Justice Department Awards over $9 Million to Combat Elder Fraud and Abuse

The Department of Justice today awarded grants totaling $9.4 million to combat elder abuse and financial fraud targeted at seniors across the United States. Elder abuse is an intentional or negligent act by any person that causes harm or a serious risk of harm to an older adult. Attorney General William P. Barr announced the awards on the 30th anniversary of the International Day of Older Persons.

“Predators who target older citizens for fraud, financial scams and physical abuse are particularly despicable, turning the golden years of our nation’s seniors into a period of poverty and suffering,” said Attorney General William P. Barr. “The Department of Justice is taking aggressive action, pursuing all legal avenues to bring these criminals to justice and supporting law enforcement officials and service providers as they ferret out scam artists, arrest abusers, and bring aid and relief to victims.”

Approximately $7.9 million of the funds were awarded to jurisdiction and service providers in the United States under two of Office of Justice Programs’ (OJP) Office for Victims of Crime (OVC) grant programs. OJP’s National Institute of Justice (NIJ) awarded the remaining $1.4 million for related research projects.

“With lockdowns in place across the country, older adults are especially vulnerable to fraud, neglect and abuse, and criminals have not hesitated to take full advantage,” said OJP Principal Deputy Assistant Attorney General Katharine T. Sullivan. “These grants, which build on previous Department of Justice investments, will help to turn the tide of deception and predation and restore victims to fiscal security and physical safety.”

Under the direction of Attorney General Barr, the Department of Justice is attacking elder fraud and abuse from all sides. A National Elder Justice Coordinator oversees the department’s work to combat elder fraud, and each of the 94 U.S. Attorneys’ Offices has a prosecutor dedicated to addressing elder justice issues. This past March, the Attorney General announced the results of the largest elder fraud sweep ever conducted, with prosecutors charging more than 400 defendants and the charged elder fraud schemes causing alleged losses of over a billion dollars. Also in March, he launched a national initiative to pursue nursing homes that provide grossly substandard care and a National Elder Fraud Hotline managed by OVC.

FY 2020 grants awarded by OVC and NIJ further the department’s mission and priorities by funding direct victim services and research projects that enhance the field’s response to victims of elder abuse and financial exploitation. Specific programs being funded include the following:

  • OVC’s Enhancing Services for Older Victims of Abuse and Financial Exploitation program awards nearly $6 million to 12 organizations to support communities in providing services to older victims of abuse and exploitation using trauma-informed approaches that protect the safety and confidentiality of victims.
  • OVC’s Training for Law Enforcement to Improve Identification of and Response to Elder Fraud Victims program (previously announced) awarded over $1.9 million to provide training and technical assistance to enhance law enforcement’s ability to identify elder fraud victims, connect those victims with available services, and bring the fraudsters to justice.
  • NIJ’s Research on the Abuse, Neglect, and Exploitation of Elderly Individuals program awarded over $1.4 million to two recipients to fund research projects to, respectively, better differentiate physical abuse of elderly individuals from accidental injury and to improve the reporting of elder abuse.

For a complete list of individual grant programs, award amounts, and jurisdictions that will receive funding, visit: https://www.ojp.gov/sites/g/files/xyckuh241/files/media/document/elderabusefactsheet.pdf. More information about OJP and its components can be found at www.ojp.gov.

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    U.S. research may be subject to undue foreign influence in cases where a researcher has a foreign conflict of interest (COI). Federal grant-making agencies can address this threat by implementing COI policies and requiring the disclosure of information that may indicate potential conflicts. GAO reviewed five agencies—which together accounted for almost 90 percent of all federal research and development expenditures at universities in fiscal year 2018—and found that three have agency-wide COI policies, while two do not (see figure). The three agencies with existing policies focus on financial interests but do not specifically address or define non-financial interests, such as multiple professional appointments. In the absence of agency-wide COI policies and definitions on non-financial interests, researchers may not fully understand what they need to report on their grant proposals, leaving agencies with incomplete information to assess the risk of foreign influence. GAO found that, regardless of whether an agency has a conflict of interest policy, all five agencies require researchers to disclose information—such as foreign support for their research—as part of the grant proposal that could be used to determine if certain conflicts exist. Elements of Conflict of Interest (COI) Policies at Agencies with the Most Federal Research Expenditures at Universities Based on a review of university documents, GAO found that all 11 of the universities in its sample have publicly available financial and non-financial COI policies for federally funded research. These policies often align with the financial COI policies or requirements of the grant-making agencies. All five agencies have mechanisms to monitor and enforce their policies and disclosure requirements when there is an alleged failure to disclose required information. All agencies rely on universities to monitor financial COI, and most agencies collect non-financial information such as foreign collaborations, that can help determine if conflicts exist. Agencies have also taken actions in cases where they identified researchers who failed to disclose financial or non-financial information. However, three agencies lack written procedures for handling allegations of failure to disclose required information. Written procedures for addressing alleged failure to disclose required information help agencies manage these allegations and consistently apply enforcement actions. In interviews, stakeholders identified opportunities to improve responses to foreign threats to research, such as harmonizing grant application requirements. Agencies have begun to address such issues. The federal government reportedly expended about $42 billion on science and engineering research at universities in fiscal year 2018. Safeguarding the U.S. research enterprise from threats of foreign influence is of critical importance. Recent reports by GAO and others have noted challenges faced by the research community to combat undue foreign influence, while maintaining an open research environment that fosters collaboration, transparency, and the free exchange of ideas. GAO was asked to review federal agency and university COI policies and disclosure requirements. In this report, GAO examines (1) COI policies and disclosure requirements at selected agencies and universities that address potential foreign threats, (2) mechanisms to monitor and enforce policies and requirements, and (3) the views of selected stakeholders on how to better address foreign threats to federally funded research. GAO reviewed laws, regulations, federal guidance, and agency and university COI policies and requirements. GAO also interviewed agency officials, university officials, and researchers. GAO is making nine recommendations to six agencies, including that grant-making agencies address non-financial conflicts of interest in their COI policies and develop written procedures for addressing cases of failure to disclose required information. Five agencies agreed with GAO's recommendations. The National Science Foundation neither agreed nor disagreed with GAO's recommendation, but identified actions it plans to take in response. For more information, contact Candice N. Wright at (202) 512-6888 or wrightc@gao.gov.
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    The Department of Justice today notified Yale University of its findings that Yale illegally discriminates against Asian American and white applicants in its undergraduate admissions process in violation of Title VI of the 1964 Civil Rights Act. The findings are the result of a two-year investigation in response to a complaint by Asian American groups concerning Yale’s conduct.   
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  • Opioid Use Disorder: Treatment with Injectable and Implantable Buprenorphine
    In U.S GAO News
    Of the medications used to treat opioid use disorder (OUD), only buprenorphine is both a controlled substance and available as an injection or implant. Buprenorphine is used to treat patients with OUD because it reduces or eliminates opioid withdrawal symptoms and blunts the euphoria or dangerous side effects of other opioids, such as heroin. When used to treat OUD, buprenorphine, in any form, is subject to additional laws and regulations that are overseen by the Drug Enforcement Administration (DEA), within the Department of Justice (DOJ) and the Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS). To ensure patient safety when injectable and implantable buprenorphine is used, the Food and Drug Administration (FDA), within HHS has also required drug companies to establish risk evaluation and mitigation strategies to help ensure the benefits of these medications outweigh their risks. Providers and pharmacies must follow a number of specific steps based on federal requirements when providing treatment with injectable and implantable buprenorphine. Providers are responsible for prescribing, storing, and administering injectable and implantable buprenorphine, while pharmacies are responsible for dispensing these medications (see figure). Representatives GAO interviewed from provider groups and pharmacies said they did not find the steps involved in treating patients to be difficult overall. However, they stated that careful and timely coordination with each other and patients is needed at key steps of the process to ensure that the patient receives treatment. Representatives from provider groups and pharmacies reported that the risk of diversion of injectable and implantable buprenorphine is low. For example, all of the provider groups GAO spoke with said that diversion of injectable or implantable buprenorphine is unlikely, and representatives from three of the six provider groups said that the design of these formulations reduces opportunities for diversion due to how they are administered. Process for Treating Opioid Use Disorder with Injectable and Implantable Buprenorphine The use of injectable and implantable buprenorphine to treat OUD is relatively low compared to oral forms of buprenorphine. HHS has reported that about 7,250 prescriptions were issued for injectable and implantable buprenorphine in fiscal year 2019, compared to over 700,000 patients who received buprenorphine prescriptions for oral formulations to treat OUD or pain in that year. In 2018, SAMHSA estimated that about one-quarter of the estimated 2 million people with OUD had received some form of substance use treatment in the prior year. One form of treatment—medication-assisted treatment (MAT)— combines behavioral therapy with the use of certain medications. HHS has identified expanding access to treatment for OUD as an important strategy for reducing opioid morbidity and mortality, which includes increasing the number of injectable and implantable buprenorphine prescriptions. Congress included a provision in the SUPPORT Act for GAO to review access to and the potential for the diversion of controlled substances administered by injection or implantation. This report focuses on injectable and implantable controlled substances that can be used to treat OUD and specifically, describes the process for treating OUD with injectable and implantable buprenorphine and what is known about their use. GAO reviewed laws, regulations, and documentation from DEA, FDA, and SAMHSA governing the process of providing treatment with buprenorphine and interviewed officials from those agencies. GAO also interviewed representatives from stakeholder groups representing MAT providers; drug companies that manufacture injectable or implantable buprenorphine; and pharmacies that dispense these medications. HHS and DOJ reviewed a draft of this report, and GAO incorporated their technical comments, as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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  • Military Spouse Employment: DOD Should Continue Assessing State Licensing Practices and Increase Awareness of Resources
    In U.S GAO News
    According to estimates from Department of Defense (DOD) survey data, roughly one-quarter of military spouses who were in the workforce and in career fields that required credentials (state licenses or certifications) were unemployed in 2017. In that same year, about one-quarter of spouses who were employed in credentialed career fields were working outside their area of expertise, and about one in seven were working part-time due to a lack of full-time opportunities—two potential indicators of underemployment. Employment outcomes for military spouses may also vary due to other factors, including their partner's rank and frequent moves, according to DOD survey data and GAO's literature review. In February 2020, the Defense State Liaison Office, which works on key issues affecting military families, assessed states' use of best practices that help military spouses transfer occupational licenses. For example, the Liaison Office found that 34 states could increase their use of interstate compacts, which allow spouses in certain career fields, such as nursing, to work in multiple states without relicensing (see figure). However, the Liaison Office does not plan to continue these assessments, or assess whether states' efforts are improving spouses' experiences with transferring licenses. As a result, DOD may not have up-to-date information on states' actions that help spouses transfer their licenses and maintain employment. Assessment by the Defense State Liaison Office of Number of States Using Interstate Compacts to Improve Military Spouse Employment DOD and the military services use a range of virtual and in-person outreach to promote awareness of employment resources among military spouses. For example, officials GAO interviewed at installations said they promoted resources through social media and at orientation briefings. Nonetheless, GAO found that inconsistent information sharing across DOD and with external stakeholders who help spouses with employment hindered the effectiveness of outreach. For instance, officials from two services said they do not have methods to regularly exchange outreach best practices or challenges, while officials from another service said they have quarterly staff calls to share lessons learned. Without strategies for sharing information among internal and external stakeholders, DOD may miss opportunities to increase spouses' awareness of available resources, and improve their employment opportunities. There were over 605,000 spouses of active duty servicemembers in the U.S. military as of 2018. These spouses may face conditions associated with the military lifestyle that make it challenging to start or maintain a career, including frequent moves and difficulties transferring occupational licenses. House Armed Services Committee Report 116-120 accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review several matters related to military spouse employment. This report examines (1) selected employment outcomes for military spouses, (2) DOD's efforts to evaluate states' licensing policies for spouses, and (3) DOD's outreach efforts to promote awareness of employment resources. GAO reviewed DOD documentation and 2017 survey data (most recent available), relevant literature, and federal laws; interviewed DOD and military services officials and relevant stakeholders; and spoke with staff at six military installations selected based on the numbers of servicemembers, among other factors. GAO is making two recommendations to DOD to continue assessing and reporting on states' efforts to help military spouses transfer occupational licenses, and to establish information sharing strategies on outreach to military spouses about employment resources. DOD concurred with both recommendations. For more information, contact Elizabeth Curda at (202) 512-7215 or curdae@gao.gov.
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  • Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care
    In U.S GAO News
    The Department of Veterans Affairs (VA) established an appointment scheduling process for the Veterans Community Care Program (VCCP) that allows up to 19 days to complete several steps from VA providers creating a referral to community care staff reviewing that referral. However, as the figure shows, VA has not specified the maximum amount of time veterans should have to wait to receive care through the program. GAO previously recommended in 2013 the need for an overall wait-time measure for veterans to receive care under a prior VA community care program. Subsequent to VA not implementing this recommendation, GAO again recommended in 2018 that VA establish an achievable wait-time goal as part of its new community care program (the VCCP). Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the VCCP through routine referrals (non-emergent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf. VA has not yet implemented GAO's 2018 recommendation that VA establish an achievable wait-time goal. Under the VA MISSION Act, VA is assigned responsibility for ensuring that veterans' appointments are scheduled in a timely manner—an essential component of quality health care. Given VA's lack of action over the prior 7 years implementing wait-time goals for various community care programs, congressional action is warranted to help achieve timely health care for veterans. Regarding monitoring of the initial steps of the scheduling process, GAO found that VA is using metrics that are remnants from the previous community care program, which are inconsistent with the time frames established in the VCCP scheduling process. This limits VA's ability to determine the effectiveness of the VCCP and to identify areas for improvement. In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner. GAO was asked to review VCCP appointment scheduling. This report examines, among other issues, the VCCP appointment scheduling process VA established and VA's monitoring of that process. GAO reviewed documentation, such as scheduling policies, and referral data related to the VCCP and assessed VA's relevant processes. GAO conducted site visits to five VAMCs in the first region to transition to VA's new provider network, and interviewed VAMC staff and a non-generalizable sample of community providers receiving referrals from those VAMCs. GAO also interviewed VA and contractor officials. GAO recommends that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO is also making three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with one of GAO's recommendations related to aligning monitoring metrics to VCCP scheduling policy time frames. GAO continues to believe this recommendation is valid, as discussed in the report. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
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  • Medicaid: CMS Needs to Implement Risk-Based Oversight of Puerto Rico’s Procurement Process
    In U.S GAO News
    Like other U.S. territories and states, Puerto Rico implements major functions of its Medicaid program by procuring services from contractors, such as the delivery of managed care services to Medicaid beneficiaries. In 2018, procurement costs represented $2.4 billion of Puerto Rico's $2.5 billion in total Medicaid expenditures. A 2019 federal indictment alleging Puerto Rico officials unlawfully steered Medicaid contracts to certain individuals has raised concerns about Puerto Rico's Medicaid procurement process, including whether this process helps ensure appropriate competition. The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services, is responsible for overseeing the Medicaid program. CMS requires states and territories to use the same process for Medicaid procurements as they do for their non-federal procurements. However, CMS has not taken steps to ensure Puerto Rico has met this requirement. Instead, CMS has relied on Puerto Rico to oversee the territory's procurement process and to attest to its compliance. CMS approved Puerto Rico's attestation of compliance in 2004 and has not required subsequent updates. CMS officials told GAO that states and territories are in the best position to ensure compliance with their respective procurement laws. GAO and others have found that competition is a cornerstone of procurement. Using competition can reduce costs, improve contractor performance, curb fraud, and promote accountability. GAO reviewed selected Puerto Rico Medicaid procurements against federal procurement standards designed to promote competition and reduce risks of fraud. States and territories are generally not required to meet such standards. However, GAO and others have found that such standards can indicate whether a state's or territory's procurement process includes necessary steps to achieve fair competition. GAO found that seven of the eight selected Puerto Rico procurements did not include important steps to promote competition and mitigate the risk for fraud, waste, and abuse, underscoring the need for federal oversight. Competitive procurements. The requests for proposals for two of the three competitive procurements GAO reviewed did not include certain information on factors used to evaluate proposals and make awards. In contrast, Puerto Rico's managed care procurement—the largest procurement reviewed—included this information. Noncompetitive procurements. None of the five noncompetitive procurements GAO reviewed documented circumstances to justify not using competitive procurements, such as a lack of competition or an emergency. Puerto Rico officials explained that territorial law allows noncompetitive procurement for professional services regardless of circumstances. Because CMS does not oversee Puerto Rico's procurement process, the agency lacks assurance that Puerto Rico's Medicaid program is appropriately managing the risk of fraud, waste, and abuse. Procurements that did not include important steps to promote competition could have unnecessarily increased Medicaid costs, reducing funding for Medicaid services to beneficiaries. States' and U.S. territories' Medicaid procurement processes can directly affect their ability to prevent fraud, waste, and abuse in the program. A 2019 federal indictment alleging fraudulent Medicaid procurements in Puerto Rico has raised questions about the program's oversight. The Consolidated Appropriations Act, 2020 includes a provision for GAO to review oversight of Puerto Rico's Medicaid procurement process and its use of competition. This report examines CMS oversight of Puerto Rico's procurement process from its initial steps through the award, and how it helps ensure competition. GAO reviewed federal regulations, guidance, and Puerto Rico's December 2020 procurement reform plan; interviewed Puerto Rico and federal officials; and reviewed eight awards that represented about 97 percent of the costs of Puerto Rico's procurements in effect as of April 2020. These procurements were selected based on variation in cost, use of competition, and other factors. GAO assessed whether CMS addressed risks in Puerto Rico's procurement process by reviewing selected procurements against certain federal standards that apply to other non-federal entities and aim to mitigate the risk of fraud, waste, and abuse. GAO also assessed CMS's policies and procedures against federal internal control standards. GAO recommends that CMS implement risk-based oversight of the Medicaid procurement process in Puerto Rico. The Department of Health and Human Services concurred with this recommendation. For more information, contact Carolyn L. Yocom at (202) 512-7114 or YocomC@gao.gov.
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