What GAO Found
Since fiscal year 2016, the Centers for Medicare & Medicaid Services (CMS) has initiated 49 financial management reviews (FMR) to examine state Medicaid agencies’ compliance with a variety of federal policies. These 49 FMRs frequently found one or more instances of states’ non-compliance.
- CMS identified instances of non-compliance that had a financial impact totaling about $358 million.
- CMS identified internal control weaknesses and directed states to make changes to their Medicaid policies.
However, FMRs have not always examined topics or states that reflect the areas of highest expenditures. In 2018, GAO recommended that CMS improve its targeting of oversight resources. CMS agreed with this recommendation, but has not yet implemented it. In addition, CMS guidance generally expects draft FMR reports to be completed in the year they began. However, two-thirds of FMRs (26 of 39) initiated in fiscal years 2016 to 2019 were still under review in June 2020, which can delay state actions to address program vulnerabilities. CMS officials said that at least five states would not take actions—such as returning federal funds for unallowable expenditures—until they received a complete report.
Status of Financial Management Reviews (FMR) Initiated in Fiscal Years 2016 to 2019, as of June 2020
CMS officials cited competing priorities, decreased staff, and the agency’s review process—which involves multiple steps and levels of review—as factors affecting their use of FMRs for oversight. CMS took steps during the course of GAO’s review to complete FMRs that had been under review for several years. The agency has not established time frames for the completion of individual review steps or for its overall review of FMR reports. Developing and implementing such time frames would provide a tool to help monitor CMS’s progress in completing FMRs and ensure prompt action on FMR findings.
Why GAO Did This Study
Over the last two decades, Medicaid—a joint, federal-state health care financing program for low-income and medically needy individuals—more than tripled in expenditures and doubled in enrollment. CMS estimates the program will continue to grow, exceeding $1 trillion in expenditures and 81 million enrollees in 2028. The size and growth of Medicaid present oversight challenges. CMS is responsible for assuring that states’ Medicaid expenditures comply with federal requirements, and FMRs are one of its financial oversight tools. CMS generally directs its regional offices to conduct one focused FMR each year on an area of high risk within their regions, typically within one state.
GAO was asked to examine CMS’s use of FMRs. In this report, GAO examines the extent to which CMS has used FMRs to oversee state Medicaid programs. GAO reviewed CMS documentation on FMR findings and their status, and resources assigned to FMRs and other financial review functions. GAO also interviewed CMS officials from all 10 regional offices and the central office, and assessed CMS’s FMR policies and procedures against federal internal control standards.
What GAO Recommends
CMS should develop and implement time frames to ensure the timely completion of FMRs. The Department of Health and Human Services concurred with our recommendation.
For more information, contact Carolyn L. Yocom at (202) 512-7114 or firstname.lastname@example.org.
- United States Files Complaint Against Nutter Home Loans for Forging Certifications and Using Unqualified Underwriters to Approve Government-Insured Reverse MortgagesBy Sam NewsSeptember 25, 2020The United States has filed a complaint under the Financial Institutions Reform, Recovery and Enforcement Act of 1989 and the False Claims Act against Nutter Home Loans, f/k/a James B. Nutter & Co. (Nutter), for forging certifications and using unqualified underwriters to approve Federal Housing Administration (FHA) insured Home Equity Conversion Mortgages (HECM), the Department of Justice announced today.[Read More…]
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- Mortality in Local Jails, 2000-2018 – Statistical TablesBy Sam NewsIn Justice NewsMay 2, 2021(Publication)
This report presents detailed statistical tables on mortality in local jails. It provides information on cause of death; decedent characteristics, and mortality rates of inmate populations.
4/29/2021, NCJ 256002, E. Ann Carson [Read More…]
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- Los Angeles Man Arrested for $27 Million PPP Fraud SchemeBy Sam NewsJuly 22, 2021A California man was arrested today in Los Angeles on criminal charges related to his alleged bank fraud, false statements in a loan application and money laundering arising from the submission of fraudulent applications for Paycheck Protection Program (PPP) funds.[Read More…]
- Department of Energy: Improved Performance Planning Could Strengthen Technology TransferBy Sam NewsFebruary 1, 2021The Department of Energy (DOE) and its national labs have taken several steps to address potential barriers to technology transfer—the process of providing DOE technologies, knowledge, or expertise to other entities. GAO characterized these barriers as (1) gaps in funding, (2) legal and administrative barriers, and (3) lack of alignment between DOE research and industry needs. For example, the “valley of death” is a gap between the end of public funding and start of private-sector funding. DOE partly addresses this gap with its Technology Commercialization Fund, which provides grants of $100,000 to $1.5 million to DOE researchers to advance promising technologies with private-sector partners. Further, DOE's Energy I-Corps program trains researchers to commercialize new technologies and to identify industry needs and potential customers. However, DOE has not assessed how many and which types of researchers would benefit from such training. Without doing so, DOE will not have the information needed to ensure its training resources target the researchers who would benefit most. Illustration of Funding Gap for Commercializing New Technologies DOE plans and tracks the performance of its technology transfer activities by setting strategic goals and objectives and annually collecting department-wide technology transfer measures, such as the number of patented inventions and licenses. However, the department does not have objective and measurable performance goals to assess progress toward the broader strategic goals and objectives it developed. For example, without a performance goal for the number of DOE researchers involved in technology transfer activities and a measure of such involvement, DOE cannot assess the extent to which it has met its objective to encourage national laboratory personnel to pursue technology transfer activities. Internal control standards for government agencies call for management to define objectives in measurable terms, either qualitative or quantitative, so that performance toward those objectives can be assessed. Moreover, DOE has not aligned the 79 existing measures that it collects with its goals and objectives, nor has it prioritized them. Some lab stakeholders said that collecting and reporting these measures is burdensome. Prior GAO work has found that having a large number of performance measures may risk creating a confusing excess of data that will obscure rather than clarify performance issues. Researchers at DOE and its 17 national labs regularly make contributions to new energy technologies, such as more efficient batteries for electric vehicles. Technology transfer officials at the labs help these researchers license intellectual property and partner with private-sector companies to bring these technologies to market. However, several recent reports have highlighted barriers and inconsistencies in technology transfer at DOE, including a 2015 commission report that found barriers related to the costs of collaboration and low maturity level of many DOE technologies. This report examines (1) steps DOE has taken to address barriers to technology transfer and (2) the extent to which DOE plans and tracks the performance of its technology transfer and commercialization activities. GAO analyzed DOE documents on technology transfer and spoke with officials at DOE and seven national labs, as well as with representatives of universities and private-sector companies. GAO selected labs across a range of DOE activities and based on their technology transfer activities. GAO recommends that DOE assess researchers' needs for commercialization training and develop objective, quantifiable, and measurable performance goals and a limited number of related performance measures for its technology transfer efforts. DOE concurred with the recommendations. For more information, contact Candice Wright at (202) 512-6888 or WrightC@gao.gov.[Read More…]
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- Survivors of Childhood Cancer: Factors Affecting Access to Follow-up CareBy Sam NewsJuly 31, 2020Stakeholders GAO interviewed and studies GAO reviewed identified three factors that affect access to follow-up care for childhood cancer survivors—individuals of any age who were diagnosed with cancer from ages 0 through 19. These factors are care affordability, survivors' and health care providers' knowledge of appropriate care, and proximity to care. Childhood cancer survivors need access to follow-up care over time for serious health effects known as late effects—such as developmental problems, heart conditions, and subsequent cancers—which result from their original cancer and its treatment. Affordability: Survivors of childhood cancer may have difficulty paying for follow-up care, which can affect their access to this care. For example, one study found that survivors were significantly more likely to have difficulty paying medical bills and delay medical care due to affordability concerns when compared to individuals with no history of cancer. Knowledge: Survivors' access to appropriate follow-up care for late effects of childhood cancer can depend on both survivors' and providers' knowledge about such care, which can affect access in various ways, according to stakeholders GAO interviewed and studies GAO reviewed: Some survivors may have been treated for cancer at an early age and may have limited awareness of the need for follow- up care. Some primary or specialty care providers may not be knowledgeable about guidelines for appropriate follow-up care, which can affect whether a survivor receives recommended treatment. Follow-up care may include psychosocial care (e.g., counseling), and palliative care (e.g., pain management). Proximity: Survivors may have difficulty reaching appropriate care settings. Stakeholders GAO interviewed and studies GAO reviewed noted that childhood cancer survivors may have to travel long distances to receive follow-up care from multidisciplinary outpatient clinics—referred to as childhood cancer survivorship clinics. The lack of proximity may make it particularly difficult for survivors with limited financial resources to adhere to recommended follow-up care. The National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC)—agencies within the Department of Health and Human Services (HHS) that conduct activities specific to childhood cancer survivors, including research about access to care—have taken steps to implement three provisions in the Childhood Cancer Survivorship, Treatment, Access, and Research Act of 2018 (Childhood Cancer STAR Act) relevant to access to care for survivors. For example, CDC has awarded a contract to develop software to improve the collection of information on individuals with childhood cancer, and NCI has funded three research projects focused on interventions aimed at addressing adverse outcomes among childhood cancer survivors. NCI has also funded research to study the health status and use of follow-up services of 2,000 young adult survivors. Stakeholders have raised questions about the ability of childhood cancer survivors to access needed follow-up care. According to the most recent data available, approximately 465,000 childhood cancer survivors—children, adolescents, and adults—were alive in the United States as of January 1, 2017. Although the 5-year survival rate for childhood cancer has increased from about 62 percent in the mid-1970s to about 86 percent in the mid-2010s, childhood cancer survivors may face late effects, which could require follow-up care across multiple stages of their lives. The conference report accompanying Public Law 115-245 included a provision for GAO to report on barriers to obtaining medical care for childhood cancer survivors, including psychosocial services and palliative care. This report identifies factors reported to affect access to follow-up care for this population. GAO spoke with officials from NCI and CDC and interviewed stakeholders such as providers who care for childhood cancer survivors, professional associations, and advocacy groups. Additionally, GAO reviewed peer-reviewed studies related to access to care for survivors, outcomes of treatment they may receive, and factors that may affect their access to follow-up care. To supplement this work, GAO reviewed the status of selected HHS activities to support access to care for childhood cancer survivors, including steps taken to implement selected provisions in the Childhood Cancer STAR Act. GAO provided a draft of this report to HHS for review and comment. HHS provided technical comments, which GAO incorporated as appropriate. For more information, contact Jessica Farb at (202) 512-7114 or FarbJ@gao.gov.[Read More…]
- Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to CareBy Sam NewsSeptember 28, 2020The 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 email@example.com.[Read More…]
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- Assistant Attorney General Makan Delrahim Delivers Remarks at Virtual MOU Signing Ceremony with Korean Prosecution ServiceBy Sam NewsNovember 18, 2020It is with great pleasure that I sign this Memorandum of Understanding on behalf of the Department of Justice alongside my good friend, Prosecutor General Yoon. Enhancing the ties between our agencies has been an important priority for me during my tenure as Assistant Attorney General of the Antitrust Division. While only a few years ago we knew comparatively little about one another, our relationship has quickly blossomed into a strong and enduring friendship. I am extremely pleased that we have succeeded in developing important and lasting ties between our agencies, as underscored by our signing of this Memorandum of Understanding today.[Read More…]
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- Indian Education: Schools Need More Assistance to Provide Distance LearningBy Sam NewsApril 29, 2021What GAO Found The Bureau of Indian Education (BIE), within the Department of the Interior (Interior), has not provided BIE-funded schools with comprehensive guidance on distance learning during the COVID-19 pandemic. In March 2020, BIE issued a short memo directing schools to “deliver flexible instruction” and “teach content,” but did not offer specific guidance on how to do so. In July 2020, 13 of the 25 schools that responded to GAO's survey said they wanted BIE to provide information on developing and implementing distance learning programs. In addition, 12 schools responded that they wanted information on distance learning methods for areas without broadband internet access. In August 2020, after some schools had already begun the school year, BIE issued a re-opening guide for the 2020-2021 school year. BIE's guidance focused primarily on preparations for in-person instruction at schools, although nearly all schools provided distance learning during the fall of 2020. The guidance contained little information on distance learning. Providing schools with comprehensive distance learning guidance will help them better navigate the current pandemic as well as potential future emergencies that lead to school building closures. BIE helped improve internet access for students at BIE-operated schools during the pandemic, but many students had not received laptops to access online learning by the end of fall 2020. BIE and other Interior offices provided over 7,000 hotspots to students to improve home internet access, but they did not order laptops for most students until September 2020. Interior officials said a nationwide IT supply shortage contributed to the delayed order for about 10,000 laptops. GAO found, however, that delays were also caused in part by BIE not having complete and accurate information on schools' IT needs. Most schools received laptops from late October 2020 to early January 2021, although some laptops still had not been delivered as of late March 2021. Once laptops were delivered, however, schools also faced challenges configuring them, leading to further delays in distributing them to students. BIE officials told GAO that to address schools' challenges with configuring laptops, they are assessing schools' IT workforce needs. Most BIE students did not receive laptops until months after the school year began, according to GAO's analysis of Interior information. Specifically, none of the laptops Interior ordered in early September 2020 arrived in time to distribute to students by the start of the school year in mid-September; by the end of December 2020, schools had not distributed over 80 percent of the student laptops Interior ordered; and as of late March 2021, schools had not distributed about 20 percent of the student laptops Interior ordered. Without accurate, complete, and up-to-date information on schools' IT needs, BIE was unable to ensure that students received laptops when they needed them. Establishing policies and procedures for assessing schools' IT needs would help guide the agency's IT purchases now and in the future, and position schools to integrate technology into their everyday curricula. Why GAO Did This Study BIE's mission is to provide quality education to approximately 41,000 students at 183 schools it funds on or near Indian reservations in 23 states. About two-thirds of these schools are operated by tribes and the remaining third are operated by BIE. In March 2020, all BIE schools closed their buildings in response to the COVID-19 pandemic. GAO reviewed distance learning at BIE schools as part of its oversight responsibilities under the CARES Act. This testimony examines the extent to which (1) BIE has provided schools with guidance to develop and implement distance learning programs during the COVID-19 pandemic, and (2) students have had the technology they need to participate in such programs. GAO analyzed the guidance BIE provided to schools on distance learning, examined BIE's provision of technology to schools and students, surveyed a non-generalizable sample of 30 schools—including 19 operated by tribes and 11 operated by BIE— with 25 schools responding, selected for geographic diversity and level of community broadband access, among other criteria, reviewed relevant federal statutes, regulations, and agency documentation, and interviewed BIE and school officials.[Read More…]
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- GPS Modernization: DOD Continuing to Develop New Jam-Resistant Capability, But Widespread Use Remains Years AwayBy Sam NewsJanuary 19, 2021The Department of Defense (DOD) is closer to being able to use military code (M-code)—a stronger, more secure signal for the Global Positioning System (GPS) designed to meet military needs. However, due to the complexity of the technology, M-code remains years away from being widely fielded across DOD. M-code-capable receiver equipment includes different components, and the development and manufacture of each is key to the modernization effort. These include: special M-code application-specific integrated circuit chips, special M-code receiver cards, being developed under the Air Force Military GPS User Equipment (MGUE) programs, and the next generation of GPS receivers capable of using M-code signals from GPS satellites. DOD will need to integrate all of these components into different types of weapon systems (see figure for notional depiction of integration for one system). Integration across DOD will be a considerable effort involving hundreds of different weapon systems, including some with complex and unique integration needs or configurations. Global Positioning System User Equipment Integration The Air Force is almost finished—approximately one year behind schedule—developing and testing one M-code card for testing on the Marine Corps Joint Light Tactical Vehicle and the Army Stryker vehicle. However, one card intended for use in aircraft and ships is significantly delayed and missed key program deadlines. The Air Force is revising its schedule for testing this card. The M-code card development delays have had ripple effects on GPS receiver modernization efforts and the weapon systems that intend to use them. For example, an Air Force receiver modernization effort that depends on the new technology will likely breach its schedule and incur additional costs because of the delay. In turn, DOD planned to incorporate that receiver into its F/A-18 fighter aircraft, AV-8B strike aircraft, and the MH-53E helicopter, but it no longer plans to do so because of the delay. DOD has not yet determined the full extent of the development effort to widely integrate and field M-code receivers across the department. The amount of additional development and integration work is expected to vary for each weapon system and could range from a few weeks to several years. DOD is taking steps to enable fielding modernized receivers that use M-code cards by working to identify integration and production challenges. DOD has been developing the capability to use its more jam-resistant military-specific GPS signal for 2 decades. The Air Force launched the first GPS satellite capable of broadcasting the M-code signal in 2005, but is only now completing development of the software and other equipment needed to use it. The GPS modernization effort spans DOD and the military services, but an Air Force program office is developing M-code cards for eventual production and integration into weapon systems. The National Defense Authorization Act for Fiscal Year 2016 included a provision that the Air Force provide quarterly reports to GAO on next-generation GPS acquisition programs, and that GAO brief congressional defense committees. Since 2016, GAO has provided briefings and reported on various aspects of GPS. This report discusses DOD's progress and challenges (1) developing M-code receiver cards, and (2) developing receivers and taking other steps to make M-code-capable receivers available for fielding. GAO reviewed schedules and cost estimates for the Air Force's MGUE programs; military service and DOD M-code implementation data; and test and integration plans for aircraft, ships, and ground vehicles. GAO also reviewed strategies for continued access to microelectronics and interviewed officials from the MGUE programs, military services, and DOD, and representatives from microelectronics developers. For more information, contact Jon Ludwigson at (202) 512-4841 or firstname.lastname@example.org.[Read More…]
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This report describes the number of persons age 16 or older who experienced identity theft in 2018.
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- North Carolina Return Preparer Sentenced to 50 Months in Prison for Multi-Year Tax Fraud SchemeBy Sam NewsFebruary 8, 2021A Rocky Mount, North Carolina, tax return preparer was sentenced to 50 months in prison today for conspiring to defraud the United States, announced Acting Deputy Assistant Attorney General Stuart M. Goldberg of the Justice Department’s Tax Division and U.S. Attorney Robert J. Higdon Jr. for the Eastern District of North Carolina.[Read More…]
- Trinidad and Tobago Travel AdvisoryBy Sam NewsSeptember 26, 2020Reconsider travel [Read More…]
- NASA Perseverance Mars Rover Scientists Train in the Nevada DesertBy Sam NewsSeptember 26, 2020Team members searched [Read More…]
- 2020 Wiretap Report: Intercepts and Convictions DecreaseBy Sam NewsIn U.S CourtsJune 28, 2021Federal and state courts reported a combined 26 percent decrease in authorized wiretaps in 2020, compared with 2019, according to the Judiciary’s 2020 Wiretap Report. Convictions in cases involving electronic surveillance also decreased.[Read More…]
- U.S. Special Envoy Lenderking Returns from Travel to Saudi Arabia, Oman, and JordanBy Sam NewsMay 7, 2021
- Grants Management: Agencies Provided Many Types of Technical Assistance and Applied Recipients’ FeedbackBy Sam NewsSeptember 10, 2020Technical assistance refers to programs, activities, and services provided by federal agencies to strengthen the capacity of grant recipients and to improve their performance of grant functions. Technical assistance can improve the performance or management of grant program recipients. Technical assistance includes the improvement of grant outcomes, grant management, grantee compliance, project monitoring and evaluation, and interactions with stakeholders. The technical assistance provided by the selected agencies—the Department of Education (Education), the Department of Health and Human Services' Administration for Children and Families (ACF), and the Department of Labor's Employment and Training Administration (ETA)—is designed to align with the requirements of each agency's grant programs and the individual grantee's needs. The types of technical assistance provided by agencies varied and included a range of delivery methods shown below. Types of Technical Assistance Provided by Selected Agencies Education tailors its approach to provide technical assistance to grantees based on recipients' needs and their efforts to obtain technical assistance. According to ACF, some grant programs have extensive, dedicated technical assistance that is grant specific, while other grant programs share technical assistance resources provided by multiple technical assistance centers. ACF's technical assistance can be based on program office oversight of the grantees that includes financial and internal control reviews and site visits. For ETA, state and local grantees administer ETA-funded programs throughout the country and technical assistance plays a role in ensuring these programs' successful implementation. According to ETA officials, technical assistance activities are based on grant program objectives. The 10 grant programs GAO reviewed evaluated technical assistance, collected feedback from recipients of the technical assistance, and incorporated feedback into technical assistance. For example, a School Safety National Activities evaluation of one of its national centers included targets for multiple performance measures and the actual performance for each measure. These measures included the percentage of milestones achieved and the percentage of technical assistance and dissemination products and services deemed to be high quality by an independent review panel. The overall goal of technical assistance is to enhance the delivery of agency programs and help ensure grantee compliance. GAO was asked to review issues related to technical assistance for grants at Education, ACF, and ETA. This report (1) describes how Education, ACF, and ETA provide technical assistance to grantees; and (2) examines to what extent these agencies evaluate the technical assistance. For this review, GAO selected 10 grant programs from the three agencies based on fiscal year 2018 funding information and the purpose of the grant. GAO reviewed documents and interviewed agency officials about the technical assistance provided, the provider and recipient of technical assistance, and the amount obligated in fiscal year 2018 for the 10 grant programs reviewed. GAO also reviewed documents and interviewed agencies about the extent to which they evaluated technical assistance, whether they gathered feedback from the recipients of technical assistance, and whether feedback was included in the evaluations for the 10 grant programs reviewed. For more information, contact Michelle Sager at (202) 512-6806 or SagerM@gao.gov.[Read More…]
- Secretary Antony J. Blinken Remarks to the Press Before the Berlin II Conference on LibyaBy Sam NewsJune 23, 2021Antony J. Blinken, [Read More…]
- Statement Regarding Federal Civil Rights Investigation Into Shooting of Jacob BlakeBy Sam NewsJanuary 5, 2021Eric S. Dreiband, Assistant Attorney General for the Civil Rights Division of the Department of Justice, and Matthew D. Krueger, U.S. Attorney for the Eastern District of Wisconsin released the following statement related to the Aug. 23, 2020, shooting of Jacob Blake:[Read More…]
- U.S.-Greenland Technical Engagement on Mining Sector Education and TrainingBy Sam NewsNovember 23, 2020