in order to insure that omha's adjudicators have decisional independence from cms, omha was established as a separate agency within the department of health and human services and reports directly to the secretary. accordingly, we operate under a separate appropriation, and we are both functionally and firstally separate from cms -- fiscally separate from cms. what had previously been a gradual, upward trend took an unexpectedly sharp turn. and omha experienced an overall 545% increase in our appeals. the rise in the number of appeals resulted both from increases in the number of beneficiaries utilizing covered services and also from the expansion of omha's responsibility to include the adjudication of appeals resulting from new audit workloads undertaken by cms, including the nationwide implementation of the recovery audit program. there have also been increases. we are pleased that omha's 2014 funding level has brought our adjudication capacity to 72,000 appeals per year. however, this capacity pales in comparison to the adjudication workload. in fiscal year '13 alone, omha is receive

in order to ensure the omha's adjudicators have decisional independent from cms, omha was established as a separate agency within the department of health and human services. reports directly to the secretary. accordingly, we operate under a separate appropriation where both functionally and physically separate from cms. between fiscal years 11 and 13, but it previously been a gradual upward trend in appeal received levels took an unexpectedly sharp turn and a tree and bricks has an overall 545% increase in our appeals. the rise in the number of appeals resulted both from increases in the number of beneficiaries utilizing covers services and also from the expansion of omha's responsibility to include the adjudication of appeals resulting from new auto workload undertaken by cms, including the nationwide implementation of the recovery audit program. there've also been been increases in medicaid state agency appeals. please omha's 2014th on a novel has allowed for the hiring of seven additional teams bringing omha's adjudication to pass 72,000 appeals per year. however, this capacity pa

and omha experienced an overall 545% increase in our appeals. the the rise in the number of appeals resulted both from increases in the number of beneficiaries utilizing covered services and also from the expansion of omha's responsibility to include the adjudication of appeals resulting from new audit workload undertaken by cms including the nationwide implementation of the recovery audit program. there have also been increases in medicaid state agency appeals. we are pleased that omha's 2014 enacted funding level has allowed for the hiring of seven additional teams bringing adjudication capacity to 72,000 appeals per year. however, this capacity pales in comparison to the adjudication workload n. fiscal year '13 alone, omha received 384,151 appeals, and in '14 through july 1st approximately 509,124 appeals. as a result, omha had over 800,000 appeals pending on july 1 of 2014. although alj team productivity has more than doubled from fiscal year '9 through '13, omha has been receiving approximately one year's worth of appeals every four to six

at omha. although i'll workload the omha have experienced rapid growth, a significant portion of the increase is a consequence to the departments efforts to implement legislation assigned to combat medicare fraud and reduce improper payments. the department is committed to crafting solutions which will bring the doctor and the resulting appeal were quoted resulting appeal workload into balance. we look forward to working with this committee and with their stakeholders to develop and implement the solutions. thank you for your time and can turn. >> chair recognizes dr. gosar. >> thank you, mr. chairman. this is griswold, can you walk us through the bible both of the appeal process? >> yes. the first two levels are conducted at cms. they are administered by cms and cms's contractors. the third level is at the office of medicare hearings and appeals and is conducted by administrative law judges. the fourth level is that the medicare appeals council, which is part of the departmental appeals board

i would also say i was very pleased when i came here to omha to be part of an agency that had for the most part that its 90 day time frame. as an administrator myself, i find the delays very troubling and unacceptable. you basically have here a workload capacity problem. >> and they get to that for a moment? reconfigure and complain for hours and nothing is going to change because the addition of 17 new alj is, talk about the simple math that make good friend, mr. meadows, had referenced. there's 500,000 appeals that will be backlogged by the end of this year. divide that by 1220 and you're working at optimal levels and i don't know that you could do any more than that. frankly i don't know that we would want you to do more than that because less than two hours and every cases less than unfair. that would suggest we would need 410 new aljs if we wanted to get rid of the backlog in a year. 410. you have asked for 17 -- or you have been given 17. so they're basically saying to the providers out there, suck it out. excuse my language, but that is what we are saying. we are not willing to

they cannot leave omha without action by an alj. so what this would do, they would be this agreed upon settlement, both parties would sign and the judge would then dismiss the appeal. said the agreement becomes the resolution of the claim. >> is that listed in the chart you gave us as a dismissal? long-term or -- >> it would end up being, it would probably be a dismissal but right now we're just tracking them separately as a settlement resolution. >> the other alternative is global settlement discussion concept, which claim it's that have very similar kinds of cases would all be invited to come in and participate in a global settlement but they could just not to i gather, is that correct? >> this is an initiative that is one of cms' initiatives, and i have to admit that my knowledge on this is limited. but it's my understanding that it would be a global settlement. >> so that what happened before it even got to? >> i think it also contemplates, they're also looking at claims pending at all levels of the process. >> we haven't seen i

of the numbers they cited which i think it's why it's old data, they said in january of 2012, the omha was hearing about 1250 appeals a week. and at the end of 2013 they were getting 15,000. so i think the rate has just accelerated over two years and i think that number tells you how audits have changed, how our practice has changed. >> the inspector general's report was from '10 and 2011, so, that is what you are saying? >> so, i would agree with that. that the appeals have mounted as hospitals have been able to change their processes and also, that they have regress utilization processes. we in our compliance program, we self deny almost $4 million a year in medicare days that we feel we cannot justify for medical necessity. so, we feel that anything that we appeal is justifiable. anything that is denied by rac we appeal. >> i'm like you, a bit confused from what i'm hearing here. it seems that what you are saying is that the racs operate like the fishermen in my district. they go out and throw a great big net and they bring in -- that's where the 12,000 -- you jump from 1500 at the