COVID-19: Urgent Actions Needed to Better Ensure an Effective Federal Response

What GAO Found

The COVID-19 pandemic has resulted in catastrophic loss of life and substantial damage to the global economy, stability, and security. According to federal data, the U.S. had an average of 116,000 new COVID-19 cases per day from November 1 through November 12, 2020. Between January 2020 and October 2020, at least 237,000 more deaths occurred from all causes, including COVID-19, than would normally be expected, according to data from the Centers for Disease Control and Prevention (CDC).

Further, while the economy has improved since July 2020, many people remain unemployed, including both those temporarily laid off and those who have permanently lost their job (see figure). Also, more households have become seriously delinquent on mortgage payments during the pandemic. In addition, GAO’s review of academic studies suggests the pandemic will likely remain a significant obstacle to more robust economic activity.

Number of Unemployed Workers Permanently Losing Jobs and on Temporary Layoff, January 2019 through October 2020

In response to the pandemic and its effects, Congress and the administration have taken a series of actions to protect the health and well-being of Americans. However, as the end of 2020 approaches, urgent actions are needed to help ensure an effective federal response on a range of public health and economic issues.

Medical Supplies

While the Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA) have made numerous efforts to mitigate supply shortages and expand the medical supply chain, shortages of certain supplies persist. In September 2020, GAO reported that ongoing constraints with the availability of certain types of personal protective equipment (PPE) and testing supplies remain due to a supply chain with limited domestic production and high global demand. In October 2020, GAO surveyed public health and emergency management officials from all states, the District of Columbia, and U.S. territories (hereafter states) and found the following:

  • Testing supplies. Most states reported no shortages of swabs or transport media, but about one-third to one-half reported shortages in other types of testing supplies (see figure).

State-Reported Testing Supply Shortages, as of October 2020

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-21-191
 

GAO surveyed officials in the 50 states; Washington, D.C.; and the five U.S. territories and received responses from 47 of the 56 locations, representing 41 states; Washington, D.C.; and all five territories. Not all states responded to every question.

  • PPE. The majority of states that responded were mainly able to fulfill requests for supplies from organizations and entities within their states. However, availability constraints continue with certain PPE, such as nitrile gloves.
  • Supplies for future vaccine needs. About one-third of states that responded stated that they were “greatly” or “completely” concerned about having sufficient vaccine-related supplies to administer COVID-19 vaccines. An additional 21 states indicated that they were moderately concerned.

In September 2020, GAO recommended that HHS, in coordination with FEMA, should

  • further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate supply chain shortages for the remainder of the pandemic;
  • immediately document roles and responsibilities for supply chain management functions transitioning to HHS, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain; and
  • devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the pandemic response.

HHS and the Department of Homeland Security disagreed with these recommendations, noting, among other things, the work that they had done to manage the medical supply chain and increase supply availability. In November 2020, HHS repeated its disagreement with GAO’s recommendations and noted its efforts to meet the needs of states.

In light of the surge in COVID-19 cases, along with reported shortages, including GAO’s nationwide survey findings, GAO underscores the critical imperative for HHS and FEMA to implement GAO’s September 2020 recommendations.

Vaccines and Therapeutics

In a recent GAO report (GAO-21-207), GAO found that there has been significant federal investment to accelerate vaccine and therapeutic development, such as through Operation Warp Speed, a partnership between the Department of Defense and HHS that aims to accelerate the development, manufacturing, and distribution of COVID-19 vaccines and therapeutics. Separately, Emergency Use Authorizations (EUA), which allow for the emergency use of medical products without Food and Drug Administration (FDA) approval or licensure provided certain statutory criteria are met, have also been used for therapeutics. As of November 9, 2020, FDA had made four therapeutics available to treat COVID-19 through EUAs. In that report, GAO recommended that FDA identify waysto uniformly discloseinformation from its scientific review of safety and effectiveness data when issuing EUAs for therapeutics and vaccines. By doing so, FDA could help improve the transparency of, and ensure public trust in, its EUA decisions. HHS neither agreed nor disagreed with the recommendation, but said it shared GAO’s goal of transparency.

COVID-19 Testing Guidance

HHS and its component agencies have taken several key actions to document a federal COVID-19 testing strategy and provide testing-related agency guidance. However, this guidance has not always been transparent, raising the risk of confusion and eroding trust in government. In particular, while it is expected that guidance will change as new information about the novel virus evolves, frequent changes to general CDC testing guidelines have not always been communicated with a scientific explanation. GAO recommends that HHS ensure that CDC clearly discloses the scientific rationale for any change to testing guidelines at the time the changeis made. HHS concurred with this recommendation.

Types of COVID-19 Testing Approaches

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-21-191

Nursing Home Care

In September 2020, the Coronavirus Commission on Safety and Quality in Nursing Homes (established by the Centers for Medicare & Medicaid Services (CMS) in June 2020) made 27 recommendations to CMS on topics such as testing, PPE, and visitation. CMS released a response to the commission that broadly outlined the actions it has taken to date, but it has not fully addressed the commission’s recommendations or provided an implementation plan to track and report progress toward implementing them.

While CMS is not obligated to implement all of the commission’s recommendations, the agency has not indicated any areas where it does not plan to take action. GAO recommends that CMS quickly develop a plan that further details how it intends to respond to and implement, as appropriate, the commission’s recommendations. HHS neither agreed nor disagreed with this recommendation and said it would refer to and act upon the commission’s recommendations, as appropriate.

In addition, the Department of Veterans Affairs (VA) partners with state governments to provide nursing home care to more than 20,000 veterans in over 150 state veterans homes. In March 2020, VA instructed its contractor to stop in-person inspections due to concerns about COVID-19. As of September 2020, these inspections had not resumed, leaving veterans at risk of receiving poor quality care. Additionally, VA does not collect timely data on the number of COVID-19 cases and deaths occurring at each state veterans home, hindering its ability to monitor and take steps to mitigate the spread of COVID-19 in these homes. GAO recommends that VA (1) develop a plan to resume inspections of state veterans homes, which may include using in-person, a mix of virtual and in-person, or fully virtual inspections, and (2) collect timely data on COVID-19 cases and deaths in each state veterans home. VA concurred with both recommendations.

Economic Impact Payments

The CARES Act included economic impact payments (EIP) for eligible individuals to address financial stress due to the pandemic. As of September 30, 2020, the Department of the Treasury (Treasury) and the Internal Revenue Service (IRS) had disbursed over 165.8 million payments to individuals, totaling $274.7 billion. According to IRS data, more than 26 million non-filers—individuals who do not normally file a tax return and may be hard to reach—received a payment (see figure). However, everyone that was supposed to receive a payment was not reached. Starting in September 2020, IRS sent notices to nearly 9 million individuals who had not yet received an EIP.

Number of Filers and Non-Filers Issued an Economic Impact Payment, as of September 30, 2020

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-21-191

Treasury and IRS officials did not plan to track and analyze the outcomes of their EIP notice mailing effort until 2021. The lack of timely analysis deprives Treasury and IRS of data they could use to assess the effectiveness of their notice strategy and redirect resources as needed to other outreach and communication efforts. GAO recommends that Treasury, in coordination with IRS, should begin tracking and publicly reporting the number of individuals who were mailed an EIP notification letter and filed for and received an EIP, and use that information to inform ongoing outreach and communications efforts. Treasury agreed with this recommendation.

Unemployment Insurance

The CARES Act created three federally funded temporary programs for unemployment insurance (UI) that expanded benefit eligibility and enhanced benefits. In its weekly news releases, the Department of Labor (DOL) publishes the number of weeks of unemployment benefits claimed by individuals in each state during the period and reports the total count as the number of people claiming benefits nationwide. DOL officials told GAO that they have traditionally used this number as a proxy for the number of individuals claiming benefits because they were closely related. However, the number of claims has not been an accurate estimate of the number of individuals claiming benefits during the pandemic because of backlogs in processing a historic volume of claims, among other data issues.

Without an accurate accounting of the number of individuals who are relying on these benefits in as close to real time as possible, policymakers may be challenged to respond to the crisis at hand. GAO recommends that DOL (1) revise its weekly news releases to clarify that in the current unemployment environment, the numbers it reports for weeks of unemployment claimed do not accurately estimate the number of unique individuals claiming benefits, and (2) pursue options to report the actual number of distinct individuals claiming benefits, such as by collecting these already available data from states. DOL agreed with the recommendation to revise its weekly news releases, and partially agreed with the recommendation to pursue options to report the actual number of distinct individuals claiming benefits.

Tax Relief for Businesses

To provide liquidity to businesses during the pandemic, the CARES Act included tax measures to help businesses receive cash refunds or other reductions to tax obligations. Some taxpayers need to file an amended income tax return to take advantage of these provisions; at the same time, IRS faces an increase in mail and paper processing delays due to the pandemic, which may delay the timely processing of this paperwork and issuance of these refunds. GAO recommends that IRS update its form instructions to include information on its electronic filing capability for tax year 2019. IRS agreed with this recommendation.

Program Integrity

Although the extent and significance of improper payments associated with COVID-19 relief funds have not yet been determined, the impact of these improper payments, including those that are the result of fraud, could be substantial. For example, numerous individuals are facing federal charges related to attempting to defraud the Paycheck Protection Program (PPP), UI program, or other federal programs, and many more investigations are underway. To address the risk of improper payments due to fraud and other causes, GAO previously recommended the following:

  • The Small Business Administration (SBA) should develop and implement plans to identify and respond to risks in the PPP to ensure program integrity, achieve program effectiveness, and address potential fraud.
  • The Office of Management and Budget (OMB), in consultation with Treasury, should issue timely guidance for auditing new and existing COVID-19-related programs, including Coronavirus Relief Fund payments, as soon as possible. Audits of entities that receive federal funds are critical to the federal government’s ability to help safeguard those funds.Also, Congress should amend the Social Security Act to explicitly allow the Social Security Administration to share its full death data with Treasury for data matching to prevent payments to ineligible individuals.

GAO maintains that implementing these recommendations fully is critically important in order to protect federal funds from improper payments resulting from fraud and other risks.

In this report, GAO also identifies new concerns about the timely reporting of improper payments for COVID-19 programs. The COVID-19 relief laws appropriated over a trillion dollars that may be spent through newly established programs to fund response and recovery efforts, such as SBA’s PPP. However, unlike the supplemental appropriations acts that provided for disaster relief related to the 2017 hurricanes and California wildfires, the COVID-19 relief laws did not require agencies to deem programs receiving these relief funds that expend more than a threshold amount as “susceptible to significant improper payments.” In addition, based on OMB guidance, improper payment estimates associated with new COVID-19 programs established in March 2020 may not be reported until November 2022, in some instances. GAO is making two recommendations:

  • OMB should develop and issueguidance directingagencies to include COVID-19 relief funding with associated key risks, such as changes to existing program eligibility rules, as part of their improper payment estimation methodologies, especially for existing programs that received COVID-19 relief funding.
  • SBA should expeditiously estimate improper payments and report estimates and error rates for PPP due to concerns about the possibility that improper payments, including those resulting from fraudulent activity, could be widespread.

GAO is also suggesting that Congress consider, in any future legislation appropriating COVID-19 relief funds, designating all executive agency programs and activities making more than $100 million in payments from COVID-19 relief funds as “susceptible to significant improper payments.”

Aviation Assistance and Preparedness

GAO identified concerns about efforts to monitor CARES Act financial assistance to the aviation sector. Treasury’s Payroll Support Program (PSP) provides $32 billion in payroll support payments and loans to help the aviation industry retain its employees. While recipients have begun submitting required compliance reports, Treasury has not yet finalized a monitoring system to identify and respond to the risk of noncompliance with PSP agreement terms, potentially hindering its ability to detect program misuse in a timely manner. GAO is recommending that Treasury finish developing and implement acompliance monitoringplan that identifies and responds to risks in the PSP. Treasury neither agreed nor disagreed with this recommendation, but committed to reviewing additional measures that may further enhance its compliance monitoring and ensure that PSP funds are used as intended.

In June 2020, GAO suggested that Congress take legislative action to require the Secretary of Transportation to work with relevant agencies, such as HHS, the Department of Homeland Security, and other stakeholders, to develop a national aviation-preparedness plan to limit the spread of communicable diseasethreats and minimize traveland trade impacts. GAO originally made this recommendation to the Department of Transportation in December 2015. GAO urges Congress to take swift action to require such a plan, without which the U.S. will not be as prepared to minimize and quickly respond to ongoing and future communicable disease events.

For more information, contact A. Nicole Clowers at (202)512-7114 or clowersa@gao.gov.

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    A resident of Topeka, Kansas, has been indicted by a federal grand jury in the U.S. District Court for the District of Kansas on federal child pornography charges, Acting Assistant Attorney General Brian Rabbitt of the Justice Department’s Criminal Division announced today.
    [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…]
  • Supreme Court Fellows Set to Begin New Term
    In U.S Courts
    Four new Supreme Court Fellows are set to begin their 2020-2021 fellowships in September working virtually, due to the coronavirus (COVID-19) pandemic.
    [Read More…]
  • Brazilian Partnership to Begin Producing NASA-Designed COVID-19 Ventilator
    In Space
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  • 16-Year-Old Cosmic Mystery Solved, Revealing Stellar Missing Link
    In Space
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  • Kevin M. Epstein Appointed as U.S. Trustee for the Southern and Western Districts of Texas
    In Crime News
    Attorney General William P. Barr has appointed Kevin M. Epstein as the U.S. Trustee for the Southern and Western Districts of Texas (Region 7) effective Jan. 1, 2021, the Executive Office for U.S. Trustees (EOUST) announced today.
    [Read More…]
  • Secretary Michael R. Pompeo With Greg Kelly of Greg Kelly Reports on Newsmax TV
    In Crime Control and Security News
    Michael R. Pompeo, [Read More…]
  • K-12 Education: School Districts Need Better Information to Help Improve Access for People with Disabilities
    In U.S GAO News
    Two-thirds of U.S. public school districts have schools with physical barriers that may limit access for people with disabilities, according to GAO's survey of district officials. Barriers, such as a lack of accessible door hardware and steep ramps, can make it challenging for students, teachers, and others with disabilities to use public school facilities (see fig.). In 55 schools across six states, the most common areas with barriers GAO observed were restrooms, interior doorways, and classrooms. GAO also observed barriers related to safety and security. For example, for security, some schools had installed double-door vestibules with limited maneuvering space that could trap people who use wheelchairs. Examples of Doorway and Auditorium Barriers GAO Observed in Schools Note: Barriers presented in this figure potentially limit physical access for people with disabilities, but taken alone, would not necessarily establish whether a legal violation has occurred. An estimated 70 percent of districts had large-scale renovations, small-scale upgrades, or accessibility evaluations planned in the next 3 calendar years, but frequently cited funding constraints as a challenge to these efforts. Districts also identified the need to prioritize projects that keep buildings operational, such as roofing and heating projects. In addition, GAO's survey, observations during site visits, and interviews with national disability groups revealed a tension between making safety and security upgrades and improving physical accessibility. The Department of Justice (Justice) has not provided technical assistance on physical accessibility in schools, and GAO's surveys indicate such help is needed. Justice has authority to provide information on interpreting the Americans with Disabilities Act of 1990 (ADA), including for public schools, and it has provided technical assistance regarding other public facilities, such as stadiums. In addition, Justice, along with the Department of Education (Education) and other federal agencies, recently launched a new website on school safety, but it does not include specific information on how to improve accessibility of public school facilities or provide information on ADA requirements in the context of school safety upgrades. Without such information, federal agencies may miss opportunities to help ensure that people with disabilities have safe and secure access to public school facilities. National reports have raised concerns about the physical accessibility of public school facilities for people with disabilities. These facilities serve important roles as schools, voting locations, and emergency shelters, among other things. GAO was asked to examine the physical accessibility of public school facilities. This report examines the extent to which (1) school districts have school facilities with physical barriers that may limit access for people with disabilities, (2) districts plan to improve the accessibility of school facilities and the challenges they face, and (3) Justice and Education assist districts and states in improving school facilities' physical accessibility. GAO conducted a nationally representative survey of school districts; surveyed states and the District of Columbia; examined 55 schools across six states, selected for variation in size and other characteristics; reviewed relevant federal laws, regulations, and guidance; and interviewed federal, state, and school district officials, and national disability groups. GAO recommends that Justice work with Education to (1) provide information specific to accessibility of public school facilities and (2) provide information on federal accessibility requirements in the context of public school safety and security. Justice neither agreed nor disagreed with GAO's recommendations. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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    In Travel
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  • United States Antitrust Agencies Co-Host the 19th Annual International Competition Network Conference
    In Crime News
    The Department of Justice’s Antitrust Division and the Federal Trade Commission (FTC) are co-hosting the International Competition Network’s (ICN) 19th annual conference, which opens today and runs through Thursday, September 17, 2020.  Assistant Attorney General Makan Delrahim and FTC Chairman Joseph J. Simons are leading the U.S. agencies’ participation in the ICN’s first virtual conference.  Assistant Attorney General Delrahim and Chairman Simons will deliver opening remarks and speak on the conference’s showcase program addressing the challenges of enforcement in the digital economy.
    [Read More…]
  • Home Health Agency and Former Owner to Pay $5.8 Million to Settle False Claims Act Allegations
    In Crime News
    Doctor’s Choice Home Care, Inc. and its former owners, Timothy Beach and Stuart Christensen, have agreed to pay $5.15 million to resolve allegations that the home health agency provided improper financial inducements to referring physicians through sham medical director agreements and bonuses to physicians’ spouses who were Doctor’s Choice employees, the Department of Justice announced today. 
    [Read More…]
  • Justice Department Acts To Shut Down Fraudulent Websites Exploiting The Covid-19 Pandemic
    In Crime News
    The United States Department of Justice announced today that it has obtained a Temporary Restraining Order in federal court to combat fraud related to the coronavirus (COVID-19) pandemic. The enforcement action, filed in Tampa, Florida, is part of the Justice Department’s ongoing efforts prioritizing the detection, investigation, and prosecution of illegal conduct related to the pandemic. The action was brought based on an investigation conducted by United States Immigration and Customs Enforcement’s (ICE) Homeland Security Investigations (HSI), in coordination with the Vietnam Ministry of Public Security.
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  • Bangladesh Travel Advisory
    In Travel
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  • New Jury Instructions Strengthen Social Media Cautions
    In U.S Courts
    A federal Judiciary committee has issued a new set of model jury instructions that federal judges may use to deter jurors from using social media to research or communicate about cases.
    [Read More…]
  • Researcher Pleaded Guilty to Conspiring to Steal Scientific Trade Secrets from Ohio Children’s Hospital to Sell in China
    In Crime News
    Former Ohio woman Li Chen, 46, pleaded guilty today via video conference in U.S. District Court today to conspiring to steal scientific trade secrets and conspiring to commit wire fraud concerning the research, identification and treatment of a range of pediatric medical conditions.
    [Read More…]
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    In Travel
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  • New York City Restaurateur Sentenced to Jail For Tax Evasion Scheme
    In Crime News
    A New York City restaurateur was sentenced to prison for a tax evasion scheme.
    [Read More…]
  • Justice Department Secures Relief for U.S. Army National Guard Reservist on Employment Discrimination Claim Against Luxury Jeweler Harry Winston
    In Crime News
    The Justice Department and the U.S. Attorney’s Office for the Southern District of Texas announced today that they resolved a claim that luxury jeweler Harry Winston, Inc. violated the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) by refusing to offer full-time employment to U.S. Army National Guard Reservist John A. Walker because of his military service obligations.
    [Read More…]
  • Prison Official Charged with Accepting Bribes and Smuggling Contraband into Correctional Institution
    In Crime News
    A federal grand jury sitting in the Eastern District of North Carolina returned an indictment on Oct. 14 charging a North Carolina Department of Public Safety official with a bribery and smuggling scheme that funneled drugs and other contraband into Caledonia Correctional Institution.
    [Read More…]
  • Justice Department Obtains $20,000 Settlement Against Tampa, Florida Towing Company for Unlawfully Selling Deployed Servicemember’s Car
    In Crime News
    The Justice Department today announced that Target Recovery Towing Inc. (Target) has agreed to enter into a court-enforceable consent order to resolve allegations that it failed to obtain a legally required court order before auctioning off a car belonging to a U.S. Marine Corps Sergeant who was deployed overseas. 
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  • Special Envoy Rayburn Travel to the United Arab Emirates and Jordan
    In Crime Control and Security News
    Joel D. Rayburn, Special [Read More…]
  • The United States Partners with Australia and Japan to Expand Reliable and Secure Digital Connectivity in Palau
    In Crime Control and Security News
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  • USDA Market Facilitation Program: Information on Payments for 2019
    In U.S GAO News
    The U.S. Department of Agriculture's (USDA) Farm Service Agency (FSA) distributed about $14.4 billion in 2019 Market Facilitation Program (MFP) payments to farming operations in all 50 states and Puerto Rico. According to USDA, these payments were intended to offset the effects of trade disruptions and tariffs targeting a variety of U.S. agricultural products. FSA distributed these payments to 643,965 farming operations. The average MFP payment per farming operation for 2019 was $22,312 but varied by county, ranging from $44 to $295,299. MFP payments for 2019 also varied by type of commodity. Three types of commodities were eligible for 2019 MFP payments: (1) nonspecialty crops (including grains and oilseeds, such as corn and soybeans); (2) specialty crops (including nuts and fruits, such as pecans and cranberries); and (3) dairy and hogs. Most of the 2019 MFP payments went to farming operations that produced nonspecialty crops. Less than 10 percent went to farming operations that produced specialty crops or dairy and hogs. USDA made approximately $519 million in additional MFP payments for 2019 compared with 2018 because of increases in payment limits—the cap on payments that members of farming operations can receive. FSA distributed these additional MFP payments to about 10,000 farming operations across 39 states. The amount of additional MFP payments that FSA distributed for 2019 varied by location. Farming operations in five states—Texas, Illinois, Iowa, Missouri, and Minnesota—received almost half of all additional payments. In May 2019, USDA announced it would distribute up to $14.5 billion in direct payments to farming operations that were affected by trade disruptions, following the approximately $8.6 billion USDA announced it had distributed for 2018. USDA referred to these 2018 and 2019 payments as the MFP. In comparison with 2018, USDA changed the 2019 payment structure for the three types of commodities that were eligible for payments. For example, USDA increased the payment limit for each of these three types. GAO was asked to review the distribution of MFP payments for 2019. This report examines, among other things, MFP payments for 2019 and how they varied by location, farming operation, and type of commodity, as well as additional MFP payments for 2019 compared with 2018 that resulted from increased payment limits. To accomplish these objectives, GAO analyzed data from USDA and interviewed agency officials knowledgeable about the data. For more information, contact Steve Morris at (202) 512-3841 or morriss@gao.gov.
    [Read More…]
  • Pain Clinic Owner Sentenced for Role in Operating Pill Mills in Tennessee and Florida
    In Crime News
    A pain clinic owner was sentenced today to over 33 years in prison for her role in operating several pill mills in Knoxville, Tennessee, and Hollywood, Florida.
    [Read More…]