COVID-19: DOD Has Focused on Strategy and Oversight to Protect Military Servicemember Health

What GAO Found

Since January 2020, the Department of Defense (DOD) has developed a strategy to protect the health of military servicemembers from COVID-19, with a goal of minimizing risks while continuing operations. The strategy tailors protection measures to local conditions and risks to health and force readiness. GAO found that DOD’s strategy applies several key considerations.

DOD Application of Key Considerations to Protect Servicemembers from COVID-19

DOD officials oversee the implementation of the department’s COVID-19 health protection strategy for servicemembers through:

  • Sustained leadership attention. In January 2020, the Secretary of Defense initiated COVID-19 planning and established a senior task force to oversee the response. Combatant command and installation officials continuously evaluate regional and local implementation and perform compliance checks. Notwithstanding these efforts, DOD officials stated that they expect some limited incidents of personnel not following protocols.
  • Data monitoring. Senior leaders and local commanders assess data on cases, community spread, and testing, among other metrics, to inform strategy implementation and assess its effectiveness.
  • Lessons learned analyses. While these analyses are ongoing as the pandemic continues, DOD has implemented mitigations to address some challenges identified, such as a new system to collect more timely and specific COVID-19 case data.

DOD has research and development projects underway to advance COVID-19 vaccines and therapeutics and improve detection methods. DOD’s investments include many projects that have specific applications for servicemembers, such as pre- and postexposure prophylactic treatments to prevent the onset of the disease.

Why GAO Did This Study

The COVID-19 pandemic poses risks to the health of U.S. servicemembers. Protecting forces from COVID-19 is therefore essential to DOD’s ability to defend the United States, maintain warfighting readiness, and support the whole-of-government response to the pandemic.

To help facilitate the COVID-19 pandemic response, Congress appropriated about $10.5 billion to DOD through the CARES Act. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight related to the pandemic. GAO was also asked to examine the military health system response to COVID-19. This report examines, in regard to COVID-19, DOD’s (1) strategy for protecting military servicemember health, (2) oversight of its strategy, and (3) research and development projects for vaccines, therapeutics, and testing.

GAO reviewed guidance and plans for health protection and pandemic response that comprise DOD’s strategy, and evaluated alignment of the strategy with key considerations from prior GAO work on pandemic preparedness. To identify oversight efforts, GAO reviewed DOD briefings on the progress of health protection measures, and analyzed 2020 DOD data on COVID-19 cases, hospitalizations, and testing.

GAO also interviewed DOD leaders, officials from the military department medical organizations, combatant commands, and four military medical treatment facilities selected on the basis of military department and location.

For more information, contact Brenda S. Farrell at (202) 512-3604 or farrellb@gao.gov.

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    GAO's analysis of Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) data show that in fiscal year 2018, 287,547 Medicare fee-for-service beneficiaries had inpatient stays that included care for severe wounds. These wounds include those where the base of the wound is covered by dead tissue or non-healing surgical wounds. About 73 percent of the inpatient stays occurred in acute care hospitals (ACH), and a smaller percentage of stays occurred in post-acute care facilities. Specifically, about 16 percent of stays were at skilled nursing facilities (SNF), and about 7 percent were at long-term care hospitals (LTCH). CMS data show that Medicare spending on stays for severe wound care was $2.01 billion in fiscal year 2018, representing a decline of about 2 percent from fiscal year 2016, when spending was about $2.06 billion. Spending declined as a result of decreases in both the total number of these stays, as well as spending per stay, which both decreased by about 1 percent. The decrease in per stay spending was likely driven, in part, by a change in where beneficiaries received care. CMS data show fewer severe wound care stays in LTCHs, which tend to be paid higher payment rates. At the same time, more severe wound care stays were at two other types of facilities that tend to be paid lower payment rates: ACHs and inpatient rehabilitation facilities. GAO's analysis of CMS data also show that, while the number of LTCHs that billed Medicare for severe wound care decreased by about 7 percent from fiscal years 2016 to 2018, Medicare beneficiaries continued to have access to other severe wound care providers. For example, CMS data show that most beneficiaries resided within 10 miles of an ACH or SNF that provided severe wound care in fiscal year 2018. Figure: Percentage of Medicare Fee-for-Service Beneficiaries Residing within 10 Miles of a Health Care Facility That Provided Any Severe Wound Care, by Facility Type, Fiscal Year 2018 Note: The “other” category includes facilities such as psychiatric hospitals or units. There is limited information on how or whether the decrease in LTCH care for severe wounds may have affected the quality of severe wound care Medicare beneficiaries receive. For example, CMS collects information on the percentage of patients with new or worsened pressure ulcers at post-acute care facilities, but it does not measure the quality of care they receive. Medicare beneficiaries with serious health conditions, such as strokes, are prone to developing severe wounds due to complications that often lead to immobility and prolonged pressure on the skin. These beneficiaries may require a long-term inpatient stay at an ACH or a post-acute care facility, such as an LTCH. LTCHs treat patients who require care for longer than 25 days, on average. In 2018, LTCHs represented about $4.2 billion in Medicare expenditures. Prior to fiscal year 2016, LTCHs received a higher payment rate for treating Medicare beneficiaries than ACHs. Beginning in fiscal year 2016, a dual payment system was phased in that paid LTCHs a rate similar to ACHs for some beneficiaries and a higher rate for beneficiaries that met certain criteria. As this payment system has moved from partial to full implementation, lawmakers had questions about how it may affect beneficiaries' severe wound care. The 21st Century Cures Act included a provision for GAO to review severe wound care provided to Medicare beneficiaries. This report describes facilities where Medicare beneficiaries received severe wound care, Medicare severe wound care spending, and what is known about the dual payment system's effect on access and quality. GAO analyzed Medicare severe wound care access and spending data for fiscal years 2016 and 2018 (the most recent data available); reviewed reports; and interviewed CMS officials, researchers, and national wound care stakeholders. HHS provided technical comments on a draft of this report, which were incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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  • Aviation Consumer Protection: Increased Transparency Could Help Build Confidence in DOT’s Enforcement Approach
    In U.S GAO News
    The 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 vonaha@gao.gov.
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  • Patient Recruiter Convicted in $2.8 Million Telemedicine Scheme Against Medicare
    In Crime News
    The owner of an Orlando-area telemarketing call center was convicted for his role in a kickback scheme involving expensive genetic tests and fraudulent telemedicine services that resulted in the payment of approximately $2.8 million in false and fraudulent claims to Medicare.
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  • Troubled Asset Relief Program: Treasury Continues Winding Down Housing Programs
    In U.S GAO News
    The Department of the Treasury (Treasury) continues to wind down housing assistance programs funded by the Troubled Asset Relief Program (TARP). Treasury has extended one program to assist certain program participants who have been affected by the COVID-19 pandemic, although limited program funds remain at this point. As of September 30, 2020, Treasury had disbursed $30.85 billion (95 percent) of the $32.56 billion TARP funds obligated to the three housing programs (see figure). The Making Home Affordable program allowed homeowners to apply for loan modifications to avoid foreclosure. Treasury will continue to provide incentive payments for loan modifications through 2023. The Housing Finance Agency Innovation Fund for the Hardest Hit Housing Markets provided funds to 18 states and the District of Columbia to help struggling homeowners through programs tailored to the state. Treasury extended this program through June 2021 because of the COVID-19 pandemic's negative economic effects on some program participants. The Federal Housing Administration (FHA) Short Refinance program allowed eligible homeowners to refinance into an FHA-insured loan. Under this program, Treasury made TARP funds available to provide additional coverage to lenders for a share of potential losses on these loans for borrowers who entered the program by December 31, 2016. Status of Troubled Asset Relief Program Housing Programs, as of September 2020 aAccording to the Department of the Treasury (Treasury), these funds have been committed to future financial incentives for existing Making Home Affordable transactions, as of September 30, 2020. bRepresents the amount of funds that states and the District of Columbia have drawn from Treasury. cIncludes about $11.6 million in administrative expenses and $10 million of reserve funds, as of September 30, 2020. Treasury will be reimbursed for unused reserve amounts. dAmounts do not add up due to rounding. In response to the 2008 housing crisis, Treasury established TARP-funded housing programs to help struggling homeowners avoid foreclosure and preserve homeownership. Since 2009, Treasury has obligated $32.56 billion for such housing programs. The Emergency Economic Stabilization Act of 2008 provided GAO with broad oversight authorities for actions taken related to TARP. This report provides an update on the status of TARP-funded housing programs, as of September 30, 2020. GAO reviewed Treasury program data and documentation, and interviewed Treasury officials. This report contains the most recently available public data at the time of GAO's review, including obligations, disbursements, and program participation. For more information, contact John H. Pendleton at (202) 512-8678 or pendletonj@gao.gov.
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  • Man Purchased Lamborghini After Receiving $3.9 Million in PPP Loans
    In Crime News
    A Florida man pleaded guilty today for fraudulently obtaining approximately $3.9 million in Paycheck Protection Program (PPP) loans and using those funds, in part, to purchase a $318,000 Lamborghini sports car for himself. Authorities seized the Lamborghini and $3.4 million from the bank accounts of David T. Hines, 29, of Miami, at the time of his arrest. Hines pleaded guilty today to one count of wire fraud and is scheduled to be sentenced on April 14.
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  • Justice Department Settles Sexual Harassment and Race Discrimination Lawsuit Against Manager and Owners of Virginia Rental Properties
    In Crime News
    The Justice Department today announced that Gary T. Price, a manager of rental properties in and around Harrisonburg, Virginia, together with owners of the properties, Alberta Lowery and GTP Investment Properties, LLC, will pay $335,000 to resolve allegations that Price sexually harassed multiple female tenants and discriminated in housing on the basis of race in violation of the federal Fair Housing Act.
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  • SAP Admits to Thousands of Illegal Exports of its Software Products to Iran and Enters into Non-Prosecution Agreement with DOJ
    In Crime News
    Software company, SAP SE, headquartered in Walldorf, Germany, has agreed to pay combined penalties of more than $8 million as part of a global resolution with the U.S. Departments of Justice (DOJ), Commerce and Treasury.
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  • Government Auditing Standards: 2018 Revision Technical Update April 2021 (Supersedes GAO-18-568G)
    In U.S GAO News
    The Yellow Book provides standards and guidance for auditors and audit organizations, outlining the requirements for audit reports, professional qualifications for auditors, and audit organization quality control. Auditors of federal, state, and local government programs use these standards to perform their audits and produce their reports. Effective Date The 2018 revision of the Yellow Book is effective for financial audits, attestation engagements, and reviews of financial statements for periods ending on or after June 30, 2020, and for performance audits beginning on or after July 1, 2019. Early implementation is not permitted. The technical updates to the 2018 revision of the Yellow Book are effective upon issuance. Revision Process Yellow Book revisions undergo an extensive, deliberative process, including public comments and input from the Comptroller General's Advisory Council on Government Auditing Standards. GAO considered all comments and input in finalizing revisions to the standards. For more information, contact James R. Dalkin at (202) 512-9535 or yellowbook@gao.gov. Visit our Yellow Book website for more information on applicable updates and alerts.
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