global economy with steven of "the washington post." after that, a liggett childhood obesity in the u.s. "washington journal" live at 7:00 a.m. eastern. >> co-chairs of the 9/11 commission discuss intelligence failures leading up to the northwest flight 253 attempted bombing. . . ç>> the hearing will come to order.

this is the second in a series of hearings will examine where the intelligence reforms in the wake of the attack of 9/11 are working. to examine the reforms in the to examine the reforms in the orist attacks and the ongoing threat in what we have done earlier may need further reform so that we cannot fulfill our responsibility to protect the homeland security of the american people. i want to go back to last week's first before we focus on this one. i very much appreciated the fact all of the witnesses in last week's hearings, and dennis blair, janet napolitano, all acknowledge that mistakes were made with regard to the

christmas day attack on the plane over detroit. all three offered to work with each other and with this committee to make our existing terrorist -- counter terrorist quicker and harder to penetrate. i thought animal blair -- i thought admiral blair was forthright and it brought him some criticism. it made him the target of some displeasure. it was the right thing to do because it was the way he felt and he spoke in what he believed to be the national interest. it is self evident that our homeland security intelligence did not work as we on this committee, congressman hamilton, post -11 with of

wanted those agencies to work. -- post 9/11 would have wanted those agencies to work. when they do deal with the shortcomings, we have some hope the problems will be fixed and obviously whatever mistakes will make one not occur again. one of the most troubling revelations last week was that none of the witnesses was consulted before the christmas day bombing was turned over to our criminal courts rather than the military, where i believe he should have been held. he was a trains to attack america by al qaeda. since our hearing, osama bin laden has boasted of al qaeda sponsorship of the christmas day attack on america. and so while al qaeda claims

credit for this attack, umar farouk abdulmutallab, who i think we can describe it as a soldier in al qaeda, and not an american citizen, now enjoys the constitutional protections of an american citizen, including a lawyer, who counseled him to remain silent even though he may have information that could protect the american people from another terrorist attack. to meet this is outrageous, a kind of alice in wonderland in turning the world on a sense -- in turning common sense on its head. i urge the authorities to turn abdulmutallab where he can be held as a prisoner of war, which he is, acknowledging with some

certainty and gratitude that this means he will be held and given rights far in excess of what the geneva convention requires enemy combatants or prisoners of war be given. we will stay on top of this to make sure this mistake, the failure to consult with -- to decide how to handle abdulmutallab and the decision to turn him over to the civilian courts is ever made again. i do believe our intelligence gathering analysis remarkably improved since the attack of 9/11. the sharing of intelligence is vastly improved. this is due in part to the judgment with us today. shares of the -- shares of thcsf

the 9/11 commission. driving the changes that make the american people more secure today than they were during 9/11. that leads us in part to refer to the act i just referred to as the 9/11 commission act. it sounds a lot better above saying the acronym. the fact is it implemented most of the bipartisan recommendations of the commission. governor kean and congressman hamilton have been unique on the commission and continue to track the implementation of their recommendations persistently over the last five years. they are testifying before us today as cochairs of the

national security preparedness group. i welcome both of you and a thank you for your service. your recommendations were comprehensive in terms of long term actions we can and should take to blunt the terrorists' appeal and to stop their ability to recruit and also to defend our nation against further attack. one of the challenges revealed in our hearings last week was the overwhelming amount of information that is collected by our intelligence and law enforcement agencies for analysis. it's been estimated that the national security agency alone collects on a daily basis four times more information than is stored in the library of congress. that is how much is being collected. i know governor kean and

congressman hamilton have been considering this challenge and i would be interested to hear how we can better organized our analysis efforts so information can be mined more quickly. after 9/11 we were saying the dots were collecting did not come together on the same board. i think now, things to your recommendations and the legislation that followed, the dots are coming together, but there are so many billions of dots, the question is, how do we seek the patterns to help us act preemptively to stop attacks against our country? another question relates to the authorities that we provide in the national counterterrorism center in the commission act.

bottom line question, do we need to give the dni additional authorities or do we need to push them harder to use the authorities they already have it? i know you have done some preliminary work on this and i look forward to the guidance that you can offer our committee as we go forward with this series of hearings. there will be a status report and perhaps recommendations for legislation or further executive action. i cannot think you enough for your efforts to secure our nation against terrorism, particularly islamist terrorism. there is no sense of morality or respect to life. that is the challenge of our lifetime. because of your service, we're

doing a lot better than we otherwise would have done in beating that challenge. senator collins. >> thank you. i do join you in welcoming our distinguished witnesses back to our committee. but for their efforts, many who are here today, we would not have accomplished as much as we were able to. nevertheless, we are hearing these words today -- intelligence failures, calls for reform, lack of accountability, failure to connect the dots, testimony by governor kean and congressman hamilton. it sounds like deja vu all over again. but in fact, there are

significant differences between now and then. when our nation was attacked on the morning of september 11, 2001, our intelligence community was hampered by an organizational structure that undermined unity of effort. it was led by director who had little authority over its various elements and of little incentive to put focus beyond the mission of the cia. it was burdened with the culture that promoted parochial agency interest over the intelligence needs of a nation. the intelligence reform act of 2004 fundamentally change our intelligence community. working with the families of the victims and with our distinguished witnesses as well as the rest of the members of the 9/11 commission, this

committee was able to pass the most substantial reforms of our intelligence agencies in more than 50 years. my favorite named for the bill is the collins-lieberman intelligence reform act. in the five years since this act became walaw, information dramatically. in 2009 alone, the intelligence community working with law enforcement and homeland security agencies has have to detect and disrupt numerous terrorist plot targeting our nation. two of the successes were the arrest of david headley in separate conspiracies. other successes were made possible by the reforms this

committee spearheaded in 2004. but standing alone, the law cannot accomplish transformation. at the end of the day, even the most powerful laws are just words on paper. they relied on the president and leaders to produce reform, to aggressively carry out the authority that they have been given, and to fight the war on terrorism, president, the secretary of state, and other leaders must use the laws we pass to their fullest extent. unfortunately, the terrorist attack at fort hood and the failed christmas day plot are stark reminders of what can happen when those authorities are not used effectively. let's just look at some of the authorities given under the 2004 law.

the dna has the clear authority to determine requirements and priorities for the management and passingç analysis on dissemination of national intelligence. the initial analysis shows the dni failed to respond to the growing threat that al qaeda posed to the united states and apparently failed to target sufficient resources at this threat. the intelligence reform act provides ample authority to insure the maximum availability to intelligence information to intelligence information -- intelligence regarding the threat posed by a majorç hasan remained stovepiped.

t(we saw filly to connect the dots, the streamsçó of intelligence reporting, with regard to the christmas day and attempted attack. i]the law directs the dni to directed the informationç intelligence systems. here again, the intelligence that may have allowed this to identified abdulmutallab as a terrorist remained undiscovered in multiple databases. disseminated, those doubts were out there -- those dots were out there. but they were not connected. the law provides the secretary of state with clear authority to revoke of the sub at any time in her discretion. yet, abdulmutallab's visa

remained valid when he boarded a flight. it remained valid, despite the fact that the state department had already decidedt( to questin him about his ties to extremists if he chose to renew his visa. i would ask -- how could he have been a threat to the united states in the future based on these extremist ties, but not a sufficient courage threat to cause his ibiza to be revoked? -- his visa to be revoked? despite the president's authority to hold abdulmutallab as an enemy belligerent and subject him to a thorough interrogation for intelligence purposes, the department of justice as we learned in our last hearing unilaterally decided to treat him as a common

criminal, as an american citizen, advise him of his right to remain silent, and grant him a lawyer at taxpayers' expense. it is outrageous carnations top intelligence officials were never even consulted on this vital decision. senator lieberman and i introduced a bill last week to try to prevent that from ever happening again. my point is that the president's must empower his senior officials to use every authority available to them to defeat the terrorist threat. doing so does not require action by congress. that is not to say that further reforms are not needed. correcting those problems is possible under the crime law.

it is a matter of using the authority. they do not require a 60-day review or more studies. they should be implemented now. nothing less than the security of our nation hangs in the balance. thank you. >> thank you very much. i want to note members of the families of some of those we lost on 9/11 whose persistence has not just matched those of kean of and hamilton and members of congress but surpassed it. it's just great that you are here. you're in the front row. we thank you and we will stick with it. if it wasn't for these folks, we never would have had the commission. if not for the commission, we never would have had the legislation.

do you guys toss a coin as to who goes first? congressman hamilton, it is great to see you. welcome. >> thank you very much for inviting governor kean and myself to be with you. we are cognizant of the fact that were not for this committee, many of the recommendations of export 9/11 commission would never have been enacted. the committee has shown extraordinary leadership on these questions over a period of years. i know that the country is safer and the country should be very grateful because of the work of this committee. we thank you for it. senator lieberman, i want to say you're exactly right about the families. this law would never come into effect if it had not been for them. governor kean and i have had a

wonderful relationship and support from them. we are appearing today because of a bipartisan groups and our written testimony gives the membership of that group the name. i know their names. they are familiar to you. it is an extraordinary group of professionals that join tom and me in this review of the 9/11 commission recommendations. at the national security prepared this group, we have been studying the implementation of the recommendations. we are still pretty early on in that review. but we do have at least some tentative conclusions to present to you today. the christmas event and at fort hood, as well, give us the opportunity to make two

important points. one is an obvious one and that is the threat from al qaeda and radical islam remains very strong. one of the members of our group, you know him by name, bruce hoffman, has observed that al qaeda it is on the march. all of us agree with that. we have expressed over and over our sense that the urgency on terrorism has been too low and we have to reject complacency and recognize that we still can see a serious threat. it is not a reason for panic but a reason for a concerted effort. the second observation would make is that we see the determination of the terrorist who would attack the homeland unabated and it reminds us the need for establishing the

national counterterrorism center in the first place. we need to support these entities and build them into strong and enduring institutions. it is imperative in our view of the dni be successful in its vital mission it has been asked to undertake for the country. we have been pleased that your committee has initiated this series of hearings on how well intelligence reform has been implemented, and that is exactly the kind of congressional oversight that we call for in the report. there has been a debate within the intelligence community on the state of intelligence reform and the effectiveness of the dni. the dni has been hobbled over enlist disputes. we're concerned over the criticism that is sometimes made over the bureaucracy of the dni and we support, as i am sure

this committee does, an ongoing re-evaluation of its functions to ensure its leanness. the congress and president gave the dni a massive to-do list, a great deal of authority in the wake of the intelligence failures of 9/11 and weapons of mass destruction. it is not enough to say the dni bureaucracy should be reduced. we need to take a freshç look t the essential tasks and then seek to adjust accordingly. in recent months, we have come to some preliminary conclusions. we have a lot more work to do. we believe they dni has achieved a meaningful measure of success in its first year. it has been worth the inevitable turmoil. it is a work in progress.

-- it is a they have repeatedly connected the dots and shared the information necessary to defeat the terrorist attacks. improvements have been made on this point of sharing the information. we continue to believe that sharing is not as prompt and as seamless as it should be. many of the successes ofing dni have been -- of the dni have been dependent under the bush administration and the obama administration. we want to continue to look closely to make sure it has the authority to do its work. it is our sense of the success of the dni in the short term it will not rise or fall on whether we make additional adjustments

to the intelligence reform and prevention act. that was a difficult piece of legislation to get enacted. it is on the books now. it will be the governing statute for a good long time. so you have to work with it. i think there probably are some ambiguities in the law. you could argue that is more a failure of exercising the authority than ambiguity. for example, section 1018, capacity designed to ensure the chain of command will not be abrogated. raises some question of authority. there have been some problems resulting from that section. we hope those have been cleared or at least improved by the

executive order 12333 put into effect in the final weeks of the bush administration. qthe greatest challenge facing dni relates to the authority and the role. from my point of view, i think from tom's as well, the burden is clearly on thew3 president to be very specific as to who is in charge of the intelligence community, where final authority lies on certain matters. you need a strong dni as a leader. the person has to drive integration, which we all know is a massive task. at the same time, the dni's authorities must be exercised

with discretio a in in consideration of the other intelligence agencies. you really do need eight discipline. the president's leadership is the key. it is crucial and it must be continuing. or we run the risk of mission confusion and decrease the prospect of long and lasting reform that was recommended after 9/11. the ability to lead the intelligence community depends on the president defining his or her role and giving them the power and the authority to act. >> thank you very much for a strong and thoughtful statement. governor kean, welcome back.

>> thank you, mr. chairman. we're all blogging are best to get this massive bill passed. -- we were all lobbying our best to get this massive bill passed. leadership has taken control in the senate. this bill will pass. so thank you. thank you very much for your leadership in that area and the incredible families of 9/11. they were the wind in our sa ils of the commission. they are lobbying to make this country safer. every time i come here and see them, i just echoed leak and the committee in saying thank you so very much. -- i just accokeeecho lee and te committee in saying thank you.

the greatest single challenge that rises is the urgent need to strengthen the analytic process. the president said there was a felony to connect the dots. we might have been able to connect disparate pieces of information. we are pleased the president asked the dni to look at this information. the dni is properly situated to assume a leadership role in applying the most rigorous standards to the analytical tradecraft. congress gave the dni the resources it needs and the resources it needs and the ability to recruit and to keep

-- another part of improving analysis is judging sources of potential tax property. as the president's review has shown, he described as strategic sense that al qaeda and the arabian sea -- in the panic -- in the arabian peninsula was becoming a threat. we collect an enormous amount of intelligence. we need the very best people, not only sorting it three for technical details, but in a strategic sense, taking that and making a decision -- where is the next attack liable to come from? and what is happening out there? you have talked about more information coming in, senator, in the library of congress. it is incredible what comes in every day. it is awash with data -- the intelligence community. in this age when we are collecting more information than ever before, the real challenge

is how to understand, under sick -- and integrated = it. do a better job of pushing information to the right people. welcome president obama's order to distribute reports more quickly and more widely. we can better sort through massive amounts of information to make sure the right people are seeing it and seeing it in time to make a difference. the technology we use must be constantly upgraded. it must be properly placed so better analysis can occur. we have heard a number of times back five years ago before the commission that the analysts were sometimes treated as second-class citizens. hopefully that is not happening today. but these people are probably if

not the most important, one of the very most important people in the whole community. we do everything we can to support them, too shy of their professionalism, and to get the best of them to stay in government. a second lesson from the christmas attacks reminds us of the importance of eliminating terrorist centuries. we found that the attackers from 9/11 benefited from the command structure that existed in afghanistan, but commission placed great emphasis in prioritizing actual potential terrorist sanctuaries. we recommended strategic strategies employed all elements of national power. the more we can keep terrorists insecure and on the run, the better off we are. we are fortunate that the attack on christmas day did not

succeed. they remind us, let's look. or are they developing centaurus? bruce hoffman observed al qaeda it is seeking out exploiting failed states in any other area of lawlessness. they have increased their activities in pakistan, nigeria, and yemen. the u.s. could take a fresh look at these areas, and deepen our commitment to make sure that they cannot exploit those territories it to launch attacks on our homeland. there are a couple of left over matters from our report. we have talked a number of times about balancing the need between civil liberties and national security. we have to get that balance right. it is absolutely important. we recommend a civil liberties

and board located in the white house which would look at the implications, whatever laws are passed come from a civil liberties. of view. the board was staffed in 2006. congress further strengthen it in 2007. we have an independent agency outside the white house. the board held numerous sessions with the fbi director among others, on terror surveillance, and other topics. çbut the board has disappeared. it has been dormant since that time. we have now a massive capacity in this country to develop data on individuals. the board should be the champion of seeing that it does not intrude on the privacy and civil liberties. we continue to believe that that board is critical to the overall

functioning, and we urged president obama to reconstitute its come up to. its members, and to allow them full access to the information to perform will reconsider an essential function. let me give you one more leftover from the 9/11 report. when those of us who are citizens come down to washington and want to find out about transportation or about lavar mental protection or education, we can go and we can hear from the various committees and participate as much as we can as part of our democracy. we can do so with intelligence. it is secret. and yet as we know, the functioning of the intelligence agencies is absolutely essential to this fight we now

have. it will be essential in the future. the public cannot really get involved because of the nature of the information. in this area, which have congressional oversight. that is why we made such a point in our report of saying how thoughimportant with thought congressional oversight was. we use the word "dysfunctional." that was not our word. it came from members of both parties on the intelligence committees. we have not seen -- we made some recommendations. congress decided not to pursue those recommendations. it is too important that congress' oversight be as good as it possibly can be. when we interviewed this director of homeland security,

she made the same. better predecessors have made. they spent almost 1/3 overtimed testifying in this complex system rather than working to actually improve our overall security in this country. we also suggested that perhaps the intelligence committees have more authority so that they can do a better job and command that from the intelligence communities. we point this out because we think it is so very important that congressional oversight insurers they are working effectively. and also to help resolve disputes of conflicting missions. we would urge the congress to look at this issue and take action to strengthen the that.

thank you very much. >> thank you, governor kean. let me say amen to what you just said. congress was quite effective at taking on some of the status quo, and notwithstanding the resistance of the department of defense, existing agencies would push through in the national interest to achieve the reforms, the one existing institution that congress approved to reform it was congress itself. you're absolutely right. we try to adopt reforms that you've gone back to this morning in an uncharacteristic experience, we lost miserably.

but i want to challenge you and i accept this challenge myself. let's figure out if we can make another run at this because it really is important and it does hamper the conduct of our homeland security and intelligence community by those involved. there's no excuse for it except turf protection, frankly. i thank you for bringing that up and let's come back to it. i think we'll do seven-minute rounds of question. someone has been kind enough to not run the clock. thank you. let me say that last winter, we noted five years of the post- 9/11 act. we decided in oversight review.

it came after both the fort hood and the christmas day bombing spree we begin this in the context of that. the fact is as we try to pull back from those events, the reforms -- the experience we had worked to protect us. maybe we had some good fortune and some good luck. the truth is that there was not a successful terrorist attacks since 9/11. but then in 2009, it seemed to was the pace of the attempted attacks against the nine states pick up. there were at least 12 better publicly known. there are others that have not been discussed in public. most troubling, up three attempted attacks actually successfully breached our homeland defenses. there was one in arkansas.

the man walked into an army recruiting office and killed an army recruiter. major hasan at fort hood, and then the attempt on christmas day. i wanted to ask either or both of you to step back a little bit and give us your best judgment about what is going on out there? what happened to increase the pace of attacks? is it just a loss of the sense of urgency? it's something different going on that we need -- is something different going on the way to respond to? >> senator, the immediate thought i have in response to your question is that al qaeda

has changed. the 9/11 attack, as we all know, was a highly sophisticated effort. it took a lot of planning and a lot of people. it did not take a lot of money. it really was impressive from the standpoint of planning and execution. i think the attacks you referred to in 2009 have been kind of solo performances. in some respects, that probably indicates progress, and it means that our aggressive actions with regard to al qaeda have been çsuccessful, at least in part. and is more difficult for al qaeda to organize the complicated attacks. but their intent remains. perhaps their capabilities have been diminished.

i do not have any doubt at all that they are sitting there somewhere plotting how to get at us. they're going to do it anyway they can, with any capability they have. if they cannot organize an effort to fly airplanes into the world trade towers, they can get one person to get on an airplane and try to blow it apart. so our guard has to stay up. i think secondly that our defenses and our offenses with regard to the terrorist threat have improved. we are a lot better than we were. that is no reason for patting ourselves on the back or complacency. but it is a fact. a lot of people in the government are very talented and they're working very hard to

block these attacks. not just the federal government but in city and state governments, as well. we all know the efforts going forward in new york city. i think both factors are present. >> governor kean? >> traditionally, al qaeda used >> traditionally, al qaeda used to talk about big things. >> al qaeda used to talk about big things. osama bin laden himself talked about a nuclear attack. the last big attack was the one in britain were there were going to block the airliners. çit does say something that thy have not succeeded in any of those things. now they are obviously saying, all right, in this sense, let's try the smaller stuff. çfor osama bin laden himself, that it was him in the tape, to take credit for a failed, and yemen -- in yemen, it is not all

that bad. it suggests they did not have much else to talk about. >> i appreciate that response. gives us all something to think about. let me focus on the dni. when we were having legislative battles over creating this, a lot of us would have guessed that the toughest battles would be with the defense intelligence committee. in fact, it seems not to have happened. çthere been battles within the intelligence community, instead. no, my question really is this -- though i think you raise reasonable questions in your testimony about whether they have become too large. you are strong in saying that we give them a lot to do. bottom line, i want to draw from you what i assume from your statements is your position, that you have no second

thoughts about creating dni. at my right about that? >> absolutely right. we believe they dni is exactly what we need right now. >> you raised questions about efficiency of spending money. i take it that when you talk about clarifying the mission, you're not talking about weakening dni. >> that is exactly right. we want to strengthen dni. we're not talking about weakening it in any way. i must say i saw a chart to of thinking dni's office the other day. i was quite surprised at things they have taken on kirk is worth a quick glance. is this really necessary to be done by the dni?

deliquescence can be raised by some of those efforts. they have a university. i do not know what that is. in this context, i do not know what is. i am not sure that is the job of the dni. i think all of that needs to be explored. we have no second thoughts. this is a great big, massive, it usually funded enterprises, the intelligence community. you have to have somebody at the top of it with authority, or just is not going to work. that authority has to be accountable. somebody has to knock heads together to get over this mind set of, i can have the information, you cannot. and get outside the stovepipe

and to force the integration of the intelligence community. that authority should be given in the dni. he cannot exercise it, no matter what the statute says, without very strong presidential backing. >> i agree. is it too early to evaluate president obama's relationship with the dni? >> my impression is that the intelligence community is relatively new to the president. i think he began to receive intelligence somewhere along the campaign. senator mccain can tell you when that happened. my impression is that his instincts were probably good but he is still feeling his way.

his preference may be -- he said i have appointed good people here. he has done some good appointments, i think. i do not think he has a firm grasp yet of the intelligence community and therefore i am pretty strong in my thought that he has to step been pretty hard here. or some of these tensions which have surfaced will have exacerbated. >> ok, thank you. my time is up. >> mr. chairman, let me follow up on the. you just raised. the law is clear on who is in charge of the intelligence community. i remember the debates we had and how difficult they were in establishing the quarterback, the one person who was going to

be accountable. and yet, in spite of what appears to be a clear legal mandate, the dni and the director of the cia still seem to be in gaged insignificant turf battles. in just the past year, reports indicate that fit white house has had to intervene in disputes over the cia's role in afghanistan, the chain of command over covert action, and the designation of the chief u.s. intelligence officer in overseas posts. those conflicts undermine the unity of the effort that was the gold that we shared and the very reason we created the dni. i am concerned by reports that the president may have inadvertently undermined the dni

by sliding with the cia in these disputes. i have two questions for you. does the president need to more clearly indicated to the intelligence community that they dni is in charge and has his full support? second, do you believe that relationship needs to be further clarified in law, or is this a matter of the law being adequate for the most part and the president needing to assert, to lay down the law, if you will? will start with you. >> we have always fought -- lee has been very articulate. the success of keeping dni will depend totally on the leadership of the president. in a way, this christmas day bombing did us a favor.

i think we were not paying close attention to this area. that is understandable. we were talking about health care and cap and trade. we got distracted a bit. everybody got distracted and we were not paying full attention to this area. cracks were allowed to form. things got a little off track. now we have a wake-up call. the president has been clear. i assume the actions will follow the statements and that he will pay strict attention to this problem. his leadership is going to be directed to this area. it is not going to happen without that. he passed to make clear what he

believes the authorities are and he has to step in on any kind of dispute. >> my answer to your first question is yes. i try to make that clear. the president does need to make it crystal clear to everybody in the intelligence community that the dni is in charge. as i have said, the exercise of that authority requires a lot of diplomacy and sensitivity. it is a real challenge in how you exercise that leadership. he should be in charge. do you need a change in the law? that is still little tougher. you're not going to change this whoplaw. of the flaws -- the flaws

have been revealed. in the longer-term, this is not the first whatever passed by the congress the may have had some ambiguity in it. it might very well be that you can refine it down the line. i do not have specific language to offer it to you today. i guess my central feeling is this is the lot and it will be that way for a while and you have to make it work. >> last week i question the dni, the head of the national counterterrorism center, and our secretary of homeland security about whether they were consulted in the decision to charge abdulmutallab as a criminal and give him his miranda rights and give him a lawyer, which caused him to stop cooperating and answering

questions. i was shocked to hear from each of these top officials that they were not consulted about a decision that had such implications for our nation's ability to better understand what may be further plots emanating from yemen. governor, what was your reaction to learning that our nation's top intelligence officials had not been consulted about the decision? >> i was shocked and i was upset. it made no sense whatsoever to may. here is a man who may have trained with other people who are trying to get into this country in one way or another, who may have worked with some of the top leadership in yemen and we do not know the details of that. he may know about other plots

that are pending. we have not found out about them. this is not just about prosecuting an individual. it is protecting the american people. things of -- decisions of this kind should not be made without the full import of the full intelligence community. the fact this was done without this kind of consultation was upsetting and shocking. i come from new york. regardless of how we feel about whether the trial should be going on in new york, again, i gather the attorney general did not consult any member of the intelligence community before making that decision. we have to get our act together. .

and that has to be clarified. i am not surprised the fbi stepped in. they weren't there. they go in. but there has to be a policy that has to be clarified. the legislation, or your proposed bill, which mandates consultation and of the dni makes all kinds of sense to me. the intelligence director should be consulted. but importantly, there must be a policy. one of the things we learned on the 9/11 commission is we got

into this interrogation, and this is a difficult business, interrogating people. and you better give very sure that you have got the right people asking the questions. we can have differences of opinion as to what kind of pressure ought to be put on a suspect. but interrogating people takes patience, and it takes skill, and you have to train an interrogator very carefully. i am attracted to the idea of a high-value interrogation group. i do not think we have paid enough attention to the professionalism, if you would, of the interrogator. i am not acquainted with the details of that, but i hope it is developing highly skilled people who know how to interrogate.

an awful lot is at stake in finding out all you possibly can. >> thank you. >> thank you, senator. briefly, one of the surprising things i have learned afterward is that there was a recommendation, and i thought an announcement of the beginning of the high value interrogation group. one of the witnesses last week referred to by the initials hig. -- weq are going to ask this question, but this far as i can determine, the group was never fully operational. never set up, so it was not in a position to be called upon to do what it would -- what we would have wanted it to do. after abdulmutallab was captured. thank you. the remaining senators well as always be called an order of appearance in the hearing room. it will be senator cropper,

mccain, kurt. >> thank you. ladies and showman, thank you for the wonderful work you continue to do for our country -- ladies and gentlemen, i want ask you a question later in my allocated time that will draw upon the great success and extraordinary leadership you provided for the 9/11 commission to see what we can garner from that experience. asv: we prepare to move forward this week on legislation on a different commission, a statutory commission on deficit reduction or perhapsoiç on a commission set up by executive order, i want toç bet some ides are around here. just for your thoughts, given the extraordinary success we realize under your leadership. the road to improvement is always under construction. and that is certainly true what i-- when it comes to stopping

the bad guys from doing bad things to our country. when you're commission completed its work and made your recommendations to us, he made a large number of recommendations -- the number 46 in my mind. do you recall how many recommendations you made to us? . . ve calculated that 80% of the commission recommendations have been adopted in whole or in part. and i think in part covers a lot of ground, but most of those, and about 20% -- a little less than 20% out right rejected -- some may still be pending in one way or another. >> ok. one of you said earlier in the response to senator lieberman's questions call me mentioned it

has been eight years since 9/11. every day terrorists are targeting us here and around the world, trying to create mayhem. and they have not had a whole lot of luck so far. it has been close. but they have missed opportunities as well. something that you have recommended and that we had adopted and that has been implemented by the executive branch is being pursued by our men and women all over the world, something is working. it does not mean we sit back and rest. but when you look what we have done, including the things it you have recommended, that you have recommended, that really seem to be working, what ut for you? when you look good with you have recommended that we have passed and implemented fed does not meet last year, maybe it is incomplete, what might that be?

what did you think is working well and is important? what are some areas that maybe we did not follow up and did not implement well? >> obviously, the creation of the dni and the congressional legislation of the nctc was the heart of our recommendation and was to force information sharing. black of information sharing was one of the things we found that probably lead to 911 as much as anything else. -- lack of information sharing was one of the things we found the probably lead to 9/11 as much as anything else. that was key. i mentioned two areas before were recommendations have not been implemented. one is the civil liberties commission. we think it is very important and basically does not exist because the president never appointed its members. secondly, congressional

oversight. we still do not believe, and we hear again from bipartisan people on both sides of the aisle that they are not satisfied in the intelligence committee that they have the ability to do the kind of oversight this country needs, and that is deeply disturbing. if they are not doing oversight, nobody is doing any oversight. it cannot continue to exist with this kind of problem. i could mention a number of others, but those are the most important. >> thank you. >> he is on the mark. on the plus side, i would think the recommendations we made with regard to the intelligence community, including the dni and the nctc and other aspects, i would judge them broadly successful. not completely, but broadly successful. i think a lot of the recommendations we made in the transportation sector, watch lists can certainly be improved.

we recommended that. better detection equipment, we recommended that. i have been a little disappointed in the slowness of the adoption of some of the detection of improvements of detection mechanisms. cargo screening and all those kinds of things i think are under way, taking a little more time probably than we want it to. but they have basically been approved. we had a whole chapter in the book on the 9/11 commission on foreign policy recommendations on the question of how to deal with the islamic world. that was not so much legislative recommendations as foreign policy, and i think we have got a ways to go in implementing those because our relationship with the islamic world is a huge foreign policy challenge and will be for decades to come in all likelihood. i want to emphasize the civil

liberties and privacy board. look, you have the capability to day of surveillance and intrusion into the lives of people that is incredible. with the government can learn about you today and all of these fancy technological devices we have got to intrude into private lives, and kate, we all support it. we think it is necessary. but if you have an argument today in the bureaucracy between the security people and civil liberties people, i will tell you who's going to win the argument. it will be the security people every time. we picked up the paper the of the day and none of the fbi had been violating the law for five or six years. and it was not ever called to the intention of the inspector general. he finally found it up. the fbi, which is supposed to be

sensitive to these matters. the point is here that you need somebody out here in the government that is checking everything that is done with regard to security and asking themselves, can it be done better with a little more respect for privacy and civil liberties? we all know the privacy and civil liberties are going to be invaded. we understand that. you cannot walk through an airport without understanding that. but i think we have to get stronger and have a group with robust powers to be a counterbalance to the argument for security. tom and i, i think all of our commissioners, are very strong on that. >> it is a very bipartisan sense. >> i have one more. then i will go back to the question. when i look at commissions that have been extraordinarily successful, i go back to 1982 with social security.

congressman hamilton and senator mccain of voted for that. we have before us this week the idea of a statutory commission that sort of gives us recommendations that are binding. there must be some kind of override that exists. most commissioners would be sitting members of congress. others say could be people like you who have a world of experience to bring to it. given the success of this commission, give us a little bit of advice is to go forward this week. >> well, pick a german like tom kane -- pick eight chairmen like tom kean. he was chairman. i was vice chairman. we knew each other by reputation bed did not know each other well.

tom walks into the room. we're going to make these joint decisions. we will not hire anybody and will not fire anybody. we will not make any decision unless we do it together. >> it was said that one of the unfortunate things we have going for us was -- a think he's to put it, reform politicians. >> i describe myself as a recovering governor. >> there's nobody in the commission, i do not think, with any interest in running for anything. and do not think anybody was looking for appointment of any kind. so our minds were clear. our agenda was trying to protect the country. that probably enabled us -- that fact probably enabled us to get over the kind of partisan -- it

was a terrible time, and this is going into one of the most divisive presidential elections in our history. we started off with the republicans sitting here and a democrat sitting over here. the first, walked in, i remembered democrats in one corner. we walked into the room and basically said to break it up. after that, i said republicans will sit next to democrats and the other way around and will not meet again unless we have the kind of the seating arrangement. but it helps to have your mind clear of any of the problems, so it can concentrate on whatever the task is, and not to care very much personally and tried to do the right thing. as a commission, we tried to do the right thing, and that was our mantra. we would argue about these things, but we would look for what the facts show and what the right thing is.

>> thank you. that was very helpful. >> thank you for being so generous with the time. thank you. >> senator mccain. >> i want to thank our witnesses for their continued service for the country. especially, i would like to welcome the 9/11 families, without whom the 9/11 commission would never have come into being and these much needed reforms being infected. i was struck that you said 80% of the recommendations probably had been enacted into law. on page 419 of the commission report, it says, strict and congressional oversight of intelligence and homeland security. of all our recommendations, strengthening congressional oversight may be among the most of gold and important. so long as oversight is covered by current congressional rules

and resolutions, we believe the american people will not get the security they want and need. it seems to me we have not implemented that very strong language that is contained in your report. is that accurate? >> unfortunately, you're totally correct. >> ines seems to me, mr. chairman, that we ought to go back at this. -- and then it seems to me that we ought to go back at this. we should do it until such time as we shame our colleagues and to be more concerned about national security than they are about turf. i hope that the next opportunity, we will join in and try to push the changes that have been recommended by the administration. would you say it is probably the most important of failure of all the recommendations that you made? >> yes, i would.

and members of the congress were on our commission and they all said and we proposed this that it was the most of the cold organization to be implemented. we said that it was the right thing to do, and everybody agreed, so we went ahead. >> i will ask the 9/11 families to go into battle again. if anybody can get it done, you all can, and i thank you. i was disturbed by the events in some things revealed in the hearing that the chairman and the co-chairmen held a short time ago. a 50-minute interrogation, a decision made to give the christmas bomber the miranda rights and a civil trial. i only know press accounts. i do not have classified information on this individual. he was talking. there had to be a pause, and

when he woke up, get a lawyer. understandably, the lawyer did what lawyers do. that is their job. i am not blaming the lawyers, but how we could have made a decision the way we did brings me to a larger issue. and that is the whole issue of and that is the whole issue of the disposition of detaine and it seems to me that the overall policy is so -- the word may be incoherent, but certainly not coordinated. the we now have kind of an ad hoc decision-making as far as the treatment of detainees. we have not yet to resolve the issue of enemy combatants we cannot bring to trial because of insufficient evidence, but yet we know that we can not release them.

we have learned there is a certain percentage that varies as much as 20%, depending on who you talk to who are back in the fight, including some in leadership role. doesn't this argue for congress and the administration, or congress alone to develop legislation that addresses all these and amorphous -- all these amorphous areas that address trials, the tension, treatment of particular this issue of enemy combatants -- that address trials and the tensidetention. so far none of that has been translated at least to a party that members of congress understand. so, senator lieberman, senator

graham and i are working to address it and want to work with the administration. to prevent another situation has evolved with the christmas ballomber but also to resolve te -- resolve the existing issue. some will be tried in new york. some will be tried in guantanamo. some may be tried in other places. does this not -- does this christmas bomber issue not focus the absolute requirement that we address this issue in the policy-making and perhaps a legislative way? >> i very much agree with your conclusion. these people present a real challenge for us within our constitutional system. the problem is you have got a detainee, you cannot prove a

criminal charge against him, let us say. at the same time, he could kill you. it does not fit in the american constitutional system. and we have not figured it out yet. i think the most important thing you said was that you and senator lieberman and senator gramm are working on it. i am delighted to hear that. i did not know it. i think we hear a lot about how government does not work very well today, how dysfunctional it is. this is been an area where the legislative branch and the executive branch have failed, flat out failed. we have had this challenge now for a good part of a decade or maybe more. neither president, bush nor obama, has dealt with it, and the congress is not dealt with it. i am delighted to know that

you're doing this. i think it is a very tough bill draft. the important characteristic that is needed in the bill, however the details are any of got to look to lawyers who know a lot more about it than i do for the details, but the law has to be perceived as being fair. perceived by americans is being fair, whatever that may mean, perceived by the foreign and international community as being fair. i think that is what you have to strive for. that does not mean you give them all the rights of the american citizen. i am not arguing that. but senator, i applaud the initiative. i think this is been a failure of the u.s. government as a whole to deal with this very, very tough problem. and i certainly wish you well on it. >> once again, thank you for your leadership. i cannot agree with lee more.

>> thank you. >> too much, senator mccain. i appreciate your leadership on this. it has been very good to work with you and senator gramm. the choice for our country in deciding how to deal with terrorism suspects we take into incarceration is not a choice between applying the rule of law and not applying the rule of law. we are a country of laws. it is a question of which rule of law. is it the rule of domestic criminal law or is it the rule of the laws of war? of course, i believe it is the second. but that was a very important exchange. thank you. senator bennett, your next. >> to add very much, mr. chairman. i it -- thank you very much. i appreciate the dialogue and appreciate the witnesses and the important subject to have discussed.

rather than go back over some of those, because i think the record is now clear, congressman hamilton, let me pick up on a comment he made. it may appear to some to be a somewhat smaller issue, but you raised it, and i have an interest in it. when you talk about the necessity for better detection equipment -- i spent a lot of time going through airports, as do we all, but i have personally experienced the morhigher technology with respect to body imaging. we have one of those on a trial basis that the salt lake airport. i went through it without any bodily harm or any psychological embarrassment.

no displays embarrassing fashion anywhere. i am drafting language and i plan to introduce it shortly, and it is legislation that technology, the magnetometer and searching the bags, which is not very effective and quite interested and very slow. -- quite interested in very slow. i think we should get tsa to employ technology with the capability to detect plastic and liquid explosives, non-metallic threads, and so on.

now -- by the way, i very much support what tsa has done with respect to privacy in these technologies, and we need to make sure that we go as far as we can to see to it that that is balanced as well. ok, we do that in the united states. now somebody gets on an airplane in yemen and transfers in amsterdam. what kind of threat to do we have in the world of transportation that says it is fine for tsa to be doing this, but it will not have any impact on the kind of thing that we saw with the christmas pa bomber? give me your reaction on how technology can be used and how we can get other countries to use it. >> do not know anything that has frustrated me personally more than the inability over a period

of years to develop adequate detection equipment. the most serious thing, in my mind, is the inability to detect nuclear materials. and knowing and spend a lot of money at that. this is a problem that goes back well before 9/11. but we still have not come up with it. so i think there has to be a crash effort, if you will, in the search and development in the scientific community to develop better technology here. the hijackers got on those airplanes in at 911 with four- inch blade knives. they knew you could not get on with eight-inch blades. these people are very sophisticated about our vulnerabilities. and whenever we make a change,

they begin to adopt -- they begin to adapt to it. so the technology has to try to keep out in front. i personally do not have any problem with the body images. i think they ought to be used. i am not that sure they would have caught our december -- stopped that incident. in other words, people have said to me that even with body imaging, he might have gone through. but in any case, there clearly better than the metal detectors. our adversaries figured out a long time ago they have got to do something other than metal in order to cause problems. now the international problem is a very difficult one, exceedingly difficult. and i know our people have spent a lot of time talking to other countries about strengthening

their procedures. i think we have to get to the place where we do not let people into this country unless they have gone through a security process that is rigorous, however defined. >> governor mccain -- kean. >> our biggest defense is not technology in that area. it is technology in identifying bad people that should not get visas and get into this country. as you know, when you go to these centers, you can see that every person is getting on an airplane at that time heading toward the united states. that is probably the moment the best -- that is probably the best defense we have.

the christmas day brombomber should have been on the no-fly list. i am for any technology we can have to recognize this. our enemies will be trying to get through our technology, and at the same time we have to upgrade our technologies. i think we should do that. it is the best defense we have. do not let the bad people get on the airplane to begin with. did not let them get visas. do not let them get to the airport. do not let them even approach getting on the airplane to the united states. >> thank you. >> thank you very much. next we have senator kirk. i might try to go vote early and come back. if i am not back when center kirk finishes, then senator burris can go next. thank you. >> thank you, mr. chairman.

thank you for your leadership and continuing oversight in this important matter. let me thank our witnesses for their selfless and patriotic service throughout your public careers. it has been inspirational to all who know and follow it. i also want to salute the families for their valor and persistence. some have worked closely with senator kennedy on help for the victims. you deserve enormous praise and gratitude for your courage. my question basically goes to the impression of almost information overload. we have talked about it and you have recognized the need to recruit and retain analysts of the highest talent and caliber and to recognize their

prominence in this whole dilemma. do you have an impression that, given the amounts of information, that there are sufficient or adequate numbers of analysts of that caliber that are dealing with this? >> my information, frankly, is not recent enough to make that conclusion. i know last time i was deeply involved in this, there was certainly not enough analysts and not good ones. they were not promoted and recognized in the same way, and we were not attracting the best people. i hope that has changed. >> well, i agree with that. this is one of the things that the national security prepared in this group needs to look at. tom said in his testimony that it drove home the importance of

the analysts, and that is correct. i do not know whether we have enough. i do not know whether the ones we never sufficiently trained i think it takes several years to produce an analyst. it is tough work. i mean, you're sitting there watching millions and millions of the banks of data coming across the screen, and 99.9% of it is useless. and then there is the knighted in there. in there. so you have to have not you have to have first-rate analysts and build redundancy into the system. i am not the least bit worried if you have two agencies of the government doing similar work with regard to analyzing intelligence, but i think the question you have raised is really critical and it needs to be followed carefully. congress needs to give full support to whatever it the intelligence community needs to

get topflight analysts. >> thank you. the other aspect of this analysis of our intelligence, and of the best volume that we have -- the vast volume we have, this is apart from the detection technology, but about the part that helps analysts' synthesize, and your great, and read a pattern. do you have an impression as to whether we have the state of the art technology that allows us to do that, and to share it with the various agencies? foreign and domestic responsibilities? because it seems to me that that the grid or state of the art technology, combined with the

human-resources you both talk about, is really the key to this whole puzzle. >> absolutely, i very much agree with that. i do not know the answer to whether or not we have busted a vr technology. on we do not.icion what i do know is that we've got to find the best people in this -- do not know whether we have the latest, a state of the art technology. times that it is massive amounts, and you have to sort through that. i do not know whether those people are in the government or in the private sector today. but wherever they are, we better find them, and we better put them to use. >> that is correct. i remember when i was talking to president clinton when we were doing the investigation, and he

pointed out that our data management was so inferior in government compared to the data management in the private- sector. he mentioned credit card companies and some other of its the had in arkansas that he said could have identified these people right away. and we just did not have that technology at that time. i hope we're better at it. i just do not know. >> thank you very much. thank you, senator. >> thank you. i echo the comments of my colleagues in reference to your work. i am retired public official, but duty called, and i am back in it. you all indicated that you're not going back in it, and you are able to do great work for the country, which we appreciate. and to the 9/11 family members, i extend my heartfelt thanks to you for your persistence. i have not been able to read your report.

as a new center here, in some general sort of questions. did you all take into consideration -- as a new center here, i have some general for the questions. did you all take into consideration information about homegrown terrorists? we hear about al qaeda and foreign services. did you take into consideration about homegrown actions? >> the 9/11 commission did not because it really was not within our mandate. but since the 9/11 commission and the development of the the phenomenon of terrorism, it is quite clear that the home grown or the lone wolf terrorist has become a major threat and concern to the country. so yes, the national security preparing this group, we will be looking at that threats and seeing how we can improve our defenses against it.

not all of the bad guys, unfortunately, are from abroad. we got a few year. >> you are right. >> i would simply agree with him. >> gentlemen, i just wonder, when you go back to the al qaeda situation now, what i tend to pick up through my basic information is that they are going to the chatter out through the various pipelines and to all our security agencies that is misleading and misdirected. you would never be able to tell what is really in fact a possible threat. that is number one. number two, i understand that they're going to try to spend us into oblivion with costs. they will have a stretch to come up with every contingency to try to protect ourselves.

the civil liberties will be coming. you have these actions that have taken place. the chatter is misleading. and the attempts to spend as into oblivion, all these various ideas, they will come up with something. they're going to tap as out eventually financially. do you have any comments on that? >> i think it has become quite clear that that approach that you're mentioning, trying to make us spend more and more and more by way of defense, is part of their strategy. and maybe it is even a successful part of the reair strategy. maybe it is one of the reasons they think they are winning in some areas. a dramatic example is 9/11

itself. what did we figure the cost? a huge amount of money. >> very modest amount of money. >> think of all the changes that have occurred in america since 9/11. what your question raises for me, senator, is one that does not ordinarily come into the debate on terrorism, and that is the question of cost effectiveness. the security people can come up with than in was number of ideas as to what you should do, and you find it very difficult to argue against any of them. because they have truth to them. i think, as we move along and as our costs continue to rise, the question you raised will become much more part of the debate.

is it cost-effective? now, obviously, you want to go on the set of security. and you clearly have. i do not know what this country spends to fight terrorism today. i am not sure anybody has made a calculation of it. if they have, i have not seen it. but it is a huge amount of money. so the cost

>> if you have the patience, i will go for one more round of questions and then a second vote. you have been extraordinarily helpful. perhaps i should say my flattery until after the second round. i want to go briefly with you about the national counter- terrorism center.

you focused understandably more on the dni, general problem, and effects of the christmas bombing. the commission that created it to serve as the primary organization in the u.s. government for integrating all intelligence pertain to terrorism and counter-terrorism. the mission manager -- however, the president's report about the christmas bombing states there is analytic redundancy between the national counter-terrorism center and a -cia. responsibility was not designated to tracking threats streams from yemen.

analytical rolls across the intelligence community need to be clarified. we need to do a better job of ensuring that someone within the community is designated as in charge of running down all leads with a particular threat stream. let me ask you first generally, what is your assessment of why counter-terrorism analytic roles and responsibilities are unclear five years after the 9/11 commission act was adopted into law? >> i am not sure i understand the question. >> i guess it is a general question about looking back five years. the law really put a charter are in place. why do you think of the

analytic roles and responsibilities still seem to be unclear five years afterward? >> i think we simply do not yet realize the importance of the analysts in the system. it terrorism is the threat, and if he had massive amounts of information coming to you, collection and is one part of intelligence. analysis is the other part of the collection site, we're very good at. the analyst cited, last good at. i think the reason for it is because we simply have not given it the priority it deserves. i am on a group that works with the director of the fbi, and he has certainly given greater priority to counter- terrorism. but in the fbi culture, the top man is the agent in charge.

if you are an fbi person, that is the job that you have an ambition to achieve. it is only in very recent years that they have begun to elevate the analyst to a comparable position as the agent in charge. when you really think about it, the analyst drives with the fbi does. if their principal function is counter-terrorism, the analyst has to drive the activity of the fbi. i do not think you have in the federal civil service the incentives that you need. maybe we do not have the pay that we need to elevate the job of the analyst. i think it is a very, very tough job. and it takes awhile for the federal bureaucracy to respond

to the need. >> would you like to add anything? >> also remember that with the exception of the fbi, you had rotating people in every one of those positions. when you passed the act, we do not have its staying for a while. we need that. we need somebody to focus on these problems, and some of them are because a change in leadership. >> is that something we should think of attempting to do by way of statutory amendment? to give the dni a longer term? >> well, the dni left voluntarily at first. i think maybe the way to do it is to have it through legislation or otherwise. and the understanding that was somebody gets the job, you know, providing that they're not doing

their job well, other than that, we expect you to stay. >> it appears that you have a 10-year term for the fbi director. and the intelligence director seems to be in a comparable position. intelligence should be as removed from politics as possible. so it makes sense to me. >> i am glad to hear that. >> i am glad to hear that. add not thought about going in, >> thanks. it does work pretty well with the fbi director as with bob muller who made the transition quite seamlessly between the administration's. let me go back and ask if you would talk a little about what you think the role should be in relationship to other analysis organizations, and to the so- called operators, or intelligence collectors. if i can borrow from what we are

discussing -- were discussing earlier about the dni, should the national counter-terrorism center be the leader of the intelligence community activities or just a coordinator? >> that is a good question. i think the analyst is the person who has to spot the problem. and to spot the threat. then there has to be an assignment of responsibility to someone to pursue vigorously that threat. i cannot think that is likely to be the analyst, but somebody has to be in charge. the analyst says we have the five strands of information here that. to x -- that point to x as a

threat -- you cannot stop there. you have to pursue. someone has to be assigned the responsibility of saying that you go after x and make sure it does not cause any problem. i don't think that is the role of the nctc. i do not think that is the role of the nctc. i am not sure that responsibility lies, but the assignment of the responsibility to investigate and to pursue a suspect has to be very clear. you mentioned the word redundancy. i answered in response to senator kirk, i think it was, redundancy does not bother me. if you have got the cia doing analytical work on the the threat and the nctc, it is ok.

the thing that impresses me about the analyst is the work can be boring. i mean, really boring. sorting through massive amounts of data and trying to figure out what is right or what is significant. and somebody is going to be asleep at the switch. cents -- so some redundancy does not bother me. >> i agree. it is the military concept, of course, for personnel and four systems. >> it is not a bad word to say you have a redundant system. is there to protect the life of a military person. >> one thing we should check on -- and do not know the answer to this. with these various agencies, who is attending nctc? what kind of priority are these agencies giving it? the the people come back with

something? -- are the people coming back with something? does anybody pay attention? one of the problems with the legislation is that these agencies have to give top priority and send their top people to the nctc to be effective. i do not know whether that is happening or not. >> it is a very good question. we're going to follow up these two introductory hearings with a series of subject matter hearings. we're going to do one on the nctc. that is a question i will ask. when we first went over to the nctc after it was established at its new quarters, i remember that it was the then director of the said, look at this. this is where the cia people sit. this is where the fbi people said. end notes, they're no walls between them. that was a big breakthrough --

and note, there are no walls between them. that was a big breakthrough. are they sending over top-notch people? we all wanted to make sure that, just as the military does, we would encourage joint nesness ad reward it i interior paths -- reward it in career paths. the last question. the 9/11 commission act also gay nctc the authority to pick -- also gave him nctc the authority to conduct a strategic operational planning for counter-terrorism activities. the memories and of the arguments over that particular provision and the fear could fill a book.

we're going to focus on this in one of our hearings. what is your assessment of how the is authorities have been used by nctc up until this time? >> my assessment is that intelligence community is kind of overwhelmed by the tactical needs. in other words, you have a large number of military commanders who want intelligence on the enemy. we're pretty good at getting that information. you have a diplomat who wants to sit down and talk with their counterpart in another country on whatever. we're pretty good in giving that diplomat, our double that, information. where we are less good, it seems to be, in the intelligence community is the question you are raising. longer-term thinking. there is a good example of it. we were behind the curve on

yemen. we did not realize how convinced they were in terms of striking the united states. but we need to have a significant element of the intelligence community thinking five years, at 10 years ahead as to where the threats will come from. that is even a tougher job, i guess, than the imminent threat, but it is very important that the u.s. not be surprised by these developments to the extent that you can possibly avoid it. i look upon our intelligence community is being very, very good. but if there is a weak spot, i think it tends to be longer term. >> well said. that is it. i thank you very much for your time. what i was going to say before was that a former secretary of

state said america is the indispensable nation of the world. i say by way, and warning that the fear the two of you have made yourself indispensable. it is quite an extraordinary act of a service you have performed. all the more important in this particular moment in our political and governmental history that you formed such a collaboration, and it is not just bipartisan. it is non-partisans. i do not think either one of you think about your party label when you do the work you're doing because it is in the national interest. as a result, it continues to make you a very important and influential. your testimony has been very substantive. i do not want to make you feel to mature, but i felt it was actually whise and very helpful to the committee -- it was a verywise. we want a swissair is the

subject matter hearings. i would like to invite you and your staff of the national security prepare and this group that we consult with you about the direction in which we're going, and we would welcome your device. i cannot thank you enough. i cannot thank you enough. it has been very constructive

>> tonight house leader filled in for gordon brown. she answered questions on british banks, the economy, the iraq war inquiry, and the afghanistan a conference in london. tonight at 9:00 p.m. eastern. >> tonight, the history of executive power from george washington to george w. bush. this author talks about his book with former assistant attorney general. part of our booktv weekend2. on weekend >> no discussion on al qaeda and weapons of mass destruction. host: our guest rolf mowatt

larssen is c.i.a. agent. thank you for being with us. guest: thank you. host: you have a piece on al-qaeda weapons of mass destruction and you spoke that bin laden wanted to get arsenals for his weapons. guest: the three messages i am trying to convey about al-qaeda's nuclear interests, is first they mounted an intense effort. it spanned over a decade in that terrorist attempt and to put those facts into a chronology will show the readers what this consists

with, and the amount of effort that went into disrupting the effort over the years. and it's a great success story that we haven't had much time to talk about. and second is to not get complacent. the report is not designed to scare people or tell people that this is an inevitable thing. 3@but to show people that al-qaeda remains an organization that can pull off a big attack. and third to ensure people that as we look at bottom-up effect, such as the christmas day attack, that we don't forget the top-down effects, the guys that schemed for two years for that attack.

that looks different, and if we put nuclear out of our mind, we won't see that. host: you said that al-qaeda in his course of decades dispatched for nuclear and chemical, and has never given up that goal. guest: that's correct, you have to start with 9/11, they tried to bring down the world trade center, failed and it took them eight years before they managed to fulfill that goal. they are determined and patient. and they plan to those things that matter to them, and we saw how bin laden approached

nuclear and biological. it's important to start with the intent that bin laden declared in 1998. host: and you mentioned it's really the top echelon that is working on these plans. guest: that's correct, and it confirms a lot of what we see today. there is no doubt that al-qaeda's terrorism circle has been fractured. but in things like this, the 9/11 and the biological nuclear, all the orders and funding was directed by bin laden himself. host: take a step back, why is this so important for them, the psychological implication. why not go out piecemeal

attacks and incident here and there. guest: i won't pretend to be an expert of what they are thinking but to take a stab at a speculative answer. on a large-scale attack to al-qaeda is to show the world they can strike at that level. it's been eight to nine years since 9/11. we have to be it is very much in their interests to do something. what weapon would create a more spectacular impact and change history? the former cia director writes in his book that a wmd would change history. that would be a starting point for what it would love to have a nuclear weapon. host: you write it that sometimes they have ignored other potential terrorist attacks, opportunities because

they are so focused on getting wmd's? guest: right, i would add to those with bio and nuclear for any big attack. ñiwith the measures we haveçsr n in the homeland combined with things we have done to damage al qaeda it has made it more difficult to launch a major attack. any major attack is therir goal. we can all probably agree that if they want to do something in the u.s. the could have by now. . . states, they could have done it by now. host: rolf larssen is c.i.a. and joining us. let's go to george on the phone line. caller: good morning, i would

like to know if al-qaeda and" other terrorists consider obama to be weaker than the bush administration. and is leon qualified to be director of the c.i.a.? guest: those are good questions to start the morning off. i couldn't know what osama bin i couldn't know what osama bin thinks about president obama. but i believe that the administration has done a great job of continuing the policies of the previous administration. if you look at the high seniors of the administration, and how they think, they are reflective of the positive efforts of the bush counterterrorism. and that has greatly affected and smashed al-qaeda's organization that existed before 9/11. as far as director penant is to

have the trust of the president. i have heard about the support of their work and i am confident he's a good choice as c.i.a. director. host: we have larry calling. caller: yes, is it not true that osama bin laden was close to president bush and his family. and wasn't it our government that at some point in time sold these biological weapons to them and that's including saddam hussein and i will get off the air and listen to his response. guest: larry, i would not agree that the u.s. supported osama

bin laden. if we read the history of the u.s. efforts to topple the soviet union and afghanistan. and at the time we supported afghanistan, the origin of many fighters. to that matter i concede your point. and of the limited actions of senior al-qaeda. they brought that up, in an encounter with an individual, he indicated you made us what we are. referring to the point you just made. obviously we didn't give al-qaeda or saddam biological weapons. and in fact, particularly, some new steps in the administration are trying to accelerate, if you will, getting rid of weapons of mass destruction around the world.

we recognize these weapons are very dangerous in anyone's hands. and the goal is to get rid of all of them. host: the claim that saddam hussein had weapons of mass destruction, how damaging over your concerns of wmd, is there someone who cried wolf factor? guest: no doubt about it, of the differences, first we are not saying and i have never said or anyone at this point that terrorists have achieved wmd. we hope we still have time and with a determined effort to prevent it. it's different in that sense, we are not claiming that

assertion to do something we want to do. expect take it seriously. and it's important to saying wmd any time, that's a problem with nuclear or weapons, people get scared. it's fear montorring and to perpetrate the psychology of fear, i don'túhave the answer but to stress to people that our goal is to put the facts out. and the goal of this report is to put a lot of facts, and i have to say i couldn't put it all. but that people can see there is a factual basis for our concerns and it's fear mongering. host: let's go to angela. caller: good morning and thank you for having c-span. i am a first time caller. this question is for your

guest, for years we have heard of weapons of mass destruction and freeing democracy to the eastern countries. and we have all of this academia and former c.i.a. and f.b.i. and different politicians and the palins and obama's and everything else, and yet we are the greatest country on earth and most powerful. but nevertheless osama bin laden has never been caught or vried like hussein. guest: as an american citizen we have a right to not be satisfied that we have not caught osama bin laden.

i don't think that we have done enough focusing on finishing that job. i regret the fact that wmd issue is in fact an intrusion in our lifestyle. i don't think the answer is to b@put that back, the fact that it's a threat. and your question gives me an opening to note, we are not just talking about this threat regarding al-qaeda. this is a threat and things that will be with us throughout this century. they will grow. one of my motivations and inoculate the public to give them more information to work with, and to get them used to the idea that these threats exist and not be surprised with them. we will be living in a more dangerous group this this

century, more groups will try to use this inspiration and the intelligence community that lead to this report, to ensure that this effort is strong and robust over the next decade. host: we have willie on the lines. caller: good morning, mr. larssen will you please explain to me the difference between fiction and fact. when you talk about weapons of mass destruction. and i can pinpoint to you because you are a former c.i.a. agent, what about israel have 200 nuclear heads. and recently you know they have that war on people [inaudible] and weapons of mass

destruction and they kill children and women and innocent people, thank you sir. guest: willie, your question to me is a broader problem that you rightly noted. as long as nuclear weapons are spreading in the middle east, the bigger this problem is in the future. i finished the previous question by stressing that this problem will live with us. and the reason for that because more countries want nuclear weapons and technology. and as nuclear weapons spread that means more information for terrorists. paradoxy at the time when nuclear war seems the lowest every, we have a situation where nuclear weapons are

spreading, north korea has a bomb and others may follow suit. and that means more places where something can go wrong. host: our guest in the c.i.a. for 20 years and in the weapons of mass destruction and worked in the agency of counterintelligence and now that you are outside looking in, what are your thoughts for how we proceed and going forward? you said we have to live with a new reality that sounds scary. but at the same time you said we need it get used to it. guest: one goal as we move forward is to reestablish with the american people. i couldn't talk about these

terms, from the inside i know how hard the work is and the efforts. mostly that is secret and the american people don't get an appreciation of how dedicated. we have had failures and we in the intelligence world see 9/11 as our failure and iraq as something we could have done. so in a way the contract for having a secret intelligence needs to be updated. and as we face these new threats, we need credibility and for the american people to be sure that we use things so these attacks don't occur. it's not for someone such as me to think about what things might be. but we need to think seriously about what they are, so we don't think about after an attack and wonder what weren't

wrong again. host: david calling from texas. caller: hello, how are you doing. let me get to the bush', the first bush had the taliban a bunch of them come here to houston in '95 and they stayed with him. and the big thing they loved about houston was the zoo. and when they went to war and the reason for bin laden because bush was cutting into their drug thing. and then let's go to bin laden, 60 something years here i am, and one thing i know, rich people don't live in no damn caves. that guy is in no cave, i don't care what you say. guest: well, where do you think

he is? i don't think he's necessarily in a cave either, that's the popular conception. when we look at the history of how we got to where we are today, i think it's very important as americans to look at this in nonpartisan terms. one of the things i found to be important and critical for the people both in armed forces and the intelligence community overseas fighting these wars. we really have to be one country on this. and we have to get beyond conspiracy theories about what is going on. i never have seen that motivation out of any administration or certainly the bureaucracies on the administration. host: let's go to jim. caller: hi, there are a few things here, the reason for terrorism because these folks

have a beef with the united states or the west. and it seems to me when we discuss the weapons of mass destructions issues and solutions, we concentrate on one road. yet we forget to are address the issue from all roads intertwined to produce these terrorit. -- terrorists. why don't we have an international conference to come up with policies to control somehow these governments the folks in their territory, or their people. and reduce their threat. otherwise we are trying to swat flies in a pond. guest: jim, i think there is a recognition that the wmd issue is part of a broader problem we have. and i wouldn't comment on how

to fix here. if terrorists are going to use a nuclear weapon, they will have to see it as a legitimate weapon to use in their struggle. there was a fatwa issued in 2003 by a radical saudi cleric who gave for justification's for using nuclear weapons in their fight against the united states. i find that to be extremely important. first, to be in that suggestion -- to suggest that, means that there seriously thinking about it. regardless of where they are in their capabilities, that is an illustration they are serious. second, that means they can sell it as a legitimate risk -- as a legitimate response in their war to their constituency. that legitimacy issue is we have to attack at the high-end. how do we ensure this does not

insure bitterness between people that makes the use of these weapons seem justifiable because it is madness. if we exchange nuclear and biological weapons, who knows what is next? it is a slippery slope. host: byzantine -- does that argument gain any traction in the countries where these are issued? >> one of the things i have learned is that i think mainstream people everywhere are similar. islam is a great religion and no way does islam condone this kind of response to a problem. nonetheless, people like osama bin laden justify this. and that's worrisome to sustain that support. host: let's go to ishmael on

the lines. caller: good morning, i want to ask the guest a couple of questions. first of all, you said to make sure that such attacks don't occur. what role does examinations of our foreign policy have going on what you said and exam the foreign policies to the effect is al-qaeda intending to include u.s. or europe in their police aid? is it as said before in the current struggle it was said that they hate us because of our freedoms and our way of life. as a c.i.a. agent what bearing do you have on that as far as foreign policy, as far as their motive compared to them hating our way of life and trying to make us part of a police aid? what role can we do as far as

not being bias and dealing with gaza and being a republic and that our republic exists and why can't another republic exist as far as weapons of mass destruction. please sir, explain to me if it's possible that another group such as al-qaeda that could have those weapons? host: let's get a response from our guest. guest: yes, i believe there is possibility of other groups. the broader question i would address by saying when bin laden conducted 9/11 part of his goal was to create a global

jihad, to create a group where terrorists would pick up and aspire that. and we saw that. but at the same time it didn't achieve the full effect at 9/11. if you look at the troops in marid, and those looking at their jihad. my personal view is that he doesn't see the u.s. that way. if you look at the groups and their motivation of attacking the united states, it was not about occupying or taking their movement to the united states, as much as it was to inspire an overreaction on the u.s. side, meaning military and the muslim world to defeat the united states -- this is their view,

not mine, to defeat the united states. and that was their goal, as they have assessed how they have done. i think they would see their own track record as a mixed bag. they achieved some things but at a tremendous price in their terms. their movement is falterring in some respects. and i will not give, it's not the place to give a detailed assessment. but those are some key elements of their thinking. but they are thinking globally, when bin laden talked in 2007 and promised to attack the united states again. he oddly i thought referred to the need to counter global participation, that we are encountering the world. and he asserted that the major corporation had killed president kennedy. rather striking probes from an islammist.

but he was appealing to the american people in that way. host: what does the attack on christmas day tell you about both the power of al-qaeda and america's ability to respond to those attacks? guest: i think on one hand those attacks will be extremely difficult to stop. not to say that we should have connected the dots better. but it's a mistake to draw an analogy that that's the biggest threat. 9/11 was planned by 19 people planning over years at a high level called trade craft. that's a much more profound threat of an individual on an

airplane. the one that we refer to as bottom-up, inspired from the bottom, taking initiative and working with a local cell, that's what we saw at christmas. the one that is more important is the one that flows from the top. to maintain the capacity to go out to a country like the united states and strike from a central planned top-driven type of attack that's difficult to stop. host: let's go to teresa from baltimore. caller: hi, i am a theorist that the gentleman was speaking about. the united states's sole purpose of occupying the middle east is voice. we send our military people over there to kill people for their oil. what makes the united states public think that we can do that and those people not want to come over here to change our way of life? guest: well, i don't think we

are in the middle east to kill people for oil. i think that in fact it's very important to go back to 9/11 and the response, the united states response to the 9/11 attacks. we had tremendous credibility in the world and tremendous support for what we did, up tie point. -- up to a point. my purpose is not to talk about that support, but the idea that we can't allow terrorists to create sanctuaries overseas, i can't support that. terrorists need to understand that we will find them and take them out. and i hope that the american people will always support that kind of counterterrorism. host: let's go to one more caller, jason.

caller: can you hear me? i have half a dozen questions. host: keep them short we have only a couple of minute. caller: the people can go to the news and i think you are lying to the american public and 9/11 was an inside job. and you may want to hangup on me, and what is your 9/11 terrorism ring? guest: i don't care to answer that question. host: what happens from here? guest: that's a great question, i first i would like to put something out there to provide a basis for scholars of these topics to look to me and others and frame out a story. you noticed i stopped at the end of 2003, there is a story

to come and yet a current story. in a problem like this the more that are researching, will better off we be. and develop methologies and i hope this helps to draw new methologies, that's part of the inspiration to inspire that work. >> rolf mowatt larssen and new skeern scholar. hi >> tomorrow on "washington girl" a discussion on the role independent voters may play in the 2010 elections.

also, china's impact on the global economy. after that, and look at child of obesity in the united states and the first lady's national campaign with the surgeon general of arkansas. "washington journal" is live at 7:00 on c-span. >> afghanistan's logar province is a mostly agricultural region south of the capital. freelance journalist, david axe, was indicted there in october and november and accompanied the american troops as he patrolled the villages and work to extend security in the area.

>> four years, it was used to launch attacks northward, toward the capital. in late 2008 and 2009, as more americans joined the coalition of reinforcements at the end of the bush administration and the beginning of the obama administration, some of those troops reinforced this small contingents in logar province. said the presence grew from about 100 guys -- so the presence grew from 100 guys to about 1000. so the coalition is on track to have about 1500 guys here.

this is one of the districts and when the army began moving reinforcements, they identified this as the place to start as the most amenable district for getting a foothold in the province. they concentrated forces and as a result, it is the safest district. most american troops and most afghan troops, the best security, you see an effect as refugees return and the businesses get started and people get back to work. the army has a security patrols to maintain that level of securities, but they have managed to create the space to do development work. >> do you know who is that the check point down the road?

is he from -- iraq? i'm sorry. i misspoke. i used to be in iraq. we're looking for a village elder rep. so that we can speak about a solar powered generation that is supposed to come to the village. at this time, it's too late. their representative is not around. he is somewhere else. if you come 9:00 or 10:00 in the morning, you guys walked up

today a little bit far and near the mosque, there will be somebody and he will show you who is the rep and introduce you. >> come with the u.s. forces and we are looking for a village rep. -- i am with u.s. forces and we're looking for a village rep. one of your neighbors down the road said it's too late and we should come back. ñi>> we just want to walk throuh

the village and talk to some people and see how everything is going, if you had any complaints. we're going to give you a number -- you can call and inform us if there are any problems or anything is going on in general. just that -- >> a couple of months ago,

people would run into their houses and hide. that's a sign of progress. they're willing to be approached by coalition forces or american forces and they will talk to us. that is a plus. small victories. >> often times, when you are on patrol, you'll see the americans pull out these big devices and take these close-up photographs of eyeballs and had a have another machine in use for fingerprints. it is a whole kit for taking what they call biometrics. the idea is when you come

across and afghan of interest, a local leader or a man of military age, certainly when you come across somebody who is a taliban suspect or local bad guy, someone else has figured -- someone else has fingered as a troublemaker, you want to create a record of this guy so if he is ever captured or he winds up dead, you have a paper trail of establishing who this guy is and establishing where he has been and in what context you have interacted with him. this all leads to various databases the coalition maintains with the afghan government and i have heard it is not one central database. some of them are local databases. afghanistan is extremely mountainous, which is good and bad for u.s. troops.

it is good because there are not a lot of u.s. troops, even with recent reinforcements and even if we get more, you are talking fewer than 100,000 people in a country that has 18 million people and is the size of texas. you cannot put an american soldier on every street corner, but want to keep an eye on the street corners. so what u.s. troops will do is pick a mountain peak in build observation post with cameras and night sensors and weapons. they will sit up there and keep an eye on the area. those mountains are usually accessible by road and are very steep. there are only two ways to resupply the mountaintop outpost. preferably, you wait for a helicopter, but there are so many helicopters in afghanistan and everyone needs them all the time. not all the helicopters can climb to certain altitude and they're not suited to every mission. the choices for resupplying

mountaintop observation post are to wait in line for a helicopter which could take weeks, or to carry this stuff up by hand or do it the afghan way and carry it up i don t. in this district, the third squadron decided to try the afghan method and would rent a donkey to drag a 300 lb generator up the mountain. americans do not use it donkey's very often and nobody had an algorithm for calculating how much don keep power you need for a given slope and a given weight over a given time. they rented one bianchi and strapped the generator to the don t make plastic/and tried to get the don t -- tried to get the don t to do that.

so they said we can do it ourselves and they picked it up and it took them about one hour, but they called the generator up the mountain slope. >> this sits in the middle of our operations in logar province. it provides us with a good view of our east and west parameters which border with the province. we first came into this area about seven or eight months ago. there was a lot of enemy activity along this msr.

once we determined we had to have an observation post and it initially started with afghan security guards to our south and what we call the upper op -- >> op is observation posts? >> yes. >> how far up are we? >> about [unintelligible] there is a lot of loose gravel and you have to be cautious. with the topics we have appeared, we can monitor pretty much anything and everything from daily activity to the local population and insurgent activities and if there are

placing explosive devices in the roads throughout the area. there are few blind spots, but we generally have this place on locked down. the enemy knows. they're learning now where we can and cannot monitor activities. i take my chances, c 90% of their activity. -- seeing that 90% of their activity. >> there is mortar team and if someone is under attack, they

will call them in and they also do terrain of denial which will give them a chance to practice but the tactic they used to scare the taliban is take a piece of terrain, sent the infantry guys out to make sure there is no livestock or people, and then they blow up that chunk of terrain. it is sort of random and the taliban, from their perspective, they see these periodic, unpredictable, massive displays of firepower. it is supposed to have a deterrent effect on the taliban. >> this is the safest district in logar province, but it is still a very dangerous province by afghanistan's standards.

these improvised roadside bombs are a constant threat and they tend to bury them in the middle of a dark road. so as you drive out on patrol, you drive right over them. in fact, i was on patrol in october and the second truck in our convoy got blown up. no one was hurt, but it turned into a big fire fight and some taliban were killed. [machine guns firing] >> ieds are the biggest threat but they do not kill anyone usually because the americans ride around in these big armored vehicles with a special shape underside to block the blast and

push it away from the vehicle. everybody loves these vehicles. they are not terribly comfortable, it is like riding around in a washing machine on the spin cycle, but they will protect you from bombs. >> i would say in this case, the threat of roadside bombs is a very serious threat and we take it seriously all the time. it's a consideration, it's always at the front of our minds. roadside bombs are the biggest concern. >> how you balance the need to protect your people with the need to continually expand this security bubble and reached into in secure areas? >> we are going to go wherever we want when we want to go there. we will use all our assets, every soldier watching where we

are driving and watching where we are walking. we checked our routes and remember where we go and remember where we have been. we watch ourselves as much as we watched the enemy and try to stay safe where are we drive or wherever we walked. we are constantly on the lookout and we just keep our eyes open and keep ourselves disciplined. >> that was a free-lance video journalist, david axe, and he was in bed with the u.s. army in afghanistan in october and november. too much more interviews and video from this trip, go to c- span.org and in the search box, type axe. >> we want to take a look at a newly updated c-span classroom website. this is where the program specialists. what is c-span classroom and what is its mission?

>> this is a free membership service for teachers designed to bring programming and other materials into classrooms to create authentic learning experiences for students. meredith, why did c-span decided to revamp the website? guest: greta, the last time we updated the website was in 2006, where we felt it was time to give a fresh website that showcases all of our resources and shows the technological advances that have occurred since 2006. host: what are some of the new features? guest: the layout allows us to show their resources that c-span classroom has. the video spectrum you see that allows the education team to access the liaison between the c-span class for members and the programming. we routinely look at programs that aired on c-span, and we look at and extract the ones

that we think teachers can use and the custom, or if they want to a general information, and put it in that section. they are able to go in and i watch the program -- either watch the program, stream it right there, or create their own video clips. for example, with the state of the union address, we have that on our page, and the teachers can go into the more information section and get information about that video and there is a share button to create their own a video clip. host: who can become a member of the web site, at how do they do that? guest: membership is free and it is open to all social studies teachers. they just need to go to our website, cspanclassroom.org, and at the top right corner, there is a link to register. another aspect we have is that teachers are in and and do not

have time to watch rtos at a particular time, then we have a video clips that are created for teachers, along with discussion questions. they can find clips two ways. at the top of the web site, there is a bar that you can click, a topic bar, and that as a whole list of topics where teachers can go in and find a video clips, on the president, federalism, economics. we have over 20 categories. or they can use our search function in that top right corner of the web site and put in anything that are looking for and it will come up p with a lit of the videos and video >> tomorrow on "washington journal" a discussion on the role independent voters may play in the 2010 election.

also, china's impact on the global economy. after that, like a childhood obesity in the u.s. and first lady -- the first lady's national campaign with the surgeon general of arkansas. that is "washington journal" at 7:00 a.m. eastern on c-span. >> coming up on c-span, attorney general eric holder and health and human services secretary, kathleen sibelius, discussing health care fraud. after that, senator byron dorgan talking about job creation on " newsmakers." attorney general eric holder estimated $60 billion are lost each year due to health care fraud.

he was joined at this summit on fraud prevention by the health and human services secretary, kathleen civilians, and a number of others. this is about two hours and 10 minutes. >> and they conduct their own independent reviews and investigations of medicare and medicaid fraud. some have resulted in prosecutions and other in new program integrity functions to prevent health care fraud. he has been the inspector general since september 2004 and is the senior official

responsible for audits, evaluations, investigations, and general law enforcement for all hhs projects. it is an honor to introduce my colleague, dan levinson. [applause] >> thank you very much. i cannot pass up an opportunity to say hello, good morning, and welcome you here as early as possible. this is such an important event for our office of inspector general because fighting fraud is what we are all about. on behalf of the 1500 dedicated professionals of our office, welcome to what looks to be a very interesting and what i undoubtedly believe will be very productive day as we gather throughout these breakout sessions to drill down on some

of the most important issues concerning health-care integrity that our programs face. again, i think you will be hearing this from others as well, when one of every three americans depends upon an efficient, economical medicare program, medicaid program, children's health insurance program, it is terribly important that we all focus on the mission at hand and for us, as i say, fighting health-care fraud is what we are all about and we have more than a score of professionals here today, people from all of our components, people from our counsel's office, audit services, the office of evaluation and inspection and our office of the investigation. you will be hearing from these folks throughout the day.

although this is our business as an inspector general's office, we cannot do it alone. who are the partners? speaking as an official of the department, cms. i was pleased to say good morning to the team handling the integrity issues from the programmatic side. that is terribly important. other partners, the department of justice, and when i say the department justice, i'm not doing total justice to how many parts of the department we really need to partner with effectively. this includes the criminal division, the civil division, the united states attorneys

across the country, the fbi, the public integrity section. there are so many key parts of justice that we work with as partners. other inspector general offices, i've seen this morning, the inspector general of the office of personnel management -- health care is what's hhs is about and it is also what dod and others is about. this is a group exercise from the executive branch perspective. i'm pleased to have representatives of the inspector general community here as well. state and local -- terribly important. i have already seen barbara here -- good morning. i talked to the former medicaid inspector general for the state of texas. they are crucial partners in being able to exercise real oversight over a very important

and growing financial pork belly up for the federal government. -- financial partner for the federal government. it's great to have the health care compliant association and many of its members here as well. the provider community must play a veryçó crucial, critical partf making sure all of this work together. we always look forward to working with our private sector partners in providing program guidance on a regular basis and appearing at church gatherings held throughout the year. -- appearing at you or gatherings held throughout the year. i want to express appreciation to the media. nbd it is crucial to reporting -- the media is crucial to reporting stories we want to tell and getting the word out to the wider public. we depend in large measure on

communication to insurer beneficiaries are keeping their eyes and ears open and corporate officials in the provider community are keeping their eyes and ears open, watching for what ever fault lines may exist in their own systems. we can only get that message out effectively if the media is conveying the message and it is great to see such a significant representation here today. i certainly want to thank congress and another -- and a number of executive-branch officials for being so supportive of our requests for dedicated funding in this very important issue. as we have said in countless been used before, for every public dollar invested in the inspector general office to fight healthcare fraud and medicare and medicaid, we turn

over $8 to the program. it's a very good return on investment. beyond the dollars, and remember dollars are always in effect a substitute for the actual service, beyond the dollars, it is the beneficiaries and the quality of care we are really talking about. as we continue to look at the way services are actually delivered, it is quality of care that ultimately rebounds to the quality of the programs in the country at large. i think i'm about to be pulled off, so i want to get that message to you. thank you very much for being here. [applause] >> we now have the pleasure of having the attorney general and secretary join us.

in a moment. here we go. welcome. it's nice to have you. welcome, secretary sibelius. [applause] we're not going to waste a moment of their time. i'm going to jump right then -- and going to jump right in. my pleasure to introduce to you the secretary of health and human services, kathleen civilians. fighting fraud is not because she took up when she arrived in washington. it is in the fabric of her lifetime of public service. in her home state of kansas, kathleen's the bilious is well known for her tough response to fraud. -- kathleen sibelius is well known for tough response to fraud.

as governor, no one had a stronger track record to watching out for kansas consumers and the financial integrity of the state's health care programs. a prime example of her skill as legislation she pushed through as governor in 2006 that made obstructing a medicaid fraud investigation a crime and expanded forfeiture lot to cover medicaid fraud and made it easier for the state to recover erroneous medicaid payments. in her first official day in washington, her senate confirmation hearing, she told a senate committee one of her first priorities is to crack down on brought. once here at hhs, she forged a strong relationship with the attorney general, eric holder, to make sure combating fraud and health care was a government- wide priority. the summit we are holding today is a direct result of their partnership. secretary, thank you for your strong commitment to the

financial integrity of our programs, the taxpayers to support them, and the beneficiaries we serve. we look forward to hearing from you. [applause] >> good morning, everybody. nice to have you all here today and thank you to migrate deputy secretary. i want to join him in welcoming all of you here today and also to thank the attorney general, not only for being here, but for his tireless command and for being a great partner in fighting fraud. i want to recognize the incoming acting deputy general who i just had a chance to say hello to. thank you for being here and your partnership in this effort. we are here because this administration has zero

tolerance for criminals who steal from taxpayers, endanger patients, and jeopardize medicare's future. at a time when many families are scraping together every last dollar to pay their medical bills, fraud, waste, and use in our health care systems are unacceptable. so today, the president has asked us to put criminals on notice. the attorney general and i have convened this unprecedented summit, featuring leaders from the public and private health- care sectors, because we believe the promise -- a problem of health care fraud is bigger than the government, law enforcement, or the private industry can handle alone. we will need all of us working together to solve it. in the fight to prevent, find, and catch the crux, we want to -- catch and prosecute the crux, we want to [unintelligible]

it is a national problem. state programs like medicaid and private insurance companies and medicare are affected. we are vulnerable because we're part of a health-care system that is undergoing rapid growth. between 1970 and today, america's annual health care spending has gone from $75 million to over $2.5 billion. that has produced significant benefits for patients, but it has also created a bigger target for criminals and a much bigger challenge for investigators. the difference between catching fraud then and now is trying to find a penny in a bathtub and now we're dealing with binding pennies in a swimming pool. it's not that we did not take steps to improve our ability to detect and prosecute fraud during the last 40 years, we did. but the problem was fraud has grown faster than our solutions. we fell behind.

americans have paid the price. today, medicare, medicaid, and private insurance companies all pay out billions of dollars in fraudulent claims. they charge americans higher premiums to pay for it. when a criminal sense a false claim to ensure, he is stealing from all of us. there are other victims like patients who get fake or unnecessary treatments from cricket health-care providers who bill insurers for the full amount. -- from a crooked healthcare providers. what is even worse is health- care laws -- health care fraud violates to sacred trusts -- a promise to taxpayers will spend money wisely and our promise to seniors and all americans will do everything we can to protect medicare for generations to come. to keep that trust, we knew we had to act now. last may, president obama asked the attorney general and me to

create a new health care fraud prevention and action task force which we call heat. .

we pay over $1 billion in claims each and every day. for the first time ever, we will have a complete picture of what kinds of claims are being filed across the country and where they are being filed. we are also getting smarter about analyzing claims in real time, using new tools and methodologies, spotting trends, whether in geographic areas or types of building. once you start looking at the data, which you find is pretty shocking.

claims for one country and can be 10 times higher than the adjacent county. miami gave johnnie is the home of 2% medicare health-care clients. they received treatment for more than $100,000 in care every year. when you see something like that, you do not need a ph.d. in statistics to know that something is going on. you're going to hear from the attorney general about how he is using this information to crack down on criminals. what are moat -- one of our most effective tools is our task force. they know more about fighting health-care fraud than just about anybody. prosecuting fraud is only part of the strategy.

the most effective way to protect the taxpayer money is to stop fraud in the first place. we have a new focus on prevention. one good example what we're doing is something i want to talk about. it is a category that includes everything from wheelchairs' to diabetes test strips. it used to be appealing to criminals because it was relatively easy to set up a fake storefronts. you had to rent a room and put equipment on the shelves and get a phone line and you were set. in the last year, we have made it harder for crooks to run the scam. first, we are conducting more random visits across the country. we having a mandatory accreditation process for durable medical equipment providers. before you become made medicare provider, you have to go through a rigorous third party review. we make sure you have the

correct licenses, the correct insurance, and in that business capital. the days when you could just hang out a shingle and start billing medicare are over. third, we require suppliers to post a $50,000 bond. if we do catch them committing fraud, at least we are guaranteed to recover some of their illegal gains right away. these are just some of the steps we're taking to prevent, catch, prosecute, and discourage defrosterfraudsters. our goal is to make the chances of getting caught much greater and the consequences so high that the vast majority of criminals get scared away. to do that, we have been listed in new group that is more passionate about defending medicare than just about anybody else, seniors themselves. for the last decade, our

department has funded an organization called the senior medicare patrol. we are trying to beef up that operation right now. the patrol is made up of seniors who are tired of seeing medicare threatened by crooks and decided to do something about it. they volunteered to get trained and reach out to senior centers and adult day centers and educate their neighbors about how to read medicare statements, how to identify fraudulent claims, and report them to the correct authorities. in the last 12 years, they have reached more than 20 million seniors. that is like having 20 million undercover cops on the street. the more seniors note about how to recognize fraudulent activity, the more criminals will be nervous about trying to cheat them. we believe we have done more to fight health care fraud in 2009 than in any other year in their country's history -- in our

country's history. we are making a historic investment that, combined with other changes, will result in billions of dollars in savings. we know that the funds we committed to fighting fraud are some of the best investments in our country makes. it returns several dollars back in savings for every dollar we invest into fighting fraud. it returns money to the trust fund and keeps our trust with taxpayers. building on the events mintz, the president made from fighting in -- building on the investments, the president made an increase to fight fraud. there are already impressive results. we are adding new programs to

strengthen our ability to prevent fraud from ever occurring. this is a personal priority. when american families are struggling to make every dollar counts, we need to be even more vigilant about how their money is spent. for these resources to have the biggest impact, we will have to combine them with the best strategy. that is where the summit sit-in. today is an incredible opportunity for some of the leading experts to hear from their peers in the private sector and vice versa. we will be able to discuss trends and suspicious claims and emerging from hot spots. more importantly, we hope we will begin to develop a relationship that will be the basis of long-term cooperation between the public and private sector. i hope i speak for everyone in

this room to say that we all need to work together, to keep patients said, lower health-care premiums, and secure medicare and medicaid for generations to come. when we took office a year ago, we saw the old way of fighting fraud just was not working during our resources wawere not keeping up the -- of fighting fraud was just not working. our resources were not keeping up with the problem. as you heard from president obama, these are exactly the kinds of tough problems that the this administration is committed to taking on when we see an opportunity to safeguard america's tax dollars or to ensure that patients get the right treatment, we are going to act. when we act, we will not be afraid to make hard choices, to break down they [unintelligible]

to use new technologies and find new partners. speaking of technology, to get the latest on how we are fighting health-care fraud, hopefully you will visit our new web site,s stopmedicarefraud.gov. one thing we know about the criminals to convict fraud are not complacent. -- criminals who commit fraud not complacent. we need to be just as active and creative and determined as they are. i think this conference is a huge step in the right direction. i want to thank all of you again for traveling across the country to be here today. i hope we have productive discussions and that everyone leaves with at least a few new ideas. no matter what the details of the strategic plan that comes

out of the summit, i can already tell you that the message for the criminals who steal from our health care system is going to be clear. your days are numbered. to talk more about our unprecedented gathering, i would like to introduce my partner in the fight against health care fraud, the attorney general of the united states air colder. -- eric holder. [applause] >> good morning kare. i think we're already starting to save some money here with the heat. [laughter] thank you so much, kathleen. i have a special thank you to deputy secretary core. lenny brewers here as well. i think you all for

participating in today's important discussion. let me also thank the institution of health for supporting a spirius. we have an opportunity to build on the record of achievement that has been established right here. today marks a critical step forward. in establishing a task force last may, the department of justice and health and human services were inspired by a common cause a'd by common sense. we realized that we have a serious problem on their hands and we decided that it was time to redouble our efforts. we also recognize that the best way to strengthen our

individual work is to combine forces and to collaborate. heat represents our commitment to fight health care fraud and to protect taxpayer dollars. but it is more than just a partnership between our agencies. it is evidence of this administration's commitment to fiscal responsibility. with more effective communication and with more efficient cooperation, we can make a measurable and meaningful progress in the fight against health care fraud. but we cannot do it alone. we need help from state and local leaders. there is no question that our ability to check taxpayer dollars and to strengthen our national health care system depends on our ability to expand the discussion beyond the federal government.

that is what this summit is really about. your presence here today is proof of a shared commitment to identify, punishing, and preventing health care fraud. secretary of sebelius and i are so grateful for your help in joining this effort. so far, heat has fostered new collaboration. it has enhanced our ability to bring abuse to lead and criminals to justice. it has enabled the recovery of stolen funds and returned millions of dollars to the united states treasury. together, we must continue to build on these achievements. last year brought record levels of achievement in our fight against health care fraud. in 2009, the justice department reached an all-time high in the number of health-care fraud charges to more than 800. we also obtained more than 580

convictions. on the civil enforcement front, the recovery is under false claims act were $2.2 billion. many of these successes can be attributed to your medicare fraud strike forces which are at the core of the heat law enforcement mission. by fostering increase collaboration, he has had strike forces act with speed and efficiency -- heat has had strike forces act with speed and efficiency. in the last eight months, we have filed more than 60 cases and charged two hundred offenders as occurred more than 50 guilty pleas.

we have uncovered more than a quarter of $1 billion in fraudulent billing. i am proud of the great work done by our agencies and their partners. i am confident we are on the right path. we cannot yet be satisfied. we cannot become complacent. we cannot ignore the unfortunate fact that health care fraud remains a significant problem. the scope of the problem is shocking. more than $60 billion san private and public health care funding is lost every year. that is a staggering amount of money. it is more than the net worth of america's eight largest private foundations. it is also more than the

highest grossing movie in america. [laughter] whether it is covered by medicare or medicaid or many of the agency's debtor becomes of fraud, is not just a string on medicare and medicaid programs. all americans must pay for health care. the enormity of the health care fraud program is equalled only by the audacity of some of the fraud schemes that we are confronting. last week, the department of justice filed claims against a management company that was operating 70 clinics across the country. these small centers serve young children in predominantly low- income areas. instead of treating kids, this company was exploiting them to siphon millions of dollars from

medicaid. many of these centers perform unnecessary and often painful dental procedures on unsuspecting helpless kids. in some cases, parents were told that healthy teeth needed to be removed. they will face a $24 million fine and interests. we are continuing to investigate the individual dentists who are dissipated in this scheme. in another case, the justice department secured a $10 million consent judgment against two former hospital executives in los angeles who preyed on homeless people. through kickbacks and coercion, they were returning homeless people -- they were turning homeless people into hospital patients. they charged for treatment that the homeless people did not receive and did not request.

this is proof their collaborative efforts are working. we are striking a blow on fraud schemes across the country. we are sending a clear message to that health care fraud will simply not be tolerated. where do we go from here? first, we must strengthen teeth. -- strengthen heat. heat will continue to work locally to pursue both civil and criminal cases. in bringing these fraudsters to justice, we will use the power of the internet and the media to warn the public. w will work to expand these teams to areas of the country where our efforts are most needed.

these teams have changed the enforcement landscape. they have also demonstrated that we must continue to think outside the box and pursue innovative, investigated, and prosecutorial strategy. we will look for the investments needed to meet our duties and do our job. i am pleased that congress and the administration have provided strong support. in 2010, the fraud fighting budget will include two hundred million dollars -- will go up from $200 million to $300 million. this is a prudent investment. for every dollar we provide to fight health care fraud, we return the dollar to the united states treasury and to taxpayer dollars. we will continue to work with congress to identify and pursue the legislative reforms to prevent, deter, and prosecute

health care fraud. these reforms range from removing barriers to increasing sanctions and penalties. finally, the department will continue to engage to fight this sector. we will seek out guidance from representatives of the insurance industry and the health care provider community. many are with us today. the vast majority of those who work in the health-care industry are honest people who want to help patients and want to follow the law. but we also know that a few bad actors have created an industry- wide problem. you also have a role to play in encouraging good behavior and holding criminals accountable. as long as health care front page and these crimes go unpunished, our health care system wrote -- as long as health care fraud pays and these crimes go unpunished, our

health care system remains at risk. we welcome and we need your help in this shared enterprise. your presence here today gives me great hope for the future. i am optimistic about what we can accomplish together and i look forward to working with all of you. thank you very much. [applause] >> thank you for being here with us today. we know that all of you will appreciate that, with their schedules, they are not in the position to state. but they will -- in the position to stay. but they will be checking in on our activities. it is a pleasure for me to introduce to you our next

speaker, representative ron corn. he has represented southeast florida since 2007. he is a longtime public servant for nearly 15 years. throughout his career, he has earned a reputation for working toward a bipartisan solutions that will improve the lives of florida's families and businesses and he is keenly aware of how critical is that we combat health care fraud. he probably knows better than anyone, coming from florida, the challenges we face and the importance of the work we do here today. he recently met with the attorney general to share his ideas for combating fraud and to pledge his support in this fight. i know we will be working with him as well in the department of human health and services to identify the key steps that we need to take going forward. it is a pleasure tofor me to welcome him to the stage.

[applause] >> thank you and good morning. i would like to thank all of you for coming today and sharing in this historic summit on medicare fraud. as secretary sebelius and attorney general holder have explained, this is a national problem that requires the combined resources. the cooperation at this point has been historic. i want to thank, publicly, attorney general holder and secretary sebelius in their leadership in spearheading this critical effort and giving it the highest level of attention in the administration. i represent a district in southwest florida. the real spark -- the real estate prices are really good

right now. you should come down right now. i represent fart lot of built up to west palm beach. -- i represent fort lauderdale up to west palm beach. we have a very large number of senior citizens, people who depend on medicare and depend on the confidence of medicare doing what it needs to do. i have people come to me with their stores of medicare fraud. they have pages and pages a bill that they have received of duplicate services. they tell stories of where they were solicited for their medicare number and a whole series of other things that we all understand our part of the medicare fraud problem. it is deplorable to think that there are people preying on our seniors out there. we know it is true. we know that fraud is about $60

billion per year. that is money that is taken out of the system that would otherwise provide medicare services. people who are providers are the doctors and hospitals and other care givers. we know that it takes more money and as more money to the cost that the seniors are paying for anything from prescription drugs and other services. most of all, it is the taxpayers who are finding something that is staggering in cost in the form of fraudulent claims. in short, we are the losers, the american taxpayers. when i came to office in congress in 2007, i vowed to help work on this issue and i appreciate the efforts of the participants to date in doing that. i will plan -- the participants

today in doing that. i am pleased to see that the strike force that was put together that has been operating in miami-dade county has had the results it has had. it combines prosecutors from the u.s. attorney's office with federal and state investigative offices, the office of inspector general, the fbi, the city of hialeah police department, and the florida fraud unit. we have seen results. you probably heard about some of them. here are just a couple for the record. in may of 2007, it was announced the arrest of 38 defendants allegedly involving $142 million in fraudulent medicare claims. results have kept coming in. good news has been more arrests and more dollars recovered.

it comes in the form of dna and home infusion and many others. the charges brought against these defendants include everything from the basic claims to conspiracy and other types of anti-kickback statutes. the targeted providers are the ones that we are going after. but the bottom line is that we need to do more. what we have seen in the miami- dade area is that it can work. it can work in providing real- time information when there is a high level of coordination and it can provide some level of deterrence. but the amount that crime -- but the amount of crime that is out there and the amount of people that are willing to scan the system is substantial. we will continue to provide more resources and make sure that information is better coordinated through the health- care system and working with our law enforcement agents. i am very proud to be part of

this process and as a member of congress to support the people that are here today, to learn more about what is being discussed and you may contact my office with suggestions and questions as we go through this. it is my privilege to reference some folks that will be speaking with you. there's greg harris from the department of justice, christopher and dennis, christopher ross, tim donovan, louis perez, and kamen grant. these folks are the ones who have the on the ground -- and cameronkim grant. these folks are the ones who have the on-the-ground experience. thank you very much. [applause]

>> we appreciate you coming out to be with us today. >> good morning, everyone it is no secret that health care fraud is a national problem. prosecution and prevention are a huge party. the fraud is both widespread and substantial. there is good news. together, the department of justice, the department of health and human services, they have developed a plan and a model that gives prosecutors, agents, and analysts to identify and prosecute and prevent this conduct. nowhere has that mauldin more successful than in miami,

florida. -- nor has that model been more successful than in miami, florida. -- know whernowhere has that mon more successful than in miami, florida. from march of 2007 to the present, there have been more than 280 defendants charged in 170 cases. that involves over $800 million in fraud. 226 million -- to a 26 of those defendants have been found guilty -- two hundred 26 -- 226 of those defendants have been found guilty. more important is the prevention side. relevant data shows that health care fraud in the miami region is down and that the work of the

prosecutors, agents, and analysts have had a preventative effect. there has been a reduction of as much as $1.75 billion in dme claims alone. the model in miami has worked and continues to work, providing a framework for the future. to describe what has happened in miami are the architects of that plan. the prosecutors, agents, and others who have worked on the ground, let me take a brief moment to introduce them. kimberly grant, the director at the center for medicare and medicaid services. she has been in that position since 2004. she oversees the anti-fraud and

abuse efforts for medicare, including oversight of dmf and anti-from contractors. chris dennis is an hhf officer. he has held that position since march 2008. he is responsible geographically for the entire state of florida and supervises 35 agencies. kim donovan is in the miami field office and oversees the white collar crimes investigation and health-care fraud program, among other crimes. she recently served as the program coordinator and supervised one of the fraud squads. kirk works at the department of

justice. he oversees the department's health care program nationally. he has held that position since 2006. he brings to it more than 10 years' experience as a federal prosecutor, both in washington with the department of justice and as an assistant united states attorney in the southern district of florida. finally, louis perez. he is also an assistant in a state's attorney. -- he is also an assistant united states attorney. he supervises 10 prosecutors to prosecute all the health care fraud. he comes to the position with more than 25 years' experience as a state and federal prosecutor. i am going to start asking questions. there may be time after the panel to us questions from the audience. chris, i am going to start with you.

we heard about the problem with the fraud scheme. i would like to take some time to have you describe the generally what those schemes are. you probably -- >> you probably have heard that florida is the mecca for health care crime. it is tested and proven throughout the rest of the unit states. it is a viral community. it consists of a lot of players, which are lawyers, providers, including doctors, patients, medicare beneficiaries, patient recruiters, billing companies, and nominee owners of these

health care facilities. to get into some of the schemes, there are several things we used to identify fraud in the florida area. two of the more privileged areas that we work where we have numerous cases are durable medical equipment and infusion therapy clinics. with a durable medical equipment, we see two key elements that must be in existence for them to carry at the scheme. -- carry out the scheme. there must be the name and number of a national provider with an identification number for the position which the physician is typically and aware of. the second piece of that are the beneficiaries medicare number. typically, the beneficiaries are

unaware of their numbers and information being compromised as well. a fraudulent durable medical equipment company will take those pieces of information for an extensive amount of time without us knowing what is going on, as much as 120 days. some of the supply is being billed are incontinent kits and orthotics. that includes elbow braces and knee braces and shoulder races. the next area that i would like to touch on is infusion therapy. fraudulent providers bill medicare for infusion therapy -- for infusion medicine to treat hiv and aids patients. any real doctor or legitimate doctor will not actually bill for these services or prescribe

a prescription for the services because it is antiquated or no way of treating hiv and aids patients. there are three parts, a clinic, which is typically a legitimate clinic. you have the patience of the medicare beneficiaries, which typically in cahoots, if you will, with the provider, the doctor. the doctor writes the prescription and gives it to the medicare beneficiary. they take it and go to the clinic to supposedly received infusion therapy services. the clinic is likely getting a kick back. when they come out, it appears that they have received some sort of therapy service. we're finding that those three components are in cahoots to give it to defraud the medicare system. some of the other areas that we

concentrate on and have identified a major schemes in south florida are comprehensive outpatient rehabilitation committees, community mental health centers, home health agencies. >> you said that there is a substantial part of the fraud were the patients themselves are involved. is that right? >> that is correct. >> go ahead. >> patients in florida are selling their information -- they are taking kickbacks to sell their information and receive the services. most of the time, they don't receive services. they receive financial reimbursement for providing their information to the

perpetrators of fraud. >> you have identified the people in this fraud, whether their lawyers -- not surprisingly, i suppose -- and doctors. can you identify the continuinu? >> of their patient recruiters, the doctors, the owners, and what we call the fall guy. >> can you explain how this spreads? >> is a very rural community. -- it is a very viral community. they stealer purchase disinformation -- they steal or

purchase of this information. >> kirk, let me ask you about the model that targets a specific areas. you have been involved in developing that model with analysis of statistical data. >> the first thing i want to say is thank you from all of us, the prosecutors and agents, who work in the streets and in the courtrooms. sometimes it can be a daunting task. when we identify, is a lose. when we prosecute, it is a list. the model we are talking about is to speed up the process so that we can prosecute. speeding it up let's have it

temporal effect on the defendant's way of thinking. in miami, back in 2006, we worked with the fbi to look at the nationwide data and say where there is the most severe problems in the country and how can we fight them? i am going to walk you through three different fraud schemes and what the data revealed. i will walk you through how we went about trying to target those schemes. i am talking about dme, hiv infusion, and home health-care parent we pull the national data from durable medical equipment. we know that -- and home health care. we pulled the national data from the durable medical equipment. when you look at that information that comes in through the bureau and through

the ig's office, we have a baseline for what is happening in the united states. you lay that on top of the claims that ended a streak into miami. when you look at thg durable medical equipment and pull the national data, for those who get to durable medical equipment back in 2006, the average was around $1,200. if you look at the state of florida, the average was $1,700. so there was a $500 difference. why is florida higher? when you take apart the $1,700 number, miami-dade county and that being approximately $6,200. when you card miami-dade county out of the rest of florida, it

falls back down to within one standard deviation of the norm. when you look at the number in miami-dade county, what makes up the $6,200? through the work of our nurse investigator, looking at the billing codes, we identified about 20 billing codes that make up the majority of that added money. they fall into categories of durable medical equipment. the first centers around the diagnosis of chronic pulmonary disease. that has within it in number of categories that include nebulized as an aerosol medications and oxygen concentrators. we also saw orthotics. the third area had a variety of pieces of medical equipment that made no sense. for example, we saw 60,000%

jump between 2005 and 2006 in a medical device that is known as an ultraviolet light. the diagnosis could was known as seasonal affective disorder. is what psychologists and psychologistpsychiatrists presce who were affected during winter when people tonight it is much like. that does not make any sense in florida when you can just ask people to step outside. [laughter] when you look at that 62 out -- when you look at that $6,200 figure, we wanted to get a good sense that the numbers we were looking at were real and that there was a medical explanation for what people were getting. to target that, we have now

killed like an onion the national data, the state data, the billing code data, and few are the providers that are billing for those cuts that are anomalous? we were able to generate a list. we were able to break those down even further. if we identified one company that has anomalous billing for co bv, where every patient has the same -- copd, where every patient has the same patterns, where they are traveling tens and 20 and $30 million to get these medications, when we look underneath that, -- and 30 miles to get these medications, when we look underneath that, there were made in the pharmacy with

powders and chemicals by the pharmacist. what we knew was that we were looking and pieces of information from what we knew about the community. we knew that the criminals were telling us that the reason we compound medication is that it is part of fraud and we do not want to pay the money to buy real medication. we want to use this compound in process, which is legal in floorfla.orida. we turned that list over to the fbi. in the investigation, [unintelligible] hiv infusion, the way the process works is that, back in

the 1980's, when hiv became identified and was a real problem in our communities, before the advent of the cock hills that now treat the virus, doctors were struggling -- of the cocktail's that now treat te virus, doctors were struggling to find ways to treat them. you would treat the blood condition with a drug called [unintelligible] you tried to raise the platelet count. in miami, these infusion treatments are very expensive and the criminals figured out that they can do this three or four times a week with high dollar returns. again, they did not have to buy the medications. they could just submit these bills. from a therapeutic standpoint, and number of antiviral some came onto the market and patients started taking oral medications and the infusion treatments tailed off. doctors would tell us that they

did not use infusion. it is not used to treat these blood conditions. in miami, in 2001, there was a spike in infusion for hiv patients. it would go from drug to drug, clinic to clinic. we found that a lot of these owners were opening these clinics and we identified the drug codes based on where you have a clinic set up and have a doctor who saw the patients getting all the same treatments and we were able to identify the codes, which are the drug couldes. we were identify who's filling those codes and making this.

in terms of working in miami to target these things, starting with what we know on the ground from people who are telling what is happening, people said that, when law enforcement got hot and i jivy infusion, people opened a home health agencies. -- got hot on hiv infusion, people opened a home health agency. they identify people with diabetes an. we were able to see -- we knew that the allied air patience for home health agency should have been less than five -- we knew that the out liaoutlier patientr home health agency should have been less than 5%.

when we looked underneath to see what those payments were, all the patients were diagnosed with diabetes. there were dgetting twice daily nursing services to inject insulin >. >> the focus has been the data. you can identify the various separations. where do you get the data from. >> cms provides the data through a number of contractors, including the pce's. when we started looking at the data, we would call data from different sources. we would want to pull from the contractor to look at the dme

data. then we would want to compared to the physician data. if you put a mall together, the schemes would become readily apparent. most of the fraud committed in all the doctors were sunning prescriptions for a separate. -- doctors -- most of the fraud committed were doctors signing prescriptions for a set price. the data that we use would come from these different sources and it would depend on the type of service we were looking at. home health agency was a program under the prospective system and would come from a contractor.

other data would come from a variety of contractors. we would have to load them onto a computer and cross-compare those items. >> on a national basis, can you use that data to identify the parts of the country where similar frauds with the same medical treatments are happening were different fronts are using that model? >> we can go across the country through many of the 400 major metropolitan areas and tell you what line items, what service is aberrational. in houston, there are problems with orthotics kits in bundles. there's also evidence transport. we can say this is the price of

line items that are out of line. then we turn it over to our medical experts that we work with to help get some analysis of why those claims might be the way they are. >> are you seeing people from miami bettethat are dispersing to other places? is that being transplanted throughout the united states? >> as we become more active in one area -- for example, prior to 2006, i do not think we did an hiv infusion case. but then we started hearing within the law enforcement community that people wanted to get a miami. we began to receive a steady infusion clinics show up on our data all of the i-90 corridor

into south carolina. just yesterday, a judge in miami sentenced an individual to avert 260 months in prison for even moving into medicare advantage because he wanted to get away from straight billing- for-service and wanted and a bandage plan for the same type of service. they were not only in changing their location, but also what they were building. we saw a spike of hiv infusion and other locations and it was people that had been from miami. now they are in detroit. >> he talked a little bit about the innovative use of the data. he also mentioned that that

gets turned over to traditional law enforcement. can you tell us a little bit about that, using surveillance and under cover and the sexy stuff, if you will? >> first of all, i cannot feel my feet. [laughter] it is so cold appear. i never thought -- it is so cold up here. i never thought i would miss miami so much. >> we will get you back there as soon as we can. >> in south florida, we have dozens of fbi agents dedicated to working health care fraud. we partnered a long time ago with hhf. we worked hand-in-hand picture nearly well.

we were to jointly. -- we work jointly. operations that come to mind that i would like to explain to you shows and some of the diversity of people involved. it also shows operations that the agents thought of. one is where we partnered with local banks. utilizing a ruse, with security from the banks, we identified the number of medicare accounts in southwest florida that had medicare funds with suspicious activity. these accounts were frozen by the banks. using areas, we called the owners of the bank accounts --

using a ruse, we called the owners of the bank accounts. a number of them admitted bad and they were involved in fraud and -- a number of them admitted that they were involved in fraud and returned that money. another operation that i want to describe for you is one that is called benny bus. in south florida, a lot of the beneficiaries are involved in the fraud. they receive money for selling their number. in this particular case, we had an individual, a subject of an investigation, who owned a medical equipment company. he was billing medicare. he began cooperating with agents

who targeted him and approached him. he cooperated. he provided a list of beneficiaries and the told us how he provided kickbacks to the beneficiaries. we devised a plan where we wired a van for audio and video and he picked up these beneficiaries. as he picked them up, he took them to a clinic. he paid the clinic owner $1,600, up $200 per prescription. the beneficiary walked in. each received one of three prescriptions, either for a nebulize are, occupational therapy, or for physical therapy. in return, they got back into the van and were paid $150 each for providing the script to the driver.

the then basically drove a provided to our office -- and the then basically drove the folks to our office where everybody was arrested. [laughter] . >> that would come into this medical supply company, medical

equipment company and purchase invoices. they were charged about 10% of what they were purchasing. if they needed 20 dowson dollars worth up -- if they needed invoices for 20 tells of dollars worth of equipment, that would pay the individual to thousand dollars. he was also cashing checks for people. his wife owned a check cashing company, and he was able to cash checks and provide cash back to these people for a buyer% fee. he cooperated with us. we wired his office for both video and for sound and identified over the course of several months 50 true owners, but the individuals who came in and set they need purchase orders for a company. here is $3,000, give me receipts for $30,000 worth of equipment.

that led to over 50 indictments. what was unique about that is we were able to identify the true owners. you'll hear more about that, i am sure. the last one i will talk to about, which is unfortunately more common than we would like, is individuals working in some of the banks in south florida. the money goes into these bank accounts and what happens this, if accounts are frozen by the banks because of suspicious activity or because bank officials know is fraud, we have had a number of instances where these bank account owners would come into the bank an attempt to private bank officials to have those accounts unfrozen or

the money is released. working with one of the banks in south florida, we saw a real pattern and got a lot of information that this was a common occurrence. people were coming in and trying to bribe the bank officials to have the money is released. we placed an undercover fbi agent as a bank employee. she received a $3,000 bribe in a short amount of time to unfreeze some of these accounts. obviously, the individual was immediately arrested afterwards. the agents in miami are always thinking of creative and innovative ways to target and investigate medicare fraud. >> let me just follow up. you mentioned the use of undercover. fbi agents who are posing as

criminals, is that fair to say? >> in this particular case, the fbi agent was just pretending to be a bank employee. >> you talked earlier about a cooperating witness who was facilitating. can you explain what a cooperating witness is and how that works? >> cooperating witnesses can be someone who has a charge against them or they are a target of investigation and they have decided to cooperate. often, it is just individuals who want to do the right thing. these are informants who are willing to give us information, not necessarily involved in crime or have been involved in crime. maybe they are a victim of crime and they want to cooperate. >> let me ask you to describe

the prosecution theory. to some extent how is the opposite of what they say on the popular show, law and order." can you explain how it works, the integration of the prosecutors and the analyst working together, and the time line you are trying to achieve in your prosecution? >> we have had to stay ahead of the computer age. we had to tool everything up so everything moves faster. the older tradition of the will federal white-collar monolith to issued dozens of subpoenas and unleash analysts and accountants, and at the end of three or four years, indict a series of people in one investigation and one press

conference. times have changed. the defendants have changed, and the schemes have changed. we target everybody that the data indicates is an offender. we charge them quickly, and instead of issuing dozens and dozens of subpoenas, we determined what is chargeable now and gets our biggest bang for the buck. for example, the old school is we think something is going on, send out subpoenas, and look at all the financial analysis. then let's gather up the data. when we started this, it was the health care providers providing the data back then. all this took months. all of this is now done in the same location in miami in one building. the data is provided to us from

a block away. pretty soon, it will be coming directly to the agents' laptops. our teams are typically composed of two hhs agents, two fbi agents, and a prosecutor working together on every case. the matter is administratively opened up. subpoenas are issued before the agent actually knows what the case is about, because the investigation is collected on the front end. in the meantime, the agent is working on the other cases that he already has completed. it is an assembly line of data, of investigative tools that the agents will put together along with the prosecutor.

the prosecutor is involved from the very beginning. he opens up the matter based on the data. the person looking at the data is someone who works in our office. it makes no difference. they are working the same exact place. what happens is, from the time when i started doing health care in 1995, you would talk about to end three years, the statute of limitations was not a concern, it was a goal. we have cases where we are charging people as offenses are being committed. in the old days, we used to interview beneficiaries. these cases now could have dozens and dozens of beneficiaries, but each offense is committed in a variety of ways. both the doctor has to be on the take or not, or the beneficiary is on the take or not.

in your typical durable medical equipment case, your fastest moving case, because they are the ones that can steal from us quickest. we have had to shorten the length of time. did not interview any of beneficiaries, or pull only claims having to do with death beneficiaries. they love to charge dead beneficiaries, because they never complain. we indict counts based on debt beneficiaries. no one to interview, no one to cost project cross-examine. what you do is, instead of investigating or interviewing 30 or 40 beneficiaries, why not send a fax over to the four

doctors that the clinic used? that will take probably one minute to send. the doctors will say these are not my patients. that case will be indicted. another was some difficulty in some districts, they did not like to arrest white-collar defendants. we arrest everybody. everybody gets arrested. no one walks. some of them, the data is cut up and people are actually indicted first. that is a traditional methodology, and there is nothing wrong with that. some of our assistance are a little anxious, so sometimes we arrest people with a complaint. we go to a judge and swear out an affidavit, and someone gets arrested on a complaint. some cannot wait for that. you get these agents from hhs,

they go and investigate the guy and they are arrested on the spot. think about the difference in a three or four year investigation as opposed to a career for week investigation. -- as opposed to a three or four week investigation. last year we indicted a third of all the health care fraud cases in the united states. it must be done faster. the team's switch cases on their own. they all work together. there is no lag time in communication. there is no difference, you have to go downtown and meet with the prosecutor. once a month, i go over there

and meet with all of the agents assigned to strike forces. we cater to what they need. in doing that, you move things along quicker. let me talk to you about something that was mentioned briefly. we have been talking about charging true owners. what happens very routinely, it would be very unusual for someone to open a health care fraud in their own name. in miami, we found that it is friends and family day every day. and this, of course, friends, instead of going on a cruise, it goes to north carolina, louisiana. what happens is, the person who is on paper is never actually the true owner.

we refer to that as a nominee owner. however, we always charge the nominee honor. talk about the impact that makes. when the nominee owner gets arrested, guess who starts to worry now? the true owner, of course. what typically happens is, we work our way up the chain. we indict the nominee owner and the true owner. these cases done in this quick way -- part d is a relatively new thing. people will try to steal from part d, so we had to write an indictment for them.

we have three teams that just specializes in a home health. now we have a team that specializes in getting medicare money from the bank accounts. these are cases that are older, and that means six months or a year. people have abandoned the account entirely. the banks tell us there is money laying in the account. we begin investigations and trace the money back to the offenders. typically, this is what happened where we went after the money first and a year later we invited -- indicted virtually all the defendants who took the money. we have a team that that is all they do. at the present time, we are making some inroads in miami. >> i cannot stress how important it is to have the agents and

prosecutors colocate and working together. they are one notch lower on the totem pole. could you talk about the sentencing as well? it is not just that you are arresting people, it is that they are going to jail. >> the standard of what is a loss is different from what is chargeable, and it is better. çówe charge of the greatest chargeable that we can prove, and at sentencing, which can bring in other acts. i want to be clear, the people in the community know that nobody gets to wall.

we do not hand out probation, and to do a sentence that is below the maximum sentence within the guideline range, you would have to come to meet as their supervisor, and no one ever comes to me. the discussions generally are, what are the appropriate variances up for. there has been some education and ball. white-collar offenses historically have got lower sentences. the case for the sentence just came back yesterday. we have had the good fortune that the judges see what has been happening. the judges themselves are tired of what is happening to health care fraud money. the judges themselves are getting sick of it, and that is where is the lead defendant got

22 years. the lower defendants got 14 years and nine years, and that was on a plea of guilty. that was not after a trial. that judge just got sick of seeing all the health care fraud that is happening in that community. ñiunfortunately, they were billg one of the district court judges mothers, one of their fathers, and a few years ago, they had billed them for double artificial arms. those cases are easier to prove than others. [laughter] the highest possible sentence that you can get within the lowest time. maximum impact, shortest period of time, the quickest use of assets that you can. that is what we have been trying to do.

>> people are involved on the front in, helping identify where the problems are. we have heard a lot about what happens when we catch the people and how they get arrested and go to jail. on the prevention side, what is happening as a result of the identification of these broad teams, and what are you and your agency doing to help on the prevention side? >> it is hard to be the program person talking about prevention efforts, because i know you are all thinking the same thing, you all are not doing a very good job. it is important to set the stage and talk about the fact that from the prevention perspective, one of the big challenges medicare has is the historical way the program has been set up. medicare continues to be focused on providing care to senior

citizens. one challenges the statutory mandate to pay claims promptly. that means we have to pay all the claims that it submitted to medicare within 14 to 30 days of receipt, or we have to pay interest. every working day we pay out 1.4 million claims, over $1 billion worth of claims. it is a real challenge from an over spike -- from an oversight perspective to review all the claims and determine where there is potentially fraudulent activity occurring. one of the best ways is to work palaver t -- to work collaborative leave with the information we get from law enforcement. >> can you talk about the auto pay and how that works? >> as i mentioned, medicare is

required to pay claims within 14 to 30 days of receipt. we have very little time to be able to go and do an in-depth review and determine whether or not the claims are legitimate on the face. most of them look like they are legitimate. it looks like they have the right service and right diagnosis. one thing we are doing is using information from law enforcement as well as information we have gotten through our more innovative dated technology techniques, to be able to put at its in place. last year we put 30,000 addicts in place nationwide, which stopped over $1 billion in payments, specifically in south florida. it has been a significant savings to the medicare program.

as we improve our techniques, it will only increase. >> you said 30,000 edits. can you explain that? >> that is just for simple things like making sure we do not pay for male pregnancy, or hopefully multiple limbs for someone who has all their arms and legs. medicare may get billed for those services, but we will not pay for their services. when it comes to fraudulent services, we take the information from law enforcement and target those edits. we have targeted home help. we made some payment changes this year and the allied air payments are kept so that no more than 10% sinccan be outlyer

payments. >> there is also an issueñi with nrollment process.n issueñi with how can be -- happen changes be made to also prevent some of the fraud from happening in the first place? >> along with the historical mandate of medicare to provide care to seniors, the other mandate was to give them as wide a choice as possible of providers. that means anyone who can fill out an application and meets basic criteria has been allowed to get into the program. in miami we have over 1600 durable medical equipment providers and over 191 -- the

result is, do we really need all of those different suppliers and providers in miami dade? we are trying to be more aggressive in screening applicants, making sure they are adhering to standards, and being more aggressive in going out and visiting them, doing background checks and ensuring they are good partners. >> does anyone from the panel have anything to add in closing? >> i just wanted to give you some status quickly about miami. this group that you see in front of you, christopher dennis and tim donovan and the supervisor

of the prosecutors, they have about 50 agents and 10 prosecutors. over the last three years they have done about one-third of the criminal health care fraud cases in the country with that staffing. it is truly an amazing feat, and they work harder than any healthcare group i have ever seen in the country. they were very well together. i just think everyone should realize that they are fantastic at this and have developed a real expertise that has become a model for the country in prosecuting health care fraud. [applause] >> the combined efforts of the strike force along with our prevention techniques have

really made a difference. last year, medicare expenditures that were built in the state of florida were $96 billion, but medicare only paid $25 billion. that is in large part because of the efforts of everyone at this table. >> are we running out of time? i know our panelists will be around for a local wild. -- for a little while. >> i will take a look at some of these questions and see what i can edit or what is appropriate. i am ensure -- i am not sure we have that much time. i will shoot for one where the writing is clear. [laughter]

how are cms career intermediaries involved in the process? >> one is through our work miami field office. we have staff on the ground in miami. one way is helping them understand the things we are seeing, debtor perspective so they know where potential leads might be developing. >> will cms outsource the fraud scoring? >> i am not quite sure what they mean, but we do use outside contractors to assist us.

>> several panelists have mentioned that some of the beneficiaries themselves are involved in medicare fraud. what steps are being taken with respect to them to flag those individuals and work on fraud prevention? >> one thing we have done is work on creating a compromise number of database where we have identified potential problems. it allows us to flag claims and be able to watch and see if the service is being billed are reasonable and necessary and meet medicare billing requirements. >> department of justice prosecutors have tried to focus on beneficiaries. what we have done recently is running out the number across different parts of the program

to see if they are professional beneficiaries. we have found those that have over a million dollars of pay claims that are obviously not legitimate. we have prosecuted beneficiaries as part of the conspiracies. it sends the message to the community that this is unacceptable to take cash in exchange for your medicare information. the going rate for a home health-care fraud is about $1,500 a month per patient. we believe there are thousands of patients taking that money. >> here is a question about help the government can effectively contract or share the information with the private side about various billing codes and various fraud going on.

i am not sure if you heard that, but that is the last question. [laughter] >> on a case specific basis, we do. we work with different organizations. we have a memo of understanding were retry to provide information back and forth, with regard to medicare advantage. our activities between the bureau and oig have become more sustained and our ability to share what we have seen in the schemes and billing patterns. >> thank you, everybody. i hope you have enjoyed this panel. [applause] >> let me also say thank you to our panelists.

this was a great died down into the world of health care fraud. -- a great dive down into the world of health care fraud. next, it is my pleasure to welcome jim roosevelt, who is our last speaker before break for lunch. jim is currently the president and chief executive officer of tufts health plan. he brings a professional career of fighting fraud in a private and public sectors. he has been the associate commissioner for retirement policy at the social security administration. he is a former board chair of the massachusetts hospital association and the current board chair of the massachusetts association of health plans, and served on the board of ahic. we have asked him to talk about the private sector's role in

battling health care fraud. please welcome jim roosevelt. [applause] >> thank you very much, bill. it is a pleasure to be with you here this morning. i am the odd person out. i came from boston, where it is even colder than it is here. i think i am the only person speaking with you here who is not a current government employee, so i am coming from a different perspective. s ceo of tufts health plan, let me give you some background. we paid out approximately $2 billion in claims every year. since 1979 when we were founded, we have been committed to providing a higher standard of health care coverage and to improving the quality of care for everyone of our members.

we have hmo plans, point of service plans, and a variety of other approaches to providing health care coverage. we are ranked third in the country for quality, and our medicare advantage plan is ranked fourth in the country. we are also a federal contractor with tricare. i appreciate the opportunity to speak about the significant challenging and complex topics we are discussing here today. my comments particularly concerned private health insurers antifraud activities, with an emphasis on practices that have been implemented tufts help plans.

like other private health plans, we have established an antifraud unit to deal with these issues. you never know where you are going to discover information that is useful in this area. i came down last night and stayed at a small hotel near downtown bethesda. it has a breakfast room, and i went in there and people were asking where others were going. i said i was going to speak at an antifraud summit, and they said fraud? let us tell you about the fraud we have encountered. everybody in the room. so that is a place you might actually want to send some investigators. [laughter]

our antifraud effort that we all engage in the face enormous challenges. the crimes and behavior's involved can be subtle and difficult to detect and investigate. we know firsthand that by working together with public agencies, we in the private sector can increase the anti- fraud performance of both private health plans and the agency's protecting government health programs. this partnership creates quality benefits for individuals receiving health care. i would like to address two topics. well motivated by common goals, public and private entities bring unique tools and approaches to fighting fraud and abuse. i would first like to describe the particular approach and strength of private health plans as they battle fraud. second, i would like to offer suggestions for strengthening

the partnerships between public and private entities in this field. i will describe our help -- our approach to such partnerships. with respect to the role of private health insurance plans and anti-fraud programs, we are part -- we view those a as part of providing outstanding customer service and cost- effective medical care. they reflect the responsibility of plans to their risk sharing partners and to our enrollees and sponsors by identifying and recovering inaccurate payments. with the payments are the result of inadvertent or intentional provider actions or misrepresentation.

the broad goal of an effective provider of a program is to analyze claims that and confirm the claim submissions accurately represent the services provided to plan members. private land fraud and abuse investigations lead to significant recoveries, all of which lower medical costs and translate into savings for our members, employer groups, and for the government. private health plans also look to identify cases where there is a link between financial greed and quality of care. private health plans pay close attention to quality. cases like these that need a medical review are difficult for public enforcement agencies to buy away quickly. we use our contractual authority and payment policy guidelines to recover for services that have been provided with potential harm to the patient. for example, an act of fraud, waste, and abuse program also

focuses on the diversion, ms shoes, and inappropriate prescribing upcoming narcotics drugs like oxycodone. an investigator works with others to address issues like abusive conduct in quality of care. prescribe or superscribed were not legitimate purposes and pharmacies that fill prescriptions when there is a known concern are investigated and referred to appropriate disease. provider fraud is also addressed at the network contrasting level and referred to the quality of care committee that we have within the health plan, when appropriate. ñe-riç9orñrxdthe key resources e insurers in battling fraud is their extensive and ongoing relationship with health-care providers. it is important to note the vast majority of providers are good, honest clinicians with the very

best in mind for our members, their patience. unfortunately, however, it only takes a few to cause great damage to cost and quality performance. private health plans are engaged with their provider community and the mutual expectations are reflected in their agreements. they expect the providers will do a number of things, provide or arrange for health services for members and an economic and efficient manner consistent with sound and evidence based medical practice, provide or authorized for members only those services that are medically necessary, maintain complete and up-to-date medical records, participate in and cooperate with appliance related activities and initiatives, and bill in accordance with guidelines and comply with payment practices.

these expectations are accompanied by tools to insure appropriate services and treatment for our customers and their members and enhance private health plans typically have the authority ought to audit providers, recover funds from providers to engage in improper and or inappropriate billing practices, to suspend future claim payments and to if the provider intentionally engages in improper billing practices i want to say a few words about the importance of training. those who decide to commit fraud are innovative and intelligent. fraud and abuse investigation and training is another area of focus for private insurance

plans. anti-fraud units are responsible for developing internal education programs within their companies to foster leads. unlike enforcement agencies that are intentionally separate and apart from the government health-care programs that audit , private health plans benefit from having their anti-fraud unit on site. as a result, coordination, referral work clothes, and education of internal departments can be regular and worthwhile function. front-line personnel are best positioned to look for signals that make raise a red flag private health plan antifraud units receive referrals from the internal people they have trained. prada awareness programs are also promoted to external sources through fraud hot lines and publications.

the national health care anti- fraud association was established in 1985 to promote a better forum for enforcement through public-private partnerships. the association assist in the training of investigators and allows plans to learn from the 84 private health plan members and their state and federal counterparts. they learn the latest trends, schemes, and abuses. it helps all the plants in the country better at fraud control. private plans have particular strengths in detecting and preventing health care fraud. one key strengths is their use of sophisticated analysis to promptly signaled leads to further investigation. most private plans dedicate

substantial resources to detection and prevention. preventing dollars from going out the door is beyond difficult. it is the gold standard in health care system that has traditionally focused on paying claims first and fast. we are telling everybody, your job every day is to pay claims as quickly as possible, but be on alert for claims that should not be paid. even after the dollars have left the plan, the use of the latest detection tools continues. government enforcement agencies may not have the statutory authority or resources to invest in the best and most current payment fraud detection software. the field has grown substantially, and private plans have embraced these companies and techniques. private health plans also are uniquely situated to protect themselves from providers who

engage in abusive or wasteful practices. there are significant dollars to be recovered in these categories, which are a step below what would criminally prosecuted as fraud. in areas involving over utilization, they are well- positioned to get at these issues quickly. private antifraud unit received ready support from their clinical services departments and medical directors to provide the necessary analysis to determine which providers are ordering or delivering unnecessary services inconsistent with sound and accepted standards of care. these in-house experts are ready to identify and address abuses that drain viable health care dollars. we seek immediate compliance from those to make medical decisions based on revenue rather than what is in the best interest of their patients.

there is a key role that structure and staffing play in enforcement and health care plans. i would like to illustrate that was telling you how we do it at tufts health plans. we support efforts to manage medical costs and ensure that limited health care dollars are spent wisely. our recovery programs produced a 7-1 returned. this unit investigates fraud and abuse issues. in certain cases, and referral to a state or federal enforcement agency occurs. the unit detects allegations of traditional schemes focusing on billing patterns and providers and maybe billing for services not rendered, and coating the

level of service administered, unbundling their services, reporting of false diagnoses, over utilizing, providing care with false credentials, or engaging in illegal marketing or referral relationships. the list of potential abuses is long. it takes a concerted effort. one key component is the placement and structure of the anti-fraud unit. appropriate placement and structure can significantly enhance effectiveness. we join activities in one deployment -- in one department with another. the and it identifies and investigates member misrepresentations related to

eligibility, fraudulent member reimbursements, international claims, and misrepresentations related to identity, which is a difficult, growing, an important subject. combining activities has created eight synergy in which leads are created. this operation mode differs from most government platforms in which beneficiaries of fraud is typically conducted within a separate agency. there have been several examples in which information was discovered that led to a provider that was ordering unnecessary or wasteful services. the synergies generated by inappropriate such project structure can be enhanced by smart staffing. we have long had an audit union, but not a formal fraud recovery

units when i became ceo in 2005. i had heard from many sources, including a physician member of our board of directors, that their worst -- there were physicians is submitted claims to us that they did not submit to medicare or some of our competitors who had acted anti- fraud units. because of my legal background, an area -- i saw it was an area we actively needed to pursue. we place the leadership of this under one associate general counsel who is also a director on the corporate level. he is a former health care fraud prosecutor. he is here with me today. he had a strong track record and enforcement in the medicaid fraud unit in the massachusetts

attorney general's office. he leads our nine investigators who have clinical, pharmacy, law enforcement, or auditing backgrounds. we increase its ability to focus on pharmacy and medical necessity issues. the staffing model is an important component of our success. i want to turn the focus to the importance of the public-private partnerships, which i believe are mutually beneficial, significant, and areas for future growth. private health plans know from experience that public-private information sharing and cooperation are key drivers to efficient and effective prevention and enforcement. we often share findings and produce leads for enforcement

agencies, including those that guard the medicare and medicaid programs. once an investigative opportunity is detected, most private anti-fraud units will review the relevant claims and medical records and as appropriate time interview providers and billing personnel to determine whether inappropriate events have occurred. if so, these cases become ripe for referral to an enforcement agency that has the authority to open grand jury investigations, subpoena witnesses, and decide whether the evidence satisfies the legal burdens for proving far couldn't -- for approving fraudulent intent. in assessing the backs and determining if fraudulent acts or provable.

it delivers a strong deterrent message to those who would engage in fraud. i reviewed the list of the open 128 provider billing investigations our unit has on going right now. just to provide perspective on our overall workload. approximately 34 of the open cases are investigations that the unit is working jointly with outside enforcement agencies on. approximately one-half of these were referred to law enforcement, and the other half were initiated by an outside enforcement agency and brought to the attention of our unit through some sort of a subpoena or information requests. it represents a healthy working model and provides me with confidence that we are making sound enforcement decisions and exercising our discretion

wisely. we are using the experience of our antifraud unit directorñrñio make a recommendation whether and which cases should be referred. within the description of private-public partnerships involved in fraud and abuse ñrinvestigations, private anti- fraud units work with several state and federal agencies. collaboration benefits both sides. in massachusetts, tufts health plans participates under the direction of the state attorney general's insurance fraud division. the task force was instituted in 1999. the recommendation to build an information sharing forum among private payers to enforce against private health care

fraud was born from -- for a specific reason. while investigating provider fraud, the division often came upon evidence that demonstrated that providers there were fraudulently billing medicaid were also taking advantage of private health plans. there is a consistent pattern of this. those providers that wish to take advantage of a system based on trust observer greater volume of government press release is leading them to the wrong conclusion, that private plans are inattentive and enforcement exists only when public moneys are involved. designed to protect taxpayer dollars, the false claims act enforcement culminates with a press story describing how government programs had been harmed, but is not readily apparent that often the same bad acts are on -- arm private

health plans and consumers. look at some of the pharmaceutical manufacturer cases. when this occurs, private health plans use their own discretion and resources to pursue a remedy. effective communication is critical to a public-private partnership. we measure our results in several ways. we address abuse the billing practices through investigation, prevention, education, recover, and referrals to and from outside enforcement agencies. we want our public counterparts to know of the providers that we believe may be hurting government programs. we have been advocates for a better communication process and work flow. the unit has open and active investigation with quite a number of massachusetts enforcement agencies. we are not unique in that these agencies exist in every state. in our case, the attorney

general's medicaid fraud control unit, the boston office of the inspector general of hhs, fbi, drug enforcement agency, division of professional licensure within our state government, and the state insurance fraud bureau. that is just in one health plan. working through longstanding barriers is another challenge that will not be easy to solve, but both sides can benefit by a better platform for timely information sharing. government enforcement agencies would benefit from the detection strength of the private health plans an additional resources we can bring to an investigation. it is important to note that government enforcement agencies have enormously broad mandates, but limited resources. this is one of the many challenges before us. private plans would benefit from better and earlier information.

however, enforcement agencies often need to conduct long and confidential investigations. private plans could be potentially paying claims to the provider when they could take a proactive role in prevention. we value our public partners. the anti-fraud unit monitors government fraud alerts, press releases, and class action litigation. the 2008 work plan highlighted hospital coating practices cost payment for inpatient stays when an outpatient or observation stay was actually delivered. leads all come from the fbi fraud group and relationships with the local office of the inspector general and the state agencies i mentioned. firms to fraud and abuse are another area that i could give

you -- pharmacy fraud and abuse is another area where i have a lot of detail. it is another important area. several areas seem critical. health insurance plans have devoted significant resources to improve anti-fraud efforts. these activities have taken place through america's health insurance plans, the national association representing nearly 1300 insurance plans, providing coverage to more than 200 million americans, and through the national health care anti- fraud association. both organizations have put forth useful ideas for expanding this partnership. in considering ways to improve fighting health-care fraud, the key areas of focus should include increased sharing of

information between public entities and private health insurance plans, better inclusion of private health insurance plans in government fraud recoveries, enhancing the ability of public and private payers to engage in joint review before payments, dedicating more public resources to anti productivity and improving safeguards against recidivist offenders, insuring a forum such as an advisory board for public and private enforcers to share information and best practices, and simplifying and making consistent processes such as those used for reporting fraud information to state government. in conclusion, i hope i have been able to shed some light on what private plans are doing to battle health care fraud, including through partnership with public entities. health insurance plans have devoted significant resources together and with government counterparts to improve antifraud activities and offer suggestions for further improvement.

we support these efforts and hope that today's summit produces a better understanding of the role and commitment of private health plans in anti- fraud enforcement. thank you very much. [applause] >> jim, thank you very much for a great deal of information for us to think about. we are going to break for lunch and start to break out section section 1:15. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010]

>> tonight on prime minister's questions, questions on british banks, the economy, the iraq war inquiry, and this week's afghanistan a conference in london. that is tonight at 9 eastern, here on c-span. tomorrow on "washington journal," in discussion on the role independent voters may play in the 2010 midterm election. also, china's impact on the global economy, with stephen mufson. after that, a look at childhood obesity in the u.s.,'s and first lady michelle, campaign with the arkansas out surgeon general. "washington journal," live at 7:00 a.m. eastern, here on c- span.