Attorney General Announces Task Force to Combat COVID-19 Fraud

U.S. Attorney General Merrick B. Garland today directed the establishment of the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across government to enhance enforcement efforts against COVID-19 related fraud.

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    In U.S GAO News
    The overall pay gap between men and women in the federal workforce has narrowed considerably, from 19 cents on the dollar in 1999 to 7 cents in 2017, but the current pay gap is greater for certain groups of women, according to GAO's analysis of data from the Office of Personnel Management (OPM). Two trends help explain why the pay gap has narrowed: (1) men and women have become more similar in measurable factors related to pay, such as occupation; and (2) women have earned slightly higher rates of pay increases than men. In 2017, most of the overall pay gap—or 6 of 7 cents on the dollar—was not explained by differences between men and women in measurable factors (see figure). This unexplained portion of the pay gap may be due to factors not captured in the data GAO analyzed, such as work experience outside the federal government, or factors that cannot be measured, such as discrimination and individual choices. In 2017, the overall and unexplained gaps were greater for certain groups. For example, compared to White men, the unexplained gap was greater for Hispanic/Latina, Black, and American Indian or Alaska Native women than for White and Asian, Native Hawaiian, or Pacific Islander women. Pay Gap between Men and Women in the Federal Workforce, 1999 to 2017 OPM and the U.S. Equal Employment Opportunity Commission (EEOC) have taken steps to analyze data on the pay gap and help agencies address it. From 2014 to 2016, OPM implemented a government-wide strategy to address the pay gap, and officials said their future efforts will include monitoring the pay gap periodically. EEOC annually collects workforce data from agencies and provides related technical assistance, and officials said they plan to expand these efforts. These data include promotions by gender and race and ethnicity, which EEOC and agencies use to identify potential barriers to career advancement, but GAO found these data were not sufficiently complete. Of the 51 data tables GAO requested, 35 were either missing or had at least one incomplete data element. EEOC officials said this is partly due to promotion applicants not being required to provide demographic information. However, EEOC has not fully assessed the reliability of these data and generally does not follow up with agencies about missing data between technical assistance visits. Without taking steps to assess and improve the quality of these data in a timelier manner, EEOC may miss opportunities to ensure equal opportunity for all promotion applicants. As the nation's largest employer, the federal government employed about 2.7 million workers in 2019. Although the pay gap between men and women in the federal workforce is smaller than it is for the entire U.S. workforce and has narrowed over time, studies show that pay disparities continue to exist. GAO was asked to explore the current status of pay equity in the federal workforce. This report examines how the pay gap between men and women in the federal workforce has changed since 1999, and what factors account for any remaining gap; and the extent to which OPM and EEOC have monitored and taken steps to address the pay gap in the federal workforce, including assessing potential disparities in promotions; among other objectives. GAO analyzed OPM's Enterprise Human Resources Integration data on about 2.1 million federal employees from September 1999 to September 2017 (the most recent reliable data available at the time of GAO's review); reviewed federal agency promotion data collected by EEOC for fiscal years 2015 through 2017 (the most recent available data); and interviewed OPM and EEOC officials and reviewed relevant documentation. GAO recommends that EEOC take steps to assess the quality of federal agency promotion data and address missing data with agencies in a timelier manner. EEOC neither agreed nor disagreed with GAO's recommendation. For more information, contact Cindy Brown Barnes at (202) 512-7215 or brownbarnesc@gao.gov.
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    The Technology Assessment (TA) Design Handbook identifies tools and approaches GAO staff and others can consider in the design of robust and rigorous technology assessments. The handbook underscores the importance of TA design (Chapter 1), outlines the process of designing TAs (Chapter 2), and describes approaches for mitigating select TA design and implementation challenges (Chapter 3). While the primary audience of this handbook is GAO staff, other organizations may also find portions of this handbook useful as they consider or conduct TAs. This is an update to the handbook published in December 2019, based on the experiences of GAO teams and a review of relevant literature and comments submitted by external experts and the public between December 2019 and December 2020. The handbook identifies three general design stages, as shown in the figure below. The handbook also highlights seven cross-cutting considerations for designing TAs: the iterative nature of TA design, congressional and policymakers' interests, resources, independence, engaging internal and external stakeholders, potential challenges, and communication strategy. In addition, the handbook provides a high-level process for developing policy options, as a tool for analyzing and articulating a range of possible actions a policymaker could consider that may enhance the benefits or mitigate the challenges of a technology. Steps in developing policy options include, as applicable: determining the potential policy objective; gathering evidence; identifying possible policy options and the relevant dimensions along which to analyze them; analyzing policy options; and presenting the results of the analysis. Summary of Key Stages of Technology Assessment Design We found that GAO TAs can use a variety of design approaches and methods. The handbook includes TA design and methodology examples, along with example objectives commonly found in GAO TAs, such as: describe a technology, assess opportunities and challenges of a technology, and assess policy implications or options. For example, some GAO TAs include an objective related to describing the status and feasibility of a technology, which GAO teams have addressed by using methodologies such as expert panels, interviews, literature and document reviews, site visits, and determining the technology readiness level. Also included in the handbook are examples of TA design and implementation challenges, along with possible mitigation strategies. We identified four general categories of challenges: (1) ensuring that the design and implementation of TAs result in useful products for Congress and other policymakers; (2) determining the policy objective and measuring potential effects; (3) researching and communicating complicated issues; and (4) engaging relevant stakeholders. For example, allowing sufficient time for writing, review, and any needed revisions is one potential mitigation strategy that could help teams write simply and clearly about technical subjects and ensure that the design and implementation of TAs result in useful products for Congress and other policymakers. In 2019, GAO created the Science, Technology Assessment, and Analytics team to expand its work on cutting-edge science and technology issues, and to provide oversight, insight, and foresight for science and technology. TAs can be used to strengthen decision-making, enhance knowledge and awareness, and provide early insights into the potential effects of technology. Systematically designing a TA can enhance its quality, credibility, and usefulness; ensure independence of the analysis; and ensure effective use of resources. Under Comptroller General Authority, we developed this handbook by generally following the format of the 2012 GAO methodology transfer paper, Designing Evaluations. Below is a summary of the approach we used to affirm and document TA design steps and considerations for this handbook. Reviewed select GAO documents, including Designing Evaluations (GAO-12-208G), published GAO TAs, select GAO products using policy analysis approaches to present policy options, and other GAO reports Reviewed select Office of Technology Assessment reports Reviewed select Congressional Research Service reports Reviewed select English-language literature regarding TAs and related to development and analysis of policy options Consulted with external experts and performed outreach, including holding an expert meeting to gather input on TA design, soliciting comments from external experts who contributed to GAO TAs published since 2015, and soliciting comments from the public Reviewed experiences of GAO teams that have successfully assessed and incorporated policy options into GAO products and TA design, including challenges to TA design and implementation and possible solutions GAO is not making any recommendations. For more information, contact Timothy M. Persons or Karen L. Howard at (202) 512-6888 or personst@gao.gov or howardk@gao.gov.
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    GAO's analysis of Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) data show that in fiscal year 2018, 287,547 Medicare fee-for-service beneficiaries had inpatient stays that included care for severe wounds. These wounds include those where the base of the wound is covered by dead tissue or non-healing surgical wounds. About 73 percent of the inpatient stays occurred in acute care hospitals (ACH), and a smaller percentage of stays occurred in post-acute care facilities. Specifically, about 16 percent of stays were at skilled nursing facilities (SNF), and about 7 percent were at long-term care hospitals (LTCH). CMS data show that Medicare spending on stays for severe wound care was $2.01 billion in fiscal year 2018, representing a decline of about 2 percent from fiscal year 2016, when spending was about $2.06 billion. Spending declined as a result of decreases in both the total number of these stays, as well as spending per stay, which both decreased by about 1 percent. The decrease in per stay spending was likely driven, in part, by a change in where beneficiaries received care. CMS data show fewer severe wound care stays in LTCHs, which tend to be paid higher payment rates. At the same time, more severe wound care stays were at two other types of facilities that tend to be paid lower payment rates: ACHs and inpatient rehabilitation facilities. GAO's analysis of CMS data also show that, while the number of LTCHs that billed Medicare for severe wound care decreased by about 7 percent from fiscal years 2016 to 2018, Medicare beneficiaries continued to have access to other severe wound care providers. For example, CMS data show that most beneficiaries resided within 10 miles of an ACH or SNF that provided severe wound care in fiscal year 2018. Figure: Percentage of Medicare Fee-for-Service Beneficiaries Residing within 10 Miles of a Health Care Facility That Provided Any Severe Wound Care, by Facility Type, Fiscal Year 2018 Note: The “other” category includes facilities such as psychiatric hospitals or units. There is limited information on how or whether the decrease in LTCH care for severe wounds may have affected the quality of severe wound care Medicare beneficiaries receive. For example, CMS collects information on the percentage of patients with new or worsened pressure ulcers at post-acute care facilities, but it does not measure the quality of care they receive. Medicare beneficiaries with serious health conditions, such as strokes, are prone to developing severe wounds due to complications that often lead to immobility and prolonged pressure on the skin. These beneficiaries may require a long-term inpatient stay at an ACH or a post-acute care facility, such as an LTCH. LTCHs treat patients who require care for longer than 25 days, on average. In 2018, LTCHs represented about $4.2 billion in Medicare expenditures. Prior to fiscal year 2016, LTCHs received a higher payment rate for treating Medicare beneficiaries than ACHs. Beginning in fiscal year 2016, a dual payment system was phased in that paid LTCHs a rate similar to ACHs for some beneficiaries and a higher rate for beneficiaries that met certain criteria. As this payment system has moved from partial to full implementation, lawmakers had questions about how it may affect beneficiaries' severe wound care. The 21st Century Cures Act included a provision for GAO to review severe wound care provided to Medicare beneficiaries. This report describes facilities where Medicare beneficiaries received severe wound care, Medicare severe wound care spending, and what is known about the dual payment system's effect on access and quality. GAO analyzed Medicare severe wound care access and spending data for fiscal years 2016 and 2018 (the most recent data available); reviewed reports; and interviewed CMS officials, researchers, and national wound care stakeholders. HHS provided technical comments on a draft of this report, which were incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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    What GAO Found In its March 2021 high-risk series update, GAO reported that significant attention was needed to improve the federal government's management of information technology (IT) acquisitions and operations, and ensure the nation's cybersecurity. Regarding management of IT, overall progress in addressing this area has remained unchanged. Since 2019, GAO has emphasized that the Office of Management and Budget (OMB) and covered federal agencies need to continue to fully implement critical requirements of federal IT acquisition reform legislation, known as the Federal Information Technology Acquisition Reform Act (FITARA), to better manage tens of billions of dollars in IT investments. For example: OMB continued to demonstrate leadership commitment by issuing guidance to implement FITARA statutory provisions, but sustained leadership and expanded capacity were needed to improve agencies' management of IT. Agencies continued to make progress with reporting FITARA milestones and plans to modernize or replace obsolete IT investments, but significant work remained to complete these efforts. Agencies improved the involvement of their agency Chief Information Officers in the acquisition process, but greater cost savings could be achieved if IT acquisition shortcomings, such as reducing duplicative IT contracts, were addressed. In March 2021, GAO reiterated the need for agencies to address four major cybersecurity challenges facing the nation: (1) establishing a comprehensive cybersecurity strategy and performing effective oversight, (2) securing federal systems and information, (3) protecting cyber critical infrastructure, and (4) protecting privacy and sensitive data. GAO identified 10 actions for agencies to take to address these challenges. However, since 2019, progress in this area has regressed—GAO's 2021 rating of leadership commitment declined from met to partially met. To help address the leadership vacuum, in January 2021, Congress enacted a statute establishing the Office of the National Cyber Director. Although the director position has not yet been filled, on April 12 the President announced his intended nominee. Overall, the federal government needs to move with a greater sense of urgency to fully address cybersecurity challenges. In particular: Develop and execute a more comprehensive federal strategy for national cybersecurity and global cyberspace. In September 2020, GAO reported that the cyber strategy and implementation plan addressed some, but not all, of the desirable characteristics of national strategies, such as goals and resources needed. Mitigate global supply chain risks. In December 2020, GAO reported that few of the 23 civilian federal agencies it reviewed implemented foundational practices for managing information and communication technology supply chain risks. Enhance the federal response to cyber incidents. In July 2019, GAO reported that most of 16 selected federal agencies had deficiencies in at least one of the activities associated with incident response processes. Why GAO Did This Study The effective management and protection of IT has been a longstanding challenge in the federal government. Each year, the federal government spends more than $100 billion on IT and cyber-related investments; however, many of these investments have failed or performed poorly and often have suffered from ineffective management. Accordingly, GAO added improving the management of IT acquisitions and operations as a high-risk area in February 2015. Information security has been on the high-risk area since 1997. In its March 2021 high-risk update, GAO reported that significant actions were required to address IT acquisitions and operations. Further, GAO noted the urgent need for agencies to take 10 specific actions on four major cybersecurity challenges. GAO was asked to testify on federal agencies' efforts to address the management of IT and cybersecurity. For this testimony, GAO relied primarily on its March 2021 high-risk update and selected prior work across IT and cybersecurity topics.
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    Through Operation Warp Speed—a partnership between the Department of Health and Human Services (HHS) and the Department of Defense (DOD)—the federal government is accelerating efforts to develop vaccines and therapeutics for COVID-19. A typical vaccine development process can take approximately 10 years or longer, but efforts under Operation Warp Speed seek to greatly accelerate this process by completing key steps simultaneously (see figure). As of October 15, 2020, Operation Warp Speed publicly announced financial support for the development or manufacturing of six COVID-19 vaccine candidates totaling more than $10 billion in obligations. It has also announced financial support for the development of therapeutics, such as a $450 million award to manufacture a monoclonal antibody treatment (a treatment that uses laboratory-made antibodies, which also may be able to serve as a prevention option). Operation Warp Speed Timeline for a Potential Vaccine Candidate Note: An Emergency Use Authorization allows for emergency use of medical products without FDA approval or licensure during a declared emergency, provided certain statutory criteria are met. The Food and Drug Administration (FDA) may temporarily allow the use of unlicensed or unapproved COVID-19 vaccines and therapeutics through emergency use authorizations (EUA), provided there is evidence that the products may be effective and that known and potential benefits outweigh known and potential risks. For vaccines, FDA issued guidance in October 2020 to provide vaccine sponsors with recommendations regarding the evidence FDA needed to support issuance of an EUA. For therapeutics, FDA has issued four EUAs as of November 9, 2020. The evidence to support FDA's COVID-19 therapeutic authorization decisions has not always been transparent, in part because FDA does not uniformly disclose its scientific review of safety and effectiveness data for EUAs, as it does for approvals for new drugs and biologics. Given the gravity of the pandemic, it is important that FDA identify ways to uniformly disclose this information to the public. By doing so, FDA could help improve the transparency of, and ensure public trust in, its EUA decisions. The U.S. had about 10.3 million cumulative reported cases of COVID-19 and about 224,000 reported deaths as of November 12, 2020. Given this catastrophic loss of life as well as the pandemic's effects on the U.S. economy, effective and safe vaccines and therapeutics are more important than ever. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines, (1) efforts of Operation Warp Speed to accelerate COVID-19 vaccine and therapeutic development; and (2) FDA's use of EUAs for COVID-19 therapeutics and vaccines, among other objectives. GAO reviewed federal laws and agency documents, including HHS and DOD information on vaccine and therapeutic development and EUAs as of November 2020. GAO interviewed or received written responses from HHS and DOD officials, and interviewed representatives from vaccine developers and manufacturers, as well as select public health stakeholders and provider groups covering a range of provider types. FDA should identify ways to uniformly disclose to the public the information from its scientific review of safety and effectiveness data when issuing EUAs for therapeutics and vaccines. HHS neither agreed nor disagreed with the recommendation, but said it shared GAO's goal of transparency and would explore approaches to achieve this goal. For more information, contact Mary Denigan-Macauley at (202) 512-7114 or deniganmacauleym@gao.gov, or Alyssa M. Hundrup at (202) 512-7114 or hundrupa@gao.gov.
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  • Nuclear Safety: DOE and the Safety Board Should Collaborate to Develop a Written Agreement to Enhance Oversight
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    The Department of Energy's (DOE) Order 140.1 included provisions inconsistent with the Defense Nuclear Facilities Safety Board's (DNFSB) original enabling statute—the statute in place when the order was issued—and with long-standing practices. For example, GAO found that Order 140.1 contained provisions restricting DNFSB's access to information that were not included in the statute. GAO also found Order 140.1 to be inconsistent with long-standing DNFSB practices regarding staff's access to certain National Nuclear Security Administration (NNSA) meetings at the Pantex Plant in Texas, where nuclear weapons are assembled and disassembled (see fig.). In December 2019, the National Defense Authorization Act for Fiscal Year 2020 (FY20 NDAA) amended DNFSB's statute to clarify and confirm DNFSB's authority and long-standing practices between the agencies. DOE replaced Order 140.1 with Order 140.1A in June 2020. National Nuclear Security Administration's Pantex Plant, Located Near Amarillo, Texas DNFSB, DOE, and NNSA officials that GAO interviewed identified concerns with Order 140.1 that GAO found are not addressed under DOE's Order 140.1A. In particular, DOE's Order 140.1A was not part of a collaborative effort to address DNFSB's remaining concerns related to access to information and other regular interagency interactions. For example, DNFSB officials cited concerns that DOE could interpret a provision of DNFSB's statute authorizing the Secretary of Energy to deny access to information in a way that could limit DNFSB access to information to which it has had access in the past. GAO has previously recommended that agencies develop formal written agreements to enhance collaboration. By collaborating to develop an agreement that, among other things, incorporates a common understanding of this provision, DOE and DNFSB could lessen the risks of DNFSB being denied access to information important for conducting oversight. DOE and NNSA officials, as well as contractor representatives involved in operating the facilities, also raised concerns that insufficient training on Order 140.1 contributed to uncertainties about how to engage with DNFSB staff when implementing the order, a problem that GAO found could persist under Order 140.1A. Providing more robust training on Order 140.1A would help ensure consistent implementation of the revised order at relevant facilities. Established by statute in 1988, DNFSB has broad oversight responsibilities regarding the adequacy of public health and safety protections at DOE defense nuclear facilities. In May 2018, DOE issued Order 140.1, a new order governing DOE's interactions with DNFSB. DNFSB raised concerns that the order could affect its ability to perform its statutory mandate. Congressional committee reports included provisions for GAO to review DOE Order 140.1. This report examines (1) the extent to which the order was consistent with DNFSB's original enabling statute and with long-standing practices, as well as actions DOE has taken in light of changes to the statute outlined in the FY20 NDAA; and (2) outstanding areas of concern that DNFSB and DOE identified, and the potential effects of these concerns on how the two agencies cooperate. GAO reviewed legislation and agency documents; visited DOE sites; and interviewed DNFSB, DOE, and NNSA officials and contractor representatives. GAO is making a recommendation to DOE and DNFSB that they collaborate to develop a written agreement, and an additional two recommendations to DOE, including that it develop more robust training on Order 140.1A. DOE and DNFSB agreed to develop a written agreement. DOE agreed with one of the other two recommendations, but did not agree to provide more robust training. GAO maintains that the recommended action is valid. For more information, contact Allison Bawden at (202) 512-3841 or bawdena@gao.gov.
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    In U.S GAO News
    What GAO Found GAO identified 112 new actions for Congress or executive branch agencies to improve the efficiency and effectiveness of government. For example: The Office of Management and Budget should improve how agencies buy common goods and services—such as medical supplies and computers—by addressing data management challenges and establishing performance metrics to help save the federal government billions of dollars over the next 5 years, as well as potentially eliminate duplicative contracts. The Internal Revenue Service (IRS) could enhance third-party information reporting to increase compliance with tax laws and raise revenue. GAO has also previously suggested (1) providing IRS with authority—with appropriate safeguards—to correct math errors and to correct errors in cases where information provided by the taxpayer does not match information in government databases and (2) establishing requirements for paid tax return preparers to help improve the accuracy of tax returns they prepare. These actions could help reduce the substantial tax gap and increase revenues. The National Nuclear Security Administration could implement cost savings programs to operate more effectively at its nuclear laboratory and production sites to potentially save hundreds of millions of dollars over approximately a 5-year period. The Department of Defense's payments to privatized housing projects have lessened the financial effects of the housing allowance rate reductions for these projects, but revising the calculation for these payments could potentially result in millions of dollars of savings. Federal agencies could improve coordination of fragmented cybersecurity requirements and related assessment programs for state agencies, potentially minimizing the burden on states and saving millions of dollars in associated federal and state costs. The Department of Health and Human Services (HHS) could improve coordination of its infectious disease modeling efforts to better identify any duplication and overlap among agencies, which could help them to better plan for and more efficiently respond to disease outbreaks. From 2011 to 2021, GAO has identified more than 1,100 actions to reduce costs, increase revenues, and improve agencies' operating effectiveness. GAO's last report in May 2020 said progress made in addressing many of the actions identified from 2011 to 2019 had resulted in approximately $429 billion in financial benefits, including $393 billion that accrued through 2019 and $36 billion that was projected to accrue in future years. Since May 2020, at least tens of billions of dollars in additional financial benefits have been achieved. For example, based on GAO's updates for spring 2021, HHS's changes to spending limit determinations for Medicaid demonstration waivers further reduced federal spending by about $30 billion in 2019. GAO estimates that tens of billions of additional dollars could be saved should Congress and executive branch agencies fully address open actions, including those that have potential financial benefits of $1 billion or more. Why GAO Did This Study The federal government has made an unprecedented financial response to the COVID-19 pandemic. Once the pandemic recedes and the economy substantially recovers, Congress and the administration will need to develop and swiftly implement an approach to place the government on a sustainable long-term fiscal path. In the short term, opportunities exist for achieving billions of dollars in financial savings and improving the efficiency and effectiveness of a wide range of federal programs in other areas. GAO has responded with annual reports to a statutory provision for it to identify and report on federal programs, agencies, offices, and initiatives—either within departments or government-wide—that have duplicative goals or activities. GAO also identifies areas that are fragmented or overlapping, as well as additional opportunities to achieve cost savings or enhance revenue collection. This report discusses the new areas identified in GAO's 2021 annual report—the 11th in this series—and examples of open actions recommended to Congress or executive branch agencies with potential financial benefits of $1 billion or more. To identify what actions exist to address these issues, GAO reviewed and updated select prior work, including matters for congressional consideration and recommendations for executive action. For more information, contact Jessica Lucas-Judy at (202) 512-6806 or lucasjudyj@gao.gov or Michelle Sager at (202) 512-6806 or sagerm@gao.gov.
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