operational details. date andot no firm people will continue to die under this program and we will put out rules and the fall. why would we put out rules now? >> we are taking action steps to respond to the oag funding. we have shared the pharmacies that are out fliers to all our people for actions today. the burdens balance that will be placed on for scribers who are part of the medicare program today that need to come into the medicare program for validation and oversight and that is a process we cannot do overnight. we have to go into a proposed rule making. that is one more step the agency can take to achieve better results. >> you've got plenty of paper work to do, i understand that.

would you commit based on the to givedations of oig us a report over the next four quarters? absolutely, the understanding is that we are happy to commit to whatever process will be helpful to this committee. >> will you publish that report so does not just come to the committee? >> we will defer to how you want the report. >> if we get it, i will make it public. one of our problems in government is we see a problem and then our rules of government make it to where we cannot save the lives of the next 1600 people that will die from a prescription drug coverage does because we are not managing the medical report d program effectively and that is not a very good excuse. not talking about you. i'm talking about us, too. making theseart changes. you're talking about lives and

money and were also talking about not just lives that are snuffed out. you're talking about lives that are destroyed and people going to prison because we have made it easy to gain the system. i hope your commitments will be there. as you can tell, i am pretty disgusted with the medicare program because i don't think we get that much from it. i plan on sending you a few follow and to the oig up on that because i don't think we're getting value out of the $40 million. i hope you will raise the contractors to where we actually get values. my time is up. you, mr. chairman. thank you for your testimony today. from my experience as attorney general, i know what a catastrophic impact this epidemic has on people that live in my state and throughout the country. don't appreciate as much as the impact it has on seniors

in the different ways that they are particularly vulnerable to people who are trying to gain the system. what i would like to find out -- i opened this question to any of you who feel competent to answer -- what are the particular focuses on a population that is clearly vulnerable to this? they trust the doctors and want to get better and some of them have long term ellises and in some cases, it is just easier to try to medicate your way out of those illnesses. rather than talk to the family and get to the heart of what is going on. are their relationships between assisted care facilities and nursing homes that are particularly problematic in this area that experienced this abuse? that i canknow directly answer the question that with regard to vulnerable population of the elderly in nursing homes and some of these drugs be very powerful -- we did

a random review of anti psychotic drugs as used in a nursing home setting. we found that 88 percent of them were prescribed against the black box warning, clearly, raising house concerts and based on the medical record review, we found 51% of the claims should not have been paid by medicare. when we did that in depth review in that volatile setting, we indeed found substantial problems. lovell we talked about dr. shopping as part of this problem. typical populations that engage in this behavior. do we seem that among the elderly population? >> when i speak to be a doctor shoppers, the majority are under 65 and are under social security disability. we just referred eight cases

last week and all of them are under 65. >> if you have any information to tell us what percentage that are over 65 engaging in this behavior -- >> i can get that for you. pain clinics and pill mills - talking about the senior population, are they being exposed to a greater extent in those settings then we find other patients are? >> i don't believe so. the pain clinic cases i reviewed are generally a younger population of drugs seekers. pain clinicsobic are not going to get treatment. they are going to get medication to feed their addiction. it is not medical care, it is more drug distribution. want to ask you

about the enrollment process. what factors to provide the greatest deterrent to keeping out the kind of positions we don't want involved in these programs? things atot to do two the same time -- we have to credentials,tions, and that has to be periodic. one of the most important changes that congress made as to require this process. there are many priest drivers who are legitimate but are formally -- there are many press scribers who are legitimate. rs.prescribe i believe that every physician who is writing prescriptions for the program is to be enrolled in the medicare system so we can validate and we are not reliant on self-reported databases and we can verify those who are

truly massage therapists vs those who are self-reporting. i believechange that the program needs to make. it will place new burdens on physicians. i'm sure this congress will hear push back from the physician community. there are scribers that do not provide medical services, they should not be enrolled and this time we move to a different framework. >> we worked in new jersey with dea to establish drop box programs where people can take their unused prescriptions and get rid of them, no questions asked. in your experience, how effective do you think those programs have been in getting at the potential problem of illegitimate prescription drugs and then being used inappropriately by a younger member of the household? >> we have taken a position that those medications, once they are expired, need to get

out of that household. that is why we have these nationwide take back programs. almost 376e took in tons of pharmaceuticals. process ofhe drafting the final regulations for take back. we may have the drop box is available across the country. in certain authorized locations and i think that will go a long way to preventing such tragedies as what we have seen in the past. >> nationwide, what percentage of the state's participate in these programs, the drop box programs? >> currently, the only drop box programs are allowed are the ones in law-enforcement facilities, either precinct houses or headquarters.

i cannot tell you exactly how many because law enforcement agencies are exempt from the statute so they could put their drop boxes in the facilities without reporting to dea. anecdotally, we talked about this in new jersey but do you get the sense that many states are getting involved in this program or not? >> i believe quite a few states are getting involved. some states have their own program. i believe north dakota has its own program. >> thank you. >> dr. coburn. the cn as aware of actions by state medical boards and restricting of licensing? for disciplinary procedures? >> to some degree but what thing we need to do to improve that data sharing. share with providers

-- insurance providers -- when you take somebody off their eligibility to be able to prescribe or treat medicare patients? jobe need to do a better than i do you do it? >> we will be doing that. >> but you don't do it now? >> not to the fullest degree. >> do you ever give the other providers a list of problematic providers -- insurance providers -- that list problematic people that are under review or are under suspicion of being a bad actor? do you ever share that information? the ones you are suspected of fraud? >> one change that we have made is that we now share those out liar pharmacies. we will be expending those lists. >> how about out liar positions -- physicians?

there are some things you can do immediately and share with other providers, part d providers and other insurers? >> cms pledges to this committee that we will take those changes which require rulemaking such as requiring physicians to enroll in the medicare program that it prescribes for part d. some changes are management changes. we will continue to act on that. >> ms. lavelle, in your testimony, you said plant sponsors are rarely aware of the actions that are taken and the information collected with the agency is rarely shared with the

private papers. it said cms does not share information on revoked medicare providers with private players. i think you just heard some good news and a commitment to this committee. uh - special investigation unit refers all cases to the medic. what have you seen from that? >> that is what the issues we have with dramatic. we are very collaborative with them. we often refer cases over but then we are never advised as to what type of action has ever taken. >> that is something that needs to be fixed as well? >> that would be very helpful to us. think a small fraction of

those cases that get referred to law enforcement are taken. oftentimes, there is a beneficiary who is complex and -- who is composite -- compliciit. it is time we hold the part d medic to a higher accountability. part of the issue is that the process now relies on a referral to be taken by law enforcement but that is not sufficient >> just because they choose not to prosecute does not mean someone has violated all law and does not mean somebody not to be banned from providing medicare provider status. you would agree with that? >> i do. how often do you see medicare participants run in this program

as far as females? how often are older patients used as part of a scam, not wanting the drugs, but using their drugs using their medicare number and provider to get the drugs? how often do we see that? >> more and more we see what they are not aware of this is happening through identity except where the numbers are used to bill medicare and they are not aware of it. that is often the case. wellpoint the dea and experience, we see a lot of younger beneficiaries involved in these investigations who are interested in getting the drugs. a socialave to have security number? >> in essence, and a letter. >> which you can fraudulently provide for that is another reason why we should take social security numbers off the medicare. that seems to be at risk. mr. chairman, thank you for this hearing.

i have to be on the floor but i would tell you that our staff needs to follow up on this but we have a commitment from mr. blum in terms of quarterly reports on oig recommendations and my hope is that they make great changes and i will look forward on working with you on legislation and solving some problems. >> you bet. >> you, dr. coburn. i want to back up a little bit. we have been talking about what we can do in the legislative branch and what you can do at cms and what we can do in law enforcement community. we have not talked about the roles of parents in this and parents are family members. talk a little bit about that. there are some communities doing a good job with federal involvement -- family involvement -- does anybody know? it cannot be just the government.

when it's all hands on deck, we need all hands including parents. >> when we did the work and anti-psychotic drugs, we recommended that families need to be more involved especially when beneficiaries are in nursing homes and not necessarily aware of everything being prescribed on their behalf. we very much made the point that this was something that everybody needed to contribute in terms of involvement. >> others? how many of your parents? ok, everybody. you can speak, you can put on your parent at if you want. >> from the medicare perspective, medicare beneficiaries take many drugs and the average i think this 12 prescriptions per beneficiary right now. the part d plans to a lot for pharmacy reviews which is not sufficient and beneficiaries are

encouraged to do a new well as a visit in the affordable care act. screenthe independent and check on the multitudes of prescription beneficiaries take is an important step in the overall process. i think there are voices here that should be at this table to speak to over-prescribing. having the physician community to get much more engaged and having the pharmaceutical manufacturers getting more engaged. one reason the players are seeing so much growth in these medications is because the flooded, ifis being you will, with these medications preparers can do so much and beneficial is to do so much and congress to do so much but there are other voices that need to be part of this conversation. the physician community, pharmaceutical community, pharmaceutical manufacturers, to insure a multifaceted strategy.

is developed. >> i don't think i heard you mention parents. >> parents, too, absolutely. >> anybody else? >> one of the biggest problems we are encountering now is that parents do not understand the dangers of these drugs. they are not talking to their children about these drugs. ago, we attempted to do a parent's program, at the second-largest school district in the country and we made sure that it was adequately marketed with email blast and news reports and we had 14 parents show up to a huge venue. i'm not so sure they understand or willing to understand how bad these drugs are and how bad the abuse is. we work with community coalitions all the time.

we partner on the take back programs. we hand out literature and try to go to every community meeting we are invited to. in the end, i think you're right, the parents do not get involved and we see tragedy over and over again. >> anybody else? a i had a daughter that was lacrosse player and tore her acl and had surgery and was sent home with a prescription and her first day back in school as a sophomore, she had several students approach her and asked if they could buy her pills. it is in our backyard. it is very insidious. we went in the school and did some parent/teacher conference and. ing. we partnered with the dea agents and did a workshop.

even if you have a babysitter over, they look in the prescription cabinet now. it is that pervasive in society right now. >> any other parents want to say anything on this? >> education outreach to we welcomei think the opportunity to join them in these outreach efforts whether it be parents or the prescribed community. that is the front line of defense from preventing these things from happening in the first place. >> the good news here is that parents don't have to worry as much about the kids being on heroin or worry as much about the kids being on cocaine or ecstasy. is bad news is that this pretty insidious.

one reason why we're having this hearing is to figure out what we can do collectively, folks in law enforcement, cms, insurance pbm's, s, the legislative branch. we can also send a message to parents. it is not good for our kids. i say that as the father of three boys, men, and the parents need to get their heads wrapped around this and understand what is going on here. they have an obligation here as well. we cannot just do it all. they have to be a partner as well i want to go back to some of the steps that cms is already taking, steps to have taken and about to take and the third area would be steps that are called for in the president's 2014 budget proposal. can you briefly run through

those or about what you have done and what you are undertaking and what would you like to do under the president's budget? our focus so far has been to put in place requirements for the part d plans to much -- to do much more comprehensive drug reviews. it is not sufficient to simply look at the point of sale. complete lookthe over the course of the year to see the full spectrum of beneficiary uses. for those beneficiaries that exceed a certain clinical threshold, we require the part d plans to contact the patient's physicians to make sure they are being well managed. if they are not, the part d plans are expected to put in place to watch and those beneficiaries that could be drug

seeking behavior's. cms is consistent with changes in law and changes that this committee has urged and now requires every drug claim paid by part d to have the providers number on it so we can track and to analysis and verify that those prescriptions are legitimate. we also hold our part d plans to a higher degree of accountability. that is the current work we are doing. in addition to the outlying analysis. cms is moving to new areas. i believe it is time for us to ofld a bigger universe oversight of all prescribed errors. cms will be up holding paramedic to a higher degree of accountability but giving it greater authority to do much more intensive reviews.

the president's budget has called for ways to promote greater part d data sharing. with limitations on state monitoring programs, they are separate systems that don't talk to each other. we know that drug seeking behavior across state boundaries and it crosses health insurance plans. paying customers of part d changes alone will not stop the cash-paying customers. one proposal for the president's budget is to provide greater assistance to drug monitoring programs by states to share data and build confidence. >> thank you. a couple more questions --

i know you're agencies are doing a lot to identify and investigate and bring to justice those that are defrauding medicare part o. what are some of the challenges facing law enforcement and what steps -- and what are steps we can take collectively that would help you and your colleagues in your work? the second follow-up would be -- can law enforcement alone curb the diversion and the use of prescription drugs? obviously not. this includes not just you at the table and others but it includes us and parents and families. let me go back to the first question -- what can those of

us at cms and the legislative branch or maybe within the administration do to provide some help for you in your work? as an investigator, one of the most frustrating things i see is when there are tools and they are not using them. they could help us in the long run by just using the prescription drug monitoring programs. if there is any way congress could push the states to do that -- right now some very good programs have less than 15% of the prescribing is using them. >> why do think that is? >> one reason i hear is that i don't have enough time. that statement tells me you don't have enough time to provide patient care. in the end, this is another diagnostic tool. wouldn't you want to know if you're patient is seeing four

different doctors? would you want to know if you are prescribing but the down and you have two other doctors prescribing a depressant -- an anti-depressant which might affect how the drug is distributed in the body? wouldn't you want to know that? it seems to me that if this tool is available in 49 states with an infrastructure in place to create a pdm, as a practitioner for a physician or a pharmacist, wouldn't you want to know what your patient is doing? is absolutely right, as much as payments for medicare. these people are paying cash and if you are true dr. shopper, you'll go to five, six, seven doctors at a time for the same illness. if i was that practitioner, i would want to know exactly what the patient is doing. many states, with the exception

of new york, kentucky, i believe tennessee now, as mandatory review of the pdm for prescribing and the other states are just not using them. >> mr. cantrell >? >> we agree we should explore increased utilization of different drug monitoring programs and even the potential lot and for over- prescribing and doctor shopping. we have seen people leave the state in order to cross state lines to find places where it is easier to get the drugs. we see that routinely in our investigations and we are very encouraged by the data sharing an additional analytics that mr. blu hasm committed to today and we think that will pay dividends down the road. our office is responsible for overseeing this huge program but

it is shrinking in the face of the growth in medicare and medicaid. we are set to lose roughly 400 bodies out of a total of 1800 at our peak in 2012. that is limiting our ability to expand our oversight and some of these areas. 1800 toreduction of around 1400. >> what is the reason for that? >> some expiring funding streams and sequestration but before sequestration, we were already facing expiring funding streams. we are operating with a reduced budget. in the face of a growing program. last year alone, our office closed down 1200 complaints due to lack of resources. those are complaints that came through the door that we did not have the resources to investigate further to determine if it was a viable criminal case are not. that number does not appear to

be going down. >> the next question i have is really for the entire panel. it focuses on state efforts to combat prescription drug abuse and diversion. some of you have mentioned in your testimony the serious efforts to combat prescription waste and fraud and abuse. for example, the prescription drug monitoring programs established and operated by state governments has had a fair amount of success in rooting out fraud in medicare as well as medicaid and in the private sector. these programs track prescriptions filled by tormacies across the state's help prevent illegal diversion or abuse. i was encouraged to hear from today's testimony that 46 states have operational monitoring

programs and additional three states have enacted legislation to establish one. we got into this a few years ago and we found there were more states that did not have that kind of monitoring. that is the good news. was maybe four years ago, 2/3 of the states had these programs operational. can you comment on the importance and effectiveness of the state run prescription drug motrin programs in combating prescription drug waste and fraud and what are the most important next steps to ensure that the monitoring programs become even more effective? biggest issues is a corner of the state of virginia known as roanoke. south where i

grew up, danville. >> we have pharmacies where we often see up to 15 license plates from outlying states. we know that they are pill mills, we know they are impacting part d and our plans as well as our medicaid plans. we have been working with the state law enforcement agencies to get them prosecuted. we have been pretty successful with referrals. is, again, a major problem in that part of the state of virginia and we are focusing on that. los angeles county is our other hot spots. roanoke, you suppose virginia would be a hot spots? i could see los angeles but -- >> have often asked that but maybe the gentleman from dea knows more than i. but i have often been told that it is a

spill over from the coal mining days. it is hard to say. ppoint thatal pain part of the world so we are trying to lock in as many as we can in the medicare program. would you refer them to for prosecution? thet depends -- usually virginia state troopers will pick up those cases. the u.s. attorney's offices have taken quite a few of the pain management providers which we often refer to as drug dealers in white lab jackets. some very egregious -- we have even had calls from the coroner's office advising us that the 14th body has come in from a particular prescribe r. they did not know who else to

call but they knew they had bluecross insurance so it is that big of a problem. thank-you >> . wein terms of next steps, plan additional of valuation work, looking at medicaid drug review programs. that is not something we have directly review but we're planning on doing reviews that will determine how they operate and how they are reviewed and which ones are effected. we think that is important place for us to go to build on the work we have discussed today. in addition to that, we will continue to look at issues associated with medicaid data overall. it is important for a national standpoint that there be complete and accurate medicaid date set which has starkly there has been difficulty in building so we plan on continuing to work that issue, hopefully getting to where we have a comprehensive data setting that will enable us to look at medicaid as a whole and not just state by state. >> i would reiterate that we

think the prescription drug marketing program does this serve as a great deterrent to this type of activity. if all states had a similar level of program, we might prevent some of those crossing state lines in order to avoid them. medicaid fraud control units so we work with them frequently and their involvement in this effort is also important. >> you. >> given the steps we're taking at cms to reduce the probability that part d is paying for inappropriate medications, i don't believe that will stop the problem. i think drugs are very inexpensive and at cms, we take further steps to bring the rate down to zero, they will shift to cash-paying transactions which means other data sources will be necessary to spot drug seeking behavior.

i think a state drug program provides a tremendous resource. the data has to be shared and cross analyzed. beneficiaries do cross state lines. focusing on the part d program will not solve the problem given the cost of these drugs which are inexpensive and they will shift to cash. >> thank you. > going back to the pdmp's - one of the most important things is connectivity between the states. if the states are not interconnected, you are not going to get a full picture of dr. shopping. the national association of pharmacies is connecting at think they have 15 states interconnected now. it prevents these people from going across the border. you could go from indiana to

kentucky, it will show up on your pdmp's. as far as why the pilled mills are going to rural areas is because they are comfortable there. when they started in florida, florida did not have a pdmp a regulatory infrastructure to prevent them from spreading. as soon as law-enforcement and regulatory infrastructure in the state of florida started passing statutes, they felt they heat and moved into georgia and rural areas off i-75. now george is getting heat and they are up in tennessee. they moved to rural areas because they are comfortable and don't believe that law enforcement or regulatory bodies will find there. it is not that those areas have a lot of pain patients. you're absolutely right, if you look at an active pain clinic, you'll see license plates from all over the place.

when we did the florida pain clinics, their license plates as far as massachusetts. you made a statement before about heroin and parents not having to worry about that because of prescription drugs. the fact is, we see more and more throughout the country where children and young adults cannot afford the prescription drugs. the street value for hydro codon is only $7. about thetart talking single entity 30 milligram 30's are talkingn, between $30-$80 per tablet. once you're addicted, you cannot afford that even if you have multiple tablets per day. what we see in rural and urban areas is kids moving to heroin. it is well documented both in

literature and by law enforcement. heroin is going to be a problem if we don't get a handle on the opiate of abuse in the united states. i want to follow up with another question. what i do at a hearing is to ask not only the witnesses to give an opening statement that asked to get a birth -- brief closing statement. if there are some points you want to reiterate, that is fine. --there something you need you thinks it needs to be re- emphasized? we welcome that. any closing thoughts you think should be mentioned either for the first time or re-emphasize, that would be helpful. i am interested in learning more about the steps that dna takes

to insure that its registry of practitioners authorized to prescribe controlled substances is accurate and up-to-date. a key preventive step for curbing fraudulent diversion of told us to substances maintain an accurate list of those positions that are authorized to prescribe in the first place. there is some challenges. i understand that the dea only has access to a list -- a less than complete list of people who have died of something called the death master fire. you have access to the public file but not the more complete file maintained by the social security administration. i would ask what steps the dea takes to ensure that the registry of controlled substance providers is accurate and up-to-

date. are there some additional steps under consideration, perhaps some that might need congressional support? believe we are bouncing our system of the social security death registry. i have to go back and look now because i thought we were looking at the complete system. if we're looking at a partial system and not getting information, i would like to get back to the committee. >> i'm told you have access to the public file but not to be more complete file maintained by the social security administration. if you could follow up on that, we will ask you to respond in writing, if you would, please. closing statement of my own but before i offer that, of like to go back to our witnesses and thank you for being here and thank you for your work. this is not an easy one.

none of us has the solution. we've got to make sure that we identified these. do you want to make a brief closing statements? i appreciate mr. blum's it's and they give us hope that we will have changes in the future. i also appreciate the work that the fraud prevention partnership has been doing. we have people in the room who have been instrumental in bringing the privates and the public and the agencies together. i have great hope that we will have a very successful partnership going forward. we have work to do. secondly, i want to reiterate and point out that the paradigm is changing for wellpoint. we no longer want to pay and chase. in doing so, we get 20-30 cents

back on the dollar. the paradigm for us is prevention and to stop the dollar's from ever going out the door. with that, i want to point out that with the medical loss ratio, we are only allowed credit for collections which is counter intuitive to our new paradigm of savings. it actually encourages recoveries because that is the only credit we get. with our new paradigm, we hope that there may be some changing activities in mlr that will give us credit for the work we do. >> thank you for that. >> in closing, i want to make three points -- it is extremely important to follow through and implement the recommendations made by our office. i would specifically mention recommendations aimed at the sponsors. for example, we have recommended

the sponsors be required to refer fraud and abuse cases to the medic. current like, that reporting is on a voluntary. there is a series of recommendations aimed specifically at the american terms of their ability to get information from sponsors, pharmacies, and prescribers. there is recommendations pertaining to the magic in terms of doing more practical data analytics. vamping in general, re- strengthening that medic function is crucial. the second point i would reiterate is the resources used -- fully funding the office in terms of the president's budget request is crucial for our oversight activities we are slated to be down 200 staff by the end of the year and on track to lose 400 staff by the end of 2015. we return $8 for every dollar invested and lost. to the extent that staff leaves,

we will no longer to contribute to that return on investment. >> stop right there -- you are urging us in this report to support the president's budget? >> to fully support -- lastly, conducting oversight hearings as to have done today is crucial to shedding light on his problems and getting all the players aligned to do something about it. >> mr. cantrell. >> want to thank you for holding this hearing and it is a great opportunity for us to talk and identify potential solutions. it has already been mentioned the resource issues. >> can mention it again >> you may have heard of the heat and air strike force teams that have tackled medicare fraud in cities across the country. we have been very successful model in tackling all types of

medicare fraud. we would like to be able to expand that kind of focus in other areas of the country and other areas of the program. with additional resources included in the president's budget, we would be able to do that sort of thing. while prescription drug fraud, and abuse, is a top priority now, i know there is more we can do with more boots on the ground. >> thank you. >> i want to thank the committee for holding this hearing. cms welcomes the oversight and it helps us build programs that better serve beneficiaries. i think it is true that when the program was established back in 2006, the focus was on making sure beneficiaries got all they needed and the oversight makes sure that beneficiaries get what they need at the point of sale. that was appropriate at the time. now we are in a different time and now the focus should make sure that that fisher is get

what they need but stop those payments -- that beneficiaries get what they need but stop those payments that are inappropriate and that will take further steps and build on current actions. it will create more friction. you'll hear about this from the physician community and pharmacies and beneficiaries themselves. the programs will need your support once that friction starts. to enroll all prescribed to the medicare program will take a huge lift and you will hear about it. the only request we have is that congress continue to support these changes but we will have to create more friction in the system to shift the paradigm from not just providing all drugs at the point of sale but to hold everyone accountable, cms, too, to stopping those drugs that are not appropriate. >> thank you. and want to thank you

senator coburn for your leadership in this area, to get the word out about these drugs. i also want to thank you for identifying education of parents and family members as very important it is part of our overall strategy because not too many people understand this. it does not really affect them until it actually affects them and then it is too late. i look forward to working with my colleagues at hhs and continuing to work with cms. as we move forward against these people who are gaining the system. are doctors shoppers and people who are diverging. we talked about sequestration. fortoo, it is problematic us. we are losing positions through attrition and we cannot fill those positions.

ouregulatory staff and special agents are included. thank you very much for this opportunity. forhank you to each of you those closing statements. dr. coburn has spent a lot of time and energy to develop a deficit reduction plan which involves roughly $1 additional revenue for every dollars on the spending side. under put together simpson-bowles. budgetsident's latest proposal for 2014 looks a lot like the efforts of the simpson- bowles deficit commission. adopted, we would

end sequestration and put ourselves on a track to reduce the deficit by another $5 trillion or the next 10 years it's. as a not balance the budget but it is closer to where we need to be. be mindful to us to of sequestration and what it does in terms of your abilities to do your jobs, i want you to know that there is a pretty good plan out there and the president is lined up behind my hope is that before the end of this fiscal year, we can actually do that or something close to that. statement.me to this we still have a huge budget deficits, over $600 billion which is better than $1.40 trillion, but we have a ways to go. don't want to go down for a little while and go back up again. many programs need greater federal assistance. as a result, if we are going to reduce our deficit, we have to include medicare but not in a

thoughtless way that the savage as older people or poor people but in a way that saves money. i want these programs for my kids and for your kids and our grandchildren as well. medicare is not running a big surplus these days. of babye title wave boomers moving into a time in their lives when they are eligible for medicare and other looking tohat is eventually run out of money in the next decade that is not good. we attack a lot of issues on this committee from a fiscal basis by looking at a waste of and it hastens the day when medicare runs out

of money. this has a more human side that we have heard here today. when you talked about your daughter, the lacrosse player, injured and back to school, taking a controlled substance for pain and having other students say they would like to buy the extra pills -- that brings it home. really brings it home as good as the folks you are at wellpoint and the work you do and the work that the inspector general's office and you folks at cms and dna, it is not enough. we cannot do it by ourselves. all hands on deck and it is a shared responsibility. we have the benefit of having some technology today that we did not have that many years ago. my mom passed away six years

ago and she was in florida for the last 30 years of her life and she had about six different doctors provide -- prescribing 16 different medicines. the others did not doubt -- did not know about the others. she was not unique. in that situation, we figured out that a medicare patient like her was receiving medicines that were not compatible with one another. we have gone way beyond that in terms of our technology and our to know what is going on in these situations. i serve on this committee and we spend a fair amount of time on homeland security. a lot of discussion in the media and across the country about what the national security agency is doing in terms of telephone calls or electronic messages over the internet.

sure badort to make people did not do harm to us. we have folks that are hacking into our systems. there is a real tension there between protecting our privacy rights as individuals and how do we protect ourselves from terrorists or cyber-terrorists. having said that, the kind of tools that are available to protect our personal safety and our national security and protect us from cyber attacks, the technology is pretty amazing. i think we are only scratching the surface in terms of what we can do in a way that is respectful to privacy rights. we can harness technology to identify whether it is a doctor who isll mill or someone a massage therapist, a dental hygienist, we want to make sure

they are prescribing was appropriate and lawful. when they don't, we have the ability to do something about that. the last thing i want to say is parents have to get their heads in the game. most kids grow up and a home where they have at least one or two parents who love them and want to make sure they are making the right decisions and the parents are setting the right examples. the government cannot do this by itself. we need to be helpful and supportive and play our role and we have a good role to play. said the parents and family members. they need to get their heads in the game. my hope is that holding a hearing like this encourages all of us to have these responsibilities to work and his problems but also the word will get home to a lot of homes across the country where parents are not as mindful as they need to be and they have a responsibility as well.

to do list for us on this side and for you on the other side of the table. thank you for helping us put that together. the work that is being done -- as i like to say, everything i do i know i can do better. i learned from my father growing up in virginia that if it is not perfect, make it better. this is not a perfect situation. we are doing better in some respects but we can to a whole lot better and we need to. this hearing is almost adjourned and i am told by this young lady over here on the left who will be retiring -- in how many days? four days -- she has been our chief clerk for longer than you imagined. it is hard to believe she is eligible for retirement. we appreciate very much for work. i don't know if we will have another hearing before you step

down. we will have a business meeting later but i just want to say in front of you and those who have admired your work before, the many years we admire and respect you and are grateful for your service not just on this committee or the senate but to this country. with the bat, the record will remain open for 15 days until july 9 at 5:00 p.m. for the submission of statements for the record and i would say to our today -- three of us rear and a number of staff. we have a vote at 5:30 with members flying in from all over the country from their home states. the fact that there are not more members here, don't be discouraged by that. and by any member , he is goingsetts

to be good. office on least until october, maybe november. we will get a lot of work out of him and he knows his stuff and will be good addition to the u.s. senate. i think that's it. with that, this hearing is adjourned. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> several live events to tell you about our companion network, cspan 3 today. the senate banking committee will have a hearing on private student loans this morning. witnesses will talk to the consumer financial year, the federal reserve, and the fdic at 10:00 eastern. after 1:30 p.m. eastern,

president obama will be at georgetown university for a speech on climate change and regulating greenhouse gases. in a few moments, today's headlines, live on [video clip] ." "washington journal." we will talk about emergency preparedness at 10:00 a.m. and a house is back in session for general speeches at noon eastern with legislative business at 2:00. minutes, we'll be joined by a republican representative from kansas, a member of the energy and intelligence committees and will talk about president to bomb us's speech today on energy issues. at 8:30 eastern, will focus on the disk diplomatic -- on the

diplomatic aspects of edwards noted. -- edward snowden. ♪ ♪ ♪ tot: welcome to washington on this tuesday, june 25, 2013. at a live image of the supreme court building. the court sits in the second day of a row. those cases we are watching party marriage and the voting rights act. across the street in the capital piddling in the senate continues -- in the capitol building the senate continues to work on immigration reform. we like to get your