where as alj, they've got everything -- >> aljs aren't clinicians. they are using discretion in terms of interpreting the law. >> in terms of tinterpreting th law and relying on testimony and evidence. where as quick level is relying on their own clinicians to interpret documentation. >> go ahead. >> congresswoman will yield. it speaks to larger issues. i want to get back at, what are the real overturn rates? are we targeting correctly? what can we do to improve the system so we're not harming good providers, which means we are harming just beneficiaries, going after fraudulent and wasteful behavior. medicare is an incredibly complex system. the reality is, that if we don't start dealing up front with the me

where as alj, they've got everything -- >> aljs aren't clinicians. they are using discretion in terms of interpreting the law. >> in terms of tinterpreting th law and relying on testimony and evidence. where as quick level is relying on their own clinicians to interpret documentation. >> go ahead. >> congresswoman will yield. it speaks to larger issues. i want to get back at, what are the real overturn rates? are we targeting correctly? what can we do to improve the system so we're not harming good providers, which means we are harming just beneficiaries, going after fraudulent and wasteful behavior. medicare is an incredibly complex system. the reality is, that if we don't start dealing up front with the medicare complexities -- we can chase this all day long and go from one extreme to the other and we're going to find significant flaws in our ability to hold providers accountable and to support providers to do a better job. and what we haven't done in this conversation, i'm as concerned as anyone else about getting it wrong and overpayments. i'm al

where as alj, they've got everything -- >> aljs aren't clinicians. they are using discretion in terms of interpreting the law. >> in terms of interpreting the law, and then they're relying more on the treating physician's testimony and evidence, whereas at the qac level they're relying more on their own clinicians to interpret the documentation. >> oh, i'm sorry. go ahead. >> if congresswoman speier will yield. it speaks to larger issues. i want to get back at, what are the real overturn rates? are we targeting correctly? what can we do to improve the system so we're not harming good providers, which means we are harming just beneficiaries, going after fraudulent and wasteful behavior. medicare is an incredibly complex system. the reality is, that if we don't start dealing up front with the medicare complexities, we can chase this all day long and go from one extreme to the other, and we're going to find significant flaws in our ability to hold providers accountable and to support providers to do a better job. and what we haven't done in this convers

the alj level is still on paper. the quick has everything electronic s.tieverythi they have to print it out and send it to the alj. they have to get papers from contractors and sort them out. it is to clarify policy and to create one system that's electronic. >> if i understand you correctly, at the level, they are very specialized, they knowt what they are looking for and e they make their determination because they are trained to lood for certain things, i guess.cau i guess that's part of what you're saying?gs, i >> correct. we didn't assess and look at which level is better.sayi they are very different.better but we have seen they have clinicians looking at it and eya specific of a complaint or appeal comes in, it comes into a part a, it is going there. complaint or appeal comes in, g specific to part b it's going there, where as to alj they've got -- >> and aljs aren't clinicians and they're using discretion in interpreting the law. >> in terms of interpreting the law, then they're relying more . on the treating

there's currently a massive backlog of 460,000 pending alj appeals for alj hearings. due to this backlog, they could take up to 28 months for a f hearing before ano alj, where providers have their money heldt by the government. not many businesses can surviveh havingel their money held for 2o months while they wait to decide if they are going to get reimbursed. committee invited nancy to testify but she was unable to appear. we will follow through on that. today, we have three witnesses. kathleen king, brian richie and deputy administrator and director for integrity to discuss how cms can present ove sight. wee must do more to strengthen t theic government programs but d particularly medicare given thee size and scope. clearly, more needs to be done to improve the efforts to recover $50 billion in over payments and other payments. today's hearing provides clarity about the areas.e pro the process cannot drive up the cost of health care for seniors and reducefo their options for o care. i lookk forward to the conversation we'll have today. with that, i recognize christ

the alj overturned decisions more than half the time. alj is also vary widely amongst themselves in decision making. this happens partly because medicare policies are not clear. oig recommends clarifying medicare policies, and then coordinating training on those policies at all levels of the appeals. administrative inefficiencies also contribute to the problem. we recommend the paper files be standardized and made electronic. in closing, more needs to be done to reduce and recover improper payment, ensure effective contractor performance and improve the appeals process. oig is committed to finding solutions to reduce waste, protect the beneficiaries and improve the program. thank you for your time. and i welcome your questions. >> thank you all. i recognize myself for five minutes for first round of questioning and then we'll just go back and forth along the dais from here. let me set some context during my time. if a provider will have something reviewed, let's talk through the process and let context for everyone on this. go back to mi