dr. agrawal. >> thank you. chairman langford, ranking member and members of the subcommittee, thank you for the invitation to discuss the program integrity effort. it's a top priority for the administration and agencywide effort for cms. we're at the forefront of our integrity efforts. i view program integrity through the lens of my experience of an emergency medicine physician who fundamentally cares about the health of patients. our health care system should offer the highest quality and most appropriate care possible to ensure the wealthiest of individuals and populations. cms is committed by preventing recovering payments for wasteful abuses. helping to extend the life of the trust fund. the importance of the efforts extend beyond dollars in health care costs alone. it is fundamentally ensuring we have the resources to provide for their care. as part of our responsibility to taxpayers and beneficiariebenefs has an obligation to perform audits, medical review and use other oversight tools. i would like to ma

dr. agrawal? >> i can't answer the claim question. but in terms of prioritization we clearly do focus on high improper payment rate areas. i think that's a requirement of the contractor itself of the program that we focus on areas where the improper payment rate is much higher. than in other areas. so you would expect to see greater portion of audits in say, for example, durable medical equipment or home health agencies. because those are where a lot of the improper payments -- >> that's what i'm trying to figure out. is that category higher than 1% of what's pulled? >> you know, we can -- we can look into this, but i believe that most of the rac audits are focused on the -- on the part "a" side. even though that the rate of -- the rate of improper payments is higher in durable medical equipment and home health providers. but the actual dollar amounts of the improper payments are higher -- >> sure. it's a larger bill as well. part "a" is going to be larger than what's going to be in part "b." and most of the smaller providers. i would

dr. agrawal. >> thank you. chairman langford, ranking member and members of the subcommittee, thank you for the invitation to discuss the program integrity effort. it's a top priority for the administration and agencywide effort for cms. we're at the forefront of our integrity efforts. i view program integrity through the lens of my experience of an emergency medicine physician who fundamentally cares about the health of patients. our health care system should offer the highest quality and most appropriate care possible to ensure the wealthiest of individuals and populations. cms is committed by preventing recovering payments for wasteful abuses. helping to extend the life of the trust fund. the importance of the efforts extend beyond dollars in health care costs alone. it is fundamentally ensuring we have the resources to provide for their care. as part of our responsibility to taxpayers and beneficiariebenefs has an obligation to perform audits, medical review and use other oversight tools. i would like to ma

dr. agrawal as well. you mentioned the incentive for racs to be able to limit that, because they lose their contingency fee if they lose on appeal. the problem with that is let me give you a fishing illustration. if you are fishing, you can put one hook in the water or you can put five hooks in the water and you may only catch one fish but you are going to catch more more often if a rack decides they are going to grab 20 different cases and they hope they win ten of them that's better than just grabbing ten of them and if it's close, go ahead and just grab that file and keep moving from there and we may win it, we may not win it. that's helpful to the rac in their contingency fee. that's certainly not helpful to the provider to go through the process. with that, i recognize dr. gosar. >> do you have any differential in your facts in terms of small providers, large providers, in overturn rates? >> i don't think the data differentiates, in terms of appeals data, i'm not aware of differences. i think the poi

dr. agrawal, let me just ask te you -- and for the ig, mr. richie, new york city -- new york state owes us $15 billion in overpayments. they flat billed more than the cms maximum for medicaid and we held hearings on that more than a year ago. what have you done to get $15 billion back while, in fact, you send out hordes of people to harass doctors with a less thanf stellar success rate of successc in accuracy in the audits? what have you done to get back from a state that knowingly billed far greater than the rate?do and it's $15 billion. it's ten years worth of your recovery. any answers?th of >> so, that is an area we're looking at now. n area >> you're looking at it?ing at $15 billion and you're looking at it?d yo >> at the request of the committee, we have -- we are currently taking on an currentl evaluation of new york state.evi we're waiting to get the findings and release the results, after which time i fins think we can have a conversation about how to proceed. >> the newspapers make it a conv abundantly aware the numbers speak for it

dr. agrawal or someone else to talk to me about what we're doing if you've got hot spots for fraud, what are you doing to shore up mistakes, so that we don't lose those providers by providing better education and support to those providers, and creating in low access areas frontier and rural states, what are you doing to assure you don't lose providers. >> thanks for clarifying. we make those types of recommendations all of the time. we have a series of reports that we call questionable billing reports, several of which i referred to in the testimony. finding questionable prescribers, questionable pharmacies and questionable home health agencies. in all of those cases we take the ones that have identified that are extreme outlyers based on the statistical test and give it to our investigations office to see if they want to further pursue, because these look severe. after that we send them to cms and cms will share with their contractors to take appropriate action and we always recommend that they take the kind of questionable criteria that we have and implement -- i know the fraud preven