Fourth Circuit Upholds Jury Conviction in Foreign-Agent Prosecution

The U.S. Court of Appeals for the Fourth Circuit today upheld an Eastern District of Virginia jury verdict convicting a man of acting and conspiring to act as an agent of the Turkish government within the United States without disclosing that relationship to the U.S. government. The Fourth Circuit also vacated an order granting a new trial and remanded the case for further proceedings before the district court.

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  • Natural Disasters: Economic Effects of Hurricanes Katrina, Sandy, Harvey, and Irma
    In U.S GAO News
    Between January 1980 and July 2020, the United States experienced 273 climate and weather disasters causing more than $1 billion in damages each, according to NOAA. The total cost of damages from these disasters exceeded $1.79 trillion, with hurricanes and tropical storms accounting for over 50 percent of these damages, according to NOAA. Across the regions affected by these hurricanes over the period from 2005 to 2015, CBO estimated that federal disaster assistance covered, on average, 62 percent of the damage costs. GAO has reported that the rising number of natural disasters and reliance on federal disaster assistance is a key source of federal fiscal exposure. GAO was asked to review the costs of natural disasters and their effects on communities. This report examines (1) estimates of the costs of damages caused by hurricanes and hurricanes' effects on overall economic activity and employment in the areas they affected, and (2) actions subsequently taken in those areas to improve resilience to future natural disasters. GAO conducted case studies of Hurricanes Katrina, Sandy, Harvey, and Irma, selected for two reasons. First, they were declared a major disaster by the President under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, which establishes key programs through which the federal government provides disaster assistance, primarily through FEMA. Second, they had sizable effects on the 50 U.S. states and the District of Columbia during the period from 2004 through 2018. GAO analyzed federal agency and other data on costs, economic activity, employment, and recovery and mitigation projects in selected areas affected by these hurricanes. GAO also visited selected recovery and mitigation project sites; interviewed experts and federal, state, and local government officials; and reviewed federal, state, and local government reports and academic studies. Hurricanes Katrina, Sandy, Harvey, and Irma (selected hurricanes) caused costly damages and challenges for some populations in affected communities. In these communities, the National Oceanic and Atmospheric Administration (NOAA) estimated the cost of damages to be approximately $170 billion for Katrina, $74 billion for Sandy, $131 billion for Harvey, and $52 billion for Irma. These estimates include the value of damages to residential, commercial, and government or municipal buildings; material assets within the buildings; business interruption; vehicles and boats; offshore energy platforms; public infrastructure; and agricultural assets. These hurricanes were also costly to the federal government. For example, in 2016, the Congressional Budget Office (CBO) estimated that federal spending exceeded $110 billion in response to Katrina and $53 billion in response to Sandy. GAO analysis suggests that the selected hurricanes were associated with widely varying effects on overall economic activity and total employment in affected metropolitan areas and counties. Economic activity was lower than expected in the month of the hurricane or some of the three subsequent months in three of the affected metropolitan areas GAO analyzed. Within one year, average economic activity in these three metropolitan areas was similar to or greater than what it had been the year before the hurricane. Total employment was lower than expected in the month of the hurricane or some of the three subsequent months in 80 of the affected counties GAO analyzed. Total employment was higher than pre-hurricane employment on average in 47 of those counties within one year but remained below pre-hurricane employment on average in the other 33 counties for at least one year. Finally, state and local government officials said that the selected hurricanes had significant impacts on communities, local governments, households, and businesses with fewer resources and less expertise, and that challenges faced by households may have impacted local businesses. Communities affected by selected hurricanes have been taking actions to improve resilience, but multiple factors can affect their decisions. Actions taken after selected hurricanes include elevating, acquiring, and rehabilitating homes; flood-proofing public buildings; repairing and upgrading critical infrastructure; constructing flood barriers; and updating building codes. A community’s decision to take resilience actions can depend on the costs and benefits of those actions to the community. Multiple factors affect these costs and benefits, including the likelihood, severity, and location of future disasters, as well as the amount of federal assistance available after a disaster. Finally, vulnerabilities remain in areas affected by selected hurricanes. For example, state and local government officials indicated that many older homes in these areas do not meet current building codes. In reports to the Federal Emergency Management Agency (FEMA), states indicate they anticipate that the scope of damages via exposure to weather hazards, such as hurricanes, will likely remain high and could expand across regions affected by the selected hurricanes. In addition, some local governments have projected that population will grow in the regions affected by selected hurricanes. For more information, contact Oliver Richard at 202-512-8424 or richardo@gao.gov.
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    In Crime News
    A Canadian citizen accused of operating a decades-long psychic mail fraud scheme was extradited to the United States and made his initial appearance today in federal court in Central Islip, New York, the Department of Justice and the U.S. Postal Inspection Service announced.
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    In U.S GAO News
    This Capsule—named for its 2-page format—draws from a number of GAO reports to provide examples of how the federal government and states have used Medicaid during pandemics, economic recessions, natural disasters, and other crises. In this Capsule, GAO cites policy considerations and reiterates a recommendation to Congress. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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    In Crime News
    The Justice Department today announced the dismantling of three terrorist financing cyber-enabled campaigns, involving the al-Qassam Brigades, Hamas’s military wing, al-Qaeda, and Islamic State of Iraq and the Levant (ISIS). This coordinated operation is detailed in three forfeiture complaints and a criminal complaint unsealed today in the District of Columbia. These actions represent the government’s largest-ever seizure of cryptocurrency in the terrorism context.
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  • Navy Shipyards: Actions Needed to Address the Main Factors Causing Maintenance Delays for Aircraft Carriers and Submarines
    In U.S GAO News
    The Navy's four shipyards completed 38 of 51 (75 percent) maintenance periods late for aircraft carriers and submarines with planned completion dates in fiscal years 2015 through 2019, for a combined total of 7,424 days of maintenance delay. For each maintenance period completed late, the shipyards averaged 113 days late for aircraft carriers and 225 days late for submarines. Maintenance Delays at Navy Shipyards for Fiscal Years 2015 through 2019 Unplanned work and workforce factors—such as shipyard workforce performance and capacity (having enough people to perform the work)—were the main factors GAO identified as causing maintenance delays for aircraft carriers and submarines. The Navy frequently cited both factors as contributing to the same days of maintenance delay. Unplanned work—work identified after finalizing maintenance plans—contributed to more than 4,100 days of maintenance delays. Unplanned work also contributed to the Navy's 36 percent underestimation of the personnel resources necessary to perform maintenance. The workforce factor contributed to more than 4,000 days of maintenance delay on aircraft carriers and submarines during fiscal years 2015 through 2019. The Navy has taken steps but has not fully addressed the unplanned work and workforce factors causing the most maintenance delays. First, the Navy updated planning documents to improve estimates and plans to annually update these data, but knowing whether changes improve results may take several years. Second, the Navy has consistently relied on high levels of overtime to carry out planned work. GAO's analysis found that high overtime among certain production shops, such as painting or welding, averaged from 25 to 32 percent for fiscal years 2015 through 2019, with peak overtime as high as 45 percent. Furthermore, shipyard officials told us that production shops at all four shipyards are working beyond their capacity. Overtime at such rates has been noted as resulting in diminished productivity. Third, the Navy initiated the Shipyard Performance to Plan initiative in the fall of 2018 to address the unplanned work and workforce factors, but it has not yet developed 13 of 25 planned metrics that could improve the Navy's understanding of the causes of maintenance delays. In addition, the Shipyard Performance to Plan initiative does not include goals, milestones, and a monitoring process along with fully developed metrics to address unplanned work and workforce weaknesses. Without fully developing metrics and implementing goals, action plans, milestones, and a monitoring process, the shipyards are not likely to address unplanned work and workforce weaknesses and the Navy is likely to continue facing maintenance delays and reduced time for training and operations with its aircraft carriers and submarines. For fiscal years 2015 through 2019, the Navy spent $2.8 billion in capital investments to address shipyard performance, among other things. However, the shipyards continue to face persistent and substantial maintenance delays that hinder the readiness of aircraft carriers and submarines. The Senate Armed Services Committee, in a report accompanying a bill for the National Defense Authorization Act for Fiscal Year 2019, included a provision for GAO to review Navy shipyards' performance. GAO evaluated the extent to which the Navy (1) completed maintenance at its shipyards on time on aircraft carriers and submarines in fiscal years 2015 through 2019, (2) has identified the main factors leading to maintenance delays, and (3) has addressed the main factors affecting any delays in that maintenance. GAO reviewed data related to Navy shipyard maintenance for fiscal years 2015 through 2019, analyzed factors contributing to delays and plans to address them, visited all four Navy shipyards, and met with Navy and shipyard officials. GAO is making three recommendations to the Navy, including updating workforce planning requirements to avoid the consistent use of overtime; completing the development of shipyard performance metrics; and developing and implementing goals, action plans, milestones, and monitoring results. The Navy concurred with all three recommendations. For more information, contact Diana Maurer, (202) 512-9627, MaurerD@gao.gov, or Asif A. Khan, (202) 512-9869, KhanA@gao.gov. 
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    In Crime News
    The Justice Department today announced its participation in a multinational operation involving actions in the United States, Canada, France, Germany, the Netherlands, and the United Kingdom to disrupt and take down the infrastructure of the malware and botnet known as Emotet. Additionally, officials in Lithuania, Sweden, and Ukraine assisted in this major cyber investigative action.
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    An Ohio physician was sentenced to 40 months in prison today for his role in illegally distributing controlled substances.
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    In Crime News
    An indictment was unsealed today charging John David McAfee with tax evasion and willful failure to file tax returns, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney D. Michael Dunavant for the Western District of Tennessee. The June 15, 2020 indictment was unsealed following McAfee’s arrest in Spain where he is pending extradition.
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    In Crime News
    A federal grand jury in Macon, Georgia, returned a 4-count indictment against former supervisory correctional officer Sergeant Patrick Sharpe, 29, and former correctional officer Jamal Scott, 33, of the Valdosta State Prison (VSP) for their roles in using excessive force against inmates incarcerated at the facility.
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    In Crime News
    The Justice Department today reached a settlement agreement with Nevada to ensure that inmates with HIV are not illegally segregated or otherwise discriminated against on the basis of HIV status and that inmates with disabilities are provided an equal opportunity to participate in and benefit from Nevada Department of Corrections (NDOC) programs.
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  • Courts Making Juror Safety a Top Priority
    In U.S Courts
    A small group of judges around the country have presided over jury trials during the COVID-19 pandemic. The number is growing as the backlog of criminal cases becomes an increasing concern among courts acutely aware that defendants are entitled to a fair, impartial, and timely trial. 
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  • COVID-19: Urgent Actions Needed to Better Ensure an Effective Federal Response
    In U.S GAO News
    The COVID-19 pandemic has resulted in catastrophic loss of life and substantial damage to the global economy, stability, and security. According to federal data, the U.S. had an average of 116,000 new COVID-19 cases per day from November 1 through November 12, 2020. Between January 2020 and October 2020, at least 237,000 more deaths occurred from all causes, including COVID-19, than would normally be expected, according to data from the Centers for Disease Control and Prevention (CDC). Further, while the economy has improved since July 2020, many people remain unemployed, including both those temporarily laid off and those who have permanently lost their job (see figure). Also, more households have become seriously delinquent on mortgage payments during the pandemic. In addition, GAO’s review of academic studies suggests the pandemic will likely remain a significant obstacle to more robust economic activity. Number of Unemployed Workers Permanently Losing Jobs and on Temporary Layoff, January 2019 through October 2020 In response to the pandemic and its effects, Congress and the administration have taken a series of actions to protect the health and well-being of Americans. However, as the end of 2020 approaches, urgent actions are needed to help ensure an effective federal response on a range of public health and economic issues. Medical Supplies While the Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA) have made numerous efforts to mitigate supply shortages and expand the medical supply chain, shortages of certain supplies persist. In September 2020, GAO reported that ongoing constraints with the availability of certain types of personal protective equipment (PPE) and testing supplies remain due to a supply chain with limited domestic production and high global demand. In October 2020, GAO surveyed public health and emergency management officials from all states, the District of Columbia, and U.S. territories (hereafter states) and found the following: Testing supplies. Most states reported no shortages of swabs or transport media, but about one-third to one-half reported shortages in other types of testing supplies (see figure). State-Reported Testing Supply Shortages, as of October 2020   GAO surveyed officials in the 50 states; Washington, D.C.; and the five U.S. territories and received responses from 47 of the 56 locations, representing 41 states; Washington, D.C.; and all five territories. Not all states responded to every question. PPE. The majority of states that responded were mainly able to fulfill requests for supplies from organizations and entities within their states. However, availability constraints continue with certain PPE, such as nitrile gloves. Supplies for future vaccine needs. About one-third of states that responded stated that they were “greatly” or “completely” concerned about having sufficient vaccine-related supplies to administer COVID-19 vaccines. An additional 21 states indicated that they were moderately concerned. In September 2020, GAO recommended that HHS, in coordination with FEMA, should further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate supply chain shortages for the remainder of the pandemic; immediately document roles and responsibilities for supply chain management functions transitioning to HHS, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain; and devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the pandemic response. HHS and the Department of Homeland Security disagreed with these recommendations, noting, among other things, the work that they had done to manage the medical supply chain and increase supply availability. In November 2020, HHS repeated its disagreement with GAO’s recommendations and noted its efforts to meet the needs of states. In light of the surge in COVID-19 cases, along with reported shortages, including GAO’s nationwide survey findings, GAO underscores the critical imperative for HHS and FEMA to implement GAO’s September 2020 recommendations. Vaccines and Therapeutics In a recent GAO report (GAO-21-207), GAO found that there has been significant federal investment to accelerate vaccine and therapeutic development, such as through Operation Warp Speed, a partnership between the Department of Defense and HHS that aims to accelerate the development, manufacturing, and distribution of COVID-19 vaccines and therapeutics. Separately, Emergency Use Authorizations (EUA), which allow for the emergency use of medical products without Food and Drug Administration (FDA) approval or licensure provided certain statutory criteria are met, have also been used for therapeutics. As of November 9, 2020, FDA had made four therapeutics available to treat COVID-19 through EUAs. In that report, GAO recommended that FDA identify waysto uniformly discloseinformation from its scientific review of safety and effectiveness data when issuing EUAs for therapeutics and vaccines. By doing so, FDA could help improve the transparency of, and ensure public trust in, its EUA decisions. HHS neither agreed nor disagreed with the recommendation, but said it shared GAO’s goal of transparency. COVID-19 Testing Guidance HHS and its component agencies have taken several key actions to document a federal COVID-19 testing strategy and provide testing-related agency guidance. However, this guidance has not always been transparent, raising the risk of confusion and eroding trust in government. In particular, while it is expected that guidance will change as new information about the novel virus evolves, frequent changes to general CDC testing guidelines have not always been communicated with a scientific explanation. GAO recommends that HHS ensure that CDC clearly discloses the scientific rationale for any change to testing guidelines at the time the changeis made. HHS concurred with this recommendation. Types of COVID-19 Testing Approaches Nursing Home Care In September 2020, the Coronavirus Commission on Safety and Quality in Nursing Homes (established by the Centers for Medicare & Medicaid Services (CMS) in June 2020) made 27 recommendations to CMS on topics such as testing, PPE, and visitation. CMS released a response to the commission that broadly outlined the actions it has taken to date, but it has not fully addressed the commission’s recommendations or provided an implementation plan to track and report progress toward implementing them. While CMS is not obligated to implement all of the commission’s recommendations, the agency has not indicated any areas where it does not plan to take action. GAO recommends that CMS quickly develop a plan that further details how it intends to respond to and implement, as appropriate, the commission’s recommendations. HHS neither agreed nor disagreed with this recommendation and said it would refer to and act upon the commission’s recommendations, as appropriate. In addition, the Department of Veterans Affairs (VA) partners with state governments to provide nursing home care to more than 20,000 veterans in over 150 state veterans homes. In March 2020, VA instructed its contractor to stop in-person inspections due to concerns about COVID-19. As of September 2020, these inspections had not resumed, leaving veterans at risk of receiving poor quality care. Additionally, VA does not collect timely data on the number of COVID-19 cases and deaths occurring at each state veterans home, hindering its ability to monitor and take steps to mitigate the spread of COVID-19 in these homes. GAO recommends that VA (1) develop a plan to resume inspections of state veterans homes, which may include using in-person, a mix of virtual and in-person, or fully virtual inspections, and (2) collect timely data on COVID-19 cases and deaths in each state veterans home. VA concurred with both recommendations. Economic Impact Payments The CARES Act included economic impact payments (EIP) for eligible individuals to address financial stress due to the pandemic. As of September 30, 2020, the Department of the Treasury (Treasury) and the Internal Revenue Service (IRS) had disbursed over 165.8 million payments to individuals, totaling $274.7 billion. According to IRS data, more than 26 million non-filers—individuals who do not normally file a tax return and may be hard to reach—received a payment (see figure). However, everyone that was supposed to receive a payment was not reached. Starting in September 2020, IRS sent notices to nearly 9 million individuals who had not yet received an EIP. Number of Filers and Non-Filers Issued an Economic Impact Payment, as of September 30, 2020 Treasury and IRS officials did not plan to track and analyze the outcomes of their EIP notice mailing effort until 2021. The lack of timely analysis deprives Treasury and IRS of data they could use to assess the effectiveness of their notice strategy and redirect resources as needed to other outreach and communication efforts. GAO recommends that Treasury, in coordination with IRS, should begin tracking and publicly reporting the number of individuals who were mailed an EIP notification letter and filed for and received an EIP, and use that information to inform ongoing outreach and communications efforts. Treasury agreed with this recommendation. Unemployment Insurance The CARES Act created three federally funded temporary programs for unemployment insurance (UI) that expanded benefit eligibility and enhanced benefits. In its weekly news releases, the Department of Labor (DOL) publishes the number of weeks of unemployment benefits claimed by individuals in each state during the period and reports the total count as the number of people claiming benefits nationwide. DOL officials told GAO that they have traditionally used this number as a proxy for the number of individuals claiming benefits because they were closely related. However, the number of claims has not been an accurate estimate of the number of individuals claiming benefits during the pandemic because of backlogs in processing a historic volume of claims, among other data issues. Without an accurate accounting of the number of individuals who are relying on these benefits in as close to real time as possible, policymakers may be challenged to respond to the crisis at hand. GAO recommends that DOL (1) revise its weekly news releases to clarify that in the current unemployment environment, the numbers it reports for weeks of unemployment claimed do not accurately estimate the number of unique individuals claiming benefits, and (2) pursue options to report the actual number of distinct individuals claiming benefits, such as by collecting these already available data from states. DOL agreed with the recommendation to revise its weekly news releases, and partially agreed with the recommendation to pursue options to report the actual number of distinct individuals claiming benefits. Tax Relief for Businesses To provide liquidity to businesses during the pandemic, the CARES Act included tax measures to help businesses receive cash refunds or other reductions to tax obligations. Some taxpayers need to file an amended income tax return to take advantage of these provisions; at the same time, IRS faces an increase in mail and paper processing delays due to the pandemic, which may delay the timely processing of this paperwork and issuance of these refunds. GAO recommends that IRS update its form instructions to include information on its electronic filing capability for tax year 2019. IRS agreed with this recommendation. Program Integrity Although the extent and significance of improper payments associated with COVID-19 relief funds have not yet been determined, the impact of these improper payments, including those that are the result of fraud, could be substantial. For example, numerous individuals are facing federal charges related to attempting to defraud the Paycheck Protection Program (PPP), UI program, or other federal programs, and many more investigations are underway. To address the risk of improper payments due to fraud and other causes, GAO previously recommended the following: The Small Business Administration (SBA) should develop and implement plans to identify and respond to risks in the PPP to ensure program integrity, achieve program effectiveness, and address potential fraud. The Office of Management and Budget (OMB), in consultation with Treasury, should issue timely guidance for auditing new and existing COVID-19-related programs, including Coronavirus Relief Fund payments, as soon as possible. Audits of entities that receive federal funds are critical to the federal government’s ability to help safeguard those funds.Also, Congress should amend the Social Security Act to explicitly allow the Social Security Administration to share its full death data with Treasury for data matching to prevent payments to ineligible individuals. GAO maintains that implementing these recommendations fully is critically important in order to protect federal funds from improper payments resulting from fraud and other risks. In this report, GAO also identifies new concerns about the timely reporting of improper payments for COVID-19 programs. The COVID-19 relief laws appropriated over a trillion dollars that may be spent through newly established programs to fund response and recovery efforts, such as SBA’s PPP. However, unlike the supplemental appropriations acts that provided for disaster relief related to the 2017 hurricanes and California wildfires, the COVID-19 relief laws did not require agencies to deem programs receiving these relief funds that expend more than a threshold amount as "susceptible to significant improper payments." In addition, based on OMB guidance, improper payment estimates associated with new COVID-19 programs established in March 2020 may not be reported until November 2022, in some instances. GAO is making two recommendations: OMB should develop and issueguidance directingagencies to include COVID-19 relief funding with associated key risks, such as changes to existing program eligibility rules, as part of their improper payment estimation methodologies, especially for existing programs that received COVID-19 relief funding. SBA should expeditiously estimate improper payments and report estimates and error rates for PPP due to concerns about the possibility that improper payments, including those resulting from fraudulent activity, could be widespread. GAO is also suggesting that Congress consider, in any future legislation appropriating COVID-19 relief funds, designating all executive agency programs and activities making more than $100 million in payments from COVID-19 relief funds as “susceptible to significant improper payments.” Aviation Assistance and Preparedness GAO identified concerns about efforts to monitor CARES Act financial assistance to the aviation sector. Treasury’s Payroll Support Program (PSP) provides $32 billion in payroll support payments and loans to help the aviation industry retain its employees. While recipients have begun submitting required compliance reports, Treasury has not yet finalized a monitoring system to identify and respond to the risk of noncompliance with PSP agreement terms, potentially hindering its ability to detect program misuse in a timely manner. GAO is recommending that Treasury finish developing and implement acompliance monitoringplan that identifies and responds to risks in the PSP. Treasury neither agreed nor disagreed with this recommendation, but committed to reviewing additional measures that may further enhance its compliance monitoring and ensure that PSP funds are used as intended. In June 2020, GAO suggested that Congress take legislative action to require the Secretary of Transportation to work with relevant agencies, such as HHS, the Department of Homeland Security, and other stakeholders, to develop a national aviation-preparedness plan to limit the spread of communicable diseasethreats and minimize traveland trade impacts. GAO originally made this recommendation to the Department of Transportation in December 2015. GAO urges Congress to take swift action to require such a plan, without which the U.S. will not be as prepared to minimize and quickly respond to ongoing and future communicable disease events. As of November 12, 2020, the U.S. had over 10.3 million cumulative reported cases of COVID-19 and about 224,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions. Four relief laws, including the CARES Act, were enacted as of November 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of September 30, 2020, of the $2.6 trillion appropriated by these acts, the federal government had obligated a total of $1.8 trillion and expended $1.6 trillion of the COVID-19 relief funds, as reported by federal agencies. The CARES Act included a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines the federal government’s continued efforts to respond to and recover from the COVID-19 pandemic. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials. GAO also sent a survey to public health and emergency management officials in the 50 states, Washington, D.C., and the five U.S. territories regarding medical supplies. GAO is making 11 new recommendations for agencies that are detailed in this Highlights and in the report. GAO is also raising one matter for congressional consideration. For more information, contact A. Nicole Clowers at (202)512-7114 or clowersa@gao.gov.
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    In U.S GAO News
    The Department of Defense (DOD) has a general expectation that its health care beneficiaries, upon receiving an urgent referral to see a specialist, will access that specialty care in 3 days or less. GAO's analysis of 16,754 urgent referrals at military treatment facilities (MTF) shows that DOD beneficiaries accessed specialty care services in 3 days or less for more than half of the urgent referrals. About 9 percent of the urgent referrals involved beneficiaries waiting 3 weeks or longer to be seen. According to DOD officials, some beneficiaries may have waited longer than 3 days due to factors such as patient preference, appointment availability, or waiting for lab results. Time to access care varied by specialty, with beneficiaries urgently referred to ophthalmology generally seeing a specialist the fastest, and those urgently referred to mental health and oncology generally waiting the longest. According to DOD officials, MTFs are responsible for monitoring beneficiaries' access to specialty care through urgent referrals. GAO found that the monitoring processes used varied by MTF and specialty care clinic at the five selected MTFs that GAO reviewed. For example, officials from one MTF told GAO they centrally manage all urgent referrals using a daily report to address any delays, while officials from another MTF told GAO that individual specialty care clinics are responsible for managing their own urgent referrals. DOD officials acknowledged such variation and MTFs have been directed to centralize their referral management and monitoring processes—an effort that is currently underway. GAO found that DOD monitors the rates at which beneficiaries receive timely and effective care, in part, through 10 outpatient health care quality measures. These measures allow DOD to make comparisons to civilian health care systems, and they are reviewed by various DOD groups at least quarterly. However, DOD officials told GAO that since October 2017, they have been unable to monitor nine of the 10 measures for MTFs using Military Health System (MHS) Genesis, DOD's new electronic health record system. According to the officials, DOD's current data warehouse—a system that stores some MHS Genesis data and can be used by MTFs to create reports on quality measures—is not capable of producing accurate reports for those measures. DOD officials told GAO they expect to implement a new data warehouse by the end of 2020. DOD officials also said they are importing data related to quality measures into another system used for quality monitoring; however, DOD does not have a targeted date for completing these data imports. Until these actions are fully implemented, groups responsible for monitoring quality care will continue to lack the data needed to offer assurance that the growing number of MTFs using MHS Genesis are providing beneficiaries with timely and effective care that will lead to better health outcomes. A draft of this report recommended that DOD establish a timeline to complete importing the quality measure-related data from MHS Genesis into DOD's system used for quality monitoring. In its review of the draft, DOD concurred with the recommendation and established a timeline for importing the data, to be available in DOD's system no later than May 2021. After reviewing the information DOD provided, GAO removed the recommendation from the final report. DOD is responsible for ensuring that beneficiaries have access to specialty care for conditions that, while not life-threatening, require immediate attention, as well as for ensuring that beneficiaries receive timely and effective care for certain routine or other services. A report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review the quality of health care in the MHS. This report examines (1) the timeliness with which beneficiaries access specialty care at MTFs through urgent referrals and DOD's efforts to monitor access, and (2) DOD's use of quality measures to monitor and improve the rates of timely and effective care received by beneficiaries at MTFs. GAO examined relevant policies, national DOD referral data (a total of 16,754 urgent referrals) for a 1-year period ending August 2019, and the most recent available quality measure data (April 2020). GAO interviewed officials from five MTFs, selected for variation in military services, geography, provision of select specialty services, and use of the electronic health record system. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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  • Information Technology: DOD Software Development Approaches and Cybersecurity Practices May Impact Cost and Schedule
    In U.S GAO News
    GAO reported in June 2020 that, of the 15 major Department of Defense (DOD) information technology (IT) programs selected for review, 11 had decreased their cost estimates as of December 2019. The decreases in cost estimates ranged from a .03 percent decrease to a 33.8 percent decrease. In contrast, the remaining four programs experienced increases in their life-cycle cost estimates—--two with increases exceeding 20 percent. Program officials reported several reasons for the increases, including testing delays and development challenges. Ten of the 15 programs had schedule delays when compared to their original acquisition program baselines. Schedule delays ranged from a delay of 1 month to a delay of 5 years. Program officials reported a variety of reasons for significant delays (delays of over 1 year) in their planned schedules, including cyber and performance issues. Regarding software development, officials from the 15 selected major IT programs that GAO reviewed reported using software development approaches that may help to limit risks to cost and schedule outcomes. For example, 10 of the 15 programs reported using commercial off-the-shelf software, which is consistent with DOD guidance to use this software to the extent practicable. Such software can help reduce software development time, allow for faster delivery, and lower life-cycle costs. In addition, 14 of the 15 programs reported using an iterative software development approach which, according to leading practices, may help reduce cost growth and deliver better results to the customer. However, programs also reported using an older approach to software development, known as waterfall, which could introduce risk for program cost growth because of its linear and sequential phases of development that may be implemented over a longer period of time. Specifically, two programs reported using a waterfall approach in conjunction with an iterative approach, while one was solely using a waterfall approach. With respect to cybersecurity, programs reported mixed implementation of specific practices, contributing to program risks that might impact cost and schedule outcomes. For example, all 15 programs reported developing cybersecurity strategies, which are intended to help ensure that programs are planning for and documenting cybersecurity risk management efforts. In contrast, only eight of the 15 programs reported conducting cybersecurity vulnerability assessments—systematic examinations of an information system or product intended to, among other things, determine the adequacy of security measures and identify security deficiencies. These eight programs experienced fewer increases in planned program costs and fewer schedule delays relative to the programs that did not report using cybersecurity vulnerability assessments. For fiscal year 2020, DOD requested approximately $36.1 billion for IT investments. Those investments included major IT programs, which are intended to help the department sustain key operations. The National Defense Authorization Act for Fiscal Year 2019 included a provision for GAO to assess selected IT programs annually through March 2023. GAO's objectives for this review were to, among other things, (1) describe the extent to which selected major IT programs have changed their planned costs and schedules since the programs' initial baselines; and (2) describe what selected software development and cybersecurity risks or challenges, if any, may impact major IT programs' acquisition outcomes. GAO selected programs based on DOD's list of major IT programs, as of April 10, 2019. From this list, GAO identified 15 major IT programs that had established an initial acquisition program baseline and that were not fully deployed by December 31, 2019. GAO compared the 15 programs' initial cost and schedule baselines to current acquisition program estimates. In addition, GAO aggregated DOD program office responses to a GAO questionnaire about software development approaches and cybersecurity practices used by the 15 programs. GAO compared this information to leading practices to identify risks and challenges affecting cost, schedule, and performance outcomes. This report is a public version of a “for official use only” report issued in June 2020. For more information, contact Kevin Walsh at (202) 512-6151 or walshk@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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  • Drug Misuse: Agencies Have Not Fully Identified How Grants That Can Support Drug Prevention Education Programs Contribute to National Goals
    In U.S GAO News
    The Department of Education (Education), the Department of Health and Human Services (HHS), and the Office of National Drug Control Policy (ONDCP) manage six key federal grant programs that can support drug prevention activities in schools. The flexibility of these grants supports a variety of drug prevention education programs. The agencies generally monitor grantees' compliance with grant requirements through periodic reporting. The aim of the National Drug Control Strategy (Strategy) is to reduce drug misuse, but HHS, and ONDCP have not fully defined how several key grant programs support the Strategy. ONDCP's guidance directs agencies to report, for each grant program, performance measures that relate to the Strategy's goals. However, some performance measures for several programs did not relate to drug prevention, did not link directly to the Strategy's prevention goals, or were not reported at all. For example: A $372 million set-aside for HHS's Substance Abuse Prevention and Treatment Block Grant program must be used on drug prevention, but HHS did not link the program's performance measures to the Strategy's prevention education goal.   ONDCP did not report on any performance measures in the Strategy or document how its $100 million Drug-Free Communities Support program contributes to achieving specific goals in the Strategy. GAO also found that the approximately $10 million grants to states component of Education's School Climate Transformation Grant program could more fully provide performance information related to the Strategy's prevention education goal. Fully understanding these programs' contributions to the goals of the National Drug Control Strategy could help Congress and the public better understand and assess how the nation's significant investments in drug prevention education programs help address the drug crisis. Most people who develop a substance use disorder begin using substances as adolescents. To reach adolescents, drug prevention programs are frequently provided in schools. Education, HHS, and ONDCP manage most federal programs that support school-based drug prevention activities. This report (1) describes how Education, HHS, and ONDCP support drug prevention activities in schools, and monitor those efforts and (2) examines the extent to which these agencies identify how their prevention activities support the National Drug Control Strategy. GAO reviewed agency documentation, the 2019 and 2020 National Drug Control Strategy documents which ONDCP identified as being most relevant to our review including the fiscal year 2019 drug control budget, ONDCP guidance, relevant federal laws, and GAO's prior work on attributes of successful performance measures that can help achieve agency goals. GAO also interviewed federal and state officials. GAO is making four recommendations, including that Education, HHS, and ONDCP clarify how grants that can include drug prevention education programs support related goals of the National Drug Control Strategy. HHS and ONCP agreed with the recommendation and Education partially concurred, saying it would explore collecting and reporting related performance data. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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  • Cybersecurity: Federal Agencies Need to Implement Recommendations to Manage Supply Chain Risks
    In U.S GAO News
    What GAO Found Federal agencies continue to face software supply chain threats. In December 2020, the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency issued an emergency directive requiring agencies to take action regarding a threat actor that had been observed leveraging a software supply chain compromise of a widely used enterprise network management software suite—SolarWinds Orion. Subsequently, the National Security Council staff formed a Cyber Unified Coordination Group to coordinate the government response to the cyberattack. The group took a number of steps, including gathering intelligence and developing tools and guidance, to help organizations identify and remove the threat. During the same month that the SolarWinds compromise was discovered, GAO reported that none of 23 civilian agencies had fully implemented selected foundational practices for managing information and communication technology (ICT) supply chain risks—known as supply chain risk management (SCRM) (see figure). Twenty-three Civilian Agencies' Implementation of Information and Communication Technology (ICT) Supply Chain Risk Management (SCRM) Practices GAO stressed that, as a result of not fully implementing the foundational practices, the agencies were at a greater risk that malicious actors could exploit vulnerabilities in the ICT supply chain, causing disruptions to mission operations, harm to individuals, or theft of intellectual property. Accordingly, GAO recommended that each of the 23 agencies fully implement these foundational practices. In May 2021, GAO received updates from six of the 23 agencies regarding actions taken or planned to address its recommendations. However, none of the agencies had fully implemented the recommendations. Until they do so, agencies will be limited in their ability to effectively address supply chain risks across their organizations. Why GAO Did This Study Federal agencies rely extensively on ICT products and services (e.g., computing systems, software, and networks) to carry out their operations. However, agencies face numerous ICT supply chain risks, including threats posed by malicious actors who may exploit vulnerabilities in the supply chain and, thus, compromise the confidentiality, integrity, or availability of an organization's systems and the information they contain. Recent events involving a software supply chain compromise of SolarWinds Orion, a network management software suite, and the shutdown of a major U.S. fuel pipeline due to a cyberattack highlight the significance of these threats. GAO was asked to testify on federal agencies' efforts to manage ICT supply chain risks. Specifically, GAO (1) describes the federal government's actions in response to the compromise of SolarWinds and (2) summarizes its prior report on the extent to which federal agencies implemented foundational ICT supply chain risk management practices. To do so, GAO reviewed its previously published reports and related information. GAO has ongoing work examining federal agencies' responses to SolarWinds and plans to issue a report on this in fall 2021.
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  • Medicare and Medicaid: COVID-19 Program Flexibilities and Considerations for Their Continuation
    In U.S GAO News
    What GAO Found In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for overseeing Medicare and Medicaid, made widespread use of program waivers and other flexibilities to expand beneficiary access to care. Some preliminary information is available on the effects of these waivers. Specifically: Medicare. CMS issued over 200 waivers and cited some of their benefits in a January 2021 report. For example, CMS reported that: Expansion of hospital capacity. More than 100 new facilities were added through the waivers that permitted hospitals to provide care in non-hospital settings, including beneficiaries' homes. Workforce expansion. Waivers and other flexibilities that relaxed certain provider enrollment requirements and allowed certain nonphysicians, such as nurse practitioners, to provide additional services expanded the provider workforce. Telehealth waivers. Utilization of telehealth services—certain services that are normally provided in-person but can also be provided using audio and audio-video technology—increased sharply. For example, utilization increased from a weekly average of about 325,000 services in mid-March to peak at about 1.9 million in mid-April 2020. Medicaid. CMS approved more than 600 waivers or other flexibilities aimed at addressing obstacles to beneficiary care, provider availability, and program enrollment. GAO has reported certain flexibilities such as telehealth as critical in reducing obstacles to care. Examples of other flexibilities included: Forty-three states suspended fee-for-service prior authorizations, which help ensure compliance with coverage and payment rules before beneficiaries can obtain certain services. Fifty states and the District of Columbia waived certain provider screening and enrollment requirements, such as criminal background checks. While likely benefitting beneficiaries and providers, these program flexibilities also increase certain risks to the Medicare and Medicaid programs and raise considerations for their continuation beyond the pandemic. For example: Increased spending. Telehealth waivers can increase spending in both programs, if telehealth services are furnished in addition to in-person services. Program integrity. The suspension of some program safeguards has increased the risks of fraud, waste, and abuse that GAO previously noted in its High-Risk report series. Beneficiary health and safety. Although telehealth has enabled the safe provision of services, the quality of telehealth services has not been fully analyzed. Why GAO Did This Study Medicare and Medicaid—two federally financed health insurance programs—spent over $1.5 trillion on health care services provided to about 140 million beneficiaries in 2020. Recognizing the critical role of these programs in providing health care services to millions of Americans, the federal government has provided for increased funding and program flexibilities, including waivers of certain federal requirements, in response to the COVID-19 pandemic. The CARES Act includes a provision for GAO to conduct monitoring and oversight of the federal government's response to the COVID-19 pandemic. In response, GAO has issued a series of government-wide reports from June 2020 through March 2021. GAO is continuing to monitor and report on these services. This testimony summarizes GAO's findings from these reports related to Medicare and Medicaid flexibilities during the COVID-19 pandemic, as well as preliminary observations from ongoing work related to telehealth waivers in both programs. Specifically, the statement focuses on what is known about the effects of these waivers and flexibilities on Medicare and Medicaid, and considerations regarding their ongoing use. To conduct this work, GAO reviewed federal laws, CMS documents and guidance, and interviewed federal and state officials. GAO also interviewed six provider and beneficiary groups, selected based on their experience with telehealth services. GAO obtained technical comments from CMS and incorporated them as appropriate. For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov or Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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