Final four sentenced in $189M Health Care Fraud Scam

Four executives of Continuum Healthcare and its various health centers have been ordered to federal prison for a massive scam perpetrated in the Houston area

Read full article at: https://www.justice.gov April 23, 2021

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    Since GAO's 2018 report, the Department of Defense (DOD) has taken action to make its network of high-tech weapon systems less vulnerable to cyberattacks. DOD and military service officials highlighted areas of progress, including increased access to expertise, enhanced cyber testing, and additional guidance. For example, GAO found that selected acquisition programs have conducted, or planned to conduct, more cybersecurity testing during development than past acquisition programs. It is important that DOD sustain its efforts as it works to improve weapon systems cybersecurity. Contracting for cybersecurity requirements is key. DOD guidance states that these requirements should be treated like other types of system requirements and, more simply, “if it is not in the contract, do not expect to get it.” Specifically, cybersecurity requirements should be defined in acquisition program contracts, and criteria should be established for accepting or rejecting the work and for how the government will verify that requirements have been met. However, GAO found examples of program contracts omitting cybersecurity requirements, acceptance criteria, or verification processes. For example, GAO found that contracts for three of the five programs did not include any cybersecurity requirements when they were awarded. A senior DOD official said standardizing cybersecurity requirements is difficult and the department needs to better communicate cybersecurity requirements and systems engineering to the users that will decide whether or not a cybersecurity risk is acceptable. Incorporating Cybersecurity in Contracts DOD and the military services have developed a range of policy and guidance documents to improve weapon systems cybersecurity, but the guidance usually does not specifically address how acquisition programs should include cybersecurity requirements, acceptance criteria, and verification processes in contracts. Among the four military services GAO reviewed, only the Air Force has issued service-wide guidance that details how acquisition programs should define cybersecurity requirements and incorporate those requirements in contracts. The other services could benefit from a similar approach in developing their own guidance that helps ensure that DOD appropriately addresses cybersecurity requirements in contracts. DOD's network of sophisticated, expensive weapon systems must work when needed, without being incapacitated by cyberattacks. However, GAO reported in 2018 that DOD was routinely finding cyber vulnerabilities late in its development process. A Senate report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's implementation of cybersecurity for weapon systems in development. GAO's report addresses (1) the extent to which DOD has made progress in implementing cybersecurity for weapon systems during development, and (2) the extent to which DOD and the military services have developed guidance for incorporating weapon systems cybersecurity requirements into contracts. GAO reviewed DOD and service guidance and policies related to cybersecurity for weapon systems in development, interviewed DOD and program officials, and reviewed supporting documentation for five acquisition programs. GAO also interviewed defense contractors about their experiences with weapon systems cybersecurity. GAO is recommending that the Army, Navy, and Marine Corps provide guidance on how programs should incorporate tailored cybersecurity requirements into contracts. DOD concurred with two recommendations, and stated that the third—to the Marine Corps—should be merged with the one to the Navy. DOD's response aligns with the intent of the recommendation. For more information, contact W. William Russell at (202) 512-4841 or russellw@gao.gov.
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  • Housing: Preliminary Analysis of Homeownership Trends for Nine Cities
    In U.S GAO News
    Following a decade of decline, including after the 2007–2009 financial crisis, the national homeownership rate started to recover in 2016 (see figure). Homeownership Rate in the United States, 1990–2018 Note: Shaded areas indicate U.S. recessions. However, not all Americans have benefitted from the recovery, even in housing markets that appear to be thriving. GAO examined homeownership trends during 2010–2018 in nine core-based statistical areas (cities)—Chicago; Cleveland; Columbia, South Carolina; Denver; Houston; Pittsburgh; San Francisco; Seattle; and Washington, D.C. In summary, among the nine cities reviewed, GAO found that during 2010–2018: The homeownership rate declined or was flat in all cities. The homeownership rate significantly declined in Chicago, Cleveland, and Houston and remained statistically unchanged in the other cities. Average home prices grew in all cities, but at considerably different rates. For example, real house prices increased significantly in Denver, San Francisco, and Seattle but much less in Chicago, Cleveland, and Columbia. The homeowner vacancy rate dropped in all cities, indicating growing constraints on the housing supply. Most significantly, by 2018, the three cities with the largest house price increases—Denver, San Francisco, and Seattle—all had homeowner vacancy rates below 1 percent and the three lowest rental vacancy rates (below 5 percent), indicating more severe constraints on supply. Most cities became denser, and some also expanded outward. Cities such as Houston and Washington, D.C., both became denser (added more housing units in developed areas) and expanded outward (added housing units in previously undeveloped areas), while cities such as Seattle and Denver grew largely by adding more density to already high-density areas. Chicago, and Pittsburgh became less dense, as limited growth came largely through outward expansion. Homeowners and recent borrowers were increasingly higher-income. All nine cities saw growth in the estimated number and percentage of households reporting annual incomes of $150,000 or more (the highest income category reported by Census). Similarly, with the exception of Columbia, real median incomes of borrowers increased in the selected cities. Homeowners and recent borrowers were increasingly older and more diverse. Most cities saw growth in homeownership among households aged 60 and older, often with corresponding decreases among younger owners. Additionally, loan originations by minority borrowers increased in all cities. GAO's analysis of homeownership trends in these nine cities during 2010–2018 illustrates two main points: (1) Cities grew differently and accommodated growth to differing degrees, and (2) who owns and who can buy a home differs by location and type of buyer, sometimes substantially. Historically, owning a home has been one of the primary ways Americans built wealth and financial security. This is one reason why the availability and price of housing is consequential to both households and policymakers. GAO was asked to assess the state of the current domestic housing market and this report, one in a series, focuses on homeownership trends. To conduct this work, GAO used data from the Census Bureau's American Community Survey and Home Mortgage Disclosure Act data (loan and application data filed by mortgage lenders), among other sources, to identify trends in nine selected cities during 2010–2018, the most current data available at the time of GAO's review. This report examines trends prior to the Covid-19 pandemic and does not account for the profound effect it likely will have on homeowners. GAO has ongoing work that will examine implementation of foreclosure and eviction protections authorized in recent legislation. GAO makes no recommendations in this report. For more information, contact Daniel Garcia-Diaz at (202) 512-8678 or garciadiazd@gao.gov.
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  • Small Business Loans: SBA Generally Incorporated Key Elements for Estimating Subsidy Cost of 7(a) Program
    In U.S GAO News
    The Small Business Administration (SBA) develops its subsidy cost estimates for the 7(a) loan guarantee program—that is, estimates of the program's net long-term cost to the government—using a cash flow model. The model uses historical data, econometric equations, and macroeconomic projections to estimate cash flows—such as guarantee fees, SBA purchases of defaulted loans, and recoveries on those loans—for the loans SBA expects to guarantee in the next fiscal year. The net present value of the cash flows (value in current dollars) is the subsidy cost estimate. SBA generally incorporated key elements of subsidy cost estimation into its estimates for the 7(a) program for the fiscal year 2020 budget. Specifically, GAO found that SBA's estimation process was largely consistent with eight key elements GAO previously identified that help ensure subsidy estimates are supported, reliable, and reasonable. For example, SBA generally validated historical data, documented the cash flow model and key assumptions, analyzed the sensitivity of estimates to alternative assumptions, and had documented policies and procedures. SBA made changes in its estimation process that collectively increased the 7(a) program's subsidy cost to $99 million for fiscal year 2020 (a 0.33 percent subsidy rate when expressed as the cost per dollar of credit assistance) from $0 for fiscal year 2019 (0 percent subsidy rate). Some of these changes were routine updates to data and economic assumptions used in the cash flow model, while others were revisions to the estimation process. Additionally, some individual changes increased the subsidy costs, while others decreased it. Some of the changes that had the largest impact on the subsidy rate included the following: Incorporating the President's economic assumptions for fiscal year 2020 decreased the rate by 0.27 percentage points. Updating the basis for the size and composition of the loan cohort SBA expected to guarantee in fiscal year 2020 increased the rate by 0.21 percentage points. Revising the methodology for estimating purchase amounts for defaulted loans to better reflect the outstanding loan balance at the time of purchase increased the rate by 0.21 percentage points. The 7(a) program is SBA's largest loan guarantee program for small businesses, with about $95 billion in outstanding loan principal as of the end of fiscal year 2019. Federal agencies that provide credit assistance are generally required to estimate the net long-term cost to the government—known as the subsidy cost—for each annual cohort of loans. SBA initially estimated a zero subsidy cost for each cohort from fiscal years 2014 through 2019, but estimated that the fiscal year 2020 cohort would have a positive subsidy cost and require appropriations. GAO was asked to evaluate SBA's subsidy estimation process for the 7(a) program. This report examines (1) how SBA estimates 7(a) subsidy costs, (2) the extent to which SBA incorporated key elements of subsidy cost estimation into its estimation process for the fiscal year 2020 budget, and (3) the changes SBA made in its estimation process for the fiscal year 2020 budget. GAO reviewed SBA documentation on its estimation process, including information on SBA's cash flow model, and compared SBA's process to key elements that GAO previously identified ( GAO-16-269 ). GAO also interviewed officials from SBA, the Office of Management and Budget, and outside auditors and contractors that annually review SBA's process and model. For more information, contact William B. Shear at (202) 512-8678 or shearw@gao.gov.
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  • Covid-19 In Nursing Homes: HHS Has Taken Steps in Response to Pandemic, but Several GAO Recommendations Have Not Been Implemented
    In U.S GAO News
    What GAO Found GAO's review of data from the Centers for Disease Control and Prevention (CDC) found that winter 2020 was marked by a significant surge in the number of COVID-19 cases and deaths in nursing homes. However, CDC data as of February 2021, show that both cases and deaths have declined by more than 80 percent since their peaks in December 2020. With the introduction of vaccines, observers are hopeful that nursing homes may be beginning to see a reprieve. Nevertheless, the emergence of more highly transmissible virus variants warrants the need for continued vigilance, according to public health officials. GAO's prior work has found that nursing homes have faced many difficult challenges battling COVID-19. While challenges related to staffing shortages have persisted through the pandemic, challenges related to obtaining Personal Protective Equipment (PPE) and conducting COVID-19 tests—although still notable—have generally shown signs of improvement since summer 2020. Further, with the decline in nursing homes cases, the Centers for Medicare and Medicaid Services (CMS) updated its guidance in March 2021 to expand resident visitation, an issue that has been an ongoing challenge during the pandemic. Some new challenges have also emerged as vaccinations began in nursing homes, such as reluctance among some staff to receive a COVID-19 vaccine. The Department of Health and Human Services (HHS), primarily through CMS and the CDC, has taken steps to address COVID-19 in nursing homes. However, HHS has not implemented several relevant GAO recommendations, including: HHS has not implemented GAO's recommendation related to the Nursing Home Commission report, which assessed the response to COVID-19 in nursing homes. CMS released the Nursing Home Commission's report and recommendations in September 2020. When the report was released, CMS broadly outlined the actions the agency had taken, but the agency did not provide a plan that would allow it to track its progress. GAO recommended in November 2020 that HHS develop an implementation plan. As of February 2021, this recommendation had not been implemented. HHS has not implemented GAO's recommendation to fill COVID-19 data voids. CMS required nursing homes to begin reporting the number of cases and deaths to the agency effective May 8, 2020. However, CMS made the reporting of the data prior to this date optional. GAO recommended in September 2020 that HHS develop a strategy to capture more complete COVID-19 data in nursing homes retroactively back to January 1, 2020. As of February 2021, this recommendation had not been implemented. Implementing GAO's recommendations could help address some of the challenges nursing homes continue to face and fill important gaps in the federal government's understanding of, and transparency around, data on COVID-19 in nursing homes. In addition to monitoring HHS's implementation of past recommendations, GAO has ongoing work related to COVID-19 outbreaks in nursing homes and CMS's oversight of infection control and emergency preparedness. Why GAO Did This Study The COVID-19 pandemic has had a disproportionate impact on the 1.4 million elderly or disabled residents in the nation's more than 15,000 Medicare- and Medicaid-certified nursing homes, who are often in frail health and living in close proximity to one another. HHS, primarily through CMS and CDC, has led the pandemic response in nursing homes. The CARES Act includes a provision for GAO to conduct monitoring and oversight of the federal government's efforts to prepare for, respond to, and recover from the COVID-19 pandemic. GAO has examined the government's response to COVID-19 in nursing homes through its CARES Act reporting (GAO-21-265, GAO-21-191, GAO-20-701, and GAO-20-625). This testimony will summarize the findings from these reports. Specifically, it describes COVID-19 trends in nursing homes and their experiences responding to the pandemic, and HHS's response to the pandemic in nursing homes. To conduct this previously reported work, GAO reviewed CDC data, agency guidance, and other relevant information on HHS's response to the COVID-19 pandemic. GAO interviewed agency officials and other knowledgeable stakeholders. In addition, GAO supplemented this information with updated data from CDC on COVID-19 cases and deaths reported by nursing homes as of February 2021. For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.
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  • Columbia Class Submarine: Delivery Hinges on Timely and Quality Materials from an Atrophied Supplier Base
    In U.S GAO News
    The Navy's schedule for constructing the first submarine of the new Columbia class is threatened by continuing challenges with the computer-aided software tool that Electric Boat, the lead shipbuilder, is using to design the submarine. These challenges will likely impede construction because the shipbuilder is late in completing design products used for building the submarine. To ensure construction begins on schedule, the Navy modified its design contract with Electric Boat to include an option for constructing the first two submarines and requested sufficient authority from Congress for fiscal year 2021 to exercise it. Navy officials stated, however, that the Navy's budget request is lower than its current cost estimate, and it is not informed by an independent cost assessment. As a result, the program will likely need more funding to reflect the increased estimate. Quality problems with supplier materials caused delays during early construction. These quality problems included missile tubes (depicted below) with defective welds. As the shipbuilders expand outsourcing to suppliers, quality assurance oversight at supplier facilities will be critical for avoiding further delays. Quad Pack of Four Submarine Missile Tubes However, the Navy has not comprehensively reassessed when to seek additional inspections at supplier facilities that could better position it to identify quality problems early enough to limit delays. The Navy plans to invest about $128 billion in 12 Columbia class nuclear-powered ballistic missile submarines. The shipbuilders will construct the Columbia class at the same time as the Virginia class attack submarines. They plan to rely on materials produced by a supplier base that is roughly 70 percent smaller than in previous shipbuilding booms. Congress included a provision in statute for GAO to examine the program's status. This report assesses the Navy's efforts to complete the design for the lead Columbia class submarine and actions the shipbuilders and the Navy have taken to prepare for construction and ensure the lead submarine is delivered according to schedule and quality expectations. GAO assessed Navy and shipbuilder design progress against cost and schedule estimates, reviewed documents, and interviewed officials about supplier readiness and quality assurance. This is a public version of a sensitive report that GAO issued in November 2020. Information that the Department of Defense (DOD) deemed sensitive has been omitted. GAO recommends that the Navy (1) provide Congress with updated cost information, (2) include information on supplier readiness in its annual report to Congress, and (3) reassess when to seek additional inspections at supplier facilities. DOD concurred with the recommendations but disagreed with some of the report's details. GAO incorporated DOD's comments as appropriate and maintains the validity of the findings, as discussed in the report. For more information, contact Shelby S. Oakley at (202) 512-4841 or oakleys@gao.gov.
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