CEO Sentenced to Prison in $150 Million Health Care Fraud, Opioid Distribution, and Money Laundering Scheme

The chief executive officer of a Michigan and Ohio-based group of pain clinics and other medical providers was sentenced today to 15 years in prison for developing and approving a corporate policy to administer unnecessary back injections to patients in exchange for prescriptions of over 6.6 million doses of medically unnecessary opioids.

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    In Crime News
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    According to the Transportation Security Administration (TSA) Surface Transportation Security Inspector Operations Plan (TSA's plan), surface transportation security inspectors—known as surface inspectors—are to enter key details for program activities in the Performance and Results Information System (PARIS)—TSA's system of record for all surface inspector activities. In December 2017, GAO reported that TSA was unable to fully account for surface inspector time spent assisting with non-surface transportation modes, including aviation, due to data limitations in PARIS, and recommended TSA address these limitations. Since GAO's report, TSA updated PARIS to better track surface inspector activities in non-surface transportation modes. Transportation Security Administration Surface Inspectors Assess Security of a Bus System TSA's plan outlines steps to align work plan activities with risk assessment findings. However, TSA cannot comprehensively ensure surface inspectors are targeting program resources to high-risk modes and locations because it does not consistently collect information on entity mode or location in PARIS. According to officials, TSA plans to update PARIS and program guidance to require inspectors to include this information in the system by the end of fiscal year 2020. TSA's plan outlines performance measures for the surface inspector program, but does not establish quantifiable performance targets for all activities. Targets indicate how well an agency aspires to perform and could include, for example, entity scores on TSA security assessments, among others. By developing targets, TSA would be better positioned to assess the surface inspector program's progress in achieving its objective of increasing security among surface transportation entities. Surface transportation—freight and passenger rail, mass transit, highway, maritime and pipeline systems—is vulnerable to global terrorism and other threats. TSA is the federal agency primarily responsible for securing surface transportation systems. The FAA Reauthorization Act of 2018 requires TSA to submit a plan to guide its Surface Transportation Security Inspectors Program. The Act includes a provision for GAO to review TSA's plan. This report examines the extent to which TSA's plan and its implementation: (1) address known data limitations related to tracking surface inspector activities among non-surface modes, (2) align surface operations with risk assessments, and how, if at all, TSA ensures inspectors prioritize activities in high-risk modes and locations, and (3) establish performance targets for the surface inspector program. GAO reviewed TSA's June 2019 plan and analyzed data on inspector activities for fiscal years 2017 through 2019. GAO interviewed officials in headquarters and a non-generalizable sample of 7 field offices selected based on geographical location and the presence of high-risk urban areas. GAO recommends that TSA establish quantifiable performance targets for the surface inspector program's activity-level performance measures. DHS concurred with our recommendation. For more information, contact Triana McNeil at (202) 512-8777 or McNeilT@gao.gov.
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  • Comparative Effectiveness Research: Patient-Centered Outcomes Research Institute and HHS Continue Activities and Plan New Efforts
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    GAO found that the Patient-Centered Outcomes Research Institute (PCORI)—a federally funded, nonprofit corporation—and the Department of Health and Human Services (HHS) have continued to perform comparative clinical effectiveness research (CER) activities required by law since our prior report issued in 2015. CER evaluates and compares health outcomes, risks, and benefits of medical treatments, services, or items. The requirements direct PCORI and HHS to, among other things, fund CER and disseminate and facilitate the implementation of CER findings. GAO's analysis of PCORI and HHS documents show that they allocated a total of about $3.6 billion for CER activities and program support during fiscal years 2010 through 2019 from the Patient Centered Outcomes Research Trust Fund (Trust Fund). Specifically, PCORI allocated about $2 billion for research awards and another $542 million for other awards, to be paid over multiple years. HHS allocated about $598 million for activities such as the dissemination and implementation of CER findings. PCORI and HHS also allocated about $470 million for program support. PCORI and HHS Allocations for Comparative Clinical Effectiveness Research (CER) Activities, Fiscal Years 2010 through 2019 aTotals may not add up due to rounding. bPCORI and HHS allocated $457 million and $13 million for program support, respectively. PCORI assessed the effectiveness of its activities using performance measures and targets. Since fiscal year 2017, when early CER projects were completed, PCORI officials reported that the institute met its performance targets, such as an increased number of research citations of its CER findings in news and online sources. HHS described accomplishments or assessed the effectiveness of its dissemination and implementation activities. PCORI and HHS officials told GAO they are planning comprehensive evaluations of their CER dissemination and implementation activities as part of their strategic plans for the next 10 years. The 2010 Patient Protection and Affordable Care Act (PPACA) authorized establishment of PCORI to conduct CER and improve its quality and relevance. PPACA also established new requirements for HHS to, among other things, disseminate findings from federally funded CER and coordinate federal programs to build data capacity for this research. To fund CER activities, PPACA established the Trust Fund, which provided a total of about $3.6 billion to PCORI and HHS for CER activities during fiscal years 2010 through 2019. The Further Consolidated Appropriations Act, 2020, added new CER requirements and extended funding at similar levels through fiscal year 2029. PPACA and the Appropriations Act 2020 included provisions that GAO review PCORI and HHS's CER activities. This report describes (1) the CER activities PCORI and HHS carried out to meet legislative requirements, (2) how PCORI and HHS allocated funding to those CER activities, and (3) PCORI and HHS efforts to evaluate the effectiveness of their CER dissemination and implementation activities, such as changes in medical practice. GAO reviewed legislative requirements and PCORI and HHS documentation and data for fiscal years 2010-2019. GAO also interviewed PCORI and HHS officials and obtained information from nine selected stakeholder groups that were familiar with PCORI's or HHS's CER activities. These groups included payer, provider, and patient organizations. GAO incorporated technical comments from PCORI and HHS as appropriate. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.
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    In U.S GAO News
    What GAO Found In 2020, the majority of which was affected by the COVID-19 pandemic, the U.S. Postal Service (USPS) experienced a 9 percent drop in total mail volume when compared to 2019. The overall drop was primarily due to a 4 percent dip in First-Class Mail and a 14 percent decline in Marketing Mail (such as advertisements). Despite a drop in total volume, 2020 package volume rose by 32 percent. A surge of election-related mail caused a temporary spike in total mail volume in September and October 2020, before falling again by year end. Overall, USPS's nationwide on-time performance fell in 2020. Average monthly on-time performance for First-Class Mail decreased from 92 percent in 2019 to 87 percent in 2020. However, decreases were more significant in certain USPS districts at different times, and nationally in December 2020. On-time performance was 48 percent in New York in April and 61 percent in Baltimore in September—both of which were nearly 90 percent prior to the pandemic (see figure). Further, national on-time performance dipped to 69 percent in December. In February 2021, the Postmaster General stated that on-time performance was affected by employees' decreased availability in COVID-19 hot spots and a surge in holiday package volume. 2020 Average Monthly On-Time Performance for First-Class Mail in Baltimore, Detroit, and New York Postal Districts USPS's revenue increased in 2020 but not enough to avoid a net loss of $8.1 billion. Rapid growth and price increases for packages, resulted in a net revenue increase of $4.3 billion. However, USPS's expenses grew by $4.4 billion, including COVID-19 related expenses, such as personal protective equipment. USPS took some cost-reduction actions in 2020 and released a new strategic plan in March 2021 that also has cost-reduction actions. In May 2020, GAO concluded that absent congressional action to transform USPS, USPS's financial problems would worsen, putting its mission and financial solvency in greater peril. The further deterioration of USPS's financial position since the start of the pandemic makes the need for congressional action even more urgent. Why GAO Did This Study USPS plays a critical role in the nation's communications and commerce. However, USPS's financial viability is not on a sustainable path and has been on GAO's High Risk List since 2009. The COVID-19 pandemic has highlighted the role of USPS in the nation's economy as well as USPS's financial difficulties. Responding to these concerns, the CARES Act, as amended in late 2020, provided USPS up to $10 billion in additional funding. The CARES Act included a provision for GAO to report on its monitoring and oversight efforts related to the COVID-19 pandemic. This report examines changes in USPS's (1) mail volume, (2) on-time performance, and (3) revenue and expenses from January through December 2020. GAO analyzed USPS mail volume, on-time performance, revenue, and expense data by month for 2020, and compared these data to similar data for 2019. GAO also reviewed its prior work, including its May 2020 report. That report had three matters for congressional consideration on: (1) determining the level of postal services, (2) the extent to which those services should be financially self-sustaining, and (3) the appropriate institutional structure of USPS. GAO also reviewed reports by USPS and the USPS Inspector General. Finally, GAO interviewed USPS officials, two package delivery companies that compete with USPS, and representatives from four mailing associations whose members send the types of mail with the highest volumes in 2020. For more information, contact Jill Naamane at (202) 512-2834 or naamanej@gao.gov.
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    In U.S GAO News
    The approach followed by the Social Security Administration (SSA) in awarding and overseeing contracts generally aligns with the requirements GAO reviewed. For the 27 contracts and orders GAO reviewed, SSA varied its approach depending on the contract type used and the dollar value. For example, one of SSA's written acquisition plans acknowledged the risks to the government associated with time-and-materials contracts. From fiscal year 2015 through 2019, SSA obligated 22.7 percent of its contract dollars on time-and-material contracts compared with 10.5 percent at other civilian agencies. In addition, from fiscal year 2015 through 2019, the rate at which SSA used competitive award procedures to achieve the best value for the agency increased by nearly 20 percentage points. This increase was the result of the agency's increased use of competition in its contracting for information technology (IT). SSA relies heavily on IT resources to support the administration of its programs and related activities. During fiscal years 2015 through 2019, about 65 percent of the $8.3 billion in contract obligations were for IT goods and services compared with about 16 percent at other civilian agencies. The figure shows the percentage of obligations for IT goods and services at SSA. Percentage of Social Security Administration's Contract Obligations for Goods and Services during Fiscal Years 2015 through 2019 SSA adopted an Agile approach to software development for some of its critical IT programs in 2015. An Agile approach to software development involves incremental improvements to software rather than the more traditional single-track approach. Subsequently, SSA developed an IT modernization plan in 2017 that states SSA will use an Agile methodology. GAO's draft Agile Assessment Guide states that an organization's acquisition policies and guidance should support an Agile development approach and identify clear roles for contracting personnel, since this is a different approach than federal agencies previously used. However, GAO found SSA's acquisition handbook does not specifically identify a role for contracting personnel with respect to contracts and task orders involving Agile, which GAO has identified as a leading practice. Identifying a role for contracting personnel in the Agile process should better position SSA to achieve its IT modernization goals and provide appropriate levels of oversight. SSA is responsible for delivering services that touch the lives of virtually every American. To do so, SSA relies on a variety of products and services, including information technology (IT) systems. SSA obligates approximately $1.5 billion annually to procure goods and services, 65 percent of which are IT-related. GAO was asked to assess how SSA implements its contracting and acquisition processes. This report examines: (1) how SSA awards and oversees contracts for products and services, and (2) the extent to which SSA has updated its guidance regarding the role of contracting personnel in software development efforts. GAO reviewed SSA's acquisition policies, interviewed contracting officials, and reviewed a non-generalizable sample of 27 high- and lower value contracts and orders with dollars obligated in fiscal years 2014 through 2018. GAO also examined data from fiscal years 2015-2019 to determine what SSA contracted for and reviewed IT guidance. GAO compared SSA's practices to leading practices for Agile software development with respect to the roles of contracting personnel. GAO recommends that SSA revise relevant guidance to identify the roles of contracting personnel in Agile software development. SSA agreed with this recommendation. For more information, contact William Woods at (202) 512-4841 or woodsw@gao.gov.
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    In U.S GAO News
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    In U.S GAO News
    Four components—Transportation Security Administration, Coast Guard, Customs and Border Protection, and the Countering Weapons of Mass Destruction Office—within the Department of Homeland Security (DHS) implemented the process to formally nominate and designate Component Acquisition Executives (CAE). However, four of the five individuals filling the CAE role—three as acting CAE—in the Management Directorate have not been subjected to this process (see figure). The process, described in guidance, entails preparing a nomination package for DHS to vet candidates' qualifications against criteria, and designating the selected individual in writing. Nomination and Designation Status of Department of Homeland Security's Management Directorate Component Acquisition Executives as of April 2020 Note: Non-major acquisitions are those with an expected life-cycle cost of less than $300 million. DHS indicated that the direct reporting relationship of acting CAEs to the DHS Chief Acquisition Officer makes designating CAEs in the Management Directorate through this process unnecessary. Without using the nomination and designation process, DHS officials lack a standard way to gain insight into the background of the acting CAEs and whether any gaps in experience need to be mitigated. For example, the CAE for the Coast Guard was nominated and designated, but the CAE did not have the acquisition experience that guidance suggests for the position. In the nomination documentation, the Coast Guard identified this issue and described the experienced staff that will support the nominated CAE. However, DHS cannot be confident that the acting CAEs in the Management Directorate are taking mitigation steps, because they have not been subject to this process. Until DHS consistently executes the nomination and designation process described in its guidance, the Chief Acquisition Officer cannot be assured that all acquisition programs are receiving oversight by individuals qualified for the CAE position. DHS invests billions of dollars each year in its major acquisition programs—such as systems to help secure the border, increase marine safety, and screen travelers—to help execute its many critical missions. In fiscal year 2020 alone, DHS planned to spend more than $10 billion on major acquisition programs, and ultimately the department plans to invest more than $200 billion over the life cycle of these programs. A critical aspect of DHS's acquisition process is oversight of this portfolio by the CAEs. Most CAEs are senior acquisition officials below the department level, within the components. The CAEs have oversight responsibilities over the components' major and non-major acquisition programs, among other duties. GAO was asked to review DHS's CAE functions. This report assesses the extent to which selected CAEs are nominated and designated to execute oversight responsibilities, among other objectives. GAO selected five DHS components, including the department-level Management Directorate, based, in part, on their number and type of acquisitions. GAO reviewed DHS's acquisition policy, guidance and documentation from the selected DHS components and interviewed CAEs, CAE support staff, and other DHS officials. GAO is making four recommendations, including that DHS execute the CAE nomination and designation process consistently as defined in its guidance. DHS concurred with all four recommendations. For more information, contact Marie A. Mak at (202) 512-4841 or makm@gao.gov.
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    In U.S GAO News
    What GAO Found Individuals who receive assistance from the federal Supplemental Security Income (SSI) program may also become eligible for Medicaid. SSI provides cash assistance to eligible individuals who are over age 65, blind, or disabled; and who have limited resources (i.e., assets) and income. Medicaid programs in 42 states and the District of Columbia use the SSI asset limit of $2,000 for an individual or $3,000 for a married couple. Medicaid programs in the remaining eight states may set an asset limit that differs from the current SSI asset limit. The Social Security Administration (SSA), which administers the SSI program, and state Medicaid programs electronically verify the assets of these individuals when determining financial eligibility: In the 42 states and the District of Columbia that use the SSI asset limit, SSA is the entity that verifies applicants' assets. SSA has two data sources to detect assets among SSI beneficiaries. The first data source is the Access to Financial Institutions initiative. This initiative verifies reported bank accounts and can detect potential undisclosed accounts from financial institutions within geographic proximity of an SSI recipient's residence. The second data source is Non-home Real Property, which uses a commercial data source to help investigate potential ownership of real property other than a primary residence. In the eight states that may set their own asset limits, the state's Medicaid program must verify Medicaid eligibility for SSI recipients using an electronic asset verification system (AVS). An AVS provides a portal between state eligibility systems and banks or other third-party systems with electronic access to financial information. Once a state has an AVS in place, state eligibility workers can submit a request through the portal to perform an asset check for a Medicaid applicant. The request is sent to different financial institutions. A vendor gathers the information from the financial institutions and returns it to the state, and eligibility workers use the information to make an eligibility determination. Some states also use their AVS to check on applicants' property information, which may come from commercial data sources. Why GAO Did This Study GAO was asked to review the use of electronic asset verification to determine eligibility for selected Medicaid beneficiaries. This report provides an overview of what is known about how state Medicaid programs verify assets of applicants who are eligible because they receive SSI, and how SSA verifies assets of SSI applicants, among other issues. To describe what is known about how state Medicaid programs and SSA verify applicants' assets, GAO reviewed its prior work, as well as related research by other organizations. GAO also obtained input from officials from the Centers for Medicare & Medicaid Services and SSA; and reviewed relevant federal laws, regulations, and guidance. The Department of Health and Human Services and SSA reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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  • General Aviation: Stakeholders Expressed Mixed Views of FAA Policies on Private Pilot Expense Sharing
    In U.S GAO News
    The Federal Aviation Administration's (FAA) primary rationale for its policies on private pilots' sharing expenses with passengers is based on passenger expectations of safety. FAA policies allow private pilots to share the cost of certain flight expenses with passengers but prohibit these pilots from engaging in “common carriage,” which is communicating to the public a willingness to fly in exchange for compensation. These policies generally prohibit pilots from using the internet to find passengers. FAA officials said these policies are in place because they are concerned the public might expect a similar level of safety on private expense-sharing flights as commercial flights. However, the safety record of commercial aviation is better than that of private flying (general aviation). For example, according to data from the National Transportation Safety Board (NTSB), commercial carriers had a fatal accident rate around 30 times lower than general aviation in 2018. FAA officials said their goal for FAA's 2020 guidance on expense sharing was to restate and clarify existing policies. Example of an Aircraft Private Pilots Could Use for Expense-Sharing Flights Stakeholders described benefits of expense sharing but expressed mixed views on FAA's policies and guidance. For example, stakeholders cited potential economic benefits to the general aviation sector and a potential expansion of the pool of future professional pilots as benefits of expense sharing. Most (eight of 13) stakeholders said FAA's 2020 guidance on expense-sharing is clear and provides sufficient information. However, some stakeholders said the guidance could provide more definitive examples of allowed expense-sharing flights, and others disagreed with how FAA defined certain concepts such as how pilots can be compensated for flying passengers. Also, stakeholders split on whether FAA should allow pilots to use the internet to find expense-sharing passengers. Seven of 15 stakeholders, including four representatives from companies with expense-sharing applications, said FAA should allow pilots to use the internet to find these passengers by citing, for example, ongoing positive experiences in Europe. However, eight stakeholders, including six of seven professional organizations, said FAA should not. These stakeholders cited safety-related risks of expense sharing including what they characterized as FAA's limited capacity to enforce current regulations and flights using less experienced pilots. Private flying is expensive, and FAA allows private pilots to reduce their costs by carrying passengers and sharing certain flight expenses with them. However, private pilots cannot engage in common carriage. If pilots do engage in common carriage, they are subject to FAA's more stringent regulations covering commercial air carriers. Some private pilots have sought to use internet applications to find expense-sharing passengers. The FAA Reauthorization Act of 2018 directed FAA to issue advisory guidance clarifying how private pilots may share expenses. In February 2020, FAA released this guidance as an advisory circular. The Act also includes a provision for GAO to review FAA's policies on expense sharing. This report describes: (1) FAA's rationale for its policies on how private pilots may find expense-sharing passengers and (2) selected stakeholder perspectives on FAA's policies and the risks and benefits of arranging these expense-sharing flights online. GAO interviewed FAA officials on how FAA developed its policies and guidance related to expense sharing. GAO also reviewed FAA's data on enforcement actions related to expense sharing and safety data from NTSB. In addition, GAO interviewed a non-generalizable sample of 15 private-sector stakeholders, including professional organizations, such as trade groups representing general aviation pilots, companies that developed expense-sharing internet applications, and flying clubs. For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.
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