Health Care Funding: Federal Obligations to and Funds Received by Certain Organizations Involved in Health-Related Services, 2016 through 2018

What GAO Found

GAO reviewed federal funding provided to various organizations that offer health-related services, such as voluntary family planning and activities related to the treatment and prevention of HIV/AIDs. In total, the organizations in our review received almost $16 billion through grants or cooperative agreements from the Department of Health and Human Services or U.S. Agency for International Development from 2016 through 2018; nearly all of this funding was received by federally qualified health centers. (See table.)

Reported Amounts of Funds Received through Federal Grants or Cooperative Agreements by Organizations in GAO’s Review, 2016-2018

Dollars in millions
Federal agency 2016 2017 2018 Total
Department of Health and Human Services (HHS)
      Federally qualified health centers (FQHC) 4,891.03 5,251.93 5,291.81 15,434.77
      Planned Parenthood Federation of America (PPFA) 94.86 106.12 103.51 304.49
      International Planned Parenthood Federation (IPPF) 2.30 2.05 1.20 5.55
      Marie Stopes International (MSI) 0.00 0.00 0.00 0.00
Total HHS 4,988.19 5,360.10 5,396.52 15,744.81
U.S. Agency for International Development (USAID)
      FQHC 0.00 0.00 0.00 0.00
      PPFA 0.00 0.00 0.00 0.00
      IPPF 2.13 5.48 7.80 15.41
      MSI 36.64 34.20 15.62 86.46
Total USAID 38.77 39.68 23.42 101.87
Total (HHS and USAID) 5,026.96 5,399.78 5,419.94 15,846.68

Source: GAO analysis of HHS, PPFA and USAID, data. | GAO-21-188R

We provided a draft of this report to the Secretary of Health and Human Services and the USAID Administrator for comment. HHS did not have any comments. USAID provided technical comments, which we incorporated as appropriate.

GAO is not making any recommendations.

Why GAO Did This Study

In order to achieve their programmatic goals, federal agencies provide funding to various organizations that, in turn, use those funds to implement programs and activities aligned with those goals. For example, federal agencies may award funding through grants or cooperative agreements for programs. The organizations that are awarded the funding receive and spend the funds over a period of time.

GAO was asked to report on federal funding for certain organizations that provide health-related services. This report describes the extent of federal funding through grants and cooperative agreements for federally qualified health centers, Planned Parenthood Federation of America, International Planned Parenthood Federation, and Marie Stopes International from 2016 through 2018. GAO obtained and reviewed information on federal funding from the Department of Health and Human Services and the U.S. Agency for International Development—the primary sources of federal funds to the organizations in our review. GAO also obtained available information from each of the organizations.

For more information, contact James Cosgrove at 202-512-7114 or cosgrovej@gao.gov.

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    What GAO Found GAO's analysis of 2020 data found that, for 20 selected brand-name prescription drugs, estimated U.S. prices paid at the retail level by consumers and other payers (such as insurers) were more than two to four times higher than prices in three selected comparison countries. The U.S. prices GAO estimated for comparison reflect confidential rebates and other price concessions, which GAO refers to as net prices. Publicly available prices for the comparison countries were gross prices that did not reflect potential discounts. As a result, the actual differences between U.S. prices and those of the other countries were likely larger than GAO estimates. The price differences varied by drug. Specifically, while estimated U.S. net prices were mostly higher than the gross prices in other countries (by as much as 10 times), some were lower. The following figure illustrates comparisons for two of GAO's selected drugs. GAO found similar differences in estimated prices paid by final payers at the manufacturer level. Estimated U.S. Net Prices and Selected Comparison Countries' Gross Prices at the Retail Level for Two Selected Drugs and Package Sizes, 2020 GAO's analysis found consumers' out-of-pocket costs for prescription drugs varied across and within all four countries but likely more within the U.S. and Canada where multiple payers had a role setting prices and designing cost-sharing for consumers, and not all consumers had prescription drug coverage. In Australia and France, prescription drug pricing was nationally regulated and prescription drug coverage was universal; thus, consumers' out-of-pocket costs within these countries for each drug were generally less varied. For example, in Australia, consumers typically paid one of two amounts for prescription drugs—either about 5 or 28 U.S. dollars in 2020. In the U.S., potential out-of-pocket costs for consumers could have varied much more widely depending on the type of coverage they had. For example, for one drug in GAO's analysis, considering only a few coverage options, consumers' out-of-pocket costs in 2020 could have ranged from a low of about 22 to a high of 514 U.S. dollars. GAO provided a draft to the Department of Health and Human Services for review and incorporated the Department's technical comments as appropriate. Why GAO Did This Study While spending on prescription drugs continues to grow worldwide, studies indicate the U.S. spends more than other countries. However, various factors—such as country-specific pricing strategies, confidential rebates to payers, and other price concessions—may obscure the actual prices of prescription drugs. GAO was asked to review U.S. and international prescription drug prices. This report (1) examines how prices at the retail and manufacturer levels in the U.S. compare to prices in three selected comparison countries—Australia, Canada, and France, and (2) provides information on consumers' out-of-pocket costs for prescription drugs in these countries. GAO analyzed 2020 price data for a non-generalizable sample of 41 brand-name drugs among those with the highest expenditures and use in the U.S. Medicare Part D program in 2017. Twenty of these drugs had price data available in all four countries. For U.S. prices, GAO estimated the net prices paid using data from various sources, including estimates of Medicare Part D rebates and other price concessions, and commercially available data. Prices for the selected comparison countries were obtained from publicly available government sources. National prices were not available for Canada, so GAO used the prices from Ontario, Canada's most populous province, as a proxy for Canadian prices. GAO also reviewed country-specific guidance and other relevant information and interviewed researchers, manufacturers, and government officials. For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.
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  • 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.”
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  • The Honorable Douglas H. Ginsburg Receives Justice Department’s 2020 John Sherman Award
    In Crime News
    The Antitrust Division of the Department of Justice today presented Judge Douglas H. Ginsburg with the John Sherman Award for his lifetime contributions to the development of antitrust law and the preservation of economic liberty.  The award is the Department of Justice’s highest antitrust honor. Assistant Attorney General Makan Delrahim presented the award and gave remarks  celebrating Judge Ginsburg’s contributions during a ceremony displayed virtually and conducted at the Robert F. Kennedy Department of Justice Building.  Judge Ginsburg also delivered remarks in accepting the award.  
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  • Detention of Armenian Soldiers
    In Crime Control and Security News
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  • Justice Department Settles Claim Against California-Based Staffing Company for Favoring Temporary Visa Workers Over U.S. Workers
    In Crime News
    The Department of Justice announced today that it signed a settlement agreement with AllianceIT, a provider of IT staffing services based in Pleasanton, California. This is the tenth settlement under the Civil Rights Division’s Protecting U.S. Workers Initiative, which is aimed at targeting, investigating, and taking enforcement actions against companies that discriminate against U.S. workers in favor of temporary foreign visa workers.
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  • Designating PRC and Hong Kong Officials After Widespread Pro-Democracy Arrests in Hong Kong
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  • Justice Department Obtains Settlement from San Diego Landlord to Resolve Claims Of Sexual Harassment Against Female Tenants
    In Crime News
    The Justice Department today announced it has reached an agreement with defendant Larry Nelson to resolve a Fair Housing Act lawsuit alleging that he sexually harassed female tenants while owning and managing San Diego area rental properties.  
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  • West Virginia Doctor Found Guilty of Unlawfully Distributing Opioids
    In Crime News
    A federal jury found a West Virginia doctor guilty today of unlawfully distributing opioids to his patients. The defendant was charged in a September 2019 indictment as part of the second Appalachian Regional Prescription Opioid (ARPO) Strike Force Takedown, a coordinated effort by the Justice Department’s Fraud Section to target unlawful drug diversion activities in areas of the country particularly hard-hit by the opioid epidemic.
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  • Texas Woman Indicted for Transporting Minor for Female Genital Mutilation
    In Crime News
    A Texas woman has been indicted for transporting a minor from the United States to a foreign country for the purpose of female genital mutilation (FGM).
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  • Former Army Special Forces Officer Charged in Russian Espionage Conspiracy
    In Crime News
    A Gainesville, Virginia, man was arrested today for conspiring with Russian intelligence operatives to provide them with United States national defense information.
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  • Disabilities Reported by Prisoners: Survey of Prison Inmates, 2016
    In Justice News
    (Publication)
    This brief presents findings based on data collected in the 2016 Survey of Prison Inmates, a survey conducted through face-to-face interviews with a national sample of state and federal prisoners across a variety of topics, such as their demographic characteristics, socio-economic background, health, and involvement with the criminal justice system.
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  • Justice Department Files Title VII Sex Discrimination Lawsuit Against Alabama Sheriff’s Office and the Mobile County Sheriff
    In Crime News
    The Department of Justice announced today that it has filed a lawsuit against the Mobile County Sheriff’s Office, Alabama’s second-largest sheriff’s office, and the Mobile County Sheriff, in his official capacity (collectively, MCSO).
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  • South Carolina Couple Pleaded Guilty to Scheme Involving Conspiracy and False Statements to Illegally Obtain a U.S. Passport
    In Crime News
    A Huger, South Carolina couple pleaded guilty today in South Carolina before the U.S. District Judge Brucie H. Hendricks in the District of South Carolina to charges stemming from their conspiracy to obtain a U.S. passport by falsely claiming they were the biological parents of a baby born in the Philippines and by using false birth records to apply for a U.S. passport for the baby.
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  • Justice Department Reaches Settlement with Old Dominion University to Resolve Disability Discrimination Complaint
    In Crime News
    Today the Justice Department announced a settlement agreement with Old Dominion University (ODU) in Norfolk, Virginia, to resolve its investigation into a complaint that ODU discriminated and retaliated against a graduate student based on disability and her related request for reasonable modifications of policy. The Civil Rights Division conducted the investigation under Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973.
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  • Texas Woman Pleads Guilty to Conspiracy to Facilitate Adoptions from Uganda Through Bribery and Fraud
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  • Ohio Treatment Facilities and Corporate Parent Agree to Pay $10.25 Million to Resolve False Claims Act Allegations of Kickbacks to Patients and Unnecessary Admissions
    In Crime News
    Oglethorpe Inc. and its three Ohio facilities, Cambridge Behavioral Hospital, Ridgeview Behavioral Hospital, and The Woods at Parkside, will pay $10.25 million to resolve alleged violations of the False Claims Act for improperly providing free long-distance transportation to patients and admitting patients at Cambridge and Ridgeview who did not require inpatient psychiatric treatment, resulting in the submission of false claims to the Medicare program. 
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  • Pennsylvania Marketer Pleads Guilty to Filing False Tax Returns
    In Crime News
    A Bryn Mawr resident pleaded guilty today to filing false tax returns, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney William M. McSwain for the Eastern District of Pennsylvania.
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  • Justice Department Files Suit Against Dallas, Texas, Towing Company for Unlawfully Selling Servicemember-Owned Vehicles
    In Crime News
    The Justice Department today filed a lawsuit in the Northern District of Texas alleging that Dallas-based towing company United Tows LLC violated the Servicemembers Civil Relief Act (SCRA), by unlawfully auctioning off vehicles owned by SCRA-protected servicemembers. 
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  • Navy Shipyards: Actions Needed to Address the Main Factors Causing Maintenance Delays for Aircraft Carriers and Submarines
    In U.S GAO News
    The Navy's four shipyards completed 38 of 51 (75 percent) maintenance periods late for aircraft carriers and submarines with planned completion dates in fiscal years 2015 through 2019, for a combined total of 7,424 days of maintenance delay. For each maintenance period completed late, the shipyards averaged 113 days late for aircraft carriers and 225 days late for submarines. Maintenance Delays at Navy Shipyards for Fiscal Years 2015 through 2019 Unplanned work and workforce factors—such as shipyard workforce performance and capacity (having enough people to perform the work)—were the main factors GAO identified as causing maintenance delays for aircraft carriers and submarines. The Navy frequently cited both factors as contributing to the same days of maintenance delay. Unplanned work—work identified after finalizing maintenance plans—contributed to more than 4,100 days of maintenance delays. Unplanned work also contributed to the Navy's 36 percent underestimation of the personnel resources necessary to perform maintenance. The workforce factor contributed to more than 4,000 days of maintenance delay on aircraft carriers and submarines during fiscal years 2015 through 2019. The Navy has taken steps but has not fully addressed the unplanned work and workforce factors causing the most maintenance delays. First, the Navy updated planning documents to improve estimates and plans to annually update these data, but knowing whether changes improve results may take several years. Second, the Navy has consistently relied on high levels of overtime to carry out planned work. GAO's analysis found that high overtime among certain production shops, such as painting or welding, averaged from 25 to 32 percent for fiscal years 2015 through 2019, with peak overtime as high as 45 percent. Furthermore, shipyard officials told us that production shops at all four shipyards are working beyond their capacity. Overtime at such rates has been noted as resulting in diminished productivity. Third, the Navy initiated the Shipyard Performance to Plan initiative in the fall of 2018 to address the unplanned work and workforce factors, but it has not yet developed 13 of 25 planned metrics that could improve the Navy's understanding of the causes of maintenance delays. In addition, the Shipyard Performance to Plan initiative does not include goals, milestones, and a monitoring process along with fully developed metrics to address unplanned work and workforce weaknesses. Without fully developing metrics and implementing goals, action plans, milestones, and a monitoring process, the shipyards are not likely to address unplanned work and workforce weaknesses and the Navy is likely to continue facing maintenance delays and reduced time for training and operations with its aircraft carriers and submarines. For fiscal years 2015 through 2019, the Navy spent $2.8 billion in capital investments to address shipyard performance, among other things. However, the shipyards continue to face persistent and substantial maintenance delays that hinder the readiness of aircraft carriers and submarines. The Senate Armed Services Committee, in a report accompanying a bill for the National Defense Authorization Act for Fiscal Year 2019, included a provision for GAO to review Navy shipyards' performance. GAO evaluated the extent to which the Navy (1) completed maintenance at its shipyards on time on aircraft carriers and submarines in fiscal years 2015 through 2019, (2) has identified the main factors leading to maintenance delays, and (3) has addressed the main factors affecting any delays in that maintenance. GAO reviewed data related to Navy shipyard maintenance for fiscal years 2015 through 2019, analyzed factors contributing to delays and plans to address them, visited all four Navy shipyards, and met with Navy and shipyard officials. GAO is making three recommendations to the Navy, including updating workforce planning requirements to avoid the consistent use of overtime; completing the development of shipyard performance metrics; and developing and implementing goals, action plans, milestones, and monitoring results. The Navy concurred with all three recommendations. For more information, contact Diana Maurer, (202) 512-9627, MaurerD@gao.gov, or Asif A. Khan, (202) 512-9869, KhanA@gao.gov. 
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  • Manager of Hospice and Home Health Companies Sentenced to Prison for Role in $150 Million Health Care Fraud Scheme
    In Crime News
    A 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. 
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  • Fourth Circuit Upholds Jury Conviction in Foreign-Agent Prosecution
    In Crime News
    The U.S. Court of Appeals for the Fourth Circuit today upheld an Eastern District of Virginia jury verdict convicting a man of acting and conspiring to act as an agent of the Turkish government within the United States without disclosing that relationship to the U.S. government. The Fourth Circuit also vacated an order granting a new trial and remanded the case for further proceedings before the district court.
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    In Justice News
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