What GAO Found
Within the Department of Homeland Security (DHS), U.S. Immigration and Customs Enforcement (ICE) met its goal to expand the 287(g) program. However, ICE has not established performance goals that cover all program activities, such as ICE’s oversight of its law enforcement agency (LEA) partners, or measures to assess the program’s performance, such as the percentage of LEA partners in compliance with annual training requirements. As a result, ICE is not well-positioned to determine the extent to which the program is achieving intended results.
ICE considers a number of factors, such as LEAs’ capability to act as an ICE force multiplier, when reviewing their suitability to join the program; however, ICE has not assessed how to optimize the use of its resources and program benefits to guide its recruitment of future 287(g) participants. For example, ICE has two models in which LEAs can participate with varying levels of immigration enforcement responsibilities. In the Jail Enforcement Model (JEM), designated state or local officers identify and process removable foreign nationals who have been arrested and booked into the LEA’s correctional facility, whereas in the Warrant Service Officer (WSO) model, the designated officers only serve warrants to such individuals. However, ICE has not assessed the mix of participants for each model that would address resource limitations, as each model has differing resource and oversight requirements. By assessing how to leverage its program resources and optimize benefits received, ICE could approach recruitment more strategically and optimize program benefits.
287(g) Participants in January 2017 and September 2020
ICE uses a number of mechanisms to oversee 287(g) JEM participants’ compliance with their agreements, such as conducting inspections and reviewing reported complaints. However, at the time of GAO’s review, ICE did not have an oversight mechanism for participants’ in the WSO model. For example, ICE did not have clear policies on 287(g) field supervisors’ oversight responsibilities or plan to conduct compliance inspections for WSO participants. An oversight mechanism could help ICE ensure that WSO participants comply with their 287(g) agreement and other relevant ICE policies and procedures.
Why GAO Did This Study
The 287(g) program authorizes ICE to enter into agreements with state and local law enforcement agencies to assist with enforcing immigration laws. The program expanded from 35 agreements in January 2017 to 150 as of September 2020.
GAO was asked to review ICE’s management and oversight of the program. This report examines (1) the extent to which ICE has developed performance goals and measures to assess the 287(g) program; (2) how ICE determines eligibility for 287(g) program participation and considers program resources; and (3) how ICE conducts oversight of 287(g) program participant compliance and addresses noncompliance. GAO reviewed ICE policies and documentation, and interviewed officials from ICE headquarters and field offices. GAO also interviewed 11 LEAs selected based on the type of 287(g) agreement, length of participation, and facility type (e.g. state or local).While not generalizable, information collected from the selected LEAs provided insights into 287(g) program operations and oversight of program participants. GAO analyzed data on 287(g) inspection results and complaints from fiscal years 2015 through 2020.
What GAO Recommends
GAO recommends that ICE (1) establish performance goals and related performance measures; (2) assess the 287(g) program’s composition to help leverage its resources and optimize program benefits; and (3) develop and implement an oversight mechanism for the WSO model. DHS concurred with the recommendations.
For more information, contact Rebecca Gambler at (202) 512-8777 or GamblerR@gao.gov.
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Evidence collected during the pandemic suggests the prevalence of behavioral health conditions has increased, while access to in-person behavioral health services has decreased: Centers for Disease Control and Prevention (CDC) survey data collected from April 2020 through February 2021 found that the percentage of adults reporting symptoms of anxiety or depression averaged 38 percent. In comparison, using similar questions, CDC found that about 11 percent of U.S. adults reported experiencing these symptoms from January to June 2019. An analysis of CDC data found that the share of emergency department visits for drug overdoses and suicide attempts were 36 and 26 percent higher, respectively, for the period of mid-March through mid-October 2020 compared to the same time period in 2019. In a February 2021 survey of its members, NCBH found that in the 3 months preceding the survey, about two-thirds of the member organizations surveyed reported demand for their services increasing and having to cancel or reschedule patient appointments or turn patients away. The survey also found that during the pandemic, 27 percent of member organizations reported laying off employees, 45 percent reported closing some programs, and 35 percent decreased the hours for staff. Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services. However, most officials were not aware of published data that could confirm their concerns, and data from reports from two states on claims denials either did not support their concerns or were inconclusive. In addition, a report in one state that examined mental health parity—requirements that behavioral health benefits are not more restrictive than medical/surgical benefits—found that the rate of complaints associated with behavioral health services was notably lower than those for medical/surgical services. The lack of available data confirming stakeholder concerns could be related to potential challenges consumers and providers face in identifying and reporting mental health parity violations, as previously reported by GAO. Specifically, in 2019, GAO found that complaints were not a reliable indicator of such violations, because consumers may not know about parity requirements or may have privacy concerns related to submitting a complaint. GAO recommended that the federal agencies involved in the oversight of mental health parity requirements evaluate the effectiveness of their oversight efforts. As of March 2021, the agencies had not yet implemented this recommendation. Why GAO Did This Study Behavioral health conditions, which include mental health and substance use disorders, affect a substantial number of adults in the United States. For example, in 2019, an estimated 52 million adults in the United States were reported to have a mental, behavioral, or emotional disorder, and 20 million people aged 12 or older had a substance use disorder. Experts have expressed concerns that the incidence of behavioral health conditions would increase as a result of stressors associated with the COVID-19 pandemic. Even before the pandemic, longstanding questions have been raised about whether coverage or claims for behavioral health services are denied or delayed at higher rates than those for other health services. GAO was asked to examine several issues about the demand for behavioral health services, as well as coverage and payment for these services. GAO examined (1) what is known about the need for and availability of behavioral health services, and how these have changed during the COVID-19 pandemic; and (2) what issues selected stakeholders identified regarding the payment of claims for behavioral health services. GAO reviewed survey data and other relevant analyses focused on the need for and availability of behavioral health services prior to and during the COVID-19 pandemic. GAO also reviewed reports from two states that compared claims for behavioral health services with those of other health services; interviewed officials from NCBH; and interviewed officials from hospital associations and insurance regulators in Oregon, Pennsylvania, Texas, and Virginia. For more information, contact John E. Dicken at 202-512-7114 or email@example.com.[Read More…]
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- Secretary Antony J. Blinken Virtual Discussion with Students on IceBy Sam NewsFebruary 27, 2021
- Federal Protective Service: Better Documented Cost Estimates Could Help Stakeholders Make Security DecisionsBy Sam NewsJune 9, 2021What GAO Found The Federal Protective Service (FPS) provides security and protection at more than 9,000 federal facilities. FPS performs a variety of security activities in conjunction with the General Services Administration (GSA), which functions as the landlord at most of these facilities, and with the federal agencies, which occupy these facilities as tenants. These stakeholders can provide important perspectives on FPS's performance of its key activities (see figure). The Federal Protective Service's Three Key Security Activities Stakeholders expressed satisfaction with many aspects of FPS's performance of key activities but also identified aspects where they thought FPS could make improvements. For example, stakeholders expressed satisfaction with the professionalism of FPS personnel and commended FPS's coordination in responding to law enforcement incidents. However, some stakeholders said they would like to see FPS oversee contract guards more often. In addition, many stakeholders said that FPS could improve the cost estimates in its security assessment reports. GAO's review of FPS's Facility Security Assessment reports found that cost estimates for the recommended security measures lacked information that could help stakeholders make decisions to accept or reject FPS's recommendations. Specifically, recent reports for 27 selected buildings did not document (1) the assumptions FPS made to produce the cost estimates (e.g., the scope of work) and (2) the sources FPS used to create the estimate. In one report, for example, FPS recommended additional fencing and provided a cost estimate with an exact dollar amount. However, FPS did not document the assumptions it used to develop the estimate, such as the height and linear feet of fence or the fencing material. According to GAO's Cost Estimating and Assessment Guide , cost estimates should provide information about the assumptions and sources used to develop an estimate so that decision-makers can understand the level of uncertainty around the estimate. By providing detailed information about the cost estimates in Facility Security Assessment reports, FPS could better inform stakeholders and potentially increase implementation of recommended security measures, designed to increase the safety of people and property at these facilities. Why GAO Did This Study Over one million employees and a range of visitors seeking services at federal facilities depend on FPS to ensure the safety of both people and property at these locations. This report examines stakeholders' perspectives on FPS's performance of three key activities. GAO identified key activities from FPS data on work hours. GAO held discussion groups with stakeholders from 27 randomly selected facilities where FPS provided guard services and responded to incidents in fiscal year 2019 and analyzed stakeholder responses from 2017-2019 to GSA's and FPS's feedback instruments. These sources of stakeholder views are not representative but collectively provide insight into stakeholders' satisfaction with how FPS is performing key activities. GAO also reviewed agency documents; interviewed FPS officials about FPS's performance; and compared FPS's security assessment reports to criteria in GAO's Cost Estimating and Assessment Guide .[Read More…]
- Prescription Drugs: Department of Veterans Affairs Paid About Half as Much as Medicare Part D for Selected Drugs in 2017By Sam NewsJanuary 14, 2021GAO found that the Department of Veterans Affairs (VA) paid, on average, 54 percent less per unit for a sample of 399 brand-name and generic prescription drugs in 2017 as did Medicare Part D, even after accounting for applicable rebates and price concessions in the Part D program. GAO also found that 233 of the 399 drugs in the sample were at least 50 percent cheaper in VA than in Medicare, and 106 drugs were at least 75 percent cheaper. Only 43 drugs were cheaper in Medicare than in VA. The percent difference in price between the two programs was greater on average for generic drugs. Specifically, VA's prices were 68 percent lower than Medicare prices for the 203 generic drugs (an average difference of $0.19 per unit) and 49 percent lower for the 196 brand-name drugs (an average difference of $4.11 per unit). Average Per-Unit Net Prices Paid by Department of Veterans Affairs and Medicare Part D for Selected Drugs, 2017 Note: GAO's sample of 399 drugs included the top 100 brand-name and generic drugs in Medicare Part D in 2017, by: (1) highest expenditures; (2) highest utilization (by quantities dispensed); and (3) highest cost-per use. Per-unit prices are weighted to reflect differences in utilization in the two programs. Medicare prices reflect expenditures after accounting for rebates and other price concessions. While there are many factors that impact prices in the complex drug market, GAO identified several key program features that may contribute to the consistent price differential between VA and Medicare Part D. For example, Medicare's beneficiaries are divided among numerous prescription drug plans, which each negotiate drug prices with manufacturers. In contrast, VA is a single integrated health system with a unified list of covered drugs—thereby possibly strengthening its bargaining position when negotiating. In addition, VA has access to significant discounts defined by law, and can then negotiate further for lower prices. These discount prices are not available to Medicare Part D plans. GAO provided a draft of this product to HHS and VA for comment. Both agencies provided technical comments, which GAO incorporated as appropriate. In 2017, combined, Medicare Part D and VA accounted for approximately $105 billion in prescription drug sales—nearly one-third of total U.S. expenditures—and covered nearly 52 million individuals. The two programs use different methods to pay for prescription drugs. Medicare reimburses Part D plan sponsors, which in turn pay pharmacies to dispense drugs. VA primarily uses a direct purchase approach to acquire drugs from manufacturers. GAO was asked to examine differences in the amounts major federal programs paid for prescription drugs. This report: (1) compares average unit prices for prescription drugs in Medicare Part D to those in the VA; and (2) describes factors affecting prices in the two programs. GAO analyzed (1) CMS data for Medicare Part D payments to retail pharmacies as well as rebates and other price concessions Part D plans received and (2) VA drug purchasing data. These data were from 2017, the most recent data available at the time of GAO's analysis. To select a sample of drugs GAO identified the top 100 brand-name and 100 generic drugs in Medicare Part D in 2017 for three categories: (1) highest expenditure, (2) highest utilization, and (3) highest cost-per use. In total, this yielded 399 non-duplicate drugs (203 generic and 196 brand-name), which represented 44 percent of Medicare Part D spending in 2017. GAO compared weighted average unit prices for these drugs. GAO interviewed CMS and VA officials, and reviewed academic and government reports to understand factors that may affect prices in the two programs. For more information, contact John Dicken at (202) 512-7114 or firstname.lastname@example.org.[Read More…]
- NASA, US and European Partner Satellite Returns First Sea Level MeasurementsBy Sam NewsIn SpaceDecember 17, 2020Launched on a Falcon 9 [Read More…]
- The Department of State Breaks Ground on the New U.S. Consulate General in Chiang Mai, ThailandBy Sam NewsSeptember 26, 2020
- Statement from Attorney General William P. Barr on the Resignation of Seattle Police Chief Carmen BestBy Sam NewsAugust 11, 2020Attorney General William P. Barr issued the following statement in response to the resignation of Seattle Police Chief Carmen Best:[Read More…]
- Confronting Heightened Cybersecurity Threats Amid COVID-19By Sam NewsDecember 29, 2020Did you know that [Read More…]
- Uganda Travel AdvisoryBy Sam NewsSeptember 26, 2020
- Media Freedom Coalition Statement on the Arrest of Roman ProtasevichBy Sam NewsMay 29, 2021
- Secretary Michael R. Pompeo With Mark Belling of the Mark Belling ShowBy Sam NewsNovember 11, 2020
- Judge Rya Zobel to Receive 2020 Devitt AwardBy Sam NewsOctober 20, 2020Senior U.S. District Judge Rya Zobel, who grew up in Nazi Germany and later became the first woman to serve as director of the Federal Judicial Center, is the recipient of the 2020 Edward J. Devitt Distinguished Service to Justice Award.[Read More…]
- This Week in Iran PolicyBy Sam NewsSeptember 26, 2020
- Manager of Hospice and Home Health Companies Sentenced to Prison for Role in $150 Million Health Care Fraud SchemeBy Sam NewsApril 21, 2021A Texas man was sentenced today to 27 months in prison for his role in a conspiracy at the Merida Group, a chain of hospice and home health agencies throughout Texas, to falsely convince thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified, thereby increasing revenue to the company.[Read More…]
- Man Pleads Guilty to Attempting to Provide Material Support to Foreign Terrorist OrganizationsBy Sam NewsApril 23, 2021A New York man pleaded guilty to attempting to provide material support and resources to the Islamic State of Iraq and al-Sham (ISIS) and the al-Nusrah Front, both designated by the U.S. Secretary of State as foreign terrorist organizations.[Read More…]
- Hospice Administrator Sentenced for Role in Hospice Fraud SchemeBy Sam NewsFebruary 19, 2021The administrator of a Southern California hospice was sentenced Thursday to 30 months in prison for his role in a multimillion dollar hospice fraud scheme.[Read More…]
- Secretary Antony J. Blinken and Mexican Secretary of Economy Tatiana Clouthier Before Their MeetingBy Sam NewsFebruary 26, 2021
- Secretary Antony J. Blinken With Wolf Blitzer of CNN’s The Situation RoomBy Sam NewsFebruary 9, 2021
- Former Louisiana Police Officer Indicted for Assaulting an ArresteeBy Sam NewsApril 29, 2021A federal grand jury in Shreveport, Louisiana, returned an indictment charging a former Shreveport police officer with assaulting an arrestee in Caddo Parish.[Read More…]