Defense Health Care: Implementation of Value-Based Initiatives in TRICARE

What GAO Found

The Defense Health Agency (DHA)—the agency within the Department of Defense (DOD) that administers DOD’s health care program, TRICARE—has identified a number of value-based initiatives for potential implementation with civilian providers and hospitals under the TRICARE program. These initiatives aim to help DHA build a value-based health care delivery system, in which providers are rewarded for value of services provided instead of volume of services provided. For these initiatives, value is generally measured in terms of improved health outcomes, enhanced experience of care for the patient, and reduced health care costs over time.

GAO found that DHA has identified 20 value-based initiatives, including a program that makes incentive payments for hospitals that meet certain quality metrics for maternity services and a program that promotes adherence to medication regimens by waiving co-payments, among others. According to DHA officials, the 20 initiatives include

  • five that have been implemented (two complete, three underway);
  • three that will be implemented in the future—two with anticipated 2020 start dates are currently on hold due to the department’s need to focus on the response to the Coronavirus Disease (COVID-19) pandemic and one that is expected to be implemented in January 2021;
  • eight that are still under review, but no decisions have been made about whether and when they might be implemented; and
  • four that were considered but will not be implemented.

Why GAO Did This Study

In fiscal year 2019, DOD offered health care services to approximately 9.6 million eligible beneficiaries worldwide through TRICARE, its regionally structured health care program. Beneficiaries may obtain health care services through DOD’s direct care system of military hospitals and clinics or from its purchased care system of civilian providers. DOD contracts with private sector companies—referred to as managed care support contractors—to develop and maintain networks of civilian providers and perform other customer service functions for its purchased care system.

The National Defense Authorization Act for Fiscal Year 2017 (NDAA 2017) required DOD to develop and implement value-based incentive initiatives in its TRICARE contracts. The NDAA 2017 also included a provision that required GAO to review these initiatives. This correspondence describes the initiatives DHA has developed and the status of each, as of June 2020. To do this work, GAO interviewed knowledgeable DHA officials and analyzed available documentation on each initiative, including decision papers, congressional reports, and Federal Register notices.

For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.

Hits: 2

News Network

  • Justice Department Files Statement of Interest in Michigan Religious Schools’ Challenge to COVID-19 Closing Order
    In Crime News
    The Justice Department today filed a statement of interest in federal district court in Kalamazoo, Michigan, arguing that the Free Exercise Clause of the Constitution requires the state of Michigan to justify why it cannot provide exemptions to its school closing order for in-person instruction at religious high schools when it provides exemptions for trade and technical instruction in person, college sports teams, and other educational activities.
    [Read More…]
  • Terra MISR Used to Visualize Cloud-top Heights From Tropical Storm Laura in 3D
    In Space
    This perspective can [Read More…]
  • DHS Office of Inspector General: Preliminary Observations on Long-Standing Management and Operational Challenges
    In U.S GAO News
    What GAO Found GAO's preliminary work has identified a number of management and operational challenges, including frequent leadership turnover, since fiscal year 2015 that have impeded the overall effectiveness of the Department of Homeland Security (DHS) Office of Inspector General (OIG). DHS OIG senior leaders have acknowledged that these challenges have contributed to organizational weaknesses, and have taken steps to begin addressing some of them. GAO's preliminary work has identified issues in the following areas, among others: Strategic planning: DHS OIG has not consistently developed strategic plans, which are a necessary input for developing the organization's other guiding documents and governance framework. Specifically, DHS OIG has operated for 4 of the past 6 years without a strategic plan, and the plan it adopted for fiscal years 2018–2019 included some, but not all, of the elements considered standard for federal entities. In 2020, DHS OIG contracted with a nonprofit academy of government experts to develop a strategic plan for fiscal years 2021–2025, with expected delivery in June 2021. Quality assurance: Internal and external reviews have reported on concerns about quality assurance in some of DHS OIG's work. In 2017 and 2018, after an internal review found that some reports issued by DHS OIG may not have adhered to the professional standards cited, DHS OIG retracted 13 audit reports that had been issued over a 5-year period. In 2018, an external review determined that DHS OIG needed to improve its system of quality control. Though DHS OIG concurred with all of the recommendations from that external review, it did not fully implement them. In addition, DHS OIG has not established roles and responsibilities for an organization-wide quality assurance program. Moreover, GAO's preliminary work indicates that current staff allocations may limit DHS OIG's quality assurance reviews to focusing on audit work and not on the other types of work it produces, including inspections, evaluations, special reviews, and management alerts. Timeliness: DHS OIG project time frames for work from its offices of Audits and Special Reviews and Evaluations have increased over the 4 fiscal years GAO assessed. For example, in fiscal year 2017, 79 of 102 Office of Audits projects were completed in 1 year or less and eight of 102 took more than 18 months. In fiscal year 2020, seven of 67 reports were completed in 1 year or less and more than half (35 of 67) took more than 18 months. In addition, DHS OIG has not assessed time frames for work completed by these offices, though timeliness in reporting is a key element of effective oversight and DHS OIG staff considered it an organizational weakness. GAO will complete its evaluation of these and other management and operational areas, and will issue a final report in the coming months. Why GAO Did This Study DHS OIG has a critical role in providing independent and objective oversight of DHS, which encompasses multiple operational and support components. OIGs are expected to maintain high standards of professionalism and integrity in light of their mission, according to quality standards developed by the community of federal Inspectors General. However, DHS OIG has faced a number of challenges that have affected its ability to carry out its oversight mission effectively. This statement is based on GAO's draft report on DHS OIG's management and operations, which is currently at the agency for comment. It provides preliminary observations on DHS OIG's strategic planning processes; quality assurance processes; and reporting time frames for work from DHS OIG's offices of Audits and Special Reviews and Evaluations. To develop these preliminary observations, GAO reviewed relevant federal laws and quality standards for federal OIGs as well as DHS OIG documentation, including organizational policies; internal communications such as emails and memoranda; and DHS OIG's semiannual reports to Congress and published reports. GAO also analyzed DHS OIG project data from fiscal years 2015 through 2020, and interviewed DHS OIG leaders and other staff.
    [Read More…]
  • PRC Military Pressure Against Taiwan Threatens Regional Peace and Stability
    In Crime Control and Security News
    Ned Price, Department [Read More…]
  • Zimbabwe Independence Day
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • DHS Annual Assessment: Most Acquisition Programs Are Meeting Goals but Data Provided to Congress Lacks Context Needed For Effective Oversight
    In U.S GAO News
    As of September 2020, 19 of the 24 Department of Homeland Security (DHS) programs GAO assessed that had DHS approved acquisition program baselines were meeting their currently established goals. However, of the 24 programs, ten had been in breach of their cost or schedule goals, or both, at some point during fiscal year 2020. A few programs experienced breaches related to external factors, such as the COVID-19 pandemic, while others breached their baseline goals because of acquisition management issues. Five of these programs rebaselined to increase costs or delay schedules, but the remaining five were still in breach status as of September 2020 (see table). Further, GAO found that some of the 19 programs that were meeting their currently established goals—including the U.S. Coast Guard's Offshore Patrol Cutter program—are at risk of future cost growth or schedule slips. DHS Major Acquisition Programs In Breach of Approved Cost or Schedule Goals (or Both) As of September 2020. Program (estimated life-cycle cost) Breach Type National Cybersecurity Protection System ($5,908 million) Schedule Homeland Advanced Recognition Technology ($3,923 million) Cost and Schedule Grants Management Modernization ($289 million) Cost and Schedule National Bio Agro-Defense Facility ($1,298 million) Schedule Medium Range Surveillance Aircraft ($15,187 million) Schedule Source: GAO analysis of Department of Homeland Security (DHS) data. | GAO-21-175 Note: The life-cycle cost information is the current acquisition program baseline cost goal as of September 2020. Programs may revise cost goals, if necessary, when the new baseline is approved. GAO found that supplemental guidance for the development of acquisition documents generally aligned with requirements in DHS's acquisition management policy. However, guidance for developing acquisition documentation in DHS's Systems Engineering Life Cycle Instruction and accompanying Guidebook does not reflect current requirements in DHS's acquisition management policy. DHS officials stated that the information related to development of acquisition documents—including the systems engineering life cycle tailoring plan—should be consistent across all of DHS's policies, instructions, and guidebooks. Inconsistent agency-wide guidance can lead to a lack of clarity on when programs should submit their program documentation. The Joint Explanatory Statement accompanying a bill to the DHS Appropriations Act, 2019, directed DHS to provide quarterly briefings on summary ratings for all major acquisition programs. While DHS is meeting this direction with summary ratings, the ratings do not include contextual information, such as programs' cost, schedule, or performance risks. This type of information would help Congress understand how the ratings relate to potential program outcomes. Determining what additional risk information is needed for DHS's major acquisition programs along with the reporting timeframes and the appropriate mechanism to provide the information, would help ensure that decision makers have needed context. DHS plans to spend more than $7 billion on its portfolio of major acquisition programs—with life-cycle costs over $300 million— in fiscal year 2021 to help execute its many critical missions. The Explanatory Statement accompanying the DHS Appropriations Act, 2015, included a provision for GAO to review DHS's major acquisitions on an ongoing basis. This report, GAO's sixth review, assesses the extent to which (1) DHS's major acquisition programs are meeting baseline goals, (2) DHS's guidance for developing acquisition documentation is consistent with DHS acquisition policy, and (3) DHS is reporting relevant information to Congress on its portfolio of major acquisition programs. GAO assessed 24 acquisition programs, including DHS's largest programs that were in the process of obtaining new capabilities as of April 2018, and programs GAO or DHS identified as at risk of poor outcomes. GAO assessed cost and schedule progress against baselines; assessed DHS's congressional reporting requirements; and interviewed DHS officials and congressional appropriations committee staff. GAO is making one recommendation for DHS to align acquisition guidance with policy, and one matter for Congress to consider determining what additional information it needs to perform oversight. DHS concurred with our recommendation. For more information, contact Marie A. Mak at (202) 512-4841 or makm@gao.gov.
    [Read More…]
  • VA Health Care: Actions Needed to Improve Oversight of Graduate Medical Education Reimbursement
    In U.S GAO News
    The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) provides training to more than 45,000 medical and dental residents annually through its Graduate Medical Education (GME) program. VHA has established policy for its GME program that details many roles and responsibilities for overseeing VA medical facilities' reimbursements to affiliated academic institutions for residents' salaries and benefits. However, this policy does not define key roles and responsibilities for VHA's central office components, its regional networks, or its medical facilities. For example, VHA's regional networks do not have defined roles and responsibilities for overseeing GME disbursements—contributing to noninvolvement or inconsistent involvement in disbursement agreement oversight. VHA officials reported that they are in the process of updating disbursement agreement policy, but did not indicate if the updates would address all identified concerns. While VHA officials said that VHA's two disbursement agreement oversight mechanisms—facility periodic audits and the Resident Disbursement Audit Process (ReDPro) checklist—are meant to have distinct but complementary purposes, GAO found that VHA policy, guidance, and the tools distributed for these oversight mechanisms did not reflect the distinct purposes officials described. VHA officials said that periodic audits are intended to be a first level of defense and to review actual payments to affiliates, whereas the ReDPro checklist is intended to be a second level of defense, aimed at reviewing the process to see if the rules related to disbursement agreements are being followed by VA medical facilities. However, the ReDPro checklist tool and VHA's recommended periodic audit tool have numerous areas of overlap, including duplicative questions. This overlap causes inefficiencies and unnecessary burden on VA medical facility staff. GAO also found additional weaknesses in the tools, guidance, and training for the two oversight mechanisms. For example, GAO found an unclear ReDPro checklist tool, along with insufficient guidance and training related to conducting the ReDPro reviews. Officials from eight of 13 facilities in GAO's review indicated that the ReDPro checklist instructions were unclear regarding appropriate supporting documents for checklist responses. These weaknesses contributed to errors and inconsistencies in ReDPro responses. the lack of a standard audit tool, and inadequate guidance and training for periodic audit teams that contributed to problematic inconsistencies in the methodologies used by the audit teams and deficiencies in some of the audits conducted. Officials from 10 of 13 facilities in GAO's review indicated that they would benefit from more tools, guidance, or training related to conducting periodic audits. These weaknesses limit the effectiveness of VHA's oversight mechanisms, and put VHA at increased risk of both not being able to identify and correct facilities' lack of adherence to disbursement agreement policy and of possible improper payments to GME affiliates. Under VHA's GME program, VA medical facilities use disbursement agreements to reimburse affiliated academic institutions for residents' salaries and benefits. VHA developed policy related to establishing and administering disbursement agreements, but audits have found that facilities have not always adhered to VHA policy—resulting in improper payments to affiliates. GAO was asked to review VHA policies and procedures related to reimbursements to affiliates for GME. This report examines (1) oversight roles and responsibilities for GME disbursement agreements and (2) VHA's mechanisms for ensuring VA medical facilities adhere to policy. GAO reviewed relevant VHA documents and federal internal control standards and interviewed VHA officials. GAO also reviewed ReDPro checklist responses and documentation from 13 VA medical facilities—selected based on factors including geographic variation, GME program size, and number of affiliates. GAO also visited four of the 13 facilities and interviewed officials at the other nine facilities. GAO is making seven recommendations to VA to define key roles in policy, reduce overlap between the ReDPro checklist and facility periodic audits, and improve the oversight mechanisms' tools, guidance, and training. VA concurred with GAO's recommendations. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
    [Read More…]
  • Iceland Travel Advisory
    In Travel
    Reconsider travel to [Read More…]
  • Michigan Man Pleads Guilty to Conspiring to Defraud the IRS and to Steal Crash Reports from the Detroit Police Department
    In Crime News
    A Birmingham, Michigan, resident pleaded guilty today to conspiring to defraud the IRS and to steal from an organization receiving federal funds, announced Acting Deputy Assistant Attorney General Stuart M. Goldberg of the Justice Department’s Tax Division.
    [Read More…]
  • Secretary Kerry Participates in the UN Security Council Open Debate on Climate and Security
    In Climate - Environment - Conservation
    John Kerry, Special [Read More…]
  • Puerto Rico Legislator Indicted for Theft, Bribery, and Fraud
    In Crime News
    A federal grand jury in the District of Puerto Rico returned a 13-count indictment against legislator María Milagros Charbonier-Laureano (Charbonier), aka “Tata,” a member of the Puerto Rico House of Representatives, as well as her husband Orlando Montes-Rivera (Montes), their son Orlando Gabriel Montes-Charbonier, and her assistant Frances Acevedo-Ceballos (Acevedo), for their alleged participation in a years-long theft, bribery, and kickback conspiracy.
    [Read More…]
  • Judge Honors Mother’s Adversity, Sacrifice by Women
    In U.S Courts
    In a highly personal talk, Judge Paula Xinis recounts how two women inspired her career in the law through their different battles with adversity: Sojourner Truth, an abolitionist who escaped from slavery, and Xinis’ mother.
    [Read More…]
  • High Ranking MS-13 Gang Member Facing Federal Firearms Charges After Nightclub Shooting
    In Crime News
    A criminal complaint was unsealed Nov. 6 charging the local leader of an MS-13 Gang clique with being a convicted felon in possession of a firearm, announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division and U.S. Attorney Don Cochran for the Middle District of Tennessee.
    [Read More…]
  • Malta National Day
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]
  • Former Cancer Center President Indicted For Participation In Long-Running Antitrust Conspiracy
    In Crime News
    A federal grand jury returned an indictment against Dr. William Harwin, founder and former President of Florida Cancer Specialists & Research Institute LLC (FCS), for conspiring to allocate medical and radiation oncology treatments for patients in Southwest Florida, the Department of Justice announced today.
    [Read More…]
  • 40 Charged in Largest Federal Racketeering Conspiracy in South Carolina History
    In Crime News
    A federal grand jury has returned a 147-count superseding indictment against 40 defendants across South Carolina in the largest federal racketeering conspiracy in South Carolina history.
    [Read More…]
  • Secretary Antony J. Blinken And Colombian Vice President and Foreign Minister Marta Lucia Ramirez Before Their Meeting
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • The U.S. Reaches $1.5 Billion Settlement with Daimler AG Over Emissions Cheating in Mercedes-Benz Diesel Vehicles
    In Crime News
    The U.S. Department of Justice, Environmental Protection Agency (EPA), and California Air Resources Board (CARB) announced today a proposed settlement with German automaker Daimler AG and its American subsidiary Mercedes-Benz USA, LLC (collectively, “Daimler”) resolving alleged violations of the Clean Air Act and California law associated with emissions cheating. 
    [Read More…]
  • Tax Administration: Opportunities Exist to Improve Oversight of Hospitals’ Tax-Exempt Status
    In U.S GAO News
    Nonprofit hospitals must satisfy three sets of requirements to obtain and maintain a nonprofit tax exemption (see figure). Requirements for Nonprofit Hospitals to Obtain and Maintain a Tax-Exemption While PPACA established requirements to better ensure hospitals are serving their communities, the law is unclear about what community benefit activities hospitals should be engaged in to justify their tax exemption. The Internal Revenue Service (IRS) identified factors that can demonstrate community benefits, but they are not requirements. IRS does not have authority to specify activities hospitals must undertake and makes determinations based on facts and circumstances. This lack of clarity makes IRS's oversight challenging. Congress could help by adding specificity to the Internal Revenue Code (IRC). While IRS is required to review hospitals' community benefit activities at least once every 3 years, it does not have a well-documented process to ensure that those activities are being reviewed. IRS referred almost 1,000 hospitals to its audit division for potential PPACA violations from 2015 through 2019. However, IRS could not identify if any of these referrals related to community benefits. GAO's analysis of IRS data identified 30 hospitals that reported no spending on community benefits in 2016, indicating potential noncompliance with providing community benefits. A well-documented process, such as clear instructions for addressing community benefits in the PPACA reviews or risk-based methods for selecting cases, would help IRS ensure it is effectively reviewing hospitals' community benefit activities. Further, according to IRS officials, hospitals with little to no community benefit expenses would indicate potential noncompliance. However, IRS was unable to provide evidence that it conducts reviews related to hospitals' community benefits because it does not have codes to track such audits. Slightly more than half of community hospitals in the United States are private, nonprofit organizations. IRS and the Department of the Treasury have recognized the promotion of health as a charitable purpose and have specified that nonprofit hospitals are eligible for a tax exemption. IRS has further stated that these hospitals can demonstrate their charitable purpose by providing services that benefit their communities as a whole. In 2010, Congress and the President enacted PPACA, which established additional requirements for tax-exempt hospitals to meet to maintain their tax exemption. GAO was asked to review IRS's implementation of requirements for tax-exempt hospitals. This report assesses IRS's (1) oversight of how tax-exempt hospitals provide community benefits, and (2) enforcement of PPACA requirements related to tax-exempt hospitals. GAO is making one matter for congressional consideration to specify in the IRC what services and activities Congress considers sufficient community benefit. GAO is also making four recommendations to IRS, including to establish a well-documented process to ensure hospitals' community benefit activities are being reviewed, and to create codes to track audit activity related to hospitals' community benefit activities. IRS agreed with GAO's recommendations. For more information, contact Jessica Lucas-Judy at (202) 512-9110 or lucasjudyj@gao.gov.
    [Read More…]
  • Justice Department Files Complaint to Stop Distribution of Unapproved, Misbranded, and Adulterated “Poly-MVA” Products
    In Crime News
    The United States filed a civil complaint to stop a California company from distributing unapproved and misbranded drugs and adulterated animal drugs, the Department of Justice announced today.
    [Read More…]
  • Florida Businesswoman Pleads Guilty to Criminal Health Care and Tax Fraud Charges and Agrees to $20.3 Million Civil False Claims Act Settlement
    In Crime News
    A Florida businesswoman has agreed to resolve criminal charges and civil claims arising out of false claims to the United States for braces and other durable medical equipment (DME), the Justice Department announced today.
    [Read More…]
  • Justice Department Defends Health Care Workers from Being Forced to Perform Abortions with Vermont Lawsuit
    In Crime News
    The Justice Department’s Civil Rights Division today filed a civil lawsuit in Vermont federal court against the University of Vermont Medical Center (UVMMC) for violating the federal anti-discrimination statute known as the “Church Amendments.” That statute prohibits health care entities like UVMMC from discriminating against health care workers who follow their conscience and refuse to perform or assist with abortions.
    [Read More…]
  • Substance Use Disorder: Medicaid Coverage of Peer Support Services for Adults
    In U.S GAO News
    Substance use disorders (SUD)—the recurrent use of alcohol or illicit drugs causing significant impairment—affected about 19.3 million adults in the United States in 2018, according to the Substance Abuse and Mental Health Services Administration. State Medicaid programs have the option to cover services offered by peer providers—individuals who use their own lived experience recovering from SUD to support others in recovery. GAO's review of Medicaid and CHIP Payment and Access Commission data found that, in 2018, 37 states covered peer support services for adults with SUDs in their Medicaid programs. Medicaid Coverage of Peer Support Services for Adults with Substance Use Disorders, 2018 Officials from the three states GAO reviewed—Colorado, Missouri, and Oregon—reported that their Medicaid programs offered peer support services as a complement, rather than as an alternative, to clinical treatment for SUD. Missouri officials said that peer providers did not maintain separate caseloads and were part of treatment teams, working in conjunction with doctors and other clinical staff. Similarly, officials in Colorado and Oregon said peer support services were only offered as part of a treatment plan. State officials reported that peer support services could be offered as an alternative to clinical treatment outside of Medicaid using state or grant funding. SUD treatment can help individuals reduce or stop substance use and improve their quality of life. In 2007, the Centers for Medicare & Medicaid Services recognized that peer providers could be an important component of effective SUD treatment, and provided guidance to states on how to cover peer support services in their Medicaid programs. However, states have flexibility in how they design and implement their Medicaid programs, and coverage for peer support services is an optional benefit. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act included a provision for GAO to report on peer support services under Medicaid. This report describes, among other objectives, the extent to which state Medicaid programs covered peer support services for adult beneficiaries with SUDs nationwide, and how selected state Medicaid programs offered peer support services for adult beneficiaries with SUDs. GAO obtained state-by-state data from the Medicaid and CHIP Payment and Access Commission on 2018 Medicaid coverage of peer support services. GAO also reviewed information and interviewed officials from a nongeneralizable sample of three states, which GAO selected for a number of reasons, including to obtain variation in delivery systems used. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
    [Read More…]
  • Public Health Preparedness: HHS Has Taken Some Steps to Implement New Authority to Speed Medical Countermeasure Innovation
    In U.S GAO News
    The Department of Health and Human Services' (HHS) Biomedical Advanced Research and Development Authority has taken steps towards implementing an authority provided by the 21st Century Cures Act to accelerate the development of medical countermeasures. Medical countermeasures are drugs, vaccines, and devices to diagnose, treat, prevent, or mitigate potential health effects of exposure to chemical, biological, radiological, and nuclear threats. However, as of June 2020, HHS had not selected a medical countermeasures innovation partner—an independent, nonprofit entity that the 21st Century Cures Act authorizes HHS to partner with to use venture capital practices and methods to invest in companies developing medical countermeasures. Towards implementing the authority, HHS has developed a vision for the innovation partner, staffed a division to manage HHS's medical innovation partnership and determined an initial amount of funding needed, solicited and considered feedback from venture capital and other stakeholders, and developed preliminary plans for structuring and overseeing the partnership. HHS officials explained this type of partnership approach was new to the agency and required due diligence to develop. According to agency officials, the innovation partner will allow HHS to invest in potentially transformative medical countermeasures that have the potential to benefit the government. For example, the innovation partner could invest in innovative wearable technologies to help early detection of viral infections. HHS officials told GAO that the partner, which is required by law to be a nonprofit entity, will be required to reinvest BARDA's revenues generated from government investments into further investments made through the partnership. BARDA's ultimate goal will be to use these revenues to fund new investments. According to a review of stakeholder comments submitted to HHS, potential venture capital partners identified concerns regarding aspects of the agency's plans for the innovation partner, which the stakeholders indicated could hinder HHS's implementation of the authority. For example, there is a statutory limit to the annual salary that can be paid to an individual from HHS's annual appropriation, which some stakeholders indicated was too low to attract an entity to manage the innovation partner funds. HHS officials told GAO they are assessing options to mitigate some of these concerns, but that plans will not be final until they select the partner. GAO provided a draft of this correspondence to HHS and the Department of Defense for review and comment. HHS did not provide comments on this report and DOD provided technical comments that we incorporated as appropriate. The COVID-19 pandemic and other public health emergencies caused by chemical, biological, radiological, and nuclear agents or emerging infectious diseases raise concern about the nation's vulnerability to, and capacity to prevent or mitigate, potential health effects from exposure to such threats. The 21st Century Cures Act authorized HHS to partner with a private, nonprofit entity that can use venture capital practices and methods to invest in companies developing promising, innovative, medical countermeasures. The 21st Century Cures Act included a provision for GAO to review activities conducted under the innovation partner authority. This report describes the status of HHS's implementation of the authority. GAO reviewed relevant statutes and HHS documentation regarding its plans and actions taken to implement the authority, reviewed responses HHS received to the two requests for information it used to collect information from venture capital and other stakeholders, interviewed HHS officials, and interviewed officials from the Department of Defense, which has partnered with a private, nonprofit entity to make investments using venture capital practices. For more information, contact Mary Denigan-Macauley at (202) 512-7114 or DeniganMacauleyM@gao.gov.
    [Read More…]
  • Alabama Tax Preparer Pleads Guilty to Filing False Tax Returns
    In Crime News
    A Birmingham, Alabama, tax return preparer pleaded guilty to aiding and assisting in the preparation of a false tax return, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney for the Northern District of Alabama Prim F. Escalona.
    [Read More…]
  • Department of Justice Invests More than $87 Million in Grants to Address School Violence
    In Crime News
    The Department of [Read More…]
  • Secretary Blinken’s Call with Algerian Foreign Minister Boukadoum
    In Crime Control and Security News
    Office of the [Read More…]
  • Appointment of Dr. Matthew Graviss as Chief Data Officer 
    In Crime Control and Security News
    Office of the [Read More…]
  • Three Foreign Nationals Charged with Conspiring to Provide Material Support to ISIS
    In Crime News
    The Justice Department announced today that three Sri Lankan citizens have been charged with terrorism offenses, including conspiring to provide material support to a designated foreign terrorist organization (ISIS).  The men were part of a group of ISIS supporters which called itself “ISIS in Sri Lanka.”  That group is responsible for the 2019 Easter attacks in the South Asian nation of Sri Lanka, which killed 268 people, including five U.S. citizens, and injured over 500 others, according to a federal criminal complaint unsealed today.
    [Read More…]
  • Service Acquisitions: DOD’s Report to Congress Identifies Steps Taken to Improve Management, But Does Not Address Some Key Planning Issues
    In U.S GAO News
    The Department of Defense (DOD) relies on contractors to provide a wide array of services, including support for management, information technology, and weapon systems. DOD obligated about $190 billion on service acquisitions in fiscal year 2019 (see figure). Department of Defense Obligations for Service Acquisitions by Military Department and Defense Agencies and Field Activities, Fiscal Year 2019 Since 2001, GAO has highlighted service acquisitions as an issue for oversight within the DOD Contract Management area in its High-Risk List. Among other things, the High-Risk List and GAO's prior work have identified that: DOD's service requirements reviews were narrowly focused on individual contracts rather than entire capability portfolios, DOD's efforts to use its inventory of contracted services to inform management decisions were hindered by data collection issues, and DOD's budget exhibits did not clearly identify service acquisitions. In October 2020, DOD issued a report to Congress describing its current mechanisms and plans for managing and overseeing service contracts. GAO found that this report addresses some of the key issues identified in GAO's High-Risk List, but does not address others. Requirement reviews. The DOD report summarizes guidance the department issued in January 2020 that links requirements reviews to budget trade-offs, and clarifies the relationship between service acquisition management and category management activities. Category management is an Office of Management and Budget-led, government-wide initiative to reorganize government spending around fewer, larger contracts and use the government's purchasing power to buy like a single enterprise. These efforts have the potential to improve how requirements reviews support budget trade-off decisions within and across capability portfolios. Inventory of contracted services. The DOD report discusses the department's recent transition to the government-wide system other federal agencies use to collect data for their inventories of contracted services, and explains that this transition is intended to reduce the burden of data collection for defense contractors and improve compliance. However, the report does not discuss how DOD plans to use this data to inform decision-making and workforce planning, the key issues GAO has identified in past work. Future-year spending plans. The DOD report does not discuss our finding in a prior report that DOD could improve its ability to strategically manage service acquisitions by improving visibility on future budgetary requirements. Instead, DOD's report states that DOD plans to address capability gaps in budget planning for service contracts in a separate effort in response to a provision in the National Defense Authorization Act for Fiscal Year 2020 that might address GAO's recommendations. DOD officials told GAO they are working to better understand that provision before initiating their effort. The Senate report on the National Defense Authorization Act for Fiscal Year 2020 included a provision for the Secretary of Defense to submit a report to the congressional defense committees on current mechanisms for overseeing defense service contracts, and for GAO to assess this report. DOD issued its report to Congress in the second week of October 2020. This GAO report assesses the extent to which that DOD report addresses service acquisition issues identified in GAO's High-Risk List and other products. GAO reviewed DOD's report to Congress on defense service acquisitions and GAO's past reports on defense service acquisitions, including GAO's 2019 High-Risk List and 11 other products issued between 2011 and 2018. GAO collected and assessed additional documentation from DOD offices and military departments, and interviewed officials from these offices and departments to collect additional information about DOD plans to improve service acquisitions. For more information, contact Timothy DiNapoli at (202) 512-4841 or DiNapoliT@gao.gov.
    [Read More…]
  • Imposing Sanctions on Iranian Entities for Activities Related to Conventional Arms Proliferation
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]
  • Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care
    In U.S GAO News
    The Department of Veterans Affairs (VA) established an appointment scheduling process for the Veterans Community Care Program (VCCP) that allows up to 19 days to complete several steps from VA providers creating a referral to community care staff reviewing that referral. However, as the figure shows, VA has not specified the maximum amount of time veterans should have to wait to receive care through the program. GAO previously recommended in 2013 the need for an overall wait-time measure for veterans to receive care under a prior VA community care program. Subsequent to VA not implementing this recommendation, GAO again recommended in 2018 that VA establish an achievable wait-time goal as part of its new community care program (the VCCP). Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the VCCP through routine referrals (non-emergent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf. VA has not yet implemented GAO's 2018 recommendation that VA establish an achievable wait-time goal. Under the VA MISSION Act, VA is assigned responsibility for ensuring that veterans' appointments are scheduled in a timely manner—an essential component of quality health care. Given VA's lack of action over the prior 7 years implementing wait-time goals for various community care programs, congressional action is warranted to help achieve timely health care for veterans. Regarding monitoring of the initial steps of the scheduling process, GAO found that VA is using metrics that are remnants from the previous community care program, which are inconsistent with the time frames established in the VCCP scheduling process. This limits VA's ability to determine the effectiveness of the VCCP and to identify areas for improvement. In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner. GAO was asked to review VCCP appointment scheduling. This report examines, among other issues, the VCCP appointment scheduling process VA established and VA's monitoring of that process. GAO reviewed documentation, such as scheduling policies, and referral data related to the VCCP and assessed VA's relevant processes. GAO conducted site visits to five VAMCs in the first region to transition to VA's new provider network, and interviewed VAMC staff and a non-generalizable sample of community providers receiving referrals from those VAMCs. GAO also interviewed VA and contractor officials. GAO recommends that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO is also making three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with one of GAO's recommendations related to aligning monitoring metrics to VCCP scheduling policy time frames. GAO continues to believe this recommendation is valid, as discussed in the report. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
    [Read More…]
  • Assistant Secretary for East Asian and Pacific Affairs David R. Stilwell on the Secretary’s Travel to Japan, Mongolia, and the Republic of Korea
    In Crime Control and Security News
    David R. Stilwell, [Read More…]
  • Secretary Blinken’s Call with Tajikistan Foreign Minister Muhriddin
    In Crime Control and Security News
    Office of the [Read More…]
  • 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.
    [Read More…]
  • Husband Sentenced to 188 Months in Prison for Human Trafficking Convictions Related to Forced Labor of Foreign Nationals
    In Crime News
    The Justice Department today announced that former Stockton, California resident Satish Kartan, 46, was sentenced today to188 months in prison for forced labor violations. In addition, U.S. District Judge Morrison C. England Jr. ordered $15,657 be paid in restitution to three victims, in part to cover their back wages and other losses.
    [Read More…]
  • Former Investment Manager Charged in Scheme to Defraud Life Insurance Company
    In Crime News
    A former investment manager was charged in an indictment unsealed today for his alleged participation in a scheme to defraud a North Carolina-based life insurance company out of over $34 million.
    [Read More…]
  • Owner of New York Tax Preparation Business Pleads Guilty to Conspiring to File False Returns
    In Crime News
    A Queens, New York return preparer pleaded guilty today to conspiracy to defraud the United States by filing false returns, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division.
    [Read More…]
  • Owner of Tax Preparation Business Sentenced to Prison for Filing False Returns
    In Crime News
    A former Gulfport, Mississippi, tax return preparer was sentenced to 46 months in prison today for aiding and assisting in the preparation of false returns, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney Mike Hurst for the Southern District of Mississippi.
    [Read More…]
  • Announcing Sanctions on the Ortega Regime in Response to Arbitrary Detentions and Other Undemocratic Moves
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • The United States and United Kingdom: Reaffirming Our Alliance
    In Crime Control and Security News
    Office of the [Read More…]
  • Three New Views of Mars’ Moon Phobos
    In Space
    Taken with the infrared [Read More…]
  • Secretary Blinken’s Travel to Costa Rica
    In Crime Control and Security News
    Ned Price, Department [Read More…]
  • The Ortega Regime’s New Authoritarian Law Undermines Democracy
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]
  • On the Occasion of World Refugee Day
    In Human Health, Resources and Services
    Michael R. Pompeo, [Read More…]
  • Assistant Attorney General Makan Delrahim Delivers Remarks at the LeadershIP Virtual Series
    In Crime News
    Broke. . . but Not No More: Opening Remarks--Innovation Policy and the Role of Standards, IP, and Antitrust
    [Read More…]
  • Defense Department Linguist Sentenced to 23 Years in Prison for Transmitting Highly Sensitive Classified National Defense Information to Aid a Foreign Government
    In Crime News
    Mariam Taha Thompson, 62, formerly of Rochester, Minnesota, was sentenced today to 23 years in prison for delivering classified national defense information to aid a foreign government. As part of her March 26 guilty plea, Thompson admitted that she believed that the classified national defense information that she was passing to a Lebanese national would be provided to Lebanese Hezbollah, a designated foreign terrorist organization.
    [Read More…]
  • [Protest of GSA Contract Award for Office Space]
    In U.S GAO News
    A firm protested the General Services Administration (GSA) decision to increase its required office space under an existing contract, contending that since GSA failed to afford it an opportunity to bid on the additional space, GSA should: (1) resolicit its requirements; and (2) allow it an opportunity to bid on the current requirements. GAO held that it would not consider the protest, since there was a pending appeal concerning the initial award of the lease, which could ultimately render any GAO decision academic. Accordingly, the protest was dismissed.
    [Read More…]
  • Judiciary Steps Up Calls to Enact Security Measures
    In U.S Courts
    Citing the latest act of violence this year, in which a judge's family and officers at two federal courthouses have come under attack, the Judiciary has stepped up its call to congressional leaders for a series of safety measures “to protect the safety of the public at our nation’s courthouses.”
    [Read More…]
  • Tanzania Travel Advisory
    In Travel
    Reconsider travel to [Read More…]
  • Secretary Antony J. Blinken Meet and Greet with Embassy San Jose Staff
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • Drug Safety: FDA’s Future Inspection Plans Need to Address Issues Presented by COVID-19 Backlog
    In U.S GAO News
    Fiscal year 2015 was the first time that the Food and Drug Administration (FDA) conducted more inspections of foreign drug manufacturers than domestic manufacturers, with the majority conducted in China and India. However, in June 2020, GAO reported that from fiscal year 2016 through fiscal year 2018, both foreign and domestic inspections decreased, in part due to staffing vacancies. While foreign inspections increased in 2019, since March 2020, FDA has largely paused foreign and domestic inspections due to the Coronavirus Disease 2019 (COVID-19) pandemic, conducting only those deemed mission critical. In January 2021, GAO reported that FDA conducted three foreign inspections in fiscal year 2020 following the pause—significantly less than in recent years. Number of FDA-Conducted Foreign Drug Manufacturing Establishment Inspections, Fiscal Years 2019–2020, by Month FDA has used alternative inspection tools to maintain some oversight of drug manufacturing quality while inspections are paused. These tools include relying on inspections conducted by foreign regulators, requesting and reviewing records and other information, and sampling and testing drugs. FDA has determined that inspections conducted by certain European regulators are equivalent to and can be substituted for an FDA inspection. Other tools provide useful information but are not equivalent. In addition, FDA was unable to complete more than 1,000 of its planned fiscal year 2020 inspections and will likely face a backlog of inspections in future years. In January 2021, GAO recommended that FDA ensure that inspection plans for future fiscal years respond to the issues presented by the backlog and that FDA fully assess the agency's alternative inspection tools. FDA concurred with both recommendations. Even before the COVID-19 pandemic, FDA faced persistent challenges conducting foreign inspections. GAO found in December 2019 that there continued to be vacancies among the investigators who conduct foreign inspections. GAO further found that FDA's practice of preannouncing foreign inspections up to 12 weeks in advance could give manufacturers the opportunity to fix problems ahead of the inspection and raised questions about their equivalence to domestic inspections. In light of COVID-19, FDA is now preannouncing both foreign and domestic inspections for the safety of its staff and manufacturers. GAO also found that language barriers can create challenges during foreign inspections as FDA generally relies on the establishment for translation services. The outbreak of COVID-19 has called greater attention to the United States' reliance on foreign drug manufacturers. FDA reports that 74 percent of establishments manufacturing active ingredients and 54 percent of establishments manufacturing finished drugs for the U.S. market were located overseas, as of May 2020. FDA is responsible for overseeing the safety and effectiveness of all drugs marketed in the United States, regardless of where they are produced, and it conducts inspections of both foreign and domestic manufacturing establishments. GAO has had long-standing concerns about FDA's ability to oversee the increasingly global pharmaceutical supply chain, an issue highlighted in GAO's High Risk Series since 2009. This statement is largely based on GAO's Drug Manufacturing Inspections enclosure in its January 2021 CARES Act report, as well as GAO's December 2019 and June 2020 testimonies. Specifically, it discusses (1) the number of FDA's foreign inspections, (2) FDA's response to the COVID-19 pandemic pause in inspections, and (3) persistent foreign inspection challenges. For that work, GAO examined FDA data from fiscal years 2012 through 2020, interviewed FDA investigators, and reviewed documents related to drug oversight during the COVID-19 pandemic, among other things. For more information, contact Mary Denigan-Macauley at (202) 512-7114 or deniganmacauleym@gao.gov.
    [Read More…]
  • North Carolina Couple Indicted for Failing to Pay Employment Taxes and Failure to File Tax Returns
    In Crime News
    A federal grand jury in Greensboro, North Carolina, returned an indictment today, charging a North Carolina couple with federal employment tax and individual income tax violations, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney Matthew G.T. Martin for the Middle District of North Carolina. 
    [Read More…]
  • Two Bizarre Brown Dwarfs Found With Citizen Scientists’ Help
    In Space
    Data from NASA’s [Read More…]
  • On the 41st Anniversary of the U.S. Embassy Takeover in Tehran
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]
  • Homeland Security: DHS Needs to Fully Implement Key Practices in Acquiring Biometric Identity Management System
    In U.S GAO News
    What GAO Found The Department of Homeland Security (DHS) initially expected to implement the entire Homeland Advanced Recognition Technology (HART) by 2021; however, no segments of the program have been deployed to date. Currently estimated to cost $4.3 billion in total, DHS plans to deploy increment 1 of the program in December 2021 and expects to implement later increments in 2022 and 2024. Increment 1 is expected to replace the functionality of the existing system. Although the multi-billion dollar HART program had suffered continuing delays, until the end of last year, the DHS Chief Information Officer (CIO) had reported the program as low risk on the IT Dashboard, a website showing, among other things, the performance and risks of agency information technology (IT) investments. In May 2020, the Office of the CIO began developing a new assessment process which led to the CIO accurately elevating HART's rating from low to high risk and reporting this rating to the IT Dashboard in November 2020. In addition, consistent with OMB guidance, the CIO fulfilled applicable oversight requirements for high-risk IT programs by, among other things, conducting a review of the program known as a TechStat review. While the CIO complied with applicable oversight requirements in conducting the TechStat review, GAO noted that DHS's associated policy was outdated. Specifically, the 2017 policy does not reflect the revised process DHS started using in 2020. As such, until the guidance is updated, other departmental IT programs deemed high risk would likely not be readily aware of the specific process requirements. Concurrent with the CIO's actions to conduct oversight, HART program management has also acted to implement important risk management practices. Specifically, GAO found that HART had fully implemented four of seven risk management best practices and partially implemented the remaining three (see table). For example, as of February 2021, the program had identified 49 active risks, including 15 related to cost and schedule and 17 related to technical issues. While DHS has plans under way to fully implement two of the partially implemented practices, until it fully implements the remaining practice its efforts to effectively monitor the status of risks and mitigation plans may be hampered. Summary of the Homeland Advanced Recognition Technology Program's Implementation of the Seven Risk Management Practices Practice GAO assessment 1. Determine risk sources and categories ● 2. Define parameters to analyze and categorize risks ● 3. Establish and maintain a risk management strategy ◑ 4. Identify and document risks ● 5. Evaluate and categorize each identified risk using defined risk categories and parameters, and determine its relative priority ● 6. Develop a risk mitigation plan in accordance with the risk management strategy ◑ 7. Monitor the status of each risk periodically and implement the risk mitigation plan as appropriate ◑ Legend: ● = Fully implemented ◑ = Partially implemented ○ = Not implemented Source: GAO analysis of agency data. | GAO-21-386 Why GAO Did This Study DHS currently uses an outdated system, implemented over 27 years ago, for providing biometric identity management services (i.e., fingerprint matching and facial recognition technology services), known as the Automated Biometric Identification System, or IDENT. In 2016, DHS initiated a multi-billion dollar program known as HART, which is intended to replace the existing system. GAO was asked to evaluate the HART program. Its specific objectives, among others, were to (1) determine the status of the program, (2) assess the extent to which the DHS CIO was accurately reporting risk and meeting applicable oversight requirements, and (3) assess the extent to which the program was identifying and managing its risks. To accomplish these objectives, GAO identified the program's schedule and cost estimates, assessed the CIO's risk ratings and HART oversight documentation and related evidence against OMB guidance, and compared the program's risk management practices to best practices that are essential to identifying and mitigating potential problems. In addition, GAO interviewed appropriate officials.
    [Read More…]
  • Incyte Corporation to Pay $12.6 Million to Resolve False Claims Act Allegations for Paying Kickbacks
    In Crime News
    A pharmaceutical company headquartered in Delaware has agreed to pay $12.6 million to resolve allegations that it violated the False Claims Act by paying kickbacks.
    [Read More…]
  • Reducing Violence Against Religious Minority Communities in Brazil
    In Human Health, Resources and Services
    Bureau of Democracy, [Read More…]
  • Chinese Energy Company, U.S. Oil & Gas Affiliate and Chinese National Indicted for Theft of Trade Secrets
    In Crime News
    A federal grand jury has returned an indictment alleging corporate entities conspired to steal technology from a Houston-area oil & gas manufacturer, announced U.S. Attorney Ryan K. Patrick and Assistant Attorney General John C. Demers of the Department of Justice’s National Security Division. Jason Energy Technologies Co. (JET) in Yantai, People’s Republic of China; Jason Oil and Gas Equipment LLC (JOG) USA and Chinese national Lei Gao aka Jason Gao, 45, are charged with conspiracy, theft of trade secrets and attempted theft of trade secrets. 
    [Read More…]
  • Secretary Michael R. Pompeo with Tony Perkins of Washington Watch with Tony Perkins
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]