mr. ritchie, if i could. you've had a pretty remarkable run in terms of the efforts by the health care fraud and abuse program which resulted in $4.3 billion in recoveries to the treasury in 2013. that represents 8 to 1 return. is that the highest level of recovery, to date, mr. ritchie. >> yes, that is. >> and how is that achieved? >> we partnered with our other partners in enforcement and the program to fight fraud, waste, and abuse through investigations, audit, through the evaluations we have done. the recovery is reported in fiscal year '13 the record recoveries. >> i think in your testimony, you referenced that sequestration will result in a 20% reduction in the oversight capabilities, is that correct? >> unfortunately, yes. >> so what does that mean in terms of what you're going to do and what we're going see in terms of waste, fraud, and abuse being properly handled? >> for our office, it's, i mean, it's not good. it's less investigations, less audit, less evaluations. i mean, i'm not the budget exper

mr. ritchie? >> good morning, chairman langford, ranking member grisham and other distinguished members of the subcommittee. thank you for the opportunity to discuss oig's work on medicare improper payments. improper payments cost taxpayers and beneficiaries about $50 billion a year. recovering these lost dollars and preventing future improper payments is paramount. in short, more action is needed from cms, its contractors and the department. cms needs to better ensure that medicare makes accurate, appropriate payments, when improper payments do occur cms needs to identify and recover them. it must also implement safeguards. it relies on contractors for many of these vital functions. this means ensuring effective contractor performance is essential. finally, the medicare appeals system needs to be fundamentally changed to ensure efficient, effective, and fair outcomes for the program, the beneficiaries and providers. my written testimony elaborates on all these areas. this morning i'll focus on fo

mr. ritchie? >> good morning, chairman langford, ranking member grisham and other distinguished members of the subcommittee. thank you for the opportunity to discuss oig's work on medicare improper payments. improper payments cost taxpayers and beneficiaries about $50 billion a year. recovering these lost dollars and preventing future improper payments is paramount. in short, more action is needed from cms, its contractors and the department. cms needs to better ensure that medicare makes accurate, appropriate payments, when improper payments do occur cms needs to identify and recover them. it must also implement safeguards. it relies on contractors for many of these vital functions. this means ensuring effective contractor performance is essential. finally, the medicare appeals system needs to be fundamentally changed to ensure efficient, effective, and fair outcomes for the program, the beneficiaries and providers. my written testimony elaborates on all these areas. this morning i'll focus on fo

mr. ritchie? >> good morning chairman lankford, ranking member grisham, and other distinguished members of the subcommittee. thank you for the opportunity to discuss oig's work on medicare improper payments. improper payments cost taxpayers and medicare beneficiaries about $50 billion a year. recovering these lost dollars and preventing future improper payments is paramount. in short, more action is needed from cms, its contractors and the department. cms needs to better ensure that medicare makes accurate, appropriate payments, when improper payments do occur cms needs to identify and recover them. it must also implement safeguards to stop additional overpayments. cms relies on contractors for many of these vital functions. this means that ensuring effective contractor performance is essential. finally, the medicare appeals system needs to be fundamentally changed to ensure efficient, effective, and fair outcomes for the program, its beneficiaries, and providers. my written testimony elaborates o

mr. ritchie, if i could interject.interjec there's a problem here. why is it that if you've got enough money to go to the third appeal with the alj, if you can hold out that long, if you're not a single provider, if you're a big hospital, you can hold out -- if you go to the alj you have a 60 to 70% chance of winning. n why wouldn't everyone just go tu that appeal process, if they can afford it?th the question i have, why the discrepancy? what do you know about the alj t system that allows for such huge swings in the determination? ok. >> okay. we looked at prior to the backlog. i think it's still relevant. we looked at the aljs and at the time 56% overturn rate. this was 2010 data. for the prior level to qualifiei independent contractor there was 20% overturn rate.01ctor t the big differences we saw, cess again, i mentioned earlier the unclear medicare policies we pc think are a trigger to a lot of this. at the alj level we found they tend to interpret them less strictly than at the prior level with the quick level.evel because they're confusing and