and h.h.s. in 2009. as a result of strike force operations since 2007, we have filed charges against more than 2300 individuals accounting for over $7 billion in medicare losses. this is a crucial part of the department of justice healthcare fraud enforcement efforts, which include the recovery of a total of $15.3 billion through false claims act cases, in cases involving fraud against federal healthcare programs since 2009. these are truly extraordinary figures and they reflect our nationwide commitment to safeguard precious public resources, to rid our healthcare systems of fraud and abuse and to sustain the integrity of programs that are essential to the public welfare. in the days ahead we will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes the system that our citizens trust with their lives. the department of justice is prepared and i am personally determined to continue working with our federal state, and local partn

you're saying that the h.h.s. exchange can't be for the state so that it is established by the choice of the state. the choice the state had was established your own exchange or let the federal government establish it for you. that was the choice. if we read it the way you're saying then we are going to read the statute as intruding on the federal-state relationship. because then the states are going to be coerced into establishing their own exchanges. and you say no they can't be coerced. but let's go back to the states are what justice breyer was talking about. in those states that don't -- citizens don't receive subsidies, we're going to have the death spiral that this system was created to avoid. states are obligated insurers are obligated to make sure that in their states whether they're part of this program or not that they have guaranteed coverage, that children are covered until they are 26, and that they base their costs on community ratings. so if they have to do that, then costs are going to rise on eve

we had a lot of conversations with h.h.s. and finally h.h.s. agreed that they would only implement this guidance for 2017 and beyond. still going to be an issue going forward. >> it's a very important development you highlighted, representative black. and i would urge the congress to take look at two things. mr. chandler: first, is that guidance actually within the scope of the affordable care act. this is traditionally an area of state regulation. and i really wonder what provision in the a.c.a. authorizes it. the second thing i would look at is whether the ferguson act prohibits this sort of federal interference in an area of traditional state regulation. so even putting the with us come of the provision aside, i actually think there is a serious question that ought to be looked into and for which once there will be standing about, about the legality of this proposal. this guidance. mrs. black: i have a very brief period of time. million redmer, did you want to reply? no. mr. kreidler. commissioner kreidler: i agree as regulators we found it

or call the h.h.s. inspector general. you're not going to get somebody in trouble unless there is trouble. we investigate things all day every day and some of them turn out not to be something and nobody is harmed. but if you don't tell us about it, we can't check it out. so working together we are going to continue to try to find where the bad guys are going and send a very powerful message that there are significant costs in jail time to this kind of conduct so we can change behavior. with that i'd like to introduce my colleague leslie caldwell assistant attorney general in charge of the criminal division. leslie caldwell: thank you director comey. today's takedown is really a prime example of 21st century, data driven policing. every day the criminal division grows more strategic in our approach to healthcare fraud, to prosecuting medicare fraud. we're analyzing billing data in real time, working with our colleagues at h.h.s., we're targeting hot spots around the country where the data shows that medicare fraud is perv

. >> h.h.s.apitol hill essentially saying if the supreme court rules against the administration, congress and the governors need to come up with a solution. we're back with a panel. a.b., this is quite the conundrum up on capitol hill and in the white house. >> yeah. it's called pass the buck. the administration has been very clear all along they have never indicated that they had any backup plan should they get an adverse ruling and the subsidies be voided. they have always said it was the congress' problem. for a while actually, the republican controlled congress wanted to come up with several plans to show the justices and show voters that they were going to be able to plan and protect to provide sort of a transition what they call bridge. they would not repeal obamacare in one day but they would not make all of those subsidies legal in a one-page plan like owe that thinks they should. then they decided not reveal their plans. there are plans. i have interviewed the people who drafted them the

and in preparation for termination or possible termination, i understand that h.h.s. has certain notice requirements you have to follow. can you just tell us, you know what you'd have to do? obviously this is what we want to happen. i want to stress that there's always that danger. dr. howard: it would be a nightmare for me personally and for our members and it would be a nightmare for our c.c.e. physicians. you cannot abandon a patient ever as a care providers. so we must ensure that that patient is taken care of somewhere. and finding a place for each of our 71,942 members would be a gargantuan task. mr. pallone: and notice requirements? dr. howard: we have to inform our patients ahead of time that this may happen, even though we may not be sure it is happening, and certainly when it maps and -- when it happens and all the efforts we can make to help them support their efforts in finding additional -- mr. pallone: when does that process begin? dr. howard: the 90-daytime limit -- 90-day time limit is sort of an unwritten notice requirement now. it can vary state by s

that's when the affordable care act was passed and the center for medicaid and medicaid services and h.h.s. forced the people in my state out of a state-based solution for health care and into the larger national solution. and many oklahomans lost their health care coverage and were forced out of it. it was already in a subsidized system and they were taken from one plan, pushed into another let's do no harm and let's try to help those individuals to be able to find their way back to a plan they like and help in that transition. second thing is pretty straightforward. states should have the freedom to choose any path to help their citizens. states should not have to check in with the the federal government to take care of their neighbors and citizens. how ridiculous is that that a state leadership would have to say we want to gel a plan to help our own citizens and the federal government to say no. they have to check with us instead. this is a repeal option for all 50 states. for the states who like it, you can keep it. but for all the states that don't, they have their own way out to be a

this legislation would allow the secretary of h.h.s. to conduct the demonstration giving managed care organizations the opportunity to offer plans with a variety of benefits structure that would lower the cost sharing. we think it makes a lot of sense and i concur and i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from texas. mr. brady: mr. speaker, i'm pleased to yield two minutes to a key member of the ways and means committee and health care professional herself, the gentlelady from tennessee, mrs. black. the speaker pro tempore: the gentleman from tennessee is recognized. mrs. black: mr. speaker, as a nurse for over 40 years, i understand the challenge of helping americans find affordable health care coverage. but the sad truth is even for those who do have health coverage, high deductibles and out-of-pocket costs can lead too many americans functionually uninsured. when families are forced to choose between buying groceries and filling a prescription, their health is sidelined and t

and in preparation for termination or possible termination, i understand that h.h.s. has certain notice requirements you have to follow. can you just tell us, you know, what you'd have to do? obviously this is what we want to happen. i want to stress that there's always that danger. dr. howard: it would be a nightmare for me personally and for our members and it would be a nightmare for our c.c.e. physicians. you cannot abandon a patient ever as a care providers. so we must ensure that that patient is taken care of somewhere. and finding a place for each of our 71,000 -- 71,942 members would be a gargantuan task. mr. pallone: and notice requirements? dr. howard: we have to inform our patients ahead of time that this may happen, even though we may not be sure it is happening and certainly when it maps and all the efforts we can make to help them support their efforts in finding additional -- mr. pallone: when does that process begin? dr. howard: the 90-daytime limit is sort of an unwritten notice requirement now. it can vary state by state because these are often state

the law ipab designates the secretary of h.h.s. with the authority to make those cuts. and to overcome those cuts, you really have to have 2/3 votes in the house and senate with commensurate cuts from somewhere else in medicare to replace those cuts that you're overcoming. so this is a board that has tremendous power, that will deal with provider payments, and cuts. now, we just dealt with the s.g.r., sustainable growth rate, in a bipartisan manner. we acted to repeal the sustainable growth rate that required cuts to provider payments for seniors. . and it was supported overwhelmingly. but if you like the s.g.r., you'll love ipab. this is the s.g.r. on steroids. and it will be very difficult to overcome these 15 unelected bureaucrats, experiod of times, whatever you want to call -- experts, whatever you want to call them. can't be a majority of docs, by the way, or the secretary, whoever makes the recommendations. now, we used the prevention fund as a pay-for, taking funds from the prevention fund until 2025 to reach the $7.1 billion but this prevention fund gets $2 bil

we tried to convince h.h.s. to withdraw the problematic features of the rule, and in exchange we would agree to engage in a substantive productive discussion on how to move forward with improvements to child support enforcement. i firmly believe that there is room for common ground. in fact, there are a number of features of the administration's proposed rule that can generate bipartisan support. any workable solution would have to include the full participation and ultimate consent of the legislative branch. any changes to the law would have to go through congress and not simply be dictated by the administration. so mr. president chairman ryan and i will do all we can to get our bill through congress and present it to the president. if we're successful, i hope he will sign it and commit to working with us in the future to advance reforms to child support enforcement. i stand ready to work with the administration and any of my colleagues on both sides of the aisle and both sides of the capitol to achieve this go

we're saying the h.h.s. exchange can't be for the state. the choice the state has is establish your own exchange or let the federal government establish it for you. that was the choice. if we read it the way you're saying, then we're going to be the -- read the statute as intruding on the fall-state relationship because then the states are going to be coerced into establishing their own exchanges. you'll say they can't be coerced, it would go back to what justice breyer was talking about. in those states that don't -- citizens don't receive subsidies, we're going to have a death spiral that this system was created to avoid. states are obligated insurers are obligated to make sure that in their states, whether they're part of this program or not, that they have guaranteed coverage chathirn -- that children are covered until they're 26 and that they base their cost on community ratings. cost arises on every insurance offered in the country three or six or nine of your states will have tightened their medicaid eligibility requirements in contr

the episode began when amid growing tensions with colonists king george iii moved the h.h.s.tt bay. the gatsby and its captain were known for destroying fishing vessels, seizing cargo and flagging down ships only to harass, humiliate and interrogate the colonials. as nick bunker, author of the book "an empire on the edge" wrote, "this harassment did not sit well with rhode islanders who had grown accustomed to a level of personal freedom unique in that time." to quote bunker, "even by american standards, rhode island was an extreme case of popular government." the chapter in his book in which he describes this is entitled "this dark affair: the gatsby incident." bunker went on to say out of all the colonies, rhode island was the one where the ocean entered most deeply into the lives of the people. and we wanted it free. in july of 1663, over 100 years before the incident, king charles ii had granted a royal charter establishing the colony of rhode island and providence plantations in new england and the charter said it was to hold forth a lively experiment that a most flouris