to better rollback these attacks. these include information sharing, border control, tackling violent extremism, and law enforcement. hurry up with -- korea what will meant it thoroughly. neglect the more fundamental approach of dealing with the conditions that are conducive to terrorism. getting rid of poverty in making development sustainable. these are essential if we are to address the root cause of terrorism. korea is a partner in this campaign. aid to leastsing

developed countries and we are giving humanitarian aid to countries threatened by isil and foreign fighters. .e must go further we must remain ever vigilant against cyber and nuclear terrorism and the utter terror and destruction they could unleash. cyber is used to finance, recruit, and incite violence. we must prevent cyberspace from becoming not only the target of terror, but also a tool of terror. nuclear terrorism however unthinkable is also a possibility. seenost-9/11 world has terrorist groups seeking nuclear materials. this is why international efforts to prevent nuclear

terrorism must be stepped up. president obama's leadership in proposing a summit on nuclear security five years ago in this say the global vision for nuclear security is getting stronger. we have a collective result is may a kickstart concrete, international actions against the new scourge of foreign fighters. the fight against faceless, nameless terrorists without borders will not be easy. we also know that terrorizing human dignity and humanity is a

strategy that is doomed to fail. seven decades ago, the founder of the u.n. defeated the totalitarian threat and envisioned a world of peace, a world that puts humanity first. this council is the guardian of our rights and dignity as humans. it must meet head on the challenge of violent extremism and foreign fighters who spread it and in the effort to stem this to, you will always -- to stem this threat, you always find in korea a partner. >> thank you. i give the floor to his excellency, administered a big cameron of great britain and northern ireland -- prime minister david cameron of great

britain and northern ireland. >> thank you. they are having beheadings, rape -- it is literally medieval in its character. of a british citizen is the latest tour. -- horror. one of the most disturbing lurkingis how they are in our own young people. the credit to our security from foreign fighters is far greater today than it has ever been in previous. i pay tribute to president obama for his personal leadership on this critical issue. it is an issue that affects us all into the overall figures have been given. , it is 500 country of these fanatics that have gone to syria and iraq. the shocking murders of james by a and david haines

fighter with an apparent british accent underlines the sinister nature of this threat. british people are sick and that a british citizen could be involved in murdering people, including a fellow order citizen who had gone to syria to help people in this way. it is a very opposite of what our peaceful, tolerant country stands for. we need a response that involves every part of government in society and every country involved in the widest possible coalition. there are no easy answers or quick fixes. i believe we will be dealing with the effects of this threat for years. .his is not just about isil it is about al-shabaab, but boko haram, everywhere there is conflict, everywhere there's poor confidence.

the violent extremism has taken hold. i believe there are three things we can do. first, reinforce our counterterrorism efforts to -- ent attacks the hunt we're introducing new powers to strengthen our ability to stop traveling, a level as to prevent british internationals from getting back into the country, to assure that airlines comply with our no-fly services toble apply for locational constraints on those remaining in the u.k., but who pose a risk. second, we must defeat the poisonous ideology of extremism that is the root cause of this terrorist threat. yes, there are websites and the preachers of violence and violent extremism. they must be taken down. as evidence emerges about the

background of those convicted of terrorist offenses, it is clear that many of them were initially influenced by preachers who claimed not to encourage violence, but whose world view could be used as a justification for it. this is the peddling of lives. jewish plot or this -- another attack was staged. the concept of inevitable clashes of civilization. you must be clear to defeat the ideology of extremism, we must deal with all forms of extremism and not just violent extremism. that means banning preachers of hate from coming to our prescribing organizations that incite terrorism at home and abroad, from incitingmism hatred and intolerance in our schools and universities and even sometimes in our prisons.

in other words, firm, decisive action to uphold the freedoms of our free and democratic society. we need to provide an alternative narrative for these young people. i was struck by what you said, secretary-general. kill terrorism. we have to say again and again this has nothing to do with the religion of islam, the religion of peace should we need muslim country and leaders to speak out as the king of jordan did so clearly today at condemning these people that say they speak the name -- in the name of islam when they do no such thing. third and finally as well as the action we each take individually in our own countries, you must do much more working together to defeat this threat. the defeat of isil will only come about if we use all of the weapons at our disposal.

we have sanctions and i believe you must do more. we must feed and a the afflicted. we must use a local subtleness to strengthen the country as a region. we need to deal with their grievances. the united kingdom is committed to meeting this challenge. only a coordinated response could tackle what is truly a global and indiscriminate threat. it was -- must be one part of the strategy to dismantle and destroy isil. our strategy must work in tandem with arab states, always in support of local people, in line and oural operations, military. we need to act and we need to act now. thank you. excellencyk -- thank his excellency. i now give the floor to australia. >> i'm happy to be here at your

urging, mr. president. right now thousands of misguided people from around the world are joining terrorist groups in syria and iraq because they claim islam is under threat and they are excited by the prospect of battle. whatever they think or say, these terrorists are not fighting for god or religious faith. at the heart of every terrorist group is an infatuation. what else can explain the beheadings, crucifixions, mass executions, rapes, and sexual slavery in every town or city that has fallen? a terrorist movement calling itself the islamic state insult islam and mocks the duty of the legitimate state toward its citizens.

to use this term is to dignify a death cult. has declared war on the world. countries need to work together to defeat it. nations have citizens fighting with iso and every country is a potential target. last week, an australian torative in syria instructed conduct demonstration killings. this week, an australian terrorist suspect savagely attacked two police men. it is hard to imagine citizens of a pluralist democracy could have succumbed to such delusions yet clearly they have. the australian government will be unflinching toward anything that threatens our future as a free, fair, the multicultural society, a beacon of hope and

exemplary of unity in every city. more than 60 us chileans are fighting with isil, austrailians are fighting with isil. our laws are changing to make sure those terrorist to try to return home could be arrested and in jail for a long time indeed. we are not just dealing with potential terrorists. we are tackling their inspiration of a broad. aircraft and special forces are now in the middle is preparing to join international -- to disrupt isil at the request of the iraqi government. i congratulate you, mr. president, for the leader should have shown in assembling a broad coalition. the participation of middle

eastern countries and this week's strike of isil in syria is the clearest demonstration that the west cannot solve this alone and will not have to. our goal is not to change people, but to protect them. it is not to change governments, but to combat terrorism. government that do not commit genocide against their own people, nor permit terrorism against hours. -- ours. that is all we seek. it believes to be darkening times. there are grounds for hope. the isil horror has generated all but universal revulsion. from many regions have declared that the isil movement is against god and against islam and against common humanity. perhaps the realization is

dawning for all people of all cultures and all faiths that he could never be right to kill in the name of god. that would be a moral victory are surpassing any military success. thank you, mr. president. >> i thank his excellency prime minister abbott for his statement. i give the floor to his excellency, prime minister of luxembourg. >> thank you, mr. president. let me express our deep condolences today to france and all of the families of the victims. terrorists use religion to commit barbaric acts. and australian

prime ministers have said now and the king of jordan saying that to use religion to commit is the worst acts thing one could do. thank you for taking the initiative to convene a security council summit. the summit is an opportunity for me to affirm the full commitment of luxembourg to counter the proposed by a foreign terrorist fighters. it is a threat that is considerably increased in recent months. it concerns us all. i think that previous speakers have very will describe the problem for europe and for my own country. the threat of terrorist fighters is a matter of growing concern. it is estimated that thousands of foreign fighters have joined terrorist groups such as the , or al state in iraq qaeda and its affiliates, particularly in syria and iraq

did when they return to their countries of origin, they continue to present a danger. the arrest of numerous fighters in the middle east and europe and the recent atrocities areitted and terrorist acts examples that attest to the fact that threat is real. there isr the threat, no magic formula. it is obvious we must all act together. the response of the international community and the security council needs to be up to the challenge. the resolution that has been unanimously adopted of the initiative of the united states and which luxembourg has been altered to cosponsor. co-sp been honored to onsor. we must prevent radicalization that could lead to terrorism and to counter violent extremism. why in how does a young person

whose record was flawless yesterday become a terrorist tomorrow? in europe, a radicalization network has been put in place by the european commission following an approach based upon local communities. this network and ask those who are in direct contact with targeted individuals or formable groups of the population in order to facilitate exchange experiences and best practices. is is part of the prevention strand of the counterterrorism strategy. it should be strengthened. this is a long-term effort that we intend to pursue coming including when luxembourg assumes the presidency of the european union during the second half of honey 15. must make every effort to try to prevent those who want to leave -- the second half of 2015. we must make every effort to try to prevent those who want to leave. activelyean union is

working on this. we need to put in place legislation in order to ensure that foreign terrorist fighters could be effectively prosecuted and brought to justice when they return. the creation of a terrorist group or terrorist trading constitute criminal offenses. i government is working on updating the criminal code and also to fully take into account the threat of foreign terrorist fighters in accordance with the provisions of the resolution we have just adopted. we must redouble efforts to dry out the financing of foreign fighters. luxembourg is conscious of its special responsibilities in this regard. my country has adopted a full and consistent arsenal of legislative and regulatory measures in the fight against money laundering and terrorist financing. we are paying particular attention to the effective implementation.

these measures take into account the recommendations of the financial action tax course. -- task force. the spec for human rights and fundamental -- respect for human rights and fundamental freedoms needs to be an integral part of our strategy if we want to achieve that aim. all the measures we take to counter the threat of foreign fighters must respect international human rights law and international humanitarian law. otherwise, we would only heighten the sense of injustice and impunity that fuels the radicalization and the spread of terrorism. u.s. the world to join and fight against the islamic state. these faceless killers have no regard for human values and do not hesitate to hurt -- recruit

children. for your attention. for your excellent statements. i now give the floor to his , minister of foreign affairs of the russian federation. .> thank you, mr. president dear colleagues, terrorism is lengthening its muscles. there is some penetrates the fiber a regional on flicks -- terrorism penetrates the fiber of regional conflicts. these groups have acquired additional capacities for their

criminal activities. there is a weakening of state institutions and the support affairs outside sponsors. other states. russia has abandoning double standards. we have all countries to implement the resolutions that andfour ending terrorism establish sanctions against the taliban and al qaeda and also that prohibit the dissemination of weapons from libya. we supported the resolution that is aimed at ratcheting up sanctions and pressure on terrorism.

,fter the intervention in iraq the problem of foreign terrorist fighters has seriously worsened. we need a comprehensive approach that encompasses social and ideological components and also that would ensure respect for the sovereignty of all states. we support the initiative of the u.s. presidency and the security council to adopt a resolution aimed at choking off any activities of foreign terrorist fighters. likee same time, we would to caution again the temptation to narrow down the problem because of the islamic state with its ideology.

there is a need to consider the problems of terrorism and in all its dimensions. establish a form involving countries of the region, the african union, league of arab states, the permanent five members of the un security council council, and other stakeholders. we should address long-standing conflicts primary being the arab-israeli conflict. this is one of the primary reasons enabling terrorist to receive moral support and recruit ever new members into their ranks. we call upon -- call for looking at the cause of the problems and avoid responding solely to their symptoms trade we will be prepared to cooperate on an equal basis as to how to -- how

this problem came up and how to work our way out of this crisis. >> we think his excellency for his statement. and now from the evils republic of china. >> china supports the convocation and the initiative of the united states of the un security council summit on terrorism as well as the resolution adopted today. this resolution which affects the commonwealth of the community should the implemented in a comprehensive and balanced manner. 13 years ago al qaeda launched the 9/11 attacks in this very

city that shot the entire world and took away over 3000 innocent lives. year, theend of last have caused heavy casualties. new terrorist incident took laced. we wish to extend our .ondolences to france at the moment we are witnessing terrorism which deserves serious international attention and vigilance. conflicts in the middle east teh deserves serious international attention and [indiscernible] they will pose a serious threat

to the security and stability of many countries and the world as a whole. in this area of rising interconnectivity terrorist financing has become easier. hashe meantime social media .ecome a battlefield -- we must stay alert for ideologies competing with us. this is a battle. rising oncesm rates again we must adhere to the practices that have been proven effective. first we must ensure sound

.oordination the u.n. and the security council have to play a role in the global war on terrorism. this is the only way to maintain coordination and take concerted action. modelst adopt a multi- approach. this is especially removing its ground. military actions must comply with the u.n. charter. we must follow a consistent standard. any active terrorism whenever and wherever it is committed or -- no double standards. should terrorism be identified with any ethnic group or religion.

we must come up with new thinking and new steps and response. china wishes to propose the following. we should step up information gathering. and step up sharing of resources and intelligence analysis. we should strengthen counterterrorism on the internet. toyou should be taken address social media. internet companies should exercise self-discipline. formulate ative to code of conduct for the industry. china will host a symposium on [indiscernible] in beijing later this year.

we must lock the channel on financing of terrorism. we must lock terrorist financing. we should promote de-radicalization while taking andon to crack down [indiscernible] positivecting more energy. the u.n. should sum up the useful experience and promote the best practices around the world are you the middle eastern countries are on the frontline of the war on terrorism. it is important for these countries to work in unity and coordination and put aside their differences. china supports these activities

and capacity building and we stand ready to [indiscernible] provide military assistance including its kurdish region. terrorism, weh have no choice to work together to address this problem. china has opposed all forms of terrorism and will continue to cooperation. terrorism has no place different -- to hide and will be thoroughly defeated. thank you. >> i think is excellency -- i thank his excellency for his statement. matters i want to mention before we go to our next speaker. 101id earlier that we had cosponsors for this resolution. we have 104.

consistent with our earlier agreement and past president -- precedent, we have opened this of countriesers that are not currently on the council. we have a deep interest not only in the problem we discussed today on the issue of foreign --hters but our critical but but are critical in a solving this problem. i want to know welcome and give the floor to his excellency, the prime minister of the republic of iraq. >> mr. president, distinguished

members of the security council. i think you for holding this meeting which reflects your attention to the question of terrorism and i thank you for your invitation to iraq to attend this high-level meeting and i thank you personally for the support you provided to iraq in confronting terrorism. iraq stands in the first line of confrontation against terrorism stateainst the islamic which has attacked iraq and displaced thousands of its citizens in the north and in the occupied areas and has killed andreds of our citizens others and has targeted religious minorities. sufferedas have

sectarian and religious cleansing. it changed its to graphics and its cultural and religious indices in addition to the booby-trapped corridor killing tens of thousands. ofihch is a mixture ideologies which claim allegiance to islam, they are calling -- causing more damage to islam and have adopted ittarian rhetoric but also is clear to all the groups that this organization is not an internal iraqi organization. it is a transnational organization that derives its strength from [indiscernible]

provide hatred for the other and finding leisure in shedding blood and beheading others. presencecing network that provides liquidity to smuggling networks in the territory under control by isis. grouppport that this enjoys from recruitment, networks throughout the world that empties into iraq for my media and propaganda networks that spread news about the success of this organization and helped recruit members.

this is not limited to iraq. we will not allow regional disagreements or international disagreements to affect the priority and primacy of this these or to disburse international alliance. allegiance is to iraq and its people. gratitude to all the states. we also affirm that this is the cornerstone. we call upon the security council to the following.

providing all forms of support and assistance and security assistance. to defeat terrorism and protect the energy, independents, and sovereignty of iraq and its landscape and water and air. second, the blocking of all sources of financing and financing networks including the purchase of oil from areas under the control of ice is. of thecking the entrance extremists to iraq and stopping all forms of support including dismantling and criminalization of recruitment networks. ices from the use of technology for its ideology including the use of the throughoutd the use

the media. and support from the entire world for refugees and the is byuction whether it occupying the states or the booby-trapped cars that explode in these areas. successful inn -- withthe progress of the use of our heroic security forces and the courageous people that have responded to the call of the spiritual leaders. iraq is also succeeded in achieving a peaceful transition of power and increasing an international alliance and this is -- according to specific time statement and this is a necessity, a priority for the confrontation of terrorism. our government while we look forward to an urgent effort to and terrorism we look forward to

constructing [indiscernible] in the world especially in the region of iraq, the neighborhood states, who stand together with us in this confrontation and this relationship would be based on political and military operations and common interests. thank you, mr. president. the thank his excellency prime minister for his statement. we recognize that iraq is on the againstnes of the fight extremism and terrorism and we are heartened by the numerous countries that have latest assistance to iraq in support of this fight. i would like to give the floor the presidentncy, of the republic of turkey. turkey has obviously been deeply

affected by oath of flow of foreign fighters and the displacement that has resulted in the -- from the conflict of neighboring states. we thank the president for being here today. >> thank you. president obama and secretary general, distinguished guests. i would like to start by for enablingriend such an important discussion at the highest level. the foreign terrorist fighters is no doubt a very important issue and it is an issue that has presented itself as a reflection and the center of a bigger problem and the collapse in our southern neighborhoods and the resulting atmosphere of chaos and instability.

unfortunately the region has become a magnet for terrorist fighters. turkey especially with the emergency of instability in syria has repeatedly made all the necessary warnings to the international community about this threat. the inertia of the international community despite the policies of violence towards the syrian population by the regime has prepared the ground for a dash for al qaeda to reemerge in syria and grow stronger under thename of isil with support of the regime. this bread of the thread toward iraq is a result of conditions on the ground and has been nurtured by the earlier sectarian policies. those circumstances, the international community has to work together. i'll problems can be overcome if the international community works together. we have to have a long-term

approach of comprehensive and realistic approach in order to overcome this threat. turkey has been taking a leading role in this direction and has the flowing to prevent of foreign fighters toward the region for quite a long time but this is not a fight to be carried out solely by turkey. the thread of foreign terrorist fighters start the moment these individuals depart from the source country. thus the combat against these individuals should start in the source countries and our initial targets therefore for us is to prevent their entry into turkey and for a long time, we have been calling upon the countries concerned to cooperate with us on this topic create unfortunately, a timely reaction has not been shown on this issue , either. upon the deterioration of the situation, we finally witnessed recently an increased share of information from the source countries.

within the scope of our struggle, against the foreign terrorist fighters, around 6300 individuals have been included in the no entry list and close to 1000 foreigners have been deported and we have established risk analysis groups at the airport. i would like to once again emphasize that we can stop this flow of foreign fighters only if our friends and partners awaiting our corporation show themselves the spirit of cooperation as well. another important issue is the -- we must will upon is the fact that the exposition of these measures and the damage to our common civilized values should not be allowed. distinguished participants, turkey has suffered for years from the malaise of terrorism that has claimed the lives of thousands of its children. we are among the best and know the pain that terror and tales.

we are among the best to know -- we would be among the first to try to make sure we can prevent youngsters from all over the world to fall into the hands of terrorism. together with the united states launched the global cap -- counterterrorism forum. -- turkey takes all national, regional, and international steps to counter this threat and is committed to taking enhanced measures in this regard. is a terrorist organization with blood on its hands and since the beginning, our government has taken all the serial legal measures in this respect. in our fight against terrorism, all measures at our -- will be taken with new regard to regional stability and humanitarian needs. there is on our turkish orders a huge pressure and since the beginning of the conflict in

syria, we have received 1,300,000 syrian refugees from every ethnic and sectarian group. , more thaneek 140,000 syrian kurdish refugees l haveve been fleeing isi found shelter in our country and we are temporarily housing refugees from iraq. despite the expectation of solidarity we have not receive the kind of support we have been looking for from the internet -- this -- come 20 in conflict create it is very sad for us. turkey's determination cannot be questioned. [inaudible] if we go deep to the roots of the conflict and ensure the desire of solidarity, we can get results. and our goal should the two create an atmosphere of peace,

democracy, and stability where millions of our syrian brothers can safely return home and our other brothers can feel themselves part of iraq. to be our goal in turkey will continue to carry out efforts in this regard. thank you. for thank his excellency his statement. i not give the lord to his highness, a mirror of the state of qatar. >> in the name of mohammed the merciful, members of the council and president, let me thank president obama for convening this important meeting and i hope that the meaning of this will strengthen our collective efforts to deal with the

phenomenon of foreign terrorist specifically [inaudible] which is why we are taking part in today's meeting. the international community agrees with respect to the diagnosis on terrorism. this is an imminent danger. hence, we need to deal with this as a priority. the peoples of the region unfortunately have hit a heavy price with respect to this phenomenon. institutions and for logical reasons. i said this morning to the general assembly that in the modern era there is no civilization that has not had to civilizations, being right, left, religious. it would be a fatal mistake to attach this violence to one culture or religion or nationality, whatever they be. it goes without saying that the international nature of

terrorism and the use of met -- modern technologies contribute to spread this courage -- scourge. this makes the response impossible essentially without international solidarity. we believe in qatar we are part of the international solidarity to deal with terrorism and we will deal with this nationally and internationally by working with international efforts. resident, there is no other choice but a security response even military, urgent response given the imminent threat posed by terrorist groups who recruit and transport terrorist combatants across borders. the current state of alert should not make us forget the origins or motivations for this phenomenon. in fact, terrorism should be a

very rare and exceptional phenomenon. however, when we see terrorist groups have under them entire populations and territories in certain countries, the only possible when the state is absent, when there is a lyrical vacuum or when they become an instrument of murder and repression, that leavesfor -- for dialogue or political reforms, gradual reforms, or civil evolutions. there are regimes of terror killing their own people and if the efforts aimed at eradicating terrorism need to bear fruit, you would have to come back to

restoring the state. the framework [indiscernible] should not be within repression cannot wait until more people are killed. we cannot overcome terrorism unless society is affected i this and we respond to the bloody repressions such as that we see in syria or the kind that we are witnessing in iraq. with respect to the rejection of other people and that -- their religion, that is different. we have heard military action is not the sole solution. this is within the framework of political solutions that open the door to a better future. violence leads to violence. therefore it is necessary to follow a political hath.

for the political aspect to be credible and we should avoid double standards when civilians are aimed, the response should be the same regardless of the origins of this violence against civilians. and one cannot stand by while thousands are killed. there is always the explanation for this but i fear that this gives a sense that there is a double standard. thirdly, we should not give cart wants to deal with terrorism. we need to ensure the rule of law and civilians should not be the victims once again. [indiscernible] we support all efforts that are based on international consensus to put an end to this scourge regardless of its motivations or the excuses given for it. >> i want to thank his imus --

his highness for his statement. unfortunately, i am being called to deliver another address and participate in another u.n. forum. my able secretary of state, john kerry, will be taking the chair. i want to say to my friends, the leaders of kenya, bulgaria, and moldova as well as my good friend stephen harford -- stephen harper from canada. and other heads of state. we very much welcome your commitment and your participation in this forum and i want to thank the entire security council for the seriousness with which we have tackled this problem. i will note that it is very rare where the united nations achieves the kind of consensus that we see represented in this resolution. and i think if you look at all the statements that have been made today, several things stand

out. number one, the brand of violent extreme terrorism that is represented by isil is something that should be rejected by all of us in the civilized world. number two, in addition to militarily dealing with the challenges, we are also going to have to change hearts and minds and that requires a wide range of strategies, and this resolution commits each of us to find tools to counter their radicalization that can lead to the recruitment of young people who obviously are not taking a -- obviously we want taking a better path in life. i want to reaffirm that the united states will be recommitted not simply to a military approach, but we also are deeply committed to working with every single country that

is prepared to cooperate in making sure that the scourge of terrorism and the use of foreign fighters for perverted ambitions is sorted and that we are going -- thwarted and we are going to make sure that we reach out to each of you individually to find out how we can be helpful and cooperative with you. i will repeat what i said at the outset of this security council meeting, though. resolutions alone will not be enough. lofty rhetoric, good intentions are not enough. we are going to have to translate words into deeds but given the seriousness with which all of us have made our presentations here today i am confident that in fact we can succeed. that we can drain the sources of the kind of extreme

radicalization that we have been seeing, that as a to clients and with the help of political resolutions of conflict in the middle east, and north africa, we can arrive at a situation in which all of our young people, rather than resorting to violence and suicide bombings, can be confident about getting a good education and seeking opportunity and raising families and living in peace. i want to say thank you to all of you for your outstanding contributions to this very important and historic effort. >> let me express my featured speakers include ted cruz and kentucky senator rand

paul. nd saturday night at 8:00 p.m. eastern a town hall meeting on tim packet of voting. salley ay night, author quinn. 9:00, authors niel green and william mullen. and matt richtel on the impact of society. and the ninth annual brooklyn book festival. former chiefs of staff and advisors talk about the relationship with the commander in chief and how he makes important decisions. and saturday night at 10:00 mr. while on the civil war.

nd author annette dunlap looks at first women's fashion. let us know what you think about the programs you're watching. -mail us at comments at c-span .org. c-span. us a tweet @ and like us. french president hollande .ondemned the beheading france's military has participated in air strikes. his remarks at the u.n. are 15 minutes.

[applause] reporting to you with particular sense of emotion because one of my compatriots has been in a terrible assassination in syria. his name was javier bordan.

he was a man of enthusiasm. and he thought that he would be le to pursue his passion moving into this area in algeria. he was abducted and beheaded. and this particular , they don't strike only those who don't think like they do. they also strike muslims, they also strike civilian populations

minorities.ike for rape, they kill, it is this reason that the fight that the international community against terrorism borders. and it is the same flag that needs to be carried, the flag of values, for which this organization was founded, human freedom,. france is fully committed in combat. africa when it was to -- fortunately it was joined by many african countries, european how the united nations. fronts has been committed each been a danger.

exists inthis threat iraq and syria. it does not only concern this because this group has conquernot only to , but this group is threatening the entire world. by provoking attacks, organizing abductions, recruiting fighters coming from all over the world train them, to show them the this group isat capable of. they can repeat and preproduce -- reproduce this terrorism movement in our own countries. therefore this threat exists not only for the region but for the world. that reason that

france has responded to the call of the iraqi authorities so that militarying them first assistance by providing weapons, in august. but also now bringing aerial groupt to avoid this continuing to progress. we want to weaken it, we want to it.ce but we also know that while settlement of the ouran crisis, all of , andts could be reduced simply thatean not them is an action against but that there can also be a political solution.

also need to be condemned because they are complicit in what has been happening for the last few years syria, 200,000 people dead and just as many displaced. and gentlemen, france is tragedyrough the following the assassination of patriots. come but france will never give in to pressure, to barbaric acts. know the contrary, france what is is expected. it knows that it carries these values, it knows that it has a to play and france will never renounce this role.

terrorism,t against will be pursued and it will be as much as is necessary with respect for law, with a respect for sovereignty of states. when wemake no mistake act. we will always do so with respect for the principles of nations.d ladies and gentlemen, i would have liked to talk to you about other things, but please my countrythat in greatis nevertheless a question which is being asked and which is being asked to you, which is when faced with this terrorism, will we remain spectators? actors together in what should be a just international order. this question if we don't respond to it or if we respond

weakly, then the terrorists theirontinue with undertakings of indoctrination. not weakness that will be the response to thrism, it is force. the force of law, the force of the united nations. point also the force of military action when it becomes necessary. ladies and gentlemen, i also wanted to talk to you about world.egions the which are also going through threats, which are threats to own security. it wanted to talk to you about ebola epidemic because i know how much it affecting our african friend. again let's look beyond those who are affected. imagine that this epidemic can remain contained just in a few countries if we don't act. this is also a global threat and here again the response must be

and therefore france and must bring to those affected by at the department tick necessary care, the protection that's required, assistance as expected because there again if there is the slightest weak understands, the slightest lack of solidarity, all of our countries .ill be affected ladies and gentlemen, i have come here before you to speak to you about what is occurring in europe. europe. ukraine.appened in but even in europe what we achieve ato do is , and, and a cease-fire this needs to be pursued.

spared from this threat. everything is fragile, vulnerable. and we need to have the same awareness of the risks and the dangers beyond the second world war. we need not only to make it a work of memory, but a task of the future, the future we want, the world we want. thing i is the last want to talk about here. want needs to we concerning climate change, but here again this is threatening not only our the one that are follow us. it's a threat to our own security, because there are more by climatelaced change than by wars. so intense and deadly.

throughout our world. therefore, france has also taken on its responsibilities, having organize a climate 2015.ence in december i'm very pleased to see that secretary, thanks to general ban ki moon, there was a which enabled us to financial institutions, society. because we want this conference to succeed. paris,y because it in because it's the world that we want. have been periods in we can decide not only for ourselves, but decide hashumanity, and this time come. dorefore, in paris we must everything to make sure a global agreement can be reached, an

can be binding, that can be differentiated according to levels of which can have its green fund to which france has contributed $1 billion for the coming years. and i hope that other countries us, because we need this green fund to enable countries which don't have this development to ensure their growth and at the same time their energy transition. ladies and gentlemen, this is a sad moment that i am experiencing today on behalf of france that the french people going through. but it is also a moment when we forward and take on our responsibility for the world, our planet. to fight terrorism, we need to act for peace, we need inequality and we also need to do our job for future generations to make sure that paris is a success for the climate. and to make sure that the united

be faithfulalways to the mandate that was given to war.llow a war, a horrific we are still facing challenges. we are certain to be able to deal with them if we are united, and together we can achieve this think this victory. thank you. [applause] >> on behalf of the general i wish to thank the president of the french republic for the statement just made. may i request representatives to remain seated while we greet the president. >> on the next "washington

journal," a look at the president's strategy for isis.ing we'll talk with an american law professor and michigan state university president on higher education, and the role of the big 10 conference. "washington journal" begins live c-span.a.m. eastern on few of the a comments we recently received from our viewers. watched you almost every morning and you guys do a great job with the programming, and i you have on are really good and the topics that you choose are really good. want to say is the --y from all side of watching the debate between two the people is so much more

public, andfor the you twice have done this a couple times and i'll turn it on go, oh, wow, you get both sides here. and think that's what is really awesome. you guys are great, but you could be awesome. get more needs to liberal type, smart commentators that are familiar with world affairs. one that comes to mind is dr. jeffrey sax. he would attribute -- contribute to a liberal point of view of our government and the world. i think he could be a fine contributor of c-span to give it balance.more >> i wanted to thank c-span for and forlanced coverage saying everybody have their on tv. that's very much appreciated in our democracy. you. >> i am so disappointed since

you changed the format. can no longer see who is speaking or what even the topic without getting out of bed and going up in front of the tv because i can't see it. really upsetly, about that. because i really do like c-span. >> continue to let us know what you think about the programs call us, e-mail us a tweet.n send >> in july, a house hearing looked at the medicare review process. backlog of more than 400,000 claim appeals waiting to be heard by law judges.ve the head of medicare's legal appeals process testified about backlog, which has delayed some hearings by 28 months. this hearing at the house

oversight subcommittee is an hour and a half. rex good afternoon. the boats will be called for that in the next 15 to 20 minutes so what i am going to do is an opportunity to go through some of our opening statements. this is an energy policy and entitlements hearing. the chair is authorized to declare recess. i would like to begin by stating the existing statement. we have [inaudible]

americans deserve an efficient effective government that works for them. and our solemn responsibility is governments accountable. we will work in partnership to deliver the fact and bring genuine reform to the bureaucracy. this is the mission of the committee. this conversation is as i mentioned already the second part of a two-part conversation about how things are going and we have multiple different entities that have a significant backup. there waiting through the appeals process. some of them for years in the appeals process. health care writers, hospitals, individuals that do not have a large cash flow and individuals and businesses that do. the issue today is, why does that exist, how do we resolve this, what are the fixes that are needed legislatively, and what can we take care of right now question mark i will yield additional time to mr. meadows

vexes boils down to people. we have to make sure to do the best we can to go after waste, fraud, and abuse which the chair has so eloquently articulated. yet at the same time, make sure that the rule of law and fairness to everyone is upheld and right now, i think there is great question. i am not singling you out because i have had some great conversations with folks within the alj and there seems to be a very compassionate desire to fix the problem. that is what we are looking for here today. my other concern and i think the concern of the american people is this whole process in terms

of when we go after waste, fraud, and abuse. if we cast such a wide net than we are taking the decision-making away from doctors, health care providers, hospitals, many people who make their decisions who are trained, who go to years of training to do that. we are transferring that decision-making capability because of reimbursements to bureaucrat. for me i have a lot more trust in the nurse or the dr. that cares for me than i do somebody that works here in washington, d.c.. i think that polls would show that to be the fact as well. so what i am looking for specifically and it will be difficult i know because you are part of it -- part of the agency, but there's this wall of separation that somehow goes up. the american people do not understand that they all see you part of hhs or part of cms you have a law, -- a wall.

what i need to do is have as much finger-pointing as possible to say this is what will solve it. knowing that i am not asking you to throw anybody under the bus. we are looking for legislative fix for appropriations that need to be done so that we can help this to quit the a problem so we can obey the laws the way it is written. i think the chairman -- i thank the chairman and i yield back. >> i will submit comments for the record to protect our time. chart with outcome rates that was given to us i the office of medicare hearing -- hearing and appeals. recognize theo

ranking member for her statement. >> thank you for holding this hearing and want to thank the beforeudge for appearing us today on this important issue. i think we can all agree that medicare providers are entitled to have their claims administered fairly, efficiently, and without undue delay so they can focus on their core mission of providing care to our nation's seniors. if they are billing and correct the, they deserve to know sooner than later. unfortunately, that is not the situation facing providers today. medicare providers appealing payment decisions made by contractors are waiting on average 387 days to have their claims adjudicated by the office of medicare hearings and appeals. for provider submitting new claims the way could be as long as 28 months just to have an appeal assigned to an alj. the current claims backlog is

unacceptable and unsustainable. omaha must make significant changes in how it does business. i look forward to hearing from the chief judge about the initiatives omaha is venting to improve efficiency and alleviate the backlog and want to remind my colleagues that the backlog is a problem that congress created. cms to beas required increasingly vigilant in detecting or reducing the amount of waste, fraud, and abuse in the 600 and dollar may care program that covers 51 million beneficiaries. this emphasis on program integrity is critical to the health of our nation's seniors and to the protection of our taxpayer dollars. this increase scrutiny has not and coupled with additional funds to address the influx of claims and appeals that have resulted. with the medicare prescription

drug act, congress created contractors and the recovery out of chair contractors pilot program. in 2010 the program was made permanent and expanded nationwide. contractors conduct audits of medicare providers. has of these contractors increased the number of claims being audited for payment accuracy in recent years. according to a 2013 gao study, the volume of contractor post payment claims reviews increased by 55% between 2011 and 2012. more audits means obviously more appeals. that is an inevitable result of the additional from integrity functions that we here have asked cms to government. congress has not provided omaha with more funding for more judges to adjudicate claims so

when we wring our hands about the number of days that these providers have to wait, we have to wring our hands and look directly at ourselves. despite a sixfold increase in the number of appeals since 's in the number of alj omaha has received constant. 192 claimsi received get received no additional funding to handle the workload. i joined my colleagues in sending a letter to the secretary of hhs citing concerns about the program and expressing the need for reform. it is also important to note that has led to the exposure of many questionable billing billing forch as hospital readmissions on the same day with the same diagnosis. durable medical equipment items delivered but never ordered i a position. hospital claims coated with

did nota patient possess and excessive units of medication ordered especially ed dose would be harmful to the patient who received it. also ensure that we preserve the central program integrity functions who performed the critically important congressionally function of reducing improper payments in the medicare program. an important part of reducing the burden on providers is insuring that appeals from adverse determinations are adjudicated in a timely manner. congress must do its part by ensuring that the budget request is fully funded. we have to give them the resources commensurate with the work load we have asked them to perform. with that, i yield back.

theembers will have requisite seven days. you are the sole individual in this airing today. we are great all that you are here. pursuant to all committee rules, all members are sworn in. if you would stand and raise your right hand? theou solemnly affirm testimony you are about to give is the truth, the whole truth, so help you god? let the record reflect the witness answered in the affirmative. we have not called for a vote yet so we are not at a critical moment yet. you may begin. >> members of the subcommittee are want to thank you for the -invitation.

we distribute the hearing program and are responsible for conducting the third level overview of medicare appeals. in order to make sure the adjudicators have independence from the cms, it was established as a separate agency within the department of health and human services and reports directly to the secretary. accordingly, we operate under separate appropriation and we are functionally and fiscally separate. andeen fiscal years of 2011 2013, what had been a gradual upward trend took an unacceptably -- unexpectedly sharp turn and omha had a 45 % increase in appeals. there were the number of been a using theciaries

process in there was the new audit workflow process including the nationwide implementation of the recovery audit program. increases also been in medicaid state agency appeals. we are pleased the 2014 enacted funding level has allowed the hiring of seven additional teams bringing the adjudication capacity to 72,000 per year. this capacity pales in comparison to the adjudication workload. in fiscal year 2013, received 24,001 hundred 51 appeals and in levels are approximately 509,100 appeals. productivity has more than doubled from fiscal year

2009 through 2013, we have been receiving approximately one years of appeals every four to six weeks driving the adjudication time frames to the current high of 387 days. recognizes the need to adjudicate appeals with greater efficiency. by the end of the fiscal year, we will release a manual utilizing best practices to standardize our business process and we are using information technology to convert our process from paper to electronic, and effort that will culminate in its first release in summer 25th team. we have also developed a template system which simplifies the work of our staff by providing standardized billable formats for routine word processing. omha also proposed and former secretary stabile yes established a departmental interagency work route that conducted a thorough review of

the appeals process and developed additional initiatives that both are currently implementing. posted two newa options for appellants the first allowing to have their claims adjudicated using statistical sampling and extrapolation methods. option uses alternative dispute resolution techniques during a facilitated settlement conference. has directed the efforts of attorneys to assist in the prioritization of beneficiary appeals. any who believe their case is not receiving priority consideration at omha may contact us directly at medicare.appeals@hhs.gov or using our toll-free number. i cangh omha is separate, provide a general outline of

initiatives being undertaken at cms which include beginning global settlement discussions similarly situated appellants, requiring the new recovery auditors to provide a 30 day discussion, allowing for recovery audit payment only after a qualified independent contractor has determined that an overpayment exists. proposed rule requiring prior authorization for durable medical equipment and requiring prior authorization for two part d services under the demonstration authority. although the department is working to address the backlog in the number of respective appeals with authority, the initiatives discussed today will be insufficient to close the gap between workload and resources at omha. of theficant portion increase is a consequence of the

department's effort to implement legislation designed to combat medicare fraud and reduce improper payments. the department is committed to crafting solutions that will bring these efforts and the resulting repeal workload and the balance. we look forward to working with this committee and stakeholders to develop and implement these solutions. inc. you for your time and concern. your time.u for can you walk us through the five levels of medicare appeals process? >> the first two levels are conducted at cms administered by cms and contractors. the third level is at the office of medicare hearings and appeals and it is conduct that by administrative law judges. the fourth level is medicare appeals council part of the is also aard and

separate agency within health and human services. the final level is with the federal district courts. describe the different level of appeals heard? >> we hear both part a and d appeals under medicare and we also hear part b. originalpart of the charge, the prescription drug appeals. we hear appeals on entitlement. we also hear part c medicare advantage appeals. >> percentages of those, what do you hear most often? it varies. in recent years, we have heard a significant number of appeals under part a, the acute-care hospital appeals. does that happen 30%, 40%,

50% of the time? >> i can get you that number. hold on just one minute. >> trends help you out. i'm trying to figure out being the health care provider always looking at trends about what's happening giving you a workload basis with which to delegate resources to. >> most of the recovery audit appeals have been part a. you can kind of use that as a gauge. 41.2% -- i'm sorry. i have the wrong list. date were recovery audit appeals. those are predominantly the part a appeals. according to hhs office of inspector general, 56% were

decided as fully favorable to the appellate or reversed previous lower decisions. what is the current rate? >> are you asking about the appeals or just overall otr's? >> overall. >> in 2014, the fully favorable otr rates is 19.3%. conducted an analysis on what factors are really driving this backlog? i would like to be a little more specific. >> we track what we call the traditional workload, the part

a/b. we have also been tracking the dual eligible for medicaid and medicare beneficiary workload. all three of those have been going up. the traditional workload has partially byargely demographics. there are just more beneficiary on the rolls who are utilizing more services. it has also been driven by ,ncreases in cms audit efforts zone program integrity, identification of improper payments, anything that results in more denials at lower levels will result in more appeals at the alj level. the recovery audit program is the one that gets a lot of attention. it was a new program in 2010. it was a start up. the increase in receipts was

dramatic. that occurred primarily at the level between 2011 and 2013 when we saw the largest spikes in that workload. thee also seen increases in dual eligible workload, beneficiaries that are eligible for both medicare and medicaid. those workloads have gone up as well. >> thank you, i yield back. >> we are going to defer until after the vote. ares not true that you handling more cases per adjudicator on an annual basis? >> that is true. so you are actually more 20% if you really look at the real numbers that your

adjudicators are actually being a lot more efficient than they have ever been before. since 2000 nine, the adjudicators have doubled productivity. >> if we look at that, this is administrativef law judges just sitting back eating bonbons no. >> i think we can both agree on that. at this particular point, you done your homework and you've looked at the previous hearings. would you say and estimate under the current rates right now based on the estimates of potential backlogs of the cases was in the budget assessment that we got, that it is an eight year backlog to adjudicate based on current staffing and current workload efficiency? >> if you do the simple math -- >> i'm a simple guy.

>> that is the number that you come up with. it however does not take into account the efficiencies that we are putting in place, the initiatives both at cms and within our pilot program. he's part of your efficiency thing there. i see that. i'm encouraged by that. you are familiar with the fact that the law says you are 90 dayd to have a turnaround. that is the law. >> they envisioned the 90-day processing. >> and you are familiar with the fact that the intent of the congress was to have the 90 day turnaround. ifthat's part of why omha

you look at the legislative created iny we were the first place to deal with cases that existed was social security. >> you're familiar with the fact lot out therea that authorizes you to take moneys from other trust funds to do three things -- higher additional administrative law judges, provide additional training, increase the staff of the department of appeals board. you are familiar with that. you're talking about the reprogramming authority. subtitle d. that, even the budget that yount, request guys have made i guess requires for an additional seven units. is that correct?

fiscal year 2014 enacted level allows for seven additional -- >> what are we doing on 2015? would president's budget give us an additional 17. >> i've done the simple math based on the president's budget and based on where we are. does that get you to 90 days? >> no. >> does it get you to less than three years? the answer is no. i want to qualify that. if we are talking about giving current authorities and current funding, then the answer is no. request,he president's so your request at this many yearspoint, how

would somebody have to wait for justice? 5.3 years. >> i think it is impossible at this point to really pin down how long they will have to wait. think an math as i outside limit. with this.lose how many businesses have to go out of business before we start abiding by the law? the 90-day timeframe envisioned by congress -- >> its law. i can give you a copy. >> i have to point out that it is in the statute and we recognize that. there is a safety valve and that as well that i need to point out, the right to escalate claims. we just move the 10-year backlog up to four? that won't work either.

i've looked at that budget. what the statute envisions. the interesting thing is that people have chosen not to escalate. this year we had 152 requests to date which i believe indicates providers and suppliers are still finding value in the alf hearing process and choose to remain in the queue. think they should escalate their claims if they are in the 10-year backlog? >> it is an option for them. >> i yield back. >> we will take a recess because the boys have been called -- the boats have been called. i would estimate it will take around somewhere around 30 minutes. maybe a little bit longer. we will reconvene at that time.

>> 9:00 is the next vote series. here at thatll time, that would not be a good sign. . do apologize for the delay we will go back and forth here. if you're ok with the number that's here, i'm ok if we just aren't opening up questions and getting through this.

is that ok with you? we will turn clocks off and i have no particular order. if you want to be able to interrupt, you will be able to do that and follow. that changes our format but it will not change yours. we typically do a very structured five-minute timed around. it is a more open process where they can ask questions at any time. if you make a statement, they are not limited to the one that does the follow-up if that is fair. we just open it up to more conversation. they will not change with happening on your side. it just changes our process. i do have a question on the numbers that you submitted to us on the recovery audit appeals work, percent increase in the non-recovery. i want to go through couple of these with you. on the outcome rates fully favorable, partially

remanded, dismissed, and other. can you give us a quick to finish in and what that means to the provider for each of those and the process that happens? fully favorable, they have overturned, partially favorable a change in the definition, unfavorable and they lost entirely and they will appeal to the fourth level at that point. what partially favorable, remanded, dismissed, and other. >> it is the number of claims that will be submitted with each appeal. a partially favorable decision would say that some of these claims are payable and some of them are not. that would be what that is. >> fully favorable if they have 10 cases in front of you and they win all 10, another provider could come in and bring 10 cases and win seven or two of them. so we do not know if they win seven or 10? >> exactly.

>> unfavorable they lost all of them. we do have some authority to send cases back to the lower level if there is information that we need from them and that information is only available from cms and its contractors. we can do some limited reman thing. >> with part eight, that seems to be a very high percentage. do we know what happens then once they go back down to the second level? with most of those, they come back to us. this large number was related to policy issue that was resolved through cms and rulemaking so those are coming back to us. >> help us understand the order. you said it comes back up and it goes to the fourth level and comes back to you?

a very high number here. you are talking about many remanded as were found only favorable, partially favorable combined. >> in these cases, many of the judges decided to remand them. they're basically questions about whether or not claims would be paid as inpatient, part b. or outpatient under part that was the basic issue. in order to get, many judges felt they needed additional information in order to make a decision. they sent these claims back to the lower level to get that information. result ofappened as a in these cases are actually going to be coming back to us. i think they have come back to us. they remanded and it's now

coming back to you. how does that show up in the statistics here? we're trying to evaluate when a very high are remanded and dismissed. it's hard to be able to tell what's going on. >> we do not double count them. they do not recount into the receipt levels when they do come back to us. we adjudicate them within the process and then we send them on. or theyher get paid don't. many of them will get appealed. >> i'm still trying to track this. they've gone to the first two levels of cns. they come to you. there is not the information that you need and you remand it back to cms. they get additional information

and that it comes back to you again? 4, 5 different events within the first three levels. >> five handoffs. >> they come back to you again be thes would basically same percentage between the fully favorable, partially, and unfavorable again? you say it's not double counted. >> it's not a double count. >> when it comes back to you again i should expect it to be similar to this percentage? i'm trying to find out what happens when it's remanded. are they more likely to be found favorable or unfavorable? the remanded does not predispose it to any sort of disposition when it comes back. when it comes back to us, we adjudicated as all other claims and we will have a hearing on it and make a decision. >> this is somewhere around 60%,

part a, being found fully favorable. you.they are coming to i should expect if they are remanded it is about the same percentage coming back again. once they are remanded, basically if they are very, very persistent in part a at least, a pretty good chance they will be found fully favorable? percentages hold true, you can use them to say what what will happen with the remand when it comes back. >> that is approximately how long? to you the first time, that consume to three years in the process then it gets remanded and goes back to cms. they handle it in three months and they are waiting back in line again maybe another three or four years to get back to you. is an incredible amount of time. >> it's my understanding that these cases are really already back with us. they were sent back in bulk.

these are already back in the hearing queue. long that took, that would be a number i would need to get back to you on. number we're trying to track based on what we have last night on this. if it's three years to get to you to get a decision, they are back in the queue again. the may have to get fully through all five of those steps. get back to this but i believe they retained the spot in the hearing queue when they are remanded. >> then they are right back to you? >> right back into the queue where they left us because they have not given up jurisdiction of the client. we have some more information but it is still with us. generally it would come back to the same judge when it was

remanded. an aberration. it was a very high number. we are not seeing that in subsequent years. we did not see that in previous years. ofyou feel that is because what is inpatient and outpatient? this deal with the two midnight rule and all of that? what a fun role. the hospitals love it. to see whatiting impact it will have at our level. we have not seen the impact yet. >> i've yet to find a fan of that rule anywhere and it seems a rule they raise consistently saying it affects their decision-making. it was in your decision and i would expect there to be quite a bit numbing at you because there's a tremendous amount of frustration around that particular rule. something we are

watching and need to watch. we need to continue to see what the appeal rates are in this inpatient-outpatient arena. able to sharee this time as well. dismissed and other. for one are cases where reason or another, usually it is has notthe appellant properly filed the request for hearing or perhaps they have abandoned the request for hearing in the process by not showing up or that sort of day and so the cases are dismissed at our level. that's the final disposition of those unless they appealed the dismissal to the medicare appeals council. >> it's unfavorable based on they did not show up, file, or complete the process? the previous decision would still stand that is unfavorable. >> the quick decision becomes the final decision.

>> what is the other? -- ok.ll actually escalations to the medicare appeals council. we have about 152 of those. occasionally, we have expedited access to judicial review but those are rare. >> thank you. i am still flummoxed by this remanded number. i just added up fully favorable, partially favorable, unfavorable and i came up with the number 21,846 which is nine from 21,855. number, are they fyting back in the light in 13 or fy 14? >> i believe they came back in

fy 13 or early fiscal year 14 right about the time cms administrator issued her ruling is on this. close,e the number is so maybe that is just part of the aberration. it would mean virtually every one of these cases was remanded because there was inadequate information. not a cumulative number. i understand that they are close to the same amount, but the remand is exclusive of the fully favorable, partially favorable. it's a separate category. >> it's a separate category which would mean we are not -- we are talking about close to 50,000 just in part a a few take all of these numbers and add them together, give or take. >> yes. >> ok.

let me ask you this. alj does not have medical training, correct? they dogeneral rule, not. i don't know whether there are any who have dual certification, medical and legal, but they are attorneys who have been selected off of the register. >> because they do not have medical training, they're trying to determine whether or not a procedure was appropriate or not, correct? >> medically reasonable and necessary, yes. >> is the system flawed at the outset? >> we have some extensive training for them that is conducted. when they come on board, we do a training session for them that but over much of this, lawyers are involved in medical-legal issues in many areas. >> they are typically advocating

for one side or another and not judging. whether something is appropriate medical procedure or not. it is more a philosophical question. for ae engaged in this long time and i just find it somewhat odd that in the end there are attorneys like you and me who have been trained a certain way but do not know whether this was an appropriate urology procedure or not. essence, what they are doing is making a judicial decision based on the evidence presented to them. in our setting, that includes the written record, the documentary evidence, and generally during the course of the hearing, also some explanations of medical either a provider

or supplier of the services. that is kind of the way the system is set up for us to be able to rely on the opinions. essentially it is the same thing i've been saying. we look at the record to determine whether it has been met. i think we are all troubled by the fact that 54% for the record that we have heard of the appeals in part a are sustained. you said earlier that the figure for the first hard of this year is less than half that, fully favorable, but fully and partially to me need to be logged together. what is the figure for 2014 for fully and partially favorable? >> i don't have a percentage. >> could you get that?

>> i certainly can. >> here's the dilemma i see. 54% of appeals are sustained. in the medical profession, if you have a better than 50-50 chance of being sustained, you will appeal. your volume is going to continue to increase as more and more providers recognize that this is a pretty good odds. when you have alj looking at a set of circumstances who is not a physician who is trained, from as someone who is not in the profession, it could be a close call. the procedure has been performed. it's not like there has not been a service that has been actually provided in most of the circumstances so you will err in favor of single sustained the appeal.

point, i wonder whether we have diminishing returns here. of a provocative, rhetorical question at this point. but i do think the construct should probably urge us to think about whether it is the way we should be doing these appeals. i would like to clarify one thing here. the percentages you are looking at are on the recovery audit appeals. thoseversal rates on appeals have been higher than the general reversal rates for the agency. if that includes all appeals. again, the numbers i have are fully favorable decisions, it was just 19.3%. numbers -- i'm sorry, that

was fully favorable otr. i keep getting to that number. i will get you a number on the reversal. when cms is actually present at these hearings, these decisions are not sustained. the cms representative is oftentimes not present. to me, again, we have a system that is not operating properly because we want fairness across the entire spectrum. one provider shows up, has their , a cms person shows up and it is not sustained but another provider shows up, same circumstances, but the cms person is not there and it is sustained, we are not providing equal protection under the law. what we has found, and there

is very limited data on this, it does come from cms, but when there is cms participation at the hearing, the reversal rate does go down. >> by how much? it was 6% almost over a few months of data that we had. i will get you the exact numbers but from about 46% down to about the percent. -- about 40%. ,s far as the reversal rates go i have that number now, which is on the dispositions. is overall favorable rate 35.2%. we had been doing a number of things which had been designed to bring our policy interpretations in line across all levels and develop some