His family and also looks at recommendation of how the treat it, and also looking at Insurance Fraud schemes with witnesses from the government and the Addiction Treatment centers. I usually dont start these meetings until the Ranking Member comes, but because of the service that we have for congressman cummings plus the fact that we had to change this meeting to adjust to that schedule, i wanted to get going, and it is going to be kind of erratic sort of operation, because i have another meeting that i have to attend to make a quorum down the hall here. So, i am going to start out, and then, i know that you want to introduce one person, and are you under a time constraint . Because if you are, i will give you the courtesy of going ahead. Mr. Chairman, i can wait until the regular. Okay. So i welcome our panelists today to our hearing on the oneyear anniversary of the support act. This landmark statute which many of us had a hand in developing responded to the Opioid Epidemic on multiple fronts. That crisis has affected every corner of our nation with approximately 130 americans dying from an overdose every single day. We have devoted a lot of federal resources to tackling the crisis and i look forward to hearing from the Surgeon General on this, of this administrations efforts to implement the support act, and now, it is on the oneyear anniversary. I also commend dr. Adams for launching his own unique initiatives to help raise Public Awareness of the risk of the opioid misuse. Challenges remain however, because roughly 20 million Americans Still struggle with the substance disorder. Addiction to other drugs including meth and heroin pose an even greater challenge to some communities ark and thieco especially true in rural america. Another issue is that few battling addiction actually seek or receive treatment. And another issue is that even those who do seek help lack the expertise to distinguish the good treatment providers from the bad, and solving this issue which is the second focus of a hearing, and easier said than done. The treatment sector includes not just extremely good and extremely bad actors, but those in between. Some for example have updated the methods to incorporate the latest research of what works best for recovering people. Also state requirements for addiction counselors and homes vary, and example, some states require licensing of the recoverying home operators while others might only use voluntary certification, and that is why we have invited two government watchdog agencies in an Addiction Treatment advocate to the committee to share expertise. We welcome back dr. Deegan macauley of jao who testified before this Committee Last year. We have seen the media reports of the socalled sober homes in pennsylvania and massachusetts and other states that exploited recovering addicts with private insurance benefits. We look forward to hearing from her on that subject of the gaos work there, and i extend a look at the Gary Cantwell who heads up the Investigative Team and his investigators worked on a high profile case involving a treatment scam in ohio, and that investigation and partnership with fbi and Law Enforcement generally led to the indictment of six people this year. All six pleaded guilty to medicaid fraud. Some have called for development of more uniform and measurable treatment standards to evaluate the effectiveness of Substance AbuseTreatment Programs. Our last witness, gary mendell has gone a step further in not only identifying eight core standards that are key to any successful program, but also launching a quality rating system. This is unchartered area, and treatment sector. We look forward to hearing from him about the progress that has been made there with the Nonprofit Organization shatter proof. We are here today, because too Many Americans have lost too many loved ones to addiction and americas Opioid Crisis has left a trail of broken hearts and homes across the country, and we are here to help communities to get on a path of health and wellness that Many Americans are desperately seeking a path forward. Working together, we can save tax dollars and save lives. Senator wyden. Thank you very much, mr. Chairman. I wanted to thank you, because this is an exceptionally important issue, and we do need to have the committee tackle it in a bipartisan way, and i also wanted to thank you for moving this mornings start time to 9 00 a. M. , because we both know that there are members who want to attend the Memorial Service for chairman cummings. Todays hearing is going to spotlight the pitfalls that americans face when they try to find quality treatment for a Substance Use disorder. An american battling this disease is often jostled and pushed around from one end of the Health Care System to the other. The last thing you need when you are suffering from this disease is yet more obstacles, ripoff artists and empty promises or just out and out abuse, and the last thing that you need is that when all you need to do is to get better. Too often people travel across the country expecting to arrive at a legitimate Treatment Facility only to find that they have fallen prey to a scheme, and the goal of which is to drain their bank account and just milk their insurance for everything that it is worth. In some instances, unscrupulous operators are working to lure patients by paying for plane tickets and promising free rent. Once the patients arrive, what they end up getting is lousy care or no care at all. And then the fraudsters just go out to bill the Insurance Companies for Health Care Services that may never have even been performed. One of the biggest problems involves facilities that allegedly treat Substance Abuse disorders that are set up to ripoff the taxpayers and the fraudsters illegally recruit patients using bribes and kickbacks and then they bilk the taxpayer by billing the Patients Health plan for medically unnecessary drug tests. Schemes like this and we are very pleased to have this really terrific group of witnesses today, and they are going to outline the schemes in detail, and of course, these schemes as well cost medicare and medicaid and private insurance hundreds of millions of dollars every year. And just this month six people operating a fraudulent Treatment Centers in ohio plead guilty to submitting 130,000 medicaid claims that totaled more than 48 million for medically assisted treatment and other services that were never leg legitimately provided. Part of the reason that this fraud is so common is because there is no way for the patient or the family to learn about the quality of the Treatment Facility before they enroll. So today, we will hear from an organization that is saying, hey, wake up, everybody, this has to change. Shatterproof is currently developing databases in multiple states that are successful to help the public evaluate, and compare substance treatment operations. And this is the type of information that American Families deserve to have, and they deserve to have it now, because it is a key tool to find quality treatment and avoid sham operators trying to make a quick buck. One other point that occurred to me as we were preparing for this hearing is its particularly important now to set in place the kind of concrete policies to rip off, and to make sure that the programs are not ripped off, and the patients are not taken advantage of, because when you are reading the morning newspaper, the fact is that states and communities may now be on the cusp of receiving tense of bitens of billions of dollars from the companies that helped to seed the epidemic. I can look down the row, because i have heard about this from virtually all of my colleagues. So if you are talking about a fund of tens of billions of dollars, a sum of that is going to be a magnet for the fraudsters and the ripoff artists, and so this hearing is going to highlight the need for the making sure that the rules of the road and the vigorous oversight so that the dollars actually go to help patients get proper care, and all of that new money doesnt just find its way into the ripoff artists. I thank the witnesses, and with chairman again, your leadership and we will work on this in a bipartisan way, and i look forward to hearing from the witnesses and the colleagues. The senator from maryland to introduce the Surgeon General. Thank you, mr. Chairman, and i thank you for giving me this courtesy and it is a real pleasure to welcome all of the witnesses today, and particularly with the welcomed the Surgeon General from mechanicsville, maryland, and a proudson of maryland and a glowing career. Mr. Chairman, he is the first winning the prestigious meyerhoff scholarship to where he received both the bachelor of science in biochemistry, and a bachelor of science in biology. Say that because we had a little conversation before dr. Freedman robows skshgs i ca robowski calls him the most successful failure. It is a program that has been extremely successful for africanamericans to get their ph. D. S and going on to extraordinarily successful life. Well, he does not have a ph. D. But he does have a masters and md degree, and has had a very successful career. I want to congratulate him for his leadership and also, a scholar and before serving as the United StatesSurgeon General, he was in the indiana Surgeon General, and dr. Adams has spent time combatting the Opioid Epidemic. He as been an advocate on behalf of the Public Health in our country, and we are proud of his service, and very proud to have him as hailed from our state of maryland. Three of you, and if i just go to the testimony, i wont feel bad, and i wont introduce you. And i have talked to all of you about in my Opening Statement, because of the time constraints, and i wanted to start with the Surgeon General. Would you start, and then, what we will do is that we will go in the order that you are sitting there at the table, and then well have questions after you all get done. Fantastic. And good morning, chairman grassly, and my wife says to tell my wife barbara hi, and we cant wait to take the kids out to farm, and i hope she told you about that. Everybody knows about my wife, but does anybody know about me . Thank you. Commissioner wiyden and if you will allow me to recognize the flags at halfstaff and lift up the accomplishments of chairman cummings, and he is the very example of public service, and my condolences to his family and those who loved him. And so, i would like to thank you for passing this act which has allowed hhs to make progress in the fight of the Opioid Epidemic. I am so pleased to be here on the oneyear anniversary. Americas overdose and addiction crisis is one of the most daunting and Public Health challenges ever. Recognizing its scale and scope, hhs launched the fivepoint strategy in 2017, and under this strategy, we are achieving better addiction and prevention and Treatment Services, and better data, and better Pain Management, and better targeting of the overdose researching drugs and Better Research. I have been engaged on this problem as an anesthesiologist on chronic and acute Pain Management, and as you heard from representative cardin, i have been on this with a fueled Opioid Epidemic, but my work is very, very personal. My younger brother philip struggles with the addiction no disease. It began with a struggle with depression and leading to opioid Substance Abuse. And my brother has been cycling in and out of incarceration, and he is currently serving a 10year prison sen stetence bec of crimes needed to support his addiction. And so i am an example that this can happen to anybody, including the nations attorney general. So to address this Opioid Epidemic, my Office Released a spotlight on opioids and a postcard at Surgeon General. Gov and also, what you need for five key messages that are e d t detd in the pub collationlycations, intervention is needed to be early. We cant wait for high school or college before we start to talk about the dangers of opioid misuse. Treatment is effective, but it has to be integrated into the Mainstream Health care. Medicationassisted treatment is the Gold Standard, but in the course of the year, 1 in 4 people with opioid use disorder receives the specialty treatment. And three, having the lock zone can save a life and serve as a bridge to treatment and recovery. I hope you know about this, and i carry it with me, and it is that easy to save a life. Since my naloxone advisory was published, too many needlessly die. And four, the Community Support services are essential. I saw this first hand when lady pence and i went to pathways to recovery and employment in which potential employees who fail drug tests are offered counseling and recovery. And this is also provided with a bakery that has employment with no judgment, no history, no background cheblg, abac background check, and their motto is that we dont bake brownies to employ people, we employ people to bake brownies. And we must move from the incarceration approach to one of treatment. And stigma and judgment are keeping the people with the addiction and people like my brother from getting the help they need. This is in my opinion killing more people than overdoses n. Conclusion, this administration and through your support the historic investment has been made in combatting the Opioid Crisis. By the end of 2019, hhs will have awarded over 9 billion to states and tribes to combat addiction and this is nearly 1 billion across 375 projects in 41 states as part of the nihs helping to end addiction long term or heal initiative, and also to samsa funds for the states to strengthen data and surveillance data. Since the start of the administrations, we have seen the amount of opioids in the nation drop 31 in terms of the prescriptions, and we have seen the number of americans recei receiving treatment grow, and now 1. 2 million americans are receiving the medication assisted treatment and we have doubled the number of data providers. And monthly, the naloxone subscriptions have raised 78 , and prevention of Overdose Deaths have dropped by 5 , and the first drop in over 20 years. We are making progress, but the challenges remain and including the resurgence of methamphetamines, and the need for syringe programs, and also to support the medication assisted programs with warm handoffs to care. And we must expand the behavioral workforce, and senator stabenow and i talked about that before the hearing. I promise you, and i promise you that hhs and my office is going to continue our commitment and the focus on the critical Public Health issue. I thank you for the opportunity to testify. I look forward to your questions. Dr. , before you begin, with all of the background in animal science, how did you end up in the gao . Well, as you are probably aware there is a nexus between the animal health, and Public Health, and gao recognizes that. Okay. I needed that explanation. Sure. Proceed, please. Sure. Chairman grassley, and Ranking Member wyde, in, and members of the committee, i am pleads to be here to report on the recovery homes. This drug use is a persistent problem that has ruined families and taken lives. The dea is reporting that since 2011 drug overdoses alone have been the leading cause of death by injury in the United States outnumbering the deaths by guns, car crashes, suicides and homicide. Recovery homes can offer safe and supportive housing, and unfortunately the bad actors have used these homes to take advantage of individuals during their time of need. Today, i would like to highlight two key findings from our report. First, gao found that all five states in our review have received complaints of the potential fraud related to recovery homes, and four of the five, florida, massachusetts, ohio and utah had or were in the process of conducting the investigations. For example, officials told gao that fraud was extensive in southeastern florida, and the Task Force Found that operators were luring individuals to homes using the deceptive marketing techniques and such as promisings of free airfare and rent. And recruiters then brokered the individuals to providers who billed their insurance for hundreds of thousands of dollars in unnecessary drug testing, and home operators were paid 300 to 500 or more per week for every patient that it referred. At the time of the report, some of the arres