Compounding Pharmacy Mogul Sentenced for Multimillion-Dollar Health Care Fraud Scheme

A Mississippi businessman was sentenced today for his role in a multimillion-dollar scheme to defraud TRICARE, the health care benefit program serving U.S. military, veterans, and their respective family members, as well as private health care benefit programs.

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    Federal entities have a variety of roles and responsibilities for supporting efforts to enhance the cybersecurity of the nation. Among other things, 23 federal entities have roles and responsibilities for developing policies, monitoring critical infrastructure protection efforts, sharing information to enhance cybersecurity across the nation, responding to cyber incidents, investigating cyberattacks, and conducting cybersecurity-related research. To fulfill their roles and responsibilities, federal entities identified activities undertaken in support of the nation's cybersecurity. For example, National Security Council (NSC) staff, on behalf of the President, and the National Institute of Standards and Technology, have developed policies, strategies, standards, and plans to guide cybersecurity efforts. The Department of Homeland Security has helped secure the nation's critical infrastructure through developing security policy and coordinating security initiatives, among other efforts. Other agencies have established initiatives to gather intelligence and share actual or possible cyberattack information. Multiple agencies have mechanisms in place to assist in responding to cyberattacks, and law enforcement components, including the Federal Bureau of Investigation, are responsible for investigating them. The White House's September 2018 National Cyber Strategy and the NSC's accompanying June 2019 Implementation Plan detail the executive branch's approach to managing the nation's cybersecurity. When evaluated together, these documents addressed several of the desirable characteristics of national strategies, but lacked certain key elements for addressing others. National Cyber Strategy and Implementation Plan are Missing Desirable Characteristics of a National Strategy Characteristic Cyber Strategy and Plan Coverage of Issue Purpose, scope, and methodology Addressed Organizational roles, responsibilities, and coordination Addressed Integration and implementation Addressed Problem definition and risk assessment Did not fully address Goals, subordinate objectives, activities, and performance measures Did not fully address Resources, investments, and risk management Did not fully address Source: GAO analysis of 2018 National Cyber Strategy and 2019 Implementation Plan . | GAO-20-629 For example, the Implementation Plan details 191 activities that federal entities are to undertake to execute the priority actions outlined in the National Cyber Strategy. These activities are assigned a level, or tier, based on the coordination efforts required to execute the activity and the extent to which NSC staff is expected to be involved. Thirty-five of these activities are designated as the highest level (tier 1), and are coordinated by a functional entity within the NSC . Ten entities are assigned to lead or co-lead these critical activities while also tasked to lead or co-lead lower tier activities. Leadership Roles for Federal Entities Assigned as Leads or Co-Leads for National Cyber Strategy Implementation Plan Activities Entity Tier 1 Activities Tier 2 Activities Tier 3 Activities National Security Council 15 7 3 Department of Homeland Security 14 19 15 Office of Management and Budget 7 6 5 Department of Commerce 5 9 35 Department of State 2 5 11 Department of Defense 1 6 17 Department of Justice 1 10 5 Department of Transportation 1 0 5 Executive Office of the President 1 0 0 General Services Administration 1 2 1 Source: GAO analysis of 2018 National Cyber Strategy and 2019 Implementation Plan . | GAO-20-629 Although the Implementation Plan defined the entities responsible for leading each of the activities; it did not include goals and timelines for 46 of the activities or identify the resources needed to execute 160 activities. Additionally, discussion of risk in the National Cyber Strategy and Implementation Plan was not based on an analysis of threats and vulnerabilities. Further, the documents did not specify a process for monitoring agency progress in executing Implementation Plan activities. Instead, NSC staff stated that they performed periodic check-ins with responsible entities, but did not provide an explanation or definition of specific level of NSC staff involvement for each of the three tier designations. Without a consistent approach to engaging with responsible entities and a comprehensive understanding of what is needed to implement all 191 activities, the NSC will face challenges in ensuring that the National Cyber Strategy is efficiently executed. GAO and others have reported on the urgency and necessity of clearly defining a central leadership role in order to coordinate the government's efforts to overcome the nation's cyber-related threats and challenges. The White House identified the NSC staff as responsible for coordinating the implementation of the National Cyber Strategy . However, in light of the elimination of the White House Cybersecurity Coordinator position in May 2018, it remains unclear which official ultimately maintains responsibility for not only coordinating execution of the Implementation Plan , but also holding federal agencies accountable once activities are implemented. NSC staff stated responsibility for duties previously attributed to the White House Cyber Coordinator were passed to the senior director of NSC's Cyber directorate; however, the staff did not provide a description of what those responsibilities include. NSC staff also stated that federal entities are ultimately responsible for determining the status of the activities that they lead or support and for communicating implementation status to relevant NSC staff. However, without a clear central leader to coordinate activities, as well as a process for monitoring performance of the Implementation Plan activities, the White House cannot ensure that entities are effectively executing their assigned activities intended to support the nation's cybersecurity strategy and ultimately overcome this urgent challenge. Increasingly sophisticated cyber threats have underscored the need to manage and bolster the cybersecurity of key government systems and the nation's cybersecurity. The risks to these systems are increasing as security threats evolve and become more sophisticated. GAO first designated information security as a government-wide high-risk area in 1997. This was expanded to include protecting cyber critical infrastructure in 2003 and protecting the privacy of personally identifiable information in 2015. In 2018, GAO noted that the need to establish a national cybersecurity strategy with effective oversight was a major challenge facing the federal government. GAO was requested to review efforts to protect the nation's cyber critical infrastructure. The objectives of this report were to (1) describe roles and responsibilities of federal entities tasked with supporting national cybersecurity, and (2) determine the extent to which the executive branch has developed a national strategy and a plan to manage its implementation. To do so, GAO identified 23 federal entities responsible for enhancing the nation's cybersecurity. Specifically, GAO selected 13 federal agencies based on their specialized or support functions regarding critical infrastructure security and resilience, and 10 additional entities based on analysis of its prior reviews of national cybersecurity, relevant executive policy, and national strategy documents. GAO also analyzed the National Cyber Strategy and Implementation Plan to determine if they aligned with the desirable characteristics of a national strategy. GAO is making one matter for congressional consideration, that Congress should consider legislation to designate a leadership position in the White House with the commensurate authority to implement and encourage action in support of the nation's cybersecurity. GAO is also making one recommendation to the National Security Council to work with relevant federal entities to update cybersecurity strategy documents to include goals, performance measures, and resource information, among other things. The National Security Council neither agreed nor disagreed with GAO's recommendation. For more information, contact Nick Marinos at (202) 512-9342 or marinosn@gao.gov.
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    Within the executive branch, GAO identified 25 federal tactical teams, and the characteristics of these teams varied. The 25 tactical teams were across 18 agencies, such as agencies within the Departments of Homeland Security, Justice, Energy, and the Interior. The number of reported team members per team ranged from two to 1,099. More than half (16 of 25) of the teams reported that they are composed of team members working for the team on a collateral basis. Most teams (17 of 25) had multiple units across various locations. Photos of Federal Tactical Teams in Action Tactical teams generally followed a similar training process, with initial training, specialty training, and ongoing training requirements. Nearly all teams (24 of 25) reported that new team members complete an initial tactical training course, which ranged from 1 week to 10 months. For example, potential new team members of the Federal Bureau of Investigation's Hostage Rescue Team complete a 10-month initial training that includes courses on firearms; helicopter operations; and surveillance, among others. Nearly all teams (24 of 25) reported offering specialized training to some team members, such as in sniper operations and breaching. Nearly all teams (24 of 25) also reported having ongoing training requirements, ranging from 40 hours per year to over 400 hours per year. The number and types of deployments varied across the 25 tactical teams for fiscal years 2015 through 2019. The number of reported deployments per tactical team during this time period ranged from 0 to over 5,000. Teams conducted different types of deployments, but some types were common among teams, such as: supporting operations of other law enforcement entities, such as other federal, state, and local law enforcement (16 of 25); providing protection details for high-profile individuals (15 of 25); responding to or providing security at civil disturbances, such as protests (13 of 25); and serving high-risk search and arrest warrants (11 of 25). Four teams reported that they had deployed in response to the Coronavirus 2019 (COVID-19) pandemic, and 16 teams reported deployments related to nationwide civil unrest and protests in May and June 2020. Tactical teams reported having various types of firearms, tactical equipment, and tactical vehicles in their inventories. Team members generally have a standard set of firearms (e.g., a pistol, a backup pistol, and a rifle), but some may also have specialized firearms (e.g., a shotgun designed to breach doors). Tactical teams also have a variety of tactical equipment, such as night vision devices to maintain surveillance of suspects or tactical robots that can go into locations to obtain audio and video information when team members cannot safely enter those locations. Tactical teams may also have tactical vehicles, such as manned aircraft (e.g., helicopters) and armored vehicles to patrol locations. The figure below identifies the number of tactical teams that reported having such items in their inventories. Number of Federal Tactical Teams That Reported Having Firearms, Tactical Equipment, and Tactical Vehicles in Their Inventories, as of January 2020 Appendix I of the report provides details on each of the 25 tactical teams, such as each team's mission; staffing; types and frequency of training; and number and types of deployments from fiscal years 2015 through 2019. This is a public version of a sensitive report issued in August 2020. Information deemed to be sensitive by the agencies in this review, such as the quantities of firearms, tactical equipment, and tactical vehicles in team inventories, has been omitted from this report. Many federal agencies employ law enforcement officers to carry out the agency's law enforcement mission and maintain the security of federal property, employees, and the public. Some of these agencies have specialized law enforcement teams—referred to as federal tactical teams in this report—whose members are selected, trained, equipped, and assigned to prevent and resolve critical incidents involving a public safety threat that their agency's traditional law enforcement may not otherwise have the capability to resolve. This report provides information on the (1) federal tactical teams and their characteristics; (2) training team members receive; (3) deployments of such teams from fiscal years 2015 through 2019; and (4) firearms, tactical equipment, and tactical vehicles in team inventories, as of January 2020. To identify federal tactical teams, GAO contacted executive branch agencies with at least 50 federal law enforcement officers. GAO administered a standardized questionnaire and data collection instrument to the identified teams to gather information on team missions, staffing, training, deployments, and inventories. GAO reviewed team documents, such as standard operating procedures, and interviewed agency officials. GAO collected descriptive information on reported deployments as of June 2020 in response to COVID-19 and nationwide civil unrest, which were ongoing during the review. GAO incorporated agency technical comments as appropriate. For more information, contact Gretta L. 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    Genetic counselors and medical geneticists are two groups who typically work together to provide genetic services, such as genetic testing and counseling. Genetic counselors have at least a master's degree in genetic counseling and assess individuals or families with or at risk for genetic conditions, and provide counseling and education on test results. Medical geneticists are typically physicians who specialize in medical genetics and genomics, and provide comprehensive genetic services, ranging from diagnosis and interpretation of test results to the management and treatment of genetic conditions. GAO's analysis of data from the professional organizations representing this workforce shows the number of genetic counselors certified to provide genetic counseling services has nearly doubled since 2009, and is projected to continue growing. The data show there were approximately 4,700 certified genetics counselors in the United States in 2019. The data also show the number of new medical geneticists has increased modestly since 2009, and the total number certified in the United States was approximately 1,240 as of April 2020. There is no widely accepted measure for how many genetic counselors and medical geneticists should be available; however, representatives from professional organizations GAO interviewed stated that demand for genetic services is rising. Data from the professional organizations representing the genetic counselor and medical geneticist workforces, as well as data from the Census Bureau, also show the number of genetic counselors and medical geneticists varied across states. States averaged seven genetic counselors per 500,000 people in 2019 and two medical geneticists per 500,000 people in 2020. Genetic counselors and medical geneticists primarily practice in hospital settings. Distribution of Genetic Counselors by State, 2019 Advances in genetic technology and research have increased the amount of information available to individuals and providers, and may have increased the demand for genetic services. The medical genetics workforce—which includes genetic counselors and medical geneticists—plays an essential role in providing access to genetic services. Some studies have identified concerns with the size of the medical genetics workforce and its ability to meet the current and future demand for genetic services. A House Committee on Appropriations report included a provision for GAO to conduct an analysis of the medical genetics workforce. This report describes, among other objectives, what is known about changes in the size of the genetic counselor and medical geneticist workforces; and what is known about the geographic distribution of these workforces. GAO reviewed relevant studies of the genetic counselor and medical geneticist workforces; interviewed agency officials and professional organizations representing each workforce; and analyzed the most recent available data on the size and distribution of each workforce in the United States, as well as population data from the Census Bureau. GAO provided a draft of this report to the Department of Health and Human Services and the Department of Labor. The Department of Health and Human Services provided technical comments, which GAO incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or CosgroveJ@gao.gov.
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    U.S. research may be subject to undue foreign influence in cases where a researcher has a foreign conflict of interest (COI). Federal grant-making agencies can address this threat by implementing COI policies and requiring the disclosure of information that may indicate potential conflicts. GAO reviewed five agencies—which together accounted for almost 90 percent of all federal research and development expenditures at universities in fiscal year 2018—and found that three have agency-wide COI policies, while two do not (see figure). The three agencies with existing policies focus on financial interests but do not specifically address or define non-financial interests, such as multiple professional appointments. In the absence of agency-wide COI policies and definitions on non-financial interests, researchers may not fully understand what they need to report on their grant proposals, leaving agencies with incomplete information to assess the risk of foreign influence. GAO found that, regardless of whether an agency has a conflict of interest policy, all five agencies require researchers to disclose information—such as foreign support for their research—as part of the grant proposal that could be used to determine if certain conflicts exist. Elements of Conflict of Interest (COI) Policies at Agencies with the Most Federal Research Expenditures at Universities Based on a review of university documents, GAO found that all 11 of the universities in its sample have publicly available financial and non-financial COI policies for federally funded research. These policies often align with the financial COI policies or requirements of the grant-making agencies. All five agencies have mechanisms to monitor and enforce their policies and disclosure requirements when there is an alleged failure to disclose required information. All agencies rely on universities to monitor financial COI, and most agencies collect non-financial information such as foreign collaborations, that can help determine if conflicts exist. Agencies have also taken actions in cases where they identified researchers who failed to disclose financial or non-financial information. However, three agencies lack written procedures for handling allegations of failure to disclose required information. Written procedures for addressing alleged failure to disclose required information help agencies manage these allegations and consistently apply enforcement actions. In interviews, stakeholders identified opportunities to improve responses to foreign threats to research, such as harmonizing grant application requirements. Agencies have begun to address such issues. The federal government reportedly expended about $42 billion on science and engineering research at universities in fiscal year 2018. Safeguarding the U.S. research enterprise from threats of foreign influence is of critical importance. Recent reports by GAO and others have noted challenges faced by the research community to combat undue foreign influence, while maintaining an open research environment that fosters collaboration, transparency, and the free exchange of ideas. GAO was asked to review federal agency and university COI policies and disclosure requirements. In this report, GAO examines (1) COI policies and disclosure requirements at selected agencies and universities that address potential foreign threats, (2) mechanisms to monitor and enforce policies and requirements, and (3) the views of selected stakeholders on how to better address foreign threats to federally funded research. GAO reviewed laws, regulations, federal guidance, and agency and university COI policies and requirements. GAO also interviewed agency officials, university officials, and researchers. GAO is making nine recommendations to six agencies, including that grant-making agencies address non-financial conflicts of interest in their COI policies and develop written procedures for addressing cases of failure to disclose required information. Five agencies agreed with GAO's recommendations. The National Science Foundation neither agreed nor disagreed with GAO's recommendation, but identified actions it plans to take in response. For more information, contact Candice N. Wright at (202) 512-6888 or wrightc@gao.gov.
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  • Child Care: Subsidy Eligibility and Receipt, and Wait Lists
    In U.S GAO News
    An estimated 1.9 million children received child care subsidies in fiscal year 2017, representing approximately 14 percent of all children estimated to be eligible under federal rules – and 22 percent of all children estimated to be eligible under state rules -- in an average month. These figures are from the Department of Health and Human Services' (HHS) analysis of fiscal year 2017 data, the most recent year for which such analysis is available. Generally, fewer families qualify for subsidies under state eligibility rules than under federal eligibility rules since most states use flexibility provided by HHS to set their income eligibility limits below the federal maximum. Health and Human Services’ Estimated Number of Children Eligible Under Federal and State Rules, and Estimated Number Receiving Child Care Subsidies, Fiscal Year 2017 GAO found that the extent to which children who meet federal child care eligibility requirements also meet state eligibility requirements varies by state as does the share of eligible children who receive Child Care and Development Fund (CCDF) subsidies. Under state requirements, the CCDF subsidy receipt rate ranged from 5 percent to 32 percent of eligible children. Under federal requirements, the CCDF subsidy receipt rate ranged from 4 percent to 18 percent of federally eligible children. According to HHS estimates, among families who met federal child care eligibility criteria, children from lower-income families were more likely to receive child care subsidies compared to children from higher-income families. These estimates also showed that preschool-age children were more likely to receive subsidies compared to older, school-age children and that Black children were more likely to receive subsidies compared to children of other races / ethnicities. As reported in previous GAO work, states have varied strategies for managing their wait lists. Some states have a single statewide list while others have sub-state lists that allow sub-state areas to have their own policies. Some states conduct full or partial eligibility determinations prior to placing families on wait lists, and many states require periodic reviews of their wait lists. According to state administrators GAO interviewed, the strategies that states use to manage their wait lists pose certain challenges. For example, state administrators told GAO that sub-state lists can contain duplication, making state-wide estimates of families in need difficult. And administrators told GAO that maintaining up-to-date contact information is challenging, in part due to insufficient technology. The Coronavirus Disease 2019 (COVID-19) pandemic has impacted child care in several ways, including cost, eligibility and subsidy receipt, according to some members of the National Association of State Child Care Administrators (NASCCA). These members told GAO that despite initial declines in the number of families receiving subsidies, some states are seeing their child care costs increase due to, for example, more school-age children using full-day care; increased expenses for additional health and safety measures; paying for more absences and for parent co-pays; and families applying for subsidies for relative care. NASCCA members noted that some states have made changes to policies to help families and providers. To help families access child care, some states have increased income eligibility for subsidies to 85 percent of the state median income; temporarily waived work requirements to receive subsidies; and covered family fees for parents when a family must quarantine due to a COVID-19 exposure. Changes to some state policies aimed at helping providers include providing funds to providers to help with increased costs, such as personal protective equipment (PPE) and additional cleaning supplies; paying providers based on their pre-COVID-19 level authorized enrollments; and raising the state's provider reimbursement rate to help providers cover overhead costs. The federal child care subsidy program known as CCDF is one of the primary sources of federal funding dedicated to assisting low-income families with child care who are working or participating in education and training. Funding for CCDF, which is administered by HHS at the federal level, comes from two funding streams: discretionary funding in the form of block grants authorized by the Child Care and Development Block Grant (CCDBG Act) of 1990, as amended, and mandatory and matching funding authorized under section 418 of the Social Security Act. CCDF was appropriated more than $8 billion in federal funds in 2019. For more information, contact Kathryn Larin at (202) 512-7215 or larink@gao.gov.
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  • Survivors of Childhood Cancer: Factors Affecting Access to Follow-up Care
    In U.S GAO News
    Stakeholders GAO interviewed and studies GAO reviewed identified three factors that affect access to follow-up care for childhood cancer survivors—individuals of any age who were diagnosed with cancer from ages 0 through 19. These factors are care affordability, survivors' and health care providers' knowledge of appropriate care, and proximity to care. Childhood cancer survivors need access to follow-up care over time for serious health effects known as late effects—such as developmental problems, heart conditions, and subsequent cancers—which result from their original cancer and its treatment. Affordability: Survivors of childhood cancer may have difficulty paying for follow-up care, which can affect their access to this care. For example, one study found that survivors were significantly more likely to have difficulty paying medical bills and delay medical care due to affordability concerns when compared to individuals with no history of cancer. Knowledge: Survivors' access to appropriate follow-up care for late effects of childhood cancer can depend on both survivors' and providers' knowledge about such care, which can affect access in various ways, according to stakeholders GAO interviewed and studies GAO reviewed: Some survivors may have been treated for cancer at an early age and may have limited awareness of the need for follow- up care. Some primary or specialty care providers may not be knowledgeable about guidelines for appropriate follow-up care, which can affect whether a survivor receives recommended treatment. Follow-up care may include psychosocial care (e.g., counseling), and palliative care (e.g., pain management). Proximity: Survivors may have difficulty reaching appropriate care settings. Stakeholders GAO interviewed and studies GAO reviewed noted that childhood cancer survivors may have to travel long distances to receive follow-up care from multidisciplinary outpatient clinics—referred to as childhood cancer survivorship clinics. The lack of proximity may make it particularly difficult for survivors with limited financial resources to adhere to recommended follow-up care. The National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC)—agencies within the Department of Health and Human Services (HHS) that conduct activities specific to childhood cancer survivors, including research about access to care—have taken steps to implement three provisions in the Childhood Cancer Survivorship, Treatment, Access, and Research Act of 2018 (Childhood Cancer STAR Act) relevant to access to care for survivors. For example, CDC has awarded a contract to develop software to improve the collection of information on individuals with childhood cancer, and NCI has funded three research projects focused on interventions aimed at addressing adverse outcomes among childhood cancer survivors. NCI has also funded research to study the health status and use of follow-up services of 2,000 young adult survivors. Stakeholders have raised questions about the ability of childhood cancer survivors to access needed follow-up care. According to the most recent data available, approximately 465,000 childhood cancer survivors—children, adolescents, and adults—were alive in the United States as of January 1, 2017. Although the 5-year survival rate for childhood cancer has increased from about 62 percent in the mid-1970s to about 86 percent in the mid-2010s, childhood cancer survivors may face late effects, which could require follow-up care across multiple stages of their lives. The conference report accompanying Public Law 115-245 included a provision for GAO to report on barriers to obtaining medical care for childhood cancer survivors, including psychosocial services and palliative care. This report identifies factors reported to affect access to follow-up care for this population. GAO spoke with officials from NCI and CDC and interviewed stakeholders such as providers who care for childhood cancer survivors, professional associations, and advocacy groups. Additionally, GAO reviewed peer-reviewed studies related to access to care for survivors, outcomes of treatment they may receive, and factors that may affect their access to follow-up care. To supplement this work, GAO reviewed the status of selected HHS activities to support access to care for childhood cancer survivors, including steps taken to implement selected provisions in the Childhood Cancer STAR Act. GAO provided a draft of this report to HHS for review and comment. HHS provided technical comments, which GAO incorporated as appropriate. For more information, contact Jessica Farb at (202) 512-7114 or FarbJ@gao.gov.
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  • NASA’s Ingenuity Mars Helicopter Recharges Its Batteries in Flight
    In Space
    Headed to the Red Planet [Read More…]
  • Attorney General Barr Chairs Meeting of the Federal Interagency Council on Crime Prevention and Improving Reentry
    In Crime News
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  • Justice Department Announces National Response Center and Offer to Bring Assistance to Minneapolis Police Department to Support Law Enforcement and Safe Communities Through Fair Policing
    In Crime News
    The Justice Department, in an announcement by Assistant Attorney General for the Civil Rights Division Eric S. Dreiband, Principal Deputy Assistant Attorney General of the Office of Justice Programs (OJP) Katharine T. Sullivan, and U.S. Attorney for the District of Minnesota Erica H. MacDonald, unveiled a new National Response Center Initiative and offered the assistance to the Minneapolis Police Department (MPD) to support law enforcement, and review, enhance and reform policies and practices to prevent the use of excessive force. The BJA Law Enforcement Training and Technical Assistance Response Center will be a national resource for all state, local, and tribal law enforcement agencies.
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  • Workrite Companies to Pay $7.1 Million to Settle Alleged Furniture Overcharges
    In Crime News
    Ergonomic office furniture maker Workrite Ergonomics LLC, a Delaware company, and its parent, Knape & Vogt Manufacturing Co. (collectively, Workrite), have agreed to pay $7.1 million to resolve allegations under the False Claims Act that they overcharged the federal government for office furniture under General Services Administration (GSA) contracts, the Department of Justice announced today. 
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  • Justice Department Settles Claim Against Texas IT Company for Using Job Advertisements that Discriminated Against and Deterred U.S. Workers in Favor of Temporary Visa Holders
    In Crime News
    The Justice Department today announced that it signed a settlement agreement with Ikon Systems, LLC (Ikon), an IT staffing and recruiting company based in Texas.
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  • Judge Rya Zobel to Receive 2020 Devitt Award
    In U.S Courts
    Senior U.S. District Judge Rya Zobel, who grew up in Nazi Germany and later became the first woman to serve as director of the Federal Judicial Center, is the recipient of the 2020 Edward J. Devitt Distinguished Service to Justice Award.
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  • 2020 International Women of Courage Award Recipients Announced
    In Women’s News
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