people will be harmed. I hope at some point my republican colleagues will admit that and we can Work Together to improve the Health Care System. I yield back. I want to ask consent that the members Opening Statements be introduced into the record and other documents be entered into the record. Now to introduce five witnesses for todays hearing. We have caroline yolkham. We welcome ann maxwell next we want to welcome mr. Paul howard who is senior fellow and director of Health Policy at Manhattan Institute as well as josh last we welcome Timothy Westmoreland welcome to all of you. Thank you to all of our witnesses for being here today. Look forward to hearing from you on this important issue. Youre aware they are holding a hearing and when doing so has the practice of taking testimony under oath. Do you desire to be advised by council . If you would please rise and raise your right hand ill swear you in. Do you swear the testimony youre about to give will be the truth, the whole truth and nothing but the truth . You have all answered the affirmative title 18 section 1001 of the United States code. I will call upon you each to give a five minute summary. Is there lights that will go on for them when they are well see. Is there something in front of you . Green means keep talking. Yellow finish up and red means stop. Chairman murphy and members of the Sub Committee, its a pleasure to be here today to discuss actions. Medicaid finances health care for a diverse population including children, adults, people who are elderly and those with disabilities. It offers a comprehensive acute and longterm Health Care Services. Medicaid is one of the largest programs in the federal gubudge. In fiscal year 2016 medicaid covered about 70 Million People and federal expenditures were expected to total about 363 billion. Unfortunately over 10 of these expenditures, over 36 billion, are estimated to be improper. That is made for treatments or services that were not covered by the program or not medically necessary or were never provided. The program size and diversity make a particularly medicaid is a federal state partnership and it states is the first line of defense. They have responsibility for screening providers and referring inspected cases of fraud and abuse. At the federal level they state Program Integrity efforts. In 2010 the Patient Protection and affordable gave states additional provider oversight tools. The act provided millions of low income americans new options for obtaining Health Care Coverage through an exchange. A marketplace may compare and Purchase Health insurance. My Statement Today focuses on four key maedicaid issues we hae identified, steps they have taken and the related challenges they continue to face. First, with regard to ensuring only eligible individuals are enrolled they have taken a variety of steps to make it more data driven yet gaps exist to ensure the accuracy of federal and state enrollment efforts indeluding enrollment for those as a result of the expansion. As one example we found federal and selected market base approved federal Health Insurance coverage for nine of 12 fictitious applications during the special enrollment period. Efforts to improve oversight cms provided states with more guidance of methods of identifying improper payments and hasnt acted in response to recommendations on requirements for states to audit managed Care Organizations and providing states with additional audit support. Further actions are needed, in particular data which allows them to track Services Received by beneficiaries that are enrolled in managed care and are not always timely or reliable. Third, cms has taken steps to strengthen the screening of providers. There are new risk based initiatives. These are important steps. There are additional challenges that remain to ensure that the databases check eligibility and states share information with each other our work identified some duplicate coverage and started conducting and intends to perform at least two times per separate year. Cms need to develop this plan more broadly and make sure they are accessing the sufficiency of these checks. Medicaid is an important form of health care. Its longterm sustain blt requires state oversight. Members of the committee, this concludes my prepared statement. I would be pleased to respond to questions. Thank you. Good morning. Thank you for the opportunity to appear before you today to discuss how to protect taxpayers and medicare patients from fraud, waste and abuse. I wanted to give you a sense of what it looks like. It can include very different kinds of schemes. For example, in one instance we indicted the owners of a network of over 30 networks that billed for sources patients didnt need. Expensive drugs were sold in the black market or billed for medicaid. It is these types of schemes that highlight medicaid against providers who steal at the expense of taxpayers and put patients at risk. Today awant to highlight actions that we can take to better protect medicaid from these types of fraud schemes and others facing medicaid. Agencies and centers for medicare and medicaid share responsibility for funding as well as protecting medicaid. We recommend they focus on three straightforward Program Integrity principals, prevent, detect and enforce. First and foremost cms must pro vent fraud, waste and abuse. Medicaid some times fall short and end up chasing of providers or to recover overpayments. They should know who they are doing business with before they give the green light to start billing. To help with that we recommend states fully implement criminal background checks and collect accurate data about providers. In addition we recommend states learn from past administrative errors to prevent improper payments. Medicaid should only be paying the right amount for the right service accurate data is an essential tool for doing this. As we have just heard National Medicaid data including data from managed Care Companies has deficiencies. Further, states cannot see the whole picture. For example, we found providers enrolled in one state Medicaid Program that have been terminated by another state without shared data states had no way of knowing this and had to find out the hard way they had enrolled fraudulent providers. Finally, its impairtive to take swift and appropriate enforcement action to correct problems as well as to pro ve prevent future harm. On thousands of wrong doers each year. However states face challenges in taking full advantage of administrative authorities including suspended provider payments. In addition it lacked a key authority. Currently these units can of patient abuse that occur within institutions. If that took place in a patients home or Different Community setting they cannot. Medicaid patients receiving services in their home should have as many protections as though in institutions. In particular a heightened