ms. grishham explained, it also typically includes medicaid or other paid sources as well. so when you layer that burden on the provider, it is tough to provide services. that's what we're hearing. so after speaking to several stakeholders in nevada particularly hospitals and medical providers, all around the las vegas valley -- and i also include some of the rural counties in nevada which are woefully underserved by enough providers, the accountability of the recovery audit contractor program seems questionable at best. and i don't understand how you continue something that doesn't even -- hasn't even been properly evaluated. while these programs have a noteworthy mission of seeking out improper payments of medicare services, it seems there are potentially per verse incentives to these r.a.c.'s. in 2010, the r.a.c. program was expanded to all 50 states and made permanent. now, again i don't know how you start something, don't evaluate it and then expand it to 50 states first of all. in 2013, over 192,000 claims were filed by these auditors to the office of medicare hearing