October 26, 2021

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Cameroonian Citizen Extradited from Romania to Face Covid-19-Related Fraud Charges

8 min read
<div>A citizen of Cameroon was extradited to the U.S. yesterday to face federal charges for his alleged involvement in a fraud scheme perpetrated against American consumers.</div>
A citizen of Cameroon was extradited to the U.S. yesterday to face federal charges for his alleged involvement in a fraud scheme perpetrated against American consumers.

More from: April 27, 2021

News Network

  • Resignation of Lebanese Prime Minister-designate Saad Hariri
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  • Coast Guard: A More Systematic Process to Resolve Recommended Actions Could Enhance Future Surge Operations
    In U.S GAO News
    What GAO Found From 2007 through 2020, the Coast Guard conducted 23 major surge operations—high-intensity, short-notice efforts to respond to catastrophic events or emergencies, such as hurricanes, oil spills, and humanitarian events. To support these surge operations, the Coast Guard deployed varying levels of personnel, aircraft, and vessels according to the events’ severity and duration. Photo of Coast Guard Personnel Responding to Hurricane Harvey (2017) The Coast Guard documents lessons learned and best practices from its major surge operations and develops recommended actions to help improve future operations. The Coast Guard also has processes for assigning recommended actions to appropriate headquarters offices and field units. However, GAO’s analysis of Coast Guard data on major surge operations shows that it has not met its goals of (1) resolving 80 percent of recommended actions or (2) resolving the actions within 18 months of being assigned. GAO analysis also found that Coast Guard headquarters offices have a higher proportion of unresolved recommended actions compared with field units. The Coast Guard Strategic Plan for 2018-2022 calls for acting on lessons learned and best practices from surge events as important factors for improving emergency management. However, the Coast Guard lacks assurance that recommended actions to address surge operation deficiencies are tracked, updated, and resolved in line with program goals. Without a more systematic process to help ensure that this occurs, the Coast Guard may not address identified issues that could affect its ability to effectively conduct future surge operations. The Coast Guard was generally able to meet statutory mission performance targets in years that it also conducted surge operations. While Coast Guard data showed variation in mission activities in years with concurrent or back-to-back surge operations, GAO was not able to determine the effect that surge operations had on mission activities because of multiple factors beyond surge operations, such as personnel transfers, that can also affect mission activities. Additionally, Coast Guard officials did not identify any statutory or regulatory impediments to the Coast Guard’s ability to conduct surge operations. Why GAO Did This Study The U.S. Coast Guard has multimission responsibilities to support response efforts and help protect life, property, and the environment. The Coast Guard must often rely on surge operations to reduce the impacts of catastrophic events, such as the Deepwater Horizon oil spill in 2010 and Hurricanes Harvey, Irma, and Maria in 2017. The William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 includes a provision for GAO to review the Coast Guard’s surge capacity to respond to catastrophic events. This report addresses (1) the number of major surge operations the Coast Guard conducted from 2007 through 2020, and what personnel and assets it used to support these operations; (2) the extent the Coast Guard documents lessons learned and best practices from its major surge operations and resolves related recommended actions; and (3) how surge operations have affected the Coast Guard's ability to conduct its statutory missions. GAO reviewed, among other things, documentation from Coast Guard surge operations from 2007 through 2020; analyzed after-action reports and performance metrics; and interviewed Coast Guard officials.
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  • High-Risk Series: Dedicated Leadership Needed to Address Limited Progress in Most High-Risk Areas
    In U.S GAO News
    Overall ratings in 2021 for 20 of GAO's 2019 high-risk areas remain unchanged, and five regressed. Seven areas improved, one to the point of removal from the High-Risk List. Two new areas are being added, bringing our 2021 High-Risk List to 36 areas. Where there has been improvement in high-risk areas, congressional actions, in addition to those by executive agencies, have been critical in spurring progress. GAO is removing Department of Defense (DOD) Support Infrastructure Management from the High-Risk List. Among other things, DOD has more efficiently utilized military installation space; reduced its infrastructure footprint and use of leases, reportedly saving millions of dollars; and improved its use of installation agreements, reducing base support costs GAO is narrowing the scope of three high-risk areas by removing segments of the areas due to progress that has been made. The affected areas are: (1) Federal Real Property (Costly Leasing) because the General Services Administration has reduced its reliance on costly leases and improved monitoring efforts; (2) DOD Contract Management (Acquisition Workforce) because DOD has significantly rebuilt its acquisition workforce; and (3) Management of Federal Oil and Gas Resources (Offshore Oil and Gas Oversight) because the Department of the Interior's Bureau of Safety and Environmental Enforcement has implemented reforms improving offshore oil and gas oversight. National Efforts to Prevent, Respond to, and Recover from Drug Misuse is being added to the High-Risk List. National rates of drug misuse have been increasing, and drug misuse has resulted in significant loss of life and harmful effects to society and the economy. GAO identified several challenges in the federal government's response, such as a need for greater leadership and coordination of the national effort, strategic guidance that fulfills all statutory requirements, and more effective implementation and monitoring. Emergency Loans for Small Businesses also is being added. The Small Business Administration has provided hundreds of billions of dollars' worth of loans and advances to help small businesses recover from adverse economic impacts created by COVID-19. While loans have greatly aided many small businesses, evidence of fraud and significant program integrity risks need much greater oversight and management attention. Nine existing high-risk areas also need more focused attention (see table). 2021 High-Risk List Areas Requiring Significant Attention High-risk areas that regressed since 2019 High-risk areas that need additional attention USPS Financial Viability IT Acquisitions and Operations Decennial Census Limiting the Federal Government's Fiscal Exposure by Better Managing Climate Change Risks Ensuring the Cybersecurity of the Nation U.S. Government's Environmental Liability Strategic Human Capital Management Improving Federal Oversight of Food Safety EPA's Process for Assessing and Controlling Toxic Chemicals   Source: GAO. | GAO-21-119SP   GAO's 2021 High-Risk List High-risk area Change since 2019 Strengthening the Foundation for Efficiency and Effectiveness Strategic Human Capital Management ↓ Managing Federal Real Propertya ↑ Funding the Nation's Surface Transportation Systemb c n/a Modernizing the U.S. Financial Regulatory Systemb ● Resolving the Federal Role in Housing Financeb ● USPS Financial Viabilityb ↓ Management of Federal Oil and Gas Resourcesa ● Limiting the Federal Government's Fiscal Exposure by Better Managing Climate Change Risksb ● Improving the Management of IT Acquisitions and Operations ● Improving Federal Management of Programs That Serve Tribes and Their Members ● Decennial Census ↓ U.S. Government's Environmental Liabilityb ● Emergency Loans for Small Businesses (new)c n/a Transforming DOD Program Management DOD Weapon Systems Acquisition ● DOD Financial Management ↑ DOD Business Systems Modernization ● DOD Approach to Business Transformation ● Ensuring Public Safety and Security Government-wide Personnel Security Clearance Processb ↑ Ensuring the Cybersecurity of the Nationb ↓ Strengthening Department of Homeland Security Management Functions ● Ensuring the Effective Protection of Technologies Critical to U.S. National Security Interests ● Improving Federal Oversight of Food Safetyb ● Protecting Public Health through Enhanced Oversight of Medical Products ● Transforming EPA's Process for Assessing and Controlling Toxic Chemicals ↓ National Efforts to Prevent, Respond to, and Recover from Drug Misuse (new)c n/a Managing Federal Contracting More Effectively VA Acquisition Managementd n/a DOE's Contract and Project Management for the National Nuclear Security Administration and Office of Environmental Management ↑ NASA Acquisition Management ↑ DOD Contract Managementa ● Assessing the Efficiency and Effectiveness of Tax Law Administration Enforcement of Tax Lawsb ● Modernizing and Safeguarding Insurance and Benefit Programs Medicare Program & Improper Paymentse ● Strengthening Medicaid Program Integrityb ● Improving and Modernizing Federal Disability Programs ● Pension Benefit Guaranty Corporation Insurance Programsb c n/a National Flood Insurance Programb ● Managing Risks and Improving VA Health Careb ↑ (↑ indicates area progressed on one or more criteria since 2019; ↓ indicates area declined on one or more criteria ; ● indicates no change; n/a = not applicable) Source: GAO. | GAO-21-119SP aRatings for a segment within this high-risk area improved sufficiently that the segment was removed. bLegislation is likely to be necessary in order to effectively address this high-risk area. cNot rated, because this high-risk area is newly added or primarily involves congressional action. dRated for the first time, because this high-risk area was newly added in 2019. eOnly rated on one segment; we did not rate other elements of the Medicare program. The federal government is one of the world's largest and most complex entities; about $6.6 trillion in outlays in fiscal year 2020 funded a broad array of programs and operations. GAO's High-Risk Series identifies government operations with vulnerabilities to fraud, waste, abuse, and mismanagement, or in need of transformation to address economy, efficiency, or effectiveness challenges. This biennial update describes the status of high-risk areas, outlines actions that are still needed to assure further progress, and identifies any new high-risk areas needing attention by the executive branch and Congress. Solutions to high-risk problems save billions of dollars, improve service to the public, and strengthen government performance and accountability. GAO uses five criteria to assess progress in addressing high-risk areas: (1) leadership commitment, (2) agency capacity, (3) an action plan, (4) monitoring efforts, and (5) demonstrated progress. This report describes GAO's views on progress made and what remains to be done to bring about lasting solutions for each high-risk area. Addressing GAO's hundreds of open recommendations across the high-risk areas and continued congressional oversight and action are essential to achieving greater progress. For more information, contact Michelle Sager at (202) 512-6806 or sagerm@gao.gov.
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  • Five Charged in Connection with COVID-Relief Fraud Scheme
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    Five individuals were charged in an indictment unsealed today for their alleged participation in a scheme to file fraudulent loan applications seeking more than $1.1 million in forgivable Paycheck Protection Program (PPP) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division and U.S. Attorney Matthew D. Krueger of the Eastern District of Wisconsin.
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  • Military Child Care: Off-Base Financial Assistance and Wait Lists for On-Base Care
    In U.S GAO News
    The Department of Defense (DOD) has reviewed the financial assistance it provides for off-base child care services and taken steps to standardize this assistance across the military services. Specifically, in August 2018, representatives of each service agreed to work toward a goal of standardizing the only element of the fee assistance calculation that varies among the services—the maximum provider rate. DOD officials said that they assess progress toward this goal each year, but have not set a definite deadline for full standardization. With respect to assistance for off-base child care at high-cost duty stations, DOD's 2020 report on its child care programs states that the Air Force, Marines, and Navy review high-cost locations annually, and the services may approve increased provider rate caps for specific high-cost locations. In addition, it states that the services may grant waivers allowing increased fee assistance for individual families experiencing hardship. DOD has also assessed factors that contribute to wait lists for on-base child care. According to DOD’s report, DOD found that wait lists are the result of a myriad of factors, including staff shortages and facility conditions that vary across service locations. Officials said DOD has worked for several years to analyze and address wait lists. In 2017, DOD launched a web portal that consolidates child care data across the services and in August 2019, DOD officials began monthly monitoring of wait list data from this portal. These data allowed DOD to identify four geographic regions and six additional locations that account for the majority of wait lists, and focus their efforts on addressing the issues affecting these regions and locations, according to the report. DOD officials said that any requests for additional resources to help address wait lists must be handled through the individual services’ budgeting processes. DOD offers child care in a variety of on- and off-base settings for children of military families. In fiscal year 2020 these child care programs received nearly $1.2 billion in federal funds; in addition, parents pay a portion of the costs. The National Defense Authorization Act for Fiscal Year 2020 required DOD to report on elements of its financial assistance to off-base child care providers and wait lists for on-base child care, and included a provision for GAO to review DOD's report. This report describes DOD's assessment of (1) financial assistance provided to off-base child care providers, and (2) its efforts to reduce wait lists for child care at military bases. GAO reviewed DOD's report on this assessment, interviewed DOD officials, and reviewed relevant federal law. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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  • Professional Standards Update No. 81
    In U.S GAO News
    To alert the audit community to changes in professional standards, we periodically issue Professional Standards Updates (PSU). These updates highlight the effective dates and issuance of recent standards and guidance related to engagements conducted in accordance with Government Auditing Standards. PSUs contain summary information only, and those affected by a change should refer to the respective standard or guidance for details. This PSU has three sections.
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  • Defense Infrastructure: Army Needs to Improve Its Facility Planning Systems to Better Support Installations Experiencing Significant Growth
    In U.S GAO News
    The Army is concurrently implementing several major force structure and basing initiatives, including Base Realignment and Closure, Grow the Force, and Army Modularity. The resulting large increase in personnel associated with these initiatives at many installations has required and will continue to require significant facility planning and construction to meet needs. GAO was asked to (1) describe the Army's investment in domestic facilities to meet the needs associated with the initiatives; (2) determine the extent to which the Army's facility planning systems are complete, current, and accurate; and (3) assess whether stationing information has been provided to installations far enough in advance to permit facility planning and acquisition to accommodate arriving personnel. To address these objectives, GAO reviewed relevant documentation; analyzed budget documents, information from Army planning systems, and facility criteria standards; visited installations; and interviewed relevant officials.For fiscal years 2006 through 2015, the Army plans to have spent about $31 billion to meet domestic installation facility needs associated with the personnel increases resulting from several major force structure and infrastructure initiatives. This investment will reduce facility shortages at the affected installations, but some shortages will still exist for certain types of facilities, including tactical vehicle maintenance facilities and battalion and company headquarters. The Army estimates that it could cost an additional $19 billion to eliminate the shortages. Yet, without these buildings, the Army will continue to rely on legacy facilities that often do not meet current Army standards or use relocatable facilities. The Army plans to evaluate these requirements and priorities in preparing future budget requests. The systems used by the Army to determine the number, type, and size of facilities needed to accommodate forces stationed at domestic installations have not always produced reliable results for some types of facilities because the systems have often relied on data that are not complete, current, or accurate. GAO examined the criteria system for 62 essential facility types and found that the system did not include the Army's current standard design criteria for 51 of the 62 facilities. Without current criteria embedded into the facility planning systems, the systems cannot help planners accurately calculate facility requirements. Additionally, GAO found that the automated calculations that produce facility allowances--a baseline for determining facility requirements--were questionable in several cases, such as producing a requirement for 74 baseball fields for Fort Bragg. Moreover, because the information from the planning systems is used to identify facility shortages and support budget decisions, incomplete, out-of-date, or inaccurate data could adversely affect management decisions about the construction and renovation of facilities. The Army has not always provided installation planners with information on stationing actions far enough in advance to allow the installations to prepare the permanent facilities necessary for arriving personnel. Army guidance recommends 5 years' lead time for submitting stationing packages for approval that require new construction; however, the size of ongoing operations in Iraq and Afghanistan, which has led to an increase in the movement of Army personnel, has made this difficult. For example, GAO found cases where installations were informed of stationing decisions with less than a year's notice, which installation officials said was far less time than needed to prepare the required facilities. As a result, new facilities have not always been available for arriving units and installations have had to employ interim measures, such as using relocatable facilities or using sustainment funds to build facilities, which, in turn, could result in needed sustainment work going unmet. GAO also found that installations were not always being notified when proposed stationing actions had been delayed or canceled, potentially leading to funds being wasted on unnecessary preparations.
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  • 5G Wireless: Capabilities and Challenges for an Evolving Network
    In U.S GAO News
    Fifth-generation (5G) wireless networks promise to provide significantly greater speeds and higher capacity to accommodate more devices. In addition, 5G networks are expected to be more flexible, reliable, and secure than existing cellular networks. The figure compares 4G and 5G performance goals along three of several performance measures. Note: Megabits per second (Mbps) is a measure of the rate at which data is transmitted, milliseconds (ms) is a measure of time equal to one thousandth of a second, and square kilometer (km²) is a measure of area. As with previous generations of mobile wireless technology, the full performance of 5G will be achieved gradually as networks evolve over the next decade. Deployment of 5G network technologies in the U.S. began in late 2018, and these initial 5G networks focus on enhancing mobile broadband. These deployments are dependent on the existing 4G core network and, in many areas, produced only modest performance improvements. To reach the full potential of 5G, new technologies will need to be developed. International bodies that have been involved in defining 5G network specifications will need to develop additional 5G specifications and companies will need to develop, test, and deploy these technologies. GAO identified the following challenges that can hinder the performance or usage of 5G technologies in the U.S. GAO developed six policy options in response to these challenges, including the status quo. They are presented with associated opportunities and considerations in the following table. The policy options are directed toward the challenges detailed in this report: spectrum sharing, cybersecurity, privacy, and concern over possible health effects of 5G technology. Policy options to address challenges to the performance or usage of U.S. 5G wireless networks Policy Option Opportunities Considerations Spectrum-sharing technologies (report p. 47) Policymakers could support research and development of spectrum sharing technologies. Could allow for more efficient use of the limited spectrum available for 5G and future generations of wireless networks. It may be possible to leverage existing 5G testbeds for testing the spectrum sharing technologies developed through applied research. Research and development is costly, must be coordinated and administered, and its potential benefits are uncertain. Identifying a funding source, setting up the funding mechanism, or determining which existing funding streams to reallocate will require detailed analysis. Coordinated cybersecurity monitoring (report p. 48) Policymakers could support nationwide, coordinated cybersecurity monitoring of 5G networks. A coordinated monitoring program would help ensure the entire wireless ecosystem stays knowledgeable about evolving threats, in close to real time; identify cybersecurity risks; and allow stakeholders to act rapidly in response to emerging threats or actual network attacks. Carriers may not be comfortable reporting incidents or vulnerabilities, and determinations would need to be made about what information is disclosed and how the information will be used and reported. Cybersecurity requirements (report p. 49) Policymakers could adopt cybersecurity requirements for 5G networks. Taking these steps could produce a more secure network. Without a baseline set of security requirements the implementation of network security practices is likely to be piecemeal and inconsistent. Using existing protocols or best practices may decrease the time and cost of developing and implementing requirements. Adopting network security requirements would be challenging, in part because defining and implementing the requirements would have to be done on an application-specific basis rather than as a one-size-fits-all approach. Designing a system to certify network components would be costly and would require a centralized entity, be it industry-led or government-led. Privacy practices (report p. 50) Policymakers could adopt uniform practices for 5G user data. Development and adoption of uniform privacy practices would benefit from existing privacy practices that have been implemented by states, other countries, or that have been developed by federal agencies or other organizations. Privacy practices come with costs, and policymakers would need to balance the need for privacy with the direct and indirect costs of implementing privacy requirements. Imposing requirements can be burdensome, especially for smaller entities. High-band research (report p. 51) Policymakers could promote R&D for high-band technology. Could result in improved statistical modeling of antenna characteristics and more accurately representing propagation characteristics. Could result in improved understanding of any possible health effects from long-term radio frequency exposure to high-band emissions. Research and development is costly and must be coordinated and administered, and its potential benefits are uncertain. Policymakers will need to identify a funding source or determine which existing funding streams to reallocate. Status quo (report p. 52) Some challenges described in this report may be addressed through current efforts. Some challenges described in this report may remain unresolved, be exacerbated, or take longer to resolve than with intervention. GAO was asked to assess the technologies associated with 5G and their implications. This report discusses (1) how the performance goals and expected uses are to be realized in U.S. 5G wireless networks, (2) the challenges that could affect the performance or usage of 5G wireless networks in the U.S., and (3) policy options to address these challenges. To address these objectives, GAO interviewed government officials, industry representatives, and researchers about the performance and usage of 5G wireless networks. This included officials from seven federal agencies; the four largest U.S. wireless carriers; an industry trade organization; two standards bodies; two policy organizations; nine other companies; four university research programs; the World Health Organization; the National Council on Radiation Protection and Measurements; and the chairman of the Defense Science Board's 5G task force. GAO reviewed technical studies, industry white papers, and policy papers identified through a literature review. GAO discussed the challenges to the performance or usage of 5G in the U.S. during its interviews and convened a one-and-a-half day meeting of 17 experts from academia, industry, and consumer groups with assistance from the National Academies of Sciences, Engineering, and Medicine. GAO received technical comments on a draft of this report from six federal agencies and nine participants at its expert meeting, which it incorporated as appropriate. For more information, contact Hai Tran at (202) 512-6888, tranh@gao.gov or Vijay A. D’Souza at (202) 512-6240, dsouzav@gao.gov.
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  • Navy Ships: Timely Actions Needed to Improve Planning and Develop Capabilities for Battle Damage Repair
    In U.S GAO News
    What GAO Found The Navy has identified several challenges with using its regular maintenance capability (which restores ships to fully operational status) to provide battle damage repairs during a great power conflict. Challenges include—the lack of established doctrine for battle damage repair, unclear command and control roles, and a shortage of repair capacity. The Navy Process for Repairing Ships Damaged in Battle The Navy is in the early stages of determining how it will provide battle damage repair during a great power conflict. Eight organizations are responsible for the Navy's 15 battle damage repair planning efforts, however the Navy has not designated an organization to lead and oversee these efforts. Without designated leadership, the Navy may be hindered in its efforts to address the many challenges it faces in sustaining its ships during a great power conflict. The Navy develops ship vulnerability models during a ship's acquisition to estimate damage during a conflict. These models are also used to inform war games that refine operational approaches and train leaders on decision-making. However, the Navy does not update these models over a ship's decades-long service life to reflect changes to key systems that could affect model accuracy. As a result, it lacks quality data on ship mission-critical failure points to inform its analysis of battle damage repair needs. Without periodically assessing and updating its models to accurately reflect the ship's mission-critical systems, the Navy has limited its ability to assess and develop battle damage repair capabilities necessary to sustain ships in a conflict with a great power competitor. Why GAO Did This Study The ability to repair and maintain ships plays a critical role in sustaining Navy readiness. After the Cold War, the Navy divested many wartime ship repair capabilities. With the rise of great power competitors capable of producing high-end threats in warfare, the Navy must now be prepared to quickly salvage and repair damage to a modern fleet. House Report 116-120, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, included a provision for GAO to assess the Navy's efforts to identify and mitigate challenges in repairing battle-damaged ships during a great power conflict. GAO's report (1) discusses the challenges the Navy has identified in using its regular maintenance capability for battle damage repair, and (2) evaluates the extent to which the Navy has begun developing the battle damage repair capability it requires to prevail in a great power conflict. GAO reviewed relevant guidance and assessed reports on naval war games and other documentation to identify challenges that may impede the planning and repair of battle-damaged ships and efforts to improve the repair capability for a great power conflict.
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  • Medicare Severe Wound Care: Spending Declines May Reflect Site of Care Changes; Limited Information Is Available on Quality
    In U.S GAO News
    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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  • Capital Fund Proposal: Upfront Funding Could Benefit Some Projects, but Other Potential Effects Not Clearly Identified
    In U.S GAO News
    What GAO Found Federal agencies have long struggled to obtain full, upfront funding for capital investments to acquire and maintain federal buildings. GAO's review of three selected federal capital projects suggests that such funding might have benefitted those projects and their agencies. For example, GAO estimated that full, upfront funding for the Department of Transportation's headquarters building might have saved up to $1.2 billion by allowing construction of a new headquarters versus what did occur—the General Services Administration (GSA) leased space for years and eventually purchased the building that it had leased. U. S. Department of Transportation's (DOT) Headquarters Washington D. C. In an effort to improve federal agencies' access to full, upfront funding for capital investments, the Office of Management and Budget (OMB) proposed the $10 billion Federal Capital Revolving Fund Act of 2018 (Capital Fund). The Capital Fund, which would be administered by GSA, could provide upfront funding for certain capital projects of $250 million or more, with agencies repaying the Capital Fund over a 15-year period. While the 2018 Capital Fund proposal has not been enacted, a Capital Fund was referenced in each of the President's budgets since 2019 and in a bill that was introduced in the Senate in May 2021. During the course of GAO's review, officials from GSA and OMB expressed different perspectives on the proposed Capital Fund, and how it might affect the existing Federal Buildings Fund (Buildings Fund) is unclear. GSA officials said that the proposed Capital Fund could divert revenue away from the existing Buildings Fund, which receives rent from GSA tenant agencies and from which GSA pays maintenance and repair costs. OMB officials told us that the Capital Fund could benefit the Buildings Fund by promoting federal ownership over leasing and possibly adding assets to GSA's inventory. GAO identified additional circumstances in which the Capital Fund could affect the Buildings Fund. For example, while the tenant agency would pay operating costs during the first 25-years, the proposal does not directly address what would occur if GSA incurred significant repair costs during this period. As GSA would administer the Capital Fund and manage the Buildings Fund, it is in the best position to analyze when these circumstances might occur and their potential scope as well as how the two funds might interact. Identifying and communicating the possible effects would help OMB and Congress more fully consider legislative proposals. Why GAO Did This Study Since 2003, federal real property management has been on GAO's High-Risk List, in part due to upfront- funding challenges. If enacted, the Capital Fund could provide upfront funding to agencies for certain projects to acquire, construct, or renovate buildings and other federal real property. The existing Buildings Fund funds such projects and the operations and maintenance needs of GSA's portfolio. GAO was asked to review the Capital Fund proposal. This report: (1) describes how federal agencies might have used expanded access to full, upfront funding had it been available, for three selected projects and (2) assesses stakeholder views on the proposed Capital Fund and whether it would affect the Buildings Fund. To assess how agencies might have used full, upfront funding, GAO reviewed three recent capital projects of $250 million or more, selected for the differences in type of project (i.e., acquisition, new construction, and renovation). GAO also analyzed the Capital Fund proposal, GSA's budget, and other documents. Additionally, GAO interviewed GSA and OMB officials.
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  • Priority Open Recommendations: Board of Governors of the Federal Reserve System
    In U.S GAO News
    What GAO Found In April 2020, GAO identified eight priority recommendations for the Federal Reserve. Since then, the Federal Reserve has implemented five of those recommendations. As of April 2021, the remaining open three priority recommendations for the Federal Reserve involve the following areas: Collaborating with other financial regulators to communicate with banks that have third-party relationships with fintech lenders about using alternative data in underwriting. Communicating uncertainties surrounding stress testing, including capital ratio estimates. Communicating uncertainties surrounding stress testing, including tolerance levels for key risks, and the degree of uncertainty in projected estimates. The Federal Reserve's continued attention to these issues could improve its ability to more effectively oversee risks to consumers and the safety and soundness of the U.S. banking system. Why GAO Did This Study Priority open recommendations are GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional or executive branch decision-making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015 GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, contact Daniel Garcia-Diaz at (202) 512-8678 or garciadiazd@gao.gov.
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