What GAO Found
Through Operation Warp Speed—a partnership between the Department of Health and Human Services (HHS) and the Department of Defense (DOD)—the federal government is accelerating efforts to develop vaccines and therapeutics for COVID-19. A typical vaccine development process can take approximately 10 years or longer, but efforts under Operation Warp Speed seek to greatly accelerate this process by completing key steps simultaneously (see figure). As of October 15, 2020, Operation Warp Speed publicly announced financial support for the development or manufacturing of six COVID-19 vaccine candidates totaling more than $10 billion in obligations. It has also announced financial support for the development of therapeutics, such as a $450 million award to manufacture a monoclonal antibody treatment (a treatment that uses laboratory-made antibodies, which also may be able to serve as a prevention option).
Operation Warp Speed Timeline for a Potential Vaccine Candidate
Note: An Emergency Use Authorization allows for emergency use of medical products without FDA approval or licensure during a declared emergency, provided certain statutory criteria are met.
The Food and Drug Administration (FDA) may temporarily allow the use of unlicensed or unapproved COVID-19 vaccines and therapeutics through emergency use authorizations (EUA), provided there is evidence that the products may be effective and that known and potential benefits outweigh known and potential risks. For vaccines, FDA issued guidance in October 2020 to provide vaccine sponsors with recommendations regarding the evidence FDA needed to support issuance of an EUA. For therapeutics, FDA has issued four EUAs as of November 9, 2020. The evidence to support FDA’s COVID-19 therapeutic authorization decisions has not always been transparent, in part because FDA does not uniformly disclose its scientific review of safety and effectiveness data for EUAs, as it does for approvals for new drugs and biologics. Given the gravity of the pandemic, it is important that FDA identify ways to uniformly disclose this information to the public. By doing so, FDA could help improve the transparency of, and ensure public trust in, its EUA decisions.
Why GAO Did This Study
The U.S. had about 10.3 million cumulative reported cases of COVID-19 and about 224,000 reported deaths as of November 12, 2020. Given this catastrophic loss of life as well as the pandemic’s effects on the U.S. economy, effective and safe vaccines and therapeutics are more important than ever.
The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines, (1) efforts of Operation Warp Speed to accelerate COVID-19 vaccine and therapeutic development; and (2) FDA’s use of EUAs for COVID-19 therapeutics and vaccines, among other objectives.
GAO reviewed federal laws and agency documents, including HHS and DOD information on vaccine and therapeutic development and EUAs as of November 2020. GAO interviewed or received written responses from HHS and DOD officials, and interviewed representatives from vaccine developers and manufacturers, as well as select public health stakeholders and provider groups covering a range of provider types.
What GAO Recommends
FDA should identify ways to uniformly disclose to the public the information from its scientific review of safety and effectiveness data when issuing EUAs for therapeutics and vaccines. HHS neither agreed nor disagreed with the recommendation, but said it shared GAO’s goal of transparency and would explore approaches to achieve this goal.
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- Drinking Water: EPA Could Use Available Data to Better Identify Neighborhoods at Risk of Lead ExposureBy Sam NewsDecember 18, 2020GAO's statistical analysis indicates that areas with older housing and vulnerable populations (e.g., families in poverty) have higher concentrations of lead service lines in the selected cities GAO examined. By using geospatial lead service line data from the selected water systems and geospatial data from the U.S. Census Bureau's American Community Survey (ACS), GAO identified characteristics of neighborhoods with higher concentrations of lead service lines. The Environmental Protection Agency's (EPA) guidance for water systems on how to identify the location of sites at high-risk of having lead service lines has not been updated since 1991 and many water systems face challenges identifying areas at risk of having lead service lines. By developing guidance for water systems that outlines methods for identifying high-risk locations using publicly available data, EPA could better ensure that public water systems test water samples from locations at greater risk of having lead service lines and identify areas with vulnerable populations to focus lead service line replacement efforts. (See figure for common sources of lead in home drinking water.) Common Sources of Lead in Drinking Water within Homes and Residences EPA has taken some actions to address the Water Infrastructure Improvements for the Nation (WIIN) Act requirement, which include developing a strategic plan regarding lead in public water systems. However, EPA's published plan did not satisfy the statutory requirement that the agency's strategic plan address targeted outreach, education, technical assistance, and risk communication undertaken by EPA, states, and public water systems. For example, the plan does not discuss public education, technical assistance or risk communication. Instead, EPA's plan focused solely on how to notify households when EPA learns of certain exceedances of lead in their drinking water. Moreover, EPA's plan is not consistent with leading practices for strategic planning. For example, EPA's plan does not set a mission statement or define long-term goals. Developing a strategic plan that meets the statutory requirement and fully reflects leading practices for strategic planning would give EPA greater assurance that it has effectively planned for how it will communicate the risks of lead in drinking water to the public. Lead in drinking water comes primarily from corrosion of service lines connecting the water main to a house or building, pipes inside a building, or plumbing fixtures. As GAO reported in September 2018, the total number of lead service lines in drinking water systems is unknown, and less than 20 of the 100 largest water systems have such data publicly available. GAO was asked to examine the actions EPA and water systems are taking to educate the public on the risks of lead in drinking water. This report examines, among other things: (1) the extent to which neighborhood data on cities served by lead service lines can be used to focus lead reduction efforts; and (2) actions EPA has taken to address WIIN Act requirements, and EPA's risk communication documents. GAO conducted a statistical analysis combining geospatial lead service line and ACS data to identify characteristics of selected communities; reviewed legal requirements and EPA documents; and interviewed EPA officials. GAO is making four recommendations, including that EPA develop (1) guidance for water systems on lead reduction efforts, and (2) a strategic plan that meets the WIIN Act requirement. EPA agreed with one recommendation and disagreed with the others. GAO continues to believe the recommendations are warranted, as discussed in the report. For more information, contact J. Alfredo Gómez at (202) 512-3841 or email@example.com.[Read More…]
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- VA Construction: VA Should Enhance the Lessons-Learned Process for Its Real-Property Donation Pilot ProgramBy Sam NewsDecember 11, 2020The Department of Veterans Affairs (VA) has received one real property donation through a partnership pilot program authorized by the Communities Helping Invest through Property and Improvements Needed for Veterans Act of 2016 (CHIP-IN Act) and is planning for a second. This Act authorized VA to accept donated real property—such as buildings or facility construction or improvements—and to contribute certain appropriated funds to donors that are entering into donation agreements with VA. Under VA's interpretation, its ability to contribute to such funds is limited to major construction projects (over $20 million). The first CHIP-IN project—an ambulatory care center in Omaha, Nebraska—opened in August 2020. Pending requested appropriations for a second CHIP-IN project, VA intends to partner with another donor group to construct an inpatient medical center in Tulsa, Oklahoma. (See figure.) Other potential donors have approached VA about opportunities that could potentially fit the CHIP-IN pilot, but these project ideas have not proceeded for various reasons, including the large donations required. VA officials told us they have developed a draft legislative proposal that seeks to address a challenge in finding CHIP-IN partnerships. For example, officials anticipate that a modification allowing VA to make funding contributions to smaller projects of $20 million and under would attract additional donors. Completed Department of Veterans Affairs' (VA) Ambulatory Care Center in Omaha, NE, and Rendering of Proposed Inpatient Facility in Tulsa, OK VA has discussed and documented some lessons learned from the Omaha project. For example, VA officials and the Omaha donor group identified and documented the benefits of a design review software that helped shorten timeframes and reduce costs compared to VA's typical review process. However, VA has not consistently followed a lessons-learned process, and as a result, other lessons, such as the decision-making that went into developing the Omaha project's donation agreement, have not been documented. Failure to document and disseminate lessons learned puts VA at risk of losing valuable insights from the CHIP-IN pilot that could inform future CHIP-IN projects or other VA construction efforts. VA has pressing infrastructure demands and a backlog of real property projects. VA can accept up to five real property donations through the CHIP-IN pilot program, which is authorized through 2021. GAO previously reported on the CHIP-IN pilot program in 2018. The CHIP-IN Act includes a provision for GAO to report on donation agreements entered into under the pilot program. This report examines: (1) the status of VA's efforts to execute CHIP-IN partnerships and identify additional potential partners and (2) the extent to which VA has collected lessons learned from the pilot, among other objectives. GAO reviewed VA documents, including project plans and budget information, and interviewed VA officials, donor groups for projects in Omaha and Tulsa, and selected non-profits with experience in fundraising. GAO compared VA's efforts to collect lessons learned with key practices for an overall lessons-learned process. GAO is making two recommendations to VA to implement a lessons-learned process. Recommendations include documenting and disseminating lessons learned from CHIP-IN pilot projects. VA concurred with GAO's recommendations. For more information, contact Andrew Von Ah at (202) 512-2834 or firstname.lastname@example.org.[Read More…]
- Countering Violent Extremism: DHS Needs to Improve Grants Management and Data CollectionBy Sam NewsFebruary 19, 2021While the Department of Homeland Security (DHS) followed the Office of Management and Budget (OMB) guidance for announcing the 2016 Countering Violent Extremism (CVE) Grant Program and reviewing applications, DHS did not document the basis for its final award decisions. In June 2017, DHS awarded a total of $10 million in CVE grants to 26 grantees for a 2-year performance period (2017 to 2019). Consistent with OMB guidance, DHS included program priorities and eligibility requirements in its grant announcement and described the process for reviewing and selecting grant applications for award. However, after DHS announced its selection of 31 applications for awards, it ran a new process resulting in revised selections, which was based on additional selection criteria not expressly listed in the grant announcement. While DHS officials explained to GAO how these additional criteria aligned with the grant announcement, these explanations do not appear in DHS's award documentation. Without such documentation, DHS cannot clearly demonstrate that its award decisions were based on the process described in the grant announcement. Figure: Location and Number of Deaths Associated with Domestic Extremist Attacks, 2010-2019 DHS did not obtain the necessary data from grantees to evaluate the overall CVE grant program. DHS required grant organizations to develop, collect, and submit their own output and outcome-related information to help enable the department to evaluate individual grantees and the overall grant program. However, a DHS review of four grant projects concluded that the grantees did not collect the type of performance information DHS needed to determine the grants' effectiveness, such as data at various time intervals to assess change in attitudinal behavior. Taking steps to ensure grantees collect and submit appropriate performance data would enable DHS to evaluate the extent that individual grant projects and the overall grant program are achieving results. Such information would help DHS manage the program and make adjustments as warranted. From 2010 through 2019, data collected through the Extremist Crime Database show that 205 deaths resulted from 59 violent extremist attacks in the United States. DHS received funding in 2016 to establish a new CVE Grant Program to support efforts by state and local governments and nongovernmental organizations to reduce risk factors associated with violent extremism. GAO was asked to review management of the CVE Grant Program. This report examines, among other things, the extent to which DHS (1) announced, reviewed, and awarded CVE grants in accordance with OMB guidance and (2) evaluated the performance of CVE grantees and the overall program. GAO reviewed documentation of DHS's actions in announcing, reviewing and awarding CVE grants; and documentation on steps taken to assess the performance of grantees and the overall program; as compared to requirements in key documents, including the CVE grant announcement, elements of internal control, and a DHS 2017 report to Congress. GAO recommends that DHS, for future CVE-related grant programs: (1) develop policy to document the rationale for award decisions, and (2) take steps to ensure that grantees collect and submit data on project performance that enable evaluation of individual grants and the overall grant program toward intended outcomes. DHS concurred with both recommendations. For more information, contact Triana McNeil at (202) 512-8777 or email@example.com.[Read More…]
- Financial Assistance: Lessons Learned from CARES Act Loan Program for Aviation and Other Eligible BusinessesBy Sam NewsDecember 10, 2020The CARES Act authorized up to $46 billion for the Department of the Treasury (Treasury) to make loans to aviation and other eligible businesses affected by the COVID-19 pandemic. Of the 267 applications submitted to the loan program, 35 loans providing $21.9 billion in assistance were executed. Treasury officials do not expect to make any additional loans before Treasury's authority to make loans expires. Applications and Loans for CARES Act Loan Program for Aviation and Other Eligible Businesses, by Category in Statute Type of business Number of applications submitted Assistance sought/available (billions of dollars) Number of loans executed Assistance provided (billions of dollars) Passenger air carrier, repair station operator, and ticket agent 183 35 / 25 23 21.2 Cargo air carrier 10 0.8 / 4 1 0.002 National security business 74 2.6 / 17 11 0.7 Total 267 38.3 / 46 35 21.9 Source: GAO analysis of Department of the Treasury data | GAO-21-198 Note: Pub. L. No. 116-136, § 4003(b)(1)-(3). Participation in the loan program varied across business types due to timing of decisions and other factors, according to stakeholders. Treasury prioritized applications from the largest passenger air carriers and executed loans with seven of them for nearly $20.8 billion. For other applicants, including smaller passenger air carriers and ticket agents, the amount of time Treasury took to evaluate their applications and other challenges affected the number of loans executed, according to selected industry associations. Treasury's authority to make new loans under this program is set to expire in December 2020, and the loan program offers Congress and Treasury lessons for designing and implementing programs of this type in the future. For example: Multiple programs, or multiple paths within a program, may better accommodate businesses of varied types and sizes. It is difficult to implement a program quickly for a wide range of businesses. In addition, a loan program well suited to large, financially sophisticated applicants will not likely be well suited to smaller businesses. Setting and communicating clear program goals could better align lender and borrower expectations. Treasury viewed itself as a lender of last resort but did not state this view in published documents. This omission led to some applicants being surprised by parts of the process, such as when Treasury encouraged over a third of all applicants to apply to another loan program before continuing to pursue a loan from Treasury. Communicating clear timelines for action can also help align lender and borrower expectations. The lack of a published timeline resulted in frustration among some applicants when loans were not made more quickly. The COVID-19 pandemic has resulted in catastrophic loss of life and substantial damage to the global economy, including the aviation sector. U.S. passenger air carriers have lost almost $20 billion and over 47,000 jobs in 2020, with losses forecast to continue into 2021. In March 2020, Congress passed, and the President signed into law, the CARES Act, which provides over $2 trillion in emergency assistance and health care response for individuals, families, and businesses affected by the COVID-19 pandemic, including businesses in the aviation sector. The CARES Act contained a provision for GAO to review the loans provided under the Act. This report examines, among other things, eligible businesses' participation in the loan program and lessons learned from the program for Congress and Treasury. GAO reviewed Treasury documents and data on applications received and loans executed; interviewed Treasury officials on the design and implementation of the program; and interviewed eight industry associations that represent the range of businesses eligible for loans, eight passenger air carriers, and other selected applicants to gather their views on the program. GAO will continue to monitor and report on CARES Act assistance to the aviation industry. This oversight includes the loan program and another Treasury program—the Payroll Support Program—that provided assistance to certain aviation businesses to continue paying employee wages, salaries, and benefits. For more information, contact Heather Krause at (202) 512-2834 or firstname.lastname@example.org.[Read More…]
- Aviation Consumer Protection: Increased Transparency Could Help Build Confidence in DOT’s Enforcement ApproachBy Sam NewsOctober 13, 2020The Department of Transportation's (DOT) enforcement approach generally uses a range of methods to encourage compliance with consumer protection regulations, including conducting outreach and information-sharing, issuing guidance, and sending non-punitive warning letters for those violations that do not rise to the level that warrants a consent order. DOT usually enters into consent orders when it has evidence of systematic or egregious violations. Such orders are negotiated between DOT and violators (e.g., airlines) and typically include civil penalties. DOT officials see benefits from using consent orders, which can include credits for actions taken to benefit consumers or to improve the travel environment. Annual consent orders increased from 20 in 2008 to 62 in 2012, but then generally declined to a low of eight in 2019. GAO's analysis showed that the decline in consent orders was most marked among those issued against non-air carrier entities (e.g., travel agents), those addressing certain types of violations such as advertising, and orders containing smaller civil penalty amounts. DOT officials said that the agency did not change its enforcement practices during this time. Examples of DOT's Compliance Promotion and Enforcement Efforts Airlines and consumer advocates GAO interviewed said that DOT's enforcement process lacked transparency, including into how investigations were conducted and resolved and about when and why DOT takes enforcement actions. Moreover, DOT publishes limited information related to the results of its enforcement activities, notably information about the number and type of consumer complaints it receives as well as issued consent orders. DOT does not publish other information such as aggregated data about the number or nature of open and closed investigations or issued warning letters. DOT is taking some actions to increase transparency, such as developing a publicly available handbook, but none of those actions appears to fully address the identified information gaps such as information about the results of investigations. Some other federal agencies provide more information about enforcement activities, including publishing warning letters or data about such letters. Publishing additional information about how DOT conducts investigations and enforcement, and about the results of enforcement activities, could improve stakeholders' understanding of DOT's process and help build confidence in its approach. Consumer advocates, airlines, and other stakeholders have raised concerns about how DOT enforces aviation consumer protection requirements. DOT has the authority to enforce requirements protecting consumers against unfair and deceptive practices, discrimination on the basis of disability or other characteristics, and other harms. The FAA Reauthorization Act of 2018 contained a provision for GAO to review DOT's enforcement of consumer protection requirements. This report examines: (1) DOT's approach to the enforcement of aviation consumer protections and the results of its efforts, and (2) selected stakeholder views on this approach and steps DOT has taken to address identified concerns. GAO reviewed DOT data on consent orders and consumer complaints; reviewed other DOT documentation related to its enforcement program; interviewed DOT officials and selected industry and consumer stakeholders, including advocacy organizations, which we identified from prior work and a literature review; and identified leading practices for regulatory enforcement. GAO is making two recommendations, including: that DOT publish information describing the process it uses to enforce consumer protections, and that DOT take additional steps to provide transparency into the results of its efforts. DOT concurred with these recommendations. For more information, contact Andrew Von Ah at (202) 512-2834 or email@example.com.[Read More…]
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- Electromagnetic Spectrum Operations: DOD Needs to Take Action to Help Ensure SuperiorityBy Sam NewsMarch 19, 2021What GAO Found The electromagnetic spectrum (the spectrum) consists of frequencies worldwide that support many civilian and military uses, from mobile phone networks and radios to navigation and weapons. This invisible battlespace is essential to Department of Defense (DOD) operations in all domains—air, land, sea, space, and cyberspace. The interruption of U.S. forces' access to the spectrum can result in a military disadvantage, preventing U.S. forces from operating as planned and desired. According to the studies by DOD and others that GAO reviewed for its December 2020 report on military operations in the spectrum, adversaries, such as China and Russia, are also aware of the importance of the spectrum and have taken significant steps to improve their own capabilities that challenge DOD and its operations. For example, studies described how China has formed new military units and fielded new unmanned aerial vehicles with spectrum warfare capabilities, and Russian electromagnetic warfare forces have demonstrated their effectiveness through successful real-world applications against U.S. and foreign militaries. These developments are particularly concerning in the context of challenges to DOD's spectrum superiority. GAO's analysis of the studies highlighted DOD management challenges such as dispersed governance, limited full-time senior-level leadership, outdated capabilities, a lengthy acquisition process, increased spectrum competition and congestion, and a gap in experienced staff and realistic training. GAO found that DOD had issued strategies in 2013 and 2017 to address spectrum-related challenges, but did not fully implement either strategy because DOD did not assign senior leaders with appropriate authorities and resources or establish oversight processes for implementation. DOD published a new strategy in October 2020, but GAO found in December 2020 the department risks not achieving the new strategy's goals because it had not taken key actions—such as identifying processes and procedures to integrate spectrum operations across the department, reforming governance structures, and clearly assigning leadership for strategy implementation. Also, it had not developed oversight processes, such as an implementation plan, that would help ensure accountability and implementation of the 2020 strategy goals (see figure). Actions to Ensure DOD Superiority in the Electromagnetic Spectrum Why GAO Did This Study The spectrum is essential for facilitating control in operational environments and affects operations in the air, land, sea, space, and cyberspace domains. Spectrum use is pervasive across warfighting domains and thus maintaining or achieving spectrum superiority against an adversary is critical to battlefield success. This statement summarizes: (1) the importance of the spectrum; (2) challenges to DOD's superiority in the spectrum; and (3) the extent to which DOD has implemented spectrum-related strategies and is positioned to achieve future goals. This statement is based on GAO's December 2020 report (GAO-21-64) and updates conducted in March 2021. For the report, GAO analyzed 43 studies identified through a literature review, reviewed DOD documentation, and interviewed DOD officials and subject matter experts. For the updates, GAO reviewed materials that DOD provided in March 2021.[Read More…]
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- Offshore Wind Energy: Planned Projects May Lead to Construction of New Vessels in the U.S., but Industry Has Made Few Decisions amid UncertaintiesBy Sam NewsDecember 8, 2020Under the Jones Act, vessels carrying merchandise between two points in the U.S. must be built and registered in the United States. Developers are planning a number of offshore wind projects along the U.S. east coast, where many states have set targets for offshore wind energy production. Stakeholders described two approaches to using vessels to install offshore wind energy projects in the U.S. Either approach may lead to the construction of new vessels that comply with the Jones Act. Under one approach, a Jones Act-compliant wind turbine installation vessel (WTIV) would carry components from a U.S. port to the site and also install the turbines. WTIVs have a large deck, legs that allow the vessel to lift out of the water, and a tall crane to lift and place turbines. Stakeholders told GAO there are currently no Jones Act-compliant vessels capable of serving as a WTIV. One company, however, has announced a plan to build one. Under the second approach, a foreign-flag WTIV would install the turbines with components carried to the site from U.S. ports by Jones Act-compliant feeder vessels (see figure). While some potential feeder vessels exist, stakeholders said larger ones would probably need to be built to handle the large turbines developers would likely use. Example of an Offshore Wind Installation in U.S. Waters Using a Foreign-Flag Installation Vessel and Jones Act-Compliant Feeder Vessels Stakeholders identified multiple challenges—which some federal programs address—associated with constructing and using Jones Act-compliant vessels for offshore wind installations. For example, stakeholders said that obtaining investments in Jones Act-compliant WTIVs—which may cost up to $500 million—has been challenging, in part due to uncertainty about the timing of federal approval for projects. According to officials at the Department of the Interior, which is responsible for approving offshore wind projects, the Department plans to issue a decision on the nation's first large-scale offshore wind project in December 2020. Some stakeholders said that if this project is approved, investors may be more willing to move forward with vessel investments. While stakeholders also said port infrastructure limitations could pose challenges to using Jones Act-compliant vessels for offshore wind, offshore wind developers and state agencies have committed to make port investments. Offshore wind, a significant potential source of energy in the United States, requires a number of oceangoing vessels for installation and other tasks. Depending on the use, these vessels may need to comply with the Jones Act. Because Jones Act-compliant vessels are generally more expensive to build and operate than foreign-flag vessels, using such vessels may increase the costs of offshore wind projects. Building such vessels may also lead to some economic benefits for the maritime industry. A provision was included in statute for GAO to review offshore wind vessels. This report examines (1) approaches to use of vessels that developers are considering for offshore wind, consistent with Jones Act requirements, and the extent to which such vessels exist, and (2) the challenges industry stakeholders have identified associated with constructing and using such vessels to support U.S. offshore wind, and the actions federal agencies have taken to address these challenges. GAO analyzed information on vessels that could support offshore wind, reviewed relevant laws and studies, and interviewed officials from federal agencies and industry stakeholders selected based on their involvement in ongoing projects and recommendations from others. For more information, contact Andrew Von Ah at (202) 512-2834 or firstname.lastname@example.org.[Read More…]
- Departments of Justice and Homeland Security Release Data on Incarcerated AliensBy Sam NewsOctober 16, 2020Today, the Department of Justice and the Department of Homeland Security released the Alien Incarceration Report for Fiscal Year 2019. The data shows that 94 percent of confirmed aliens incarcerated in Federal Bureau of Prisons (BOP) and United States Marshals Service (USMS) facilities were unlawfully present in the United States. Additionally, the report found that nearly 70 percent of known or suspected aliens in BOP custody had been convicted of a non-immigration-related offense, and 39 percent of known or suspected aliens in USMS custody had committed a non-immigration-related offense.[Read More…]
- COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted ActionsBy Sam NewsSeptember 21, 2020In the government’s ongoing response to the COVID-19 pandemic, the Congress and the administration have taken action on multiple fronts to address challenges that have contributed to catastrophic loss of life and profound economic disruption. These actions have helped direct much-needed federal assistance to support many aspects of public life, including local public health systems and private-sector businesses. However, the nation faces continued public health risks and economic difficulties for the foreseeable future. Among other challenges, the public health system, already strained from months of responding to COVID-19 cases, will face the additional task of managing the upcoming flu season. At the same time, many of the federal, state, and local agencies responsible for responding to the ongoing public health emergency are called on to prepare for and respond to the current hurricane season. Timely and concerted federal leadership will be required in responding to these and other challenges. GAO has identified lessons learned and issues in need of continued attention by the Congress and the administration, including the need to collect reliable data that can drive decision-making; to establish mechanisms for accountability and transparency; and to protect against ongoing cyber threats to patient information, intellectual property, public health data, and intelligence. Attention to these issues can help to make federal efforts as effective as possible. GAO has also identified a number of opportunities to help the federal government prepare for the months ahead while improving the ongoing federal response: Medical Supply Chain The Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA), with support from the Department of Defense (DOD), have taken numerous, significant efforts to mitigate supply shortages and expand the medical supply chain. For example, the agencies have coordinated to deliver supplies directly to nursing homes and used Defense Production Act authorities to increase the domestic production of supplies. However, shortages of certain types of personal protective equipment and testing supplies remain due to a supply chain with limited domestic production and high global demand. The Food and Drug Administration (FDA) and FEMA have both identified shortages, and officials from seven of the eight states GAO interviewed in July and August 2020 identified previous or ongoing shortages of testing supplies, including swabs, reagents, tubes, pipettes, and transport media. Testing supply shortages have contributed to delays in turnaround times for testing results. Delays in processing test results have multiple serious consequences, including delays in isolating those who test positive and tracing their contacts in a timely manner, which can in turn exacerbate outbreaks by allowing the virus to spread undetected. In addition, states and other nonfederal entities have experienced challenges tracking supply requests made through the federal government and planning for future needs. GAO is making the following recommendations: HHS, in coordination with FEMA, should 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. 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. HHS and FEMA—working with relevant stakeholders—should 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 COVID-19 pandemic response. HHS and the Department of Homeland Security (DHS) objected to GAO’s initial draft recommendations. GAO made revisions based on their comments. GAO maintains that implementation of its modified recommendations is both warranted and prudent. These actions could contribute to ensuring a more effective response by helping to mitigate challenges with the stability of the medical supply chain and the ability of nonfederal partners to track, plan, and budget for ongoing medical supply needs. Vaccines and Therapeutics Multiple federal agencies continue to support the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19. These efforts are aimed at accelerating the traditional timeline to create a vaccine (see figure). Traditional Timeline for Development and Creation of a Vaccine Note: See figure 5 in the report. As these efforts proceed, clarity on the federal government’s plans for distributing and administering vaccine, as well as timely, clear, and consistent communication to stakeholders and the public about those plans, is essential. DOD is supporting HHS in developing plans for nationwide distribution and administration of a vaccine. In September 2020, HHS indicated that it will soon send a report to Congress outlining a distribution plan, but did not provide a specific date for doing so. GAO recommends that HHS, with support from DOD, establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and in developing such a plan ensure that it is consistent with best practices for project planning and scheduling and outlines an approach for how efforts will be coordinated across federal agencies and nonfederal entities. DOD partially concurred with the recommendation, clarifying that it is supporting HHS in developing plans for nationwide distribution and administration of vaccine. HHS neither agreed nor disagreed with the recommendation, but noted factors that complicate the publication of a plan. GAO maintains that a time frame is necessary so all relevant stakeholders will be best positioned to begin their planning.On September 16, 2020, HHS and DOD released two documents outlining a strategy for any COVID-19 vaccine. GAO will evaluate these documents and report on them in future work.GAO will also continue to conduct related work, including examining federal efforts to accelerate the development and manufacturing of COVID-19 vaccines and therapeutics. COVID-19 Data Data collected by the Centers for Disease Control and Prevention (CDC) suggest a disproportionate burden of COVID-19 cases, hospitalizations, and deaths exists among racial and ethnic minority groups, but GAO identified gaps in these data. To help address these gaps, on July 22, 2020, CDC released a COVID-19 Response Health Equity Strategy. However, the strategy does not assess whether having the authority to require states and jurisdictions to report race and ethnicity information is necessary to ensure CDC can collect such data. CDC’s strategy also does not specify how it will involve key stakeholders, such as health care providers, laboratories, and state and jurisdictional health departments. GAO recommends that CDC (1) determine whether having the authority to require the reporting of race and ethnicity information for cases, hospitalizations, and deaths is necessary for ensuring more complete data, and if so, seek such authority from Congress; (2) involve key stakeholders to help ensure the complete and consistent collection of demographic data; and (3) take steps to help ensure its ability to comprehensively assess the long-term health outcomes of persons with COVID-19, including by race and ethnicity. HHS agreed with the recommendations. In addition, HHS’s data on COVID-19 in nursing homes do not capture the early months of the pandemic. HHS’s Centers for Medicare & Medicaid Services (CMS) began requiring nursing homes to report COVID-19 data to CDC by May 17, 2020, starting with information as of May 8, 2020, but made reporting prior to May 8, 2020 optional. By not requiring nursing homes to submit data from the first 4 months of 2020, HHS is limiting the usefulness of the data in helping to understand the effects of COVID-19 in nursing homes. GAO recommends that HHS, in consultation with CMS and CDC, develop a strategy to capture more complete data on COVID-19 cases and deaths in nursing homes retroactively back to January 1, 2020. HHS partially agreed with this recommendation by noting the value of having complete data, but expressed concern about the burden of collecting it. GAO maintains the importance of collecting these data to inform the government’s continued response and recovery, and HHS could ease the burden by incorporating data previously reported to CDC or to state or local public health offices. Economic Impact Payments The Department of the Treasury’s (Treasury) Internal Revenue Service (IRS) has issued economic impact payments (EIP) to all eligible individuals for whom IRS has the necessary information to do so; however, not everyone eligible was able to be initially identified. To help ensure all eligible recipients received their payments in a more timely manner, IRS took several actions to address challenges GAO reported on in June, including a policy change—reopening the Non-Filers tool registration period for federal benefit recipients and extending it through September 30—that should allow some eligible recipients to receive supplemental payments for qualifying children sooner than expected. However, Treasury and IRS lack updated information on how many eligible recipients have yet to receive these funds. The lack of such information could hinder outreach efforts and place potentially millions of individuals at risk of missing their payment. GAO recommends that Treasury, in coordination with IRS, (1) update and refine the estimate of eligible recipients who have yet to file for an EIP to help target outreach and communications efforts and (2) make estimates of eligible recipients who have yet to file for an EIP, and other relevant information, available to outreach partners to raise awareness about how and when to file for EIP. Treasury and IRS neither agreed nor disagreed with the recommendations and described actions they are taking in concert with the recommendations to notify around 9 million individuals who may be eligible for an EIP. Coronavirus Relief Fund The Coronavirus Relief Fund (CRF) is the largest program established in the four COVID-19 relief laws that provides aid to states, the District of Columbia, localities, tribal governments, and U.S. territories. Audits of entities that receive federal funds, including CRF payments, are critical to the federal government’s ability to help safeguard those funds. Auditors that conduct single audits follow guidance in the Single Audit Act’s Compliance Supplement, which the Office of Management and Budget (OMB) updates and issues annually in coordination with federal agencies. OMB issued the 2020 Compliance Supplement in August 2020, but the Compliance Supplement specified that OMB is still working with federal agencies to identify the needs for additional guidance for auditing new COVID-19-related programs, including the CRF payments, as well as existing programs with compliance requirement changes. According to OMB, an addendum on COVID-19-related programs, including the CRF payments, will be issued in the fall of 2020. Further delays in issuing this guidance could adversely affect auditors’ ability to issue consistent and timely reports. GAO recommends that OMB, in consultation with Treasury, issue the addendum to the 2020 Compliance Supplement as soon as possible to provide the necessary audit guidance, as many single audit efforts are underway. OMB neither agreed nor disagreed with the recommendation. Guidance for K-12 Schools State and local school district officials tasked with reassessing their operating status and ensuring their school buildings are safe are generally relying on guidance and recommendations from federal, state, and local public health and education officials. However, portions of CDC’s guidance on reopening K-12 schools are inconsistent, and some federal guidance appears misaligned with CDC’s risk-based approach on school operating status. Based on GAO’s review, Education has updated the information and CDC has begun to do so. GAO recommends that CDC ensure that, as it makes updates to its guidance related to schools’ operating status, the guidance is cogent, clear, and internally consistent. HHS agreed with the recommendation. Tracking Contract Obligations Federal agencies are tracking contract actions and associated obligations in response to COVID-19 using a National Interest Action (NIA) code in the Federal Procurement Data System-Next Generation. The COVID-19 NIA code was established in March 2020 and was recently extended until March 31, 2021, while a draft of this report recommending that DHS and DOD extend the code beyond September 30, 2020, was with the agencies for comment. GAO has identified inconsistencies in establishing and closing these codes following previous emergencies, and has continued concerns with the criteria that DHS and DOD rely on to determine whether to extend or close a code and whether the code meets long-term needs. GAO recommends that DHS and DOD make updates to the 2019 NIA Code Memorandum of Agreement so as to enhance visibility for federal agencies, the public, and Congress on contract actions and associated obligations related to disaster events, and to ensure the criteria for extending or closing the NIA code reflect government-wide needs for tracking contract actions in longer-term emergencies, such as a pandemic. DHS and DOD did not agree, but GAO maintains implementation of its recommendation is essential. Address Cybersecurity Weaknesses Since March 2020, malicious cyber actors have exploited COVID-19 to target organizations that make up the health care and public health critical infrastructure sector, including government entities, such as HHS. GAO has identified numerous cybersecurity weaknesses at multiple HHS component agencies, including CMS, CDC, and FDA, over the last 6 years, such as weaknesses in key safeguards to limit, prevent, and detect inappropriate access to computer resources. Additionally, GAO’s March 2019 high-risk update identified cybersecurity and safeguarding the systems supporting the nation’s critical infrastructure, such as health care, as high-risk areas. As of July 2020, CMS, FDA, and CDC had made significant progress by implementing 350 (about 81 percent) of the 434 recommendations GAO issued in previous reports to address these weaknesses. Based on the imminent cybersecurity threats, GAO recommends that HHS expedite implementation of GAO’s prior recommendations regarding cybersecurity weaknesses at its component agencies. HHS agreed with the recommendation. As of September 10, 2020, the U.S. had over 6.3 million cumulative reported cases of COVID-19 and over 177,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted as of September 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of July 31, 2020, the federal government had obligated a total of $1.6 trillion and expended $1.5 trillion of the COVID-19 relief funds as reported by federal agencies on USAspending.gov. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This third report examines key actions the federal government has taken to address the COVID-19 pandemic and evolving lessons learned relevant to the nation’s response to pandemics. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials, as well as industry representatives. GAO is making 16 new recommendations for agencies that are detailed in this Highlights and in the report. For more information, contact A. Nicole Clowers at (202) 512-7114 or email@example.com.[Read More…]
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- More than 700 Members Of Transnational Organized Crime Groups Arrested in Central America in U.S. Assisted OperationBy Sam NewsNovember 27, 2020Today, senior law enforcement officials from the United States, El Salvador, Guatemala and Honduras announced criminal charges in Central America against more than 700 members of transnational criminal organizations, primarily MS-13 and 18th Street gangs, which resulted from a one-week coordinated law enforcement action under Operation Regional Shield (ORS).[Read More…]
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- Five Peruvians Extradited For Overseeing Call Centers That Threatened And Defrauded Spanish-Speaking U.S. ConsumersBy Sam NewsOctober 27, 2020Five residents of Lima, Peru, were extradited to the United States and made their initial appearances in Miami federal court, where they stand accused of operating a large fraud and extortion scheme targeting Spanish-speaking consumers in the United States, the Department of Justice and U.S. Postal Inspection Service announced today.[Read More…]
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- Justice Department Sues Monopolist Google For Violating Antitrust LawsBy Sam NewsOctober 20, 2020Today, the Department of Justice — along with eleven state Attorneys General — filed a civil antitrust lawsuit in the U.S. District Court for the District of Columbia to stop Google from unlawfully maintaining monopolies through anticompetitive and exclusionary practices in the search and search advertising markets and to remedy the competitive harms. The participating state Attorneys General offices represent Arkansas, Florida, Georgia, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Montana, South Carolina, and Texas.[Read More…]
- Justice Department Releases Report On Modernizing The Administrative Procedure ActBy Sam NewsAugust 11, 2020WASHINGTON – The Justice Department released a report today on the need for Congress to update and improve the Administrative Procedure Act (APA), the 74-year-old statute setting forth the procedures agencies must follow when regulating individuals, businesses, non-profits, and state and local government entities. The report, entitled Modernizing the Administrative Procedure Act, discusses how the administrative state has developed in ways not foreseen by the APA in 1946, how the APA might be legislatively improved, and how this Administration’s improvements to agencies’ regulatory processes could inform modernizing the APA. The Justice Department, which significantly shaped the original APA, hopes that the ideas and insights discussed in the report will encourage and inform much needed action by Congress to modernize the APA.[Read More…]
- Retirement Security: Older Women Report Facing a Financially Uncertain FutureBy Sam NewsAugust 13, 2020In all 14 focus groups GAO held with older women, women described some level of anxiety about financial security in retirement. Many expressed concerns about the future of Social Security and Medicare benefits, and the costs of health care and housing. Women in the groups also cited a range of experiences that hindered their retirement security, such as divorce or leaving the workforce before they planned to (see fig.). Women in all 14 focus groups said their lack of personal finance education negatively affected their ability to plan for retirement. Many shared ideas about personal finance education including the view that it should be incorporated into school curriculum starting in kindergarten and continuing through college, and should be available through all phases of life. Women Age 70 and Over by Marital Status Note: Percentages do not add up to 100 percent due to rounding. Individual women's financial security is also linked to their household where resources may be shared among household members. According to the 2016 Survey of Consumer Finances, among households with older women, about 23 percent of those with white respondents and 40 percent of those with African American respondents fell short of a measure of retirement confidence, indicating their income was not sufficient to maintain their standard of living. The likelihood of a household reporting high retirement confidence rose in certain cases. For example among households of similar wealth, those with greater liquidity in their portfolio and those with defined benefit plan income were more likely to report high retirement confidence. Older adults represent a growing portion of the U.S. population and older women have a longer life expectancy, on average, than older men. Prior GAO work has found that challenges women face during their working years can affect their lifetime earnings and retirement income. For example, we found women were overrepresented in low wage professions, paid less money than their male counterparts during their careers, and were more likely to leave the workforce to care for family members. Taken together, these trends may have significant effects on women's financial security in retirement. GAO was asked to report on the financial security of older women. This report examines (1) women retirees' perspectives on their financial security, and (2) what is known about the financial security of older women in retirement. GAO held 14 non-generalizable focus groups with older women in both urban and rural areas in each of the four census regions. GAO also analyzed data from three nationally representative surveys—the 2019 Current Population Survey, the Health and Retirement Study (2002-2014 longitudinal data), and the 2016 Survey of Consumer Finances. For more information, contact Charles Jeszeck at (202) 512-7215 or firstname.lastname@example.org.[Read More…]
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- Critical Infrastructure Protection: Treasury Needs to Improve Tracking of Financial Sector Cybersecurity Risk Mitigation EffortsBy Sam NewsSeptember 17, 2020The federal government has long identified the financial services sector as a critical component of the nation's infrastructure. The sector includes commercial banks, securities brokers and dealers, and providers of the key financial systems and services that support these functions. Altogether, the sector holds about $108 trillion in assets and faces a variety of cybersecurity-related risks. Key risks include (1) an increase in access to financial data through information technology service providers and supply chain partners; (2) a growth in sophistication of malware—software meant to do harm—and (3) an increase in interconnectivity via networks, the cloud, and mobile applications. Cyberattacks that exploit risks can occur against either public or private components of the sector. For example, in February 2016, hackers were able to install malware on the Bangladesh Central Bank's system through a service provider, which then directed the Federal Reserve Bank of New York to transfer money to accounts in other Asian countries. This attack resulted in the theft of approximately $81 million. Several industry groups and firms are taking steps to enhance the security and resilience of the U.S. financial services sector through a broad range of cyber risk mitigation efforts. These efforts include coordinating within the sector through groups such as the Financial Services Sector Coordinating Council and the Financial Systemic Analysis and Resilience Center, conducting industrywide incident response exercises, sharing threat and vulnerability information, developing and providing guidance in conducting risk assessments, and offering cybersecurity-related training. The Departments of Homeland Security and the Treasury and federal financial regulators are also taking multiple steps to support cybersecurity and resilience through risk mitigation efforts. Among other things, federal agencies provide cybersecurity expertise and conduct simulation exercises related to cyber incident response and recovery. Treasury, as the designated lead agency for the financial sector, plays a key role in supporting many of the efforts to enhance the sector's cybersecurity and resiliency. For example, Treasury's Assistant Secretary for Financial Institutions serves as the chair of the committee of government agencies with sector responsibilities, and Treasury coordinates federal agency efforts to improve the sector's cybersecurity and related communications. However, Treasury does not track efforts or prioritize them according to goals established by the sector for enhancing cybersecurity and resiliency. Treasury also has not fully implemented GAO's previous recommendation to establish metrics related to the value and results of the sector's risk mitigation efforts. Further, the 2016 sector-specific plan, which is intended to direct sector activities, does not identify ways to measure sector progress and is out of date. Among other things, the sector-specific plan lacks information on sector-related requirements laid out in the 2019 National Cyber Strategy Implementation Plan . Unless more widespread and detailed tracking and prioritization of efforts occurs according to the goals laid out in the sector-specific plan, the sector could be insufficiently prepared to deal with cyber-related risks, such as those caused by increased access to data by third parties. For decades, the federal government has taken steps to protect the nation's critical infrastructures. The financial services sector's reliance on information technology makes it a leading target for cyber-based attacks. Recent high-profile breaches at commercial entities have heightened concerns that data are not being adequately protected. Under the Comptroller General's authority, GAO initiated this review to (1) describe the key cyber-related risks facing the financial sector; (2) describe steps the financial services industry is taking to share information on and address risks to its sector; and (3) assess steps federal agencies are taking to enhance the security and resilience of the sector. GAO analyzed relevant reports and information to determine risks and mitigation efforts and compared agency efforts against federal policies and guidance. GAO also interviewed officials at 16 private sector entities, two self-regulatory organizations, and eight federal agencies, including the Department of the Treasury. GAO is making recommendations to Treasury to track and prioritize the sector's cyber risk mitigation efforts, and to update the sector's plan with metrics for measuring progress and information on how sector efforts will meet sector goals and requirements, including those contained within the National Cyber Strategy Implementation Plan. Treasury generally agreed with the recommendations. For more information, contact Nick Marinos at (202) 512-9342 or email@example.com or Michael Clements at (202) 512-7763 or ClementsM@gao.gov.[Read More…]
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- Twenty-Four Defendants, Including Alleged Aryan Circle Gang Members and Associates Indicted on Racketeering, Firearms, and Drug Charges in Multiple StatesBy Sam NewsOctober 14, 2020Five indictments in three different states were unsealed today as law enforcement officers arrested twenty-four defendants, including alleged Aryan Circle (AC) gang members and associates, on charges of racketeering conspiracy, violent crimes in aid of racketeering, drug conspiracy, and unlawful firearms trafficking.[Read More…]
- Veterans Community Care Program: Immediate Actions Needed to Ensure Health Providers Associated with Poor Quality Care Are ExcludedBy Sam NewsFebruary 1, 2021The Department of Veterans Affairs (VA) has implemented contracts with Optum and TriWest to set up networks of community providers as part of the new Veterans Community Care Program (VCCP). However, the two contractors' processes for implementing eligibility restrictions established by the VA MISSION Act, as outlined in their policies and reflected in their contracts, may not consistently exclude all ineligible providers from participating in the VCCP. The VA MISSION Act prohibits providers from participating in the VCCP if they have lost a state medical license, for example, as a result of revocation or termination for cause or due to concerns about poor quality of care. However, VA's contracts with these contractors do not require the verification of providers' history of license sanctions, including a revoked license, in all states during credentialing. Only one of the two contractors has a process that includes verifying providers' licensure history in all states and neither has a sufficient process for continuously monitoring provider licenses. Contractor Processes for Implementing VA MISSION Act Restrictions on Community Care Provider Eligibility In May 2019, VA began tracking providers who do not meet the eligibility restrictions established by the VA MISSION Act. However, this tracking does not address providers removed from VA prior to this date. As of September 2020, VA had deactivated 136 ineligible VA providers from VCCP participation. GAO reviewed data going back to July 1, 2016 and identified an additional 227 providers that had been removed from VA employment and are potentially providing care in the VCCP. VA stated it has no plans to further review these providers. VA officials said these providers were eligible to participate in the VCCP because they were removed from VA employment before the VA MISSION Act restrictions were effective. Thus, there is a continued risk that former VA providers associated with quality of care concerns are participating in the VCCP. The VA MISSION Act of 2018 established a new community care program, the VCCP, aimed at providing care to veterans when it could not reasonably be delivered by providers at VA medical facilities. The act also requires VA to exclude from participation in the VCCP providers who lost a license for violating medical license requirements in any state or who VA removed from employment for quality of care concerns or otherwise suspended from VA employment. The VA MISSION Act included provisions for GAO to report on the implementation of restrictions on certain health care providers' participation in the VCCP. This report examines, among other issues, VA and contractor processes to implement these eligibility restrictions on provider participation in the VCCP. GAO reviewed VA's contracts and contractor policies related to VCCP provider credentialing, interviewed VA and contractor officials, and assessed the provider credentialing requirements and processes. In addition, GAO collected data on former VA providers and compared these data to the database of VCCP providers. GAO is making three recommendations to VA, including that VA require its contractors to have credentialing and monitoring policies that ensure compliance with VA MISSION Act license restrictions and that it assess the risk to veterans when former VA providers with quality concerns continue to provide VCCP care. VA generally agreed with GAO's three recommendations. For more information, contact Sharon M. Silas at (202) 512-7114 or firstname.lastname@example.org.[Read More…]
- Statement from Acting Solicitor General Jeffrey B. Wall on the Passing of Former Solicitor General Drew S. Days IIIBy Sam NewsNovember 17, 2020Today, Acting Solicitor General Jeffrey B. Wall issued the following statement on the passing of former Solicitor General Drew S. Days III:[Read More…]
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- Veteran Suicide: VA Needs Accurate Data and Comprehensive Analyses to Better Understand On-Campus SuicidesBy Sam NewsSeptember 9, 2020The Department of Veterans Affairs' (VA) process for identifying on-campus suicides does not include a step for ensuring the accuracy of the number of suicides identified. As a result, its numbers are inaccurate. VA's Veterans Health Administration (VHA) first started tracking on-campus veteran suicides in October 2017, and uses the results to inform VA leadership and Congress. GAO reviewed the data and found errors in the 55 on-campus veteran suicides VHA identified for fiscal years 2018 and 2019, including 10 overcounts (deaths that should not have been reported but were) and four undercounts (deaths that should have been reported but were not). Examples of Errors on the Department of Veterans Affairs' (VA) List of 55 On-Campus Veteran Suicides for Fiscal Years 2018 and 2019 (as of September 2019) VA has taken some steps to address on-campus veteran suicides, such as issuing guidance and staff training. However, GAO found that the analyses informing these efforts are limited. Specifically, VHA requires root cause analyses—processes to determine what can be done to prevent recurrences of incidents—for some but not all on-campus veteran suicides. According to VHA officials, only 25 percent of on-campus suicides from October 2017 to April 2019 met the criteria for a root cause analysis. does not make use of all relevant information VA collects about these deaths, such as clinical and demographic data collected through other VA suicide prevention efforts. VHA officials said they could not link the different sources of information, but GAO found that selected medical facilities could do so. Without accurate information on the number of suicides and comprehensive analyses of the underlying causes, VA does not have a full understanding of the prevalence and nature of on-campus suicides, hindering its ability to address them. VA established suicide prevention as its highest clinical priority. In recent years, there have been reports of veterans dying by suicide on VA campuses—in locations such as inpatient settings, parking lots, and on the grounds of cemeteries. GAO was asked to review veteran deaths by suicide on VA campuses. This report examines (1) VA's process to track the number of veterans that died by suicide on VA campuses, and (2) steps VA has taken to address these types of suicides. GAO reviewed the sources of information VHA uses to identify and analyze on-campus veteran suicides, VA and VHA strategic plans and policies related to suicide prevention and reporting, and federal internal control standards. GAO also interviewed VA and VHA central office officials, and officials from three medical facilities that GAO selected because they reportedly had on-campus veteran suicides between fiscal years 2018 and 2019. GAO is making three recommendations, including that VA improve its process to accurately identify all on-campus veteran suicides and conduct more comprehensive analyses of these occurrences. VA did not concur with one of GAO's recommendations related to conducting root cause analyses. GAO continues to believe that this recommendation is valid, as discussed in the report. For more information, contact Debra A. Draper at (202) 512-7114 or email@example.com.[Read More…]
- VA Police: Actions Needed to Improve Data Completeness and Accuracy on Use of Force Incidents at Medical CentersBy Sam NewsSeptember 8, 2020The Department of Veterans Affairs' (VA) policy on use of force states that police officers must use the minimal level of force that is reasonably necessary to gain control of a situation and should only utilize physical control methods on an individual when the force is justified by the individual's actions. To guide officers, VA developed a Use of Force Continuum Scale to define and clarify the categories of force that can be used. Categories of Force on the VA’s Use of Force Continuum Scale According to VA policy, all police officers must receive training on the VA's use of force policy when hired and biannually thereafter. Officers are trained—through classroom lectures and scenarios that emphasize effective communication techniques—to use the minimal level of force to deescalate a situation. Officers record use of force incidents electronically and the chief of police decides which, if any, use of force incidents need to be investigated in accordance with VA guidance. Chiefs of Police at the six facilities GAO visited conducted investigations in a similar manner, by reviewing evidence and comparing an officer's action with the VA's use of force policy to determine whether actions were justified. While most investigations are conducted at the local level, VA headquarters may also run investigations for certain incidents, such as when it receives a complaint against an officer. VA police officers record incidents in a database, Report Executive, but GAO's analysis indicates that VA data on use of force incidents are not sufficiently complete and accurate for reporting numbers or trends at medical centers nationwide. For example, GAO found that 176 out of 1,214 use of force incident reports did not include the specific type of force used. Further, Report Executive does not track incidents by individual medical centers. By addressing these limitations, VA can more effectively monitor use of force trends by type of force or medical facility, among other variables, to understand the VA's use of force incidents nationwide. GAO also found that VA does not systematically collect or analyze use of force investigation findings from local medical centers, limiting its ability to provide effective oversight. Specifically, there is no policy requiring Chiefs of Police to submit all investigations on use of force to VA headquarters, and VA does not have a database designed to collect and analyze data on use of force investigations. Collecting and analyzing such data nationwide would allow VA to better assess the impact of its deescalation policies and improve the agency's oversight efforts. About 5,000 VA police officers are responsible for securing and protecting 138 VA medical centers across the country. These officers are authorized to investigate crimes, make arrests, and carry firearms. The Dr. Chris Kirkpatrick Whistleblower Protection Act of 2017 included a provision that GAO assess aspects of the VA police services. This report addresses (1) what the VA's policies are on the use of force by police officers at medical centers, and what training officers receive on the use of force; (2) how VA records and investigates use of force incidents at medical centers; and (3) the extent to which VA sufficiently collects and analyzes use of force data at medical centers. To address these objectives, GAO reviewed VA policies, procedures, and training materials on the use of force and interviewed VA officials at headquarters and six local medical centers, selected to represent varying size and locations. GAO reviewed VA data on use of force incidents recorded from May 10, 2019, through May 10, 2020—the most recent full year data were available. GAO is making five recommendations, including that VA improve the completeness and accuracy of its use of force data; implement a tool to analyze use of force incidents at medical centers nationwide; ensure that medical centers submit all use of force investigations to VA headquarters; and analyze the use of force investigation data. The VA concurred with each of GAO's recommendations. For more information, contact Gretta L. Goodwin at (202) 512-8777 or firstname.lastname@example.org.[Read More…]
- TriWest Healthcare Alliance Corp. Agrees to Pay $179.7 Million to Resolve Overpayments from the Department of Veterans AffairsBy Sam NewsDecember 31, 2020TriWest Healthcare Alliance Corp. has agreed to pay the United States $179,700,000 to resolve claims that it received overpayments from the U.S. Department of Veterans Affairs (VA) in connection with its administration of certain VA health care programs, the Department of Justice announced today.[Read More…]
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