Testimony of:  
Brian P. Ritchie 
Acting Deputy Inspector General for Evaluation and Inspections 
Office of Inspector General 
U.S. Department of Health and Human Services 
 
 
 
Hearing: 
Medicare Mismanagement: Oversight of the Federal 
Government Efforts to Recapture Misspent Funds 
 
House Committee on Oversight and Government Reform 
Subcommittee on Energy Policy, Health Care and Entitlements 
 
May 20, 2014 
2154 Rayburn House Office Building 
9:30 AM 
 
 
 
 
 
 
 
 
 
 
 
   
Testimony of: 
Brian P. Ritchie 
Acting Deputy Inspector General for Evaluation and Inspections 
Office of Inspector General 
U.S. Department of Health and Human Services 
Hearing Title: Medicare Mismanagement: Oversight of the Federal Government Efforts to 
Recapture Misspent Funds 
House Committee on Oversight and Government Reform 
Subcommittee on Energy Policy, Health Care and Entitlements 
 
 
Good morning, Chairman Lankford, Ranking Member Speier, and other distinguished Members 
of the Subcommittee.  Thank you for the opportunity to testify about the U.S. Department of 
Health and Human Services (the Department) Office of Inspector Generals (OIG) 
recommendations to prevent Medicare improper payments, increase recoveries of overpayments, 
ensure effective performance by contractors, and improve the Medicare appeals process that 
resolves disputes over improper payments.  Fighting waste, fraud, and abuse in Medicare is a top 
goal, and improper payments cost Medicare billions of dollars each year.  Reducing this amount 
is paramount.   
 
In short, more action is needed from the Centers for Medicare & Medicaid Services (CMS), its 
contractors, and the Department to achieve this goal.  CMS needs to better ensure that Medicare 
makes accurate and appropriate payments.  When improper payments do occur, CMS needs to 
identify and recover them.  It must also implement safeguards, as needed, to prevent recurrence.  
CMS relies on contractors for most of these crucial functions; therefore, ensuring effective 
contractor performance is essential.  Finally, the Medicare appeals system needs fundamental 
changes to resolve issues about improper payments efficiently, effectively, and fairly.  OIG has 
recommended numerous actions to advance these outcomes.   
 
Overall, the Department has implemented many of OIGs recommendations, resulting in cost 
savings, improved program operations, and enhanced protections for beneficiaries.  In fiscal year 
(FY) 2013, OIG audits and investigations resulted in expected recoveries of $5.8 billion in stolen 
or misspent funds across Department programs.  In addition, OIG reported estimated savings of 
more than $19 billion resulting from legislative and regulatory actions supported by OIG 
recommendations.1  The Health Care Fraud and Abuse Control Program (a joint program of the 
Department, OIG, and the Department of Justice to fight waste, fraud, and abuse in Medicare and 
Medicaid) returned more than $8 for every $1 invested.2   
 
                                                           
1 Office of Inspector Generals Semiannual Report to Congress, Fall 2013, available online at 
http://oig.hhs.gov/reports-and-publications/archives/semiannual/2013/SAR-F13-OS.pdf. 
  
2 The $8 to $1 return on investment is a three-year rolling average from FY 2010-2013.  For more details on this and 
other HCFAC accomplishments, see the FY 2013 Health Care Fraud and Abuse Control Program Report, available 
online at http://oig.hhs.gov/reports-and-publications/hcfac/index.asp.  
 
1  House Committee on Oversight and Government Reform, Subcommittee on Energy Policy, Health Care and Entitlements 
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  Despite these successes, further actions are needed to protect Medicare and Medicaid from 
waste, fraud, and abuse.  In March 2014, OIG issued its Compendium of Priority 
Recommendations, which highlights additional opportunities for cost savings and program and 
quality improvements.3  Implementing these recommendations could result in billions of 
additional dollars saved.  My testimony today focuses on a selection of those key 
recommendations. 
 
CMS Needs to Better Ensure that Medicare Makes Accurate and Appropriate Payments  
 
Overall, improper Medicare payments cost taxpayers and beneficiaries about $50 billion a year.4  
Medicare fee for service, the largest program, reported an error rate of 10.1 percent ($36 billion) 
in FY 2013.  OIGs audits and evaluations have identified opportunities to reduce Medicare 
improper payments for specific program areas and services.  Examples of two critical areas 
include payments for prescription drugs and payments to home health agencies. 
 
Better Protect Medicare and Beneficiaries from Inappropriate Prescribing, Use, and Billing for 
Prescription Drugs 
 
OIG has extensively examined CMSs monitoring and oversight of the Part D program and the 
effectiveness of controls to ensure appropriate payment and patient safety.  Our work has found 
limitations in program safeguards that leave Part D vulnerable to improper payments and 
Medicare patients vulnerable to potentially harmful prescribing.  For example, we found that 
Medicare inappropriately paid millions of dollars for prescriptions from unauthorized 
prescribers, such as massage therapists and athletic trainers.5   
 
Further, thousands of retail pharmacies demonstrated extremely high billing for at least one of 
the eight measures of questionable billing we developed (e.g., billing for very high numbers of 
prescriptions per Medicare patient). 6  For example, one pharmacy billed an average of 116 
prescriptions per Medicare patient  almost 5 times the national average of 24 prescriptions per 
Medicare patient.  Pharmacies with questionable billing could have billed for drugs that were not 
medically necessary or that were not provided to beneficiaries.  We have also uncovered extreme 
prescribing patterns by hundreds of physicians (e.g., prescribing extremely high numbers of 
prescriptions per Medicare patient, relative to their peers).7  For example, over 100 general-care 
                                                           
3 Office of Inspector Generals Compendium of Priority Recommendations, March 2014, available online at 
http://oig.hhs.gov/reports-and-publications/compendium/index.asp. 
  
4 Department of Health and Human Services FY 2013 Agency Financial Report, available online at 
http://www.hhs.gov/afr/2013-hhs-agency-financial-report.pdf. 
 
5 Medicare Inappropriately Paid for Drugs Ordered by Individuals Without Prescribing Authority, OEI-02-09-
00608, June 2013, available at http://oig.hhs.gov/oei/reports/oei-02-09-00608.asp.   
 
6 Retail Pharmacies With Questionable Part D Billing, OEI-02-09-00600, May 2012, available at 
http://oig.hhs.gov/oei/reports/oei-02-09-00600.asp.   
 
7 Prescribers With Questionable Patterns In Medicare Part D, OEI-02-09-00603, June 2013, available at 
http://oig.hhs.gov/oei/reports/oei-02-09-00603.asp.   
 
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  physicians prescribed at a rate of more than 70 prescriptions per Medicare patient.  Nationally, 
general-care physicians average 13 prescriptions per Medicare patient.  While questionable 
billing is not necessarily improper or fraudulent, it may be an indication of such and warrants 
further scrutiny.   
 
These vulnerabilities are even more concerning in light of the increasing number of OIG 
investigations into prescription drug fraud.  For example, a physician in Kansas and his wife ran 
a pill mill and wrote thousands of medically unnecessary prescriptions for narcotics. The 
physician was directly linked to the deaths of four patients, and he billed the drugs to Federal 
health care programs and private insurers for over $4 million dollars.  Both the physician and his 
wife were sentenced to more than 30 years in prison.8  The serious and growing problem of 
prescription drug abuse lends a greater urgency to efforts to address fraud and improve 
monitoring and oversight of Part D.9 
 
Key OIG recommendations to CMS related to the issues described above include: 
 
  require Part D plans to verify that prescribers have the authority to prescribe, 
 
  instruct the Medicare program integrity contractor to expand its analysis of prescribers, and  
 
  provide Part D plans with additional guidance on monitoring prescribing patterns. 
 
CMS issued a proposed rule that would require all prescribers of Part D drugs to be enrolled in 
the Medicare fee-for-service program (or officially opt out).10  If implemented, this requirement 
could help CMS, Part D plans, and the Medicare program integrity contractor enhance their 
monitoring and better prevent and detect Part D improper payments and potential fraud. 
 
CMS Should Better Prevent, Identify, and Recover Improper Payments to Home Health Agencies 
 
For decades, OIG has raised concerns about improper Medicare payments to and fraud 
committed by home health agencies.  CMS has taken steps to protect against improper Medicare 
billing for home health services, but these actions have not fully addressed the problem.   
 
For example, CMS implemented a requirement of the Affordable Care Act that practitioners who 
certify Medicare patients as eligible for home health services must document their face-to-face 
encounters with those patients.  However, OIG found that almost one-third of home health 
services claims in 2011 and 2012 did not meet these requirements, resulting in $2 billion in 
                                                           
8 U.S. Department of Justice Press Release, Jury:  Haysville Doctor and Wife Guilty in Deadly Prescription Drug 
Overdoses, June 24, 2010, available online at http://www.justice.gov/usao/ks/PressReleases/2010/jun/June24a.html. 
  
9 See Spotlight on Drug Diversion, available at http://oig.hhs.gov/newsroom/spotlight/2013/diversion.asp.   
 
10 Federal Register, Volume 79, Number 7, pages 1982-1987, published January 10, 2014, available online at 
http://www.gpo.gov/fdsys/pkg/FR-2014-01-10/pdf/2013-31497.pdf.  
 
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  improper payments.11  Furthermore, CMS has struggled to collect all of the overpayments to 
home health agencies that it has identified and has not implemented a requirement promulgated 
in 1998 that home health agencies obtain surety bonds, which could aid in recouping some of 
these funds.12 
 
In addition,  OIG found that in 2010, one-quarter of home health agencies met the threshold of at 
least one of six questionable billing measures that we created (e.g., billing for unusually high 
numbers of visits per patient or average payment amounts per patient, relative to other home 
health agencies).13  For example, 13 home health agencies billed for more than 300 visits per 
Medicare patient in 2010.  In comparison, the median number of visits per Medicare patient 
across all Medicare home health agencies was only 32.  Further, OIG investigations have 
uncovered significant home health fraud, including a case in Texas involving more than 
$300 million in alleged fraudulent Medicare billing.14 
 
Key OIG recommendations to CMS related to improper payments for home health services 
include: 
 
  create a standardized form to ensure better compliance with the face-to-face encounter 
documentation requirements, 
 
  implement the surety bond requirement for home health agencies, and 
 
  increase monitoring of Medicare claims for home health services. 
 
 
CMS Should Maximize Recovery of Improper Payments and Better Address Payment 
Vulnerabilities to Prevent Improper Payments 
 
The ultimate goal is preventing improper payments entirely.  However, the reality is that 
Medicare pays billions of dollars improperly each year.  CMS must maximize the recovery of 
overpayments identified by its contractors and others.  It is also paramount to prevent the 
recurrence of improper payments by identifying why they occurred and improving program 
safeguards accordingly.   
 
                                                           
11 Limited Compliance with Medicares Home Health Face to Face Documentation Requirements, OEI-01-12-
00390, April 2014, available online at http://oig.hhs.gov/oei/reports/oei-01-12-00390.asp.  
 
12 Surety Bonds Remain an Unused Tool to Protect Medicare from Home Health Overpayments, OEI-03-12-00070, 
September 2012, available online at http://oig.hhs.gov/oei/reports/oei-03-12-00070.asp.  
 
13 Inappropriate and Questionable Billing by Medicare Home Health Agencies, OEI-04-11-00240, August 2012, 
available online at http://oig.hhs.gov/oei/reports/oei-04-11-00240.asp.  
 
14 U.S. Department of Justice Press Release, Dallas Doctor Arrested for Alleged Role in Nearly $375 Million Health 
Care Fraud Scheme, February 28, 2012, available online at http://www.justice.gov/opa/pr/2012/February/12-crm-
260.html.  
 
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  Maximize Recovery of Overpayments 
 
CMSs challenges in recovering overpayments are not limited to home health agencies.  OIG 
examined overpayments in currently not collectible status  a classification that CMS uses for 
overpayments in which the provider has not made a repayment for at least six months.15  In 
FY 2010, CMS reported that $543 million in overpayments had been newly designated as 
currently not collectible.  However, CMS had limited information to track most of these 
overpayments in its accounting system.  For those it did track, virtually all went uncollected.  
According to contractors, inaccurate provider contact information delays or prevents some 
overpayment-demand letters from reaching providers.  Expanding the types of provider 
identifiers used to offset overpayment could improve debt recovery efforts, particularly for 
providers with multiple Medicare national provider identifiers. 
 
These challenges echo earlier OIG findings that the vast majority of overpayments identified by 
CMSs program integrity contractors went uncollected.  Further, CMS did not adequately track 
information on these overpayments and their collection status.16 
 
CMS contracts with Recovery Auditors (RACs) to identify Medicare improper payments for 
recovery (in cases of Medicare overpayments) or return (in cases of Medicare underpayments).  
OIG reviewed the RAC program for the Medicare fee-for-service program in 2010 and 2011.17   
 
RACs audits identified improper payments totaling $1.3 billion in FYs 2010 and 2011.  These 
audits resulted in about $768 million recovered from providers and about $135 million in 
payments returned to providers.   
 
Better Address Vulnerabilities to Prevent Improper Payments 
 
In addition to recovering overpayments, CMS uses RAC audits to identify vulnerabilities and 
develop corrective action plans to prevent future improper payments.  Vulnerabilities have 
included, for example, billing for services or supplies on behalf of deceased beneficiaries.  By 
June 2012, CMS reported that it had taken corrective actions to address most of the 
vulnerabilities it had identified from the 2010 and 2011 RAC audits.  These corrective actions 
were not considered closed, however, because CMS had not yet evaluated their effectiveness, a 
key step in its process.  Thus, it is not clear to what extent these corrective actions have 
prevented improper payments from recurring. 
 
                                                           
15 Medicares Currently Not Collectible Overpayments, OEI-03-11-00670, June 2013, available online at 
http://oig.hhs.gov/oei/reports/oei-03-11-00670.pdf.  
 
16 Collection Status of Medicare Overpayments Identified by Program Safeguard Contractors, OEI-03-08-00030, 
May 2010, available online at http://oig.hhs.gov/oei/reports/oei-03-08-00030.pdf.   
 
17 Medicare Recovery Audit Contractors and CMSs Actions to Address Improper Payments, Referrals of Potential 
Fraud, and Performance, OEI-04-11-00680, September 2013, available online at http://oig.hhs.gov/oei/reports/oei-
04-11-00680.pdf. 
 
5  House Committee on Oversight and Government Reform, Subcommittee on Energy Policy, Health Care and Entitlements 
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  CMS has missed opportunities to address improper payment vulnerabilities identified by its 
program integrity contractors.  In 2011, OIG found that CMS had resolved or taken significant 
action on only about a quarter of the vulnerabilities that its program integrity contractors had 
reported in 2009.18 
 
Key OIG recommendations to CMS to maximize recovery of improper payments and address 
payment vulnerabilities include: 
 
  improve tracking and monitor the status of overpayment collections, 
 
  expand the types of provider identifiers used to recover overpayments, 
 
  address program vulnerabilities identified by contractors in a timely manner, and  
 
  evaluate the effectiveness of corrective actions. 
 
CMS Needs to Ensure Effective Performance by Its Contractors  
 
CMS relies on contractors to operate vital functions of the Medicare program, including paying 
claims, running program integrity activities, identifying overpayments, and recouping 
overpayments.  CMS contracts with Medicare Administrative Contractors (MACs) to process 
claims and implement payment safeguards; program integrity contractors, including the 
Medicare Drug Integrity Contractor (MEDIC), Zone Program Integrity Contractors (ZPICs), and 
Program Safeguard Contractors (PSCs), to protect Medicare from fraud and abuse; and RACs to 
identify and collect overpayments.  OIG reviews of these contractors over the past decade have 
consistently identified problems, including failure to use data to assess contractor performance 
and inadequate response when contractors do not meet performance standards. 19 
 
Use Data More Effectively to Oversee Contractor Performance and Include Key Metrics in 
Performance Evaluations 
  
Program integrity contractors are required to periodically report to CMS data describing their 
activities.  However, OIG found that the data used by CMS to oversee ZPICs were not accurate 
or uniform, preventing a conclusive assessment of contractor activities.  Further, OIG found 
significant differences in fraud detection efforts across ZPICs (and in earlier work, across PSCs) 
that could not be explained by differences in budget or oversight responsibility.  Yet, CMS had 
not assessed the wide variation across contractors activity data, and CMS contractor 
                                                           
18 Addressing Vulnerabilities Reported by Medicare Benefit Integrity Contractors, OEI-03-10-00500, December 
2011, available online at http://oig.hhs.gov/oei/reports/oei-03-10-00500.asp.  
 
19 Findings and recommendations from a series of OIG evaluations of contractor oversight and performance are 
summarized and referenced in OIGs Compendium of Priority Recommendations, March 2014, available online at   
http://oig.hhs.gov/reports-and-publications/compendium/index.asp. 
 
6  House Committee on Oversight and Government Reform, Subcommittee on Energy Policy, Health Care and Entitlements 
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  performance evaluations provide few quantitative details about the contractors achievements in 
detecting and deterring fraud and abuse.20  
 
Additionally, CMSs performance evaluations for RACs lacked metrics related to key contract 
requirements, such as identification of improper payments.  In response to our report, CMS noted 
that it has revised its RAC evaluations to incorporate metrics on identification of improper 
payments and accuracy rates and is considering additional performance measures.  We 
encourage CMS to continue to increase its use of performance metrics and data to oversee 
contractor performance.21 
 
Evaluate Contractor Performance in a Timely Manner and Respond More Effectively When 
Performance Requirements Go Unmet 
 
OIG found that CMS conducts extensive activities to review MACs performance.  However, the 
reviews are not always conducted in time to inform future contract award decisions.  Further, 
CMS did not ensure that its MACs resolved or developed action plans to address unmet quality 
assurance standards.22     
 
Key OIG recommendations to CMS related to contractor performance include: 
 
  improve and more effectively use data to assess contractor performance, including to analyze 
performance across contractors and assess the causes of variation; 
 
  strengthen performance evaluations and include key metrics to assess how well contractors 
are performing core functions; and 
 
  conduct performance evaluations in a timely manner and address unmet performance 
standards more effectively. 
 
 
The Medicare Appeals System Needs Fundamental Changes 
 
Medicare appeals decisions affect providers, beneficiaries, and the program as a whole.  It is 
imperative that the appeals system be efficient, effective, and fair.  
 
                                                           
20 Zone Program Integrity Contractors Data Issues Hinder Effective Oversight, OEI-03-09-00520, November 2011, 
available online at http://oig.hhs.gov/oei/reports/oei-03-09-00520.asp.  
 
21 Medicare Recovery Audit Contractors and CMS's Actions To Address Improper Payments, Referrals of Potential 
Fraud, and Performance, OEI-04-11-00680, August 2013, available online at http://oig.hhs.gov/oei/reports/oei-04-
11-00680.asp. 
 
22 Medicare Administrative Contractors Performance, OEI-03-11-00740, January 2014, available online at 
http://oig.hhs.gov/oei/reports/oei-03-11-00740.asp.  
 
7  House Committee on Oversight and Government Reform, Subcommittee on Energy Policy, Health Care and Entitlements 
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  In recent years, the system has experienced an unprecedented surge of appeals.23  According to 
the Office of Medicare Hearings and Appeals (OMHA), from FY 2012 to 2013, the number of 
appeals reaching the Administrative Law Judges (ALJ, the third level of appeals) doubled.24  
OMHA estimates that its backlog will reach a million claims by the end of this fiscal year.  A 
concerted effort by all key playersincluding CMS, OMHA, and Congressis needed to 
address this issue and to maintain the integrity of the appeals system.   
 
Before the recent surge, OIG completed work that focused on the ALJ level of appeals.25  
Although the work covered FY 2010, many of the findings and recommendations are relevant to 
understanding and addressing the current challenges.   
 
A small percentage of providers account for a large number of appeals 
 
Medicare providers make up the vast majority  85 percent  of appellants.  Moreover, only 2 
percent of providers accounted for nearly one-third of all ALJ appeals.  Specifically, 96 
providers filed at least 50 appeals each with 1 provider filing over 1,000 appeals.  ALJ staff has 
raised concerns that some providers appeal every payment denial and may have incentives to 
appeal because the cost is minimal and a favorable decision for the appellant is likely. 
 
For more than half of appeals, ALJs decided fully in favor of appellants 
 
In 2010, ALJs reversed prior-level decisions and decided fully in favor of appellants for 
56 percent of appeals.  In comparison, Qualified Independent Contractors (QICs)  the second 
level of appeals  decided fully in favor of appellants for only 20 percent of appeals.  Appellants 
were most likely to receive favorable ALJ decisions for Part A hospital appeals (72 percent) and 
least likely for Parts C and D appeals (18 percent and 19 percent, respectively).   
 
Differences between ALJ and prior-level decisions were due to different interpretations of 
Medicare policies and other factors 
 
Several factors led to ALJs reaching different decisions than those in the prior level of appeals.  
We found that ALJs tended to interpret Medicare policies less strictly than did QICs.  QICs also 
tend to be more specialized in Medicare program areas than ALJs and have clinicians on staff; 
ALJs tend to rely on evidence and testimony from the treating physicians.  Both QIC and ALJ 
staff noted that lack of clarity in some Medicare policies is also a factor in the differing 
decisions. 
 
                                                           
23 OIG found that Medicare redeterminations  the first level in the Medicare appeals process  increased by 
33 percent from 2008 to 2012.  Increases in appeals by Part A providers related to RAC audits was one driver of the 
increase.  See The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness, 
OEI-01-12-00150, October 2013, available online at http://oig.hhs.gov/oei/reports/oei-01-12-00150.asp.    
 
24 Department of Health and Human Services, Justification of Estimates for Appropriations Committees, Fiscal Year 
2015, available online at http://www.hhs.gov/budget/fy2015/fy-2015-hhs-congressional-budget-justification.pdf. 
 
25 Improvements Are Needed at the Administrative Law Judge Level of Medicare Appeals, OEI-02-10-00340, 
November 2012, available online at https://oig.hhs.gov/oei/reports/oei-02-10-00340.asp. 
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  Further, ALJs vary amongst themselves in decision-making.  The fully favorable rate for 
appellants ranged from 18 to 85 percent among the 66 ALJs.   
 
CMS participation affects the outcome of appeals 
 
CMS participated in 10 percent of ALJ appeals in FY 2010.  For those in which CMS 
participated, the ALJs were less likely to decide fully in favor of the appellant.    
 
Current practices regarding appeals documents are highly inefficient 
 
Both CMS and ALJ staff identified problems with case files.  They reported that a case file at the 
ALJ level often differed in content, organization, and format compared to the same appeals case 
file at the QIC level, creating inefficiencies in the appeals system.  Because the QICs case files 
are almost entirely electronic and ALJs primarily accept only paper case files, the QICs must 
convert the files to paper format before sending to the ALJs.  Most staff noted that this process is 
resource intensive and prone to error.  
 
Key recommendations to OMHA and CMS related to improving the appeals process include: 
 
  identify and clarify Medicare policies that are being interpreted differently and develop and 
coordinate training on those policies; 
 
  standardize case files and make them electronic; 
 
  continue to increase CMS participation in ALJ appeals; and 
 
  implement a quality assurance process to review ALJ decisions. 
 
 
OIG Will Continue Working to Prevent and Recover Medicare Improper Payments 
 
Reducing Medicare improper payments and ensuring effective program administration requires a 
concerted effort by a number of key players, including the Department, CMS, CMS contractors, 
providers, Congress, and OIG.   
 
More action is needed to ensure that payments are made accurately.  Any improper payments 
that do occur must be identified and recovered, and solutions must be identified and 
implemented to prevent recurrence.  As CMS relies on contractors for most of these crucial 
functions, oversight of and accountability for contractor performance is paramount.  Finally, the 
Medicare appeals system to resolve issues about improper payments must operate efficiently, 
effectively, and fairly. 
 
While CMS has taken some important steps to identify and recover improper payments and 
implement safeguards to prevent them, our work demonstrates that further improvements are 
9  House Committee on Oversight and Government Reform, Subcommittee on Energy Policy, Health Care and Entitlements 
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  needed.  A comprehensive list of OIGs priority recommendations can be found in our 
Compendium of Priority Recommendations on our Web site.26   
 
OIG will continue to audit and evaluate Medicare payments and vulnerabilities and recommend 
solutions to reduce the billions of dollars wasted each year.  We are challenged in meeting this 
mission by declining resources for Medicare and Medicaid oversight at a time when these 
programs and our responsibilities are growing.  By the end of this fiscal year, we expect to 
reduce our Medicare and Medicaid oversight by about 20 percent.  Yet the Department estimated 
that Medicare and Medicaid outlays would grow by about 20 percent from 2012 to 2014.  Full 
funding of our 2015 budget request would enable us to provide more robust oversight and 
advance solutions to protect the Medicare and Medicaid programs, beneficiaries, and taxpayers. 
 
We are committed to strong oversight of Medicare to reduce waste, fraud and abuse as 
comprehensively and effectively as possible with the tools and resources we have available.  At 
stake are billions of dollars, the solvency of the program, and the health and well-being of 
beneficiaries.  
 
Thank you for your interest and support and for the opportunity to discuss some of our work 
related to Medicare oversight.  I am happy to answer any questions you may have. 
 
                                                           
26 Available at http://oig.hhs.gov/reports-and-publications/compendium/index.asp.   
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