Justice Department Finds that Alameda County, California, Violates the Americans with Disabilities Act and the U.S. Constitution

The Justice Department concluded today, based upon a thorough investigation, that there is reasonable cause to believe that Alameda County is violating the Americans with Disabilities Act (ADA) in its provision of mental health services, and that conditions and practices at the county’s Santa Rita Jail violate the U.S. Constitution and the ADA.

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  • Priority Open Recommendations: Office of Science and Technology Policy
    In U.S GAO News
    What GAO Found As of June 2021, the Office of Science and Technology Policy (OSTP) had 11 open recommendations. We are identifying three recommendations from our prior work as priorities for implementation by OSTP. These three recommendations relate to strengthening interagency collaboration on science and technology issues. As the challenges of the 21st century grow, it is increasingly important for executive agencies to consider how the federal government can maximize performance and results through improved collaboration. Our prior work has shown that many issues, including those in science and technology, cut across multiple agencies. In this regard, OSTP plays a critical role in bringing agencies together under the committees and subcommittees of the National Science and Technology Council. This mechanism provides a valuable opportunity for agencies to coordinate on implementing an administration's research and development priorities and to address cross-cutting science and technology issues, such as scientific integrity, public access to federally funded research results, reliability of research results, supply chains for critical materials, and others. Strengthening interagency coordination in these areas could help amplify the synergistic effects of related research conducted by different agencies, avoid unnecessary overlapping or duplicative research and development efforts, and share lessons learned or coordinate actions to address science and technology issues. Why GAO Did This Study Priority open recommendations are the GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional and/or executive branch decision-making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015 GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. This is the first year that we are providing a priority recommendation letter to OSTP. For more information, contact John Neumann at (202) 512-6888 or neumannj@gao.gov.
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  • Multinational Industrial Engineering Company To Pay $22 Million To Settle False Claims Act Allegations Relating to Evaded Customs Duties
    In Crime News
    Linde GmbH and its U.S. subsidiary Linde Engineering North America LLC (LENA) (together, “Linde”) have agreed to pay the United States more than $22.2 million to resolve allegations that Linde violated the False Claims Act by knowingly making false statements on customs declarations to avoid paying duties owed on the companies’ imports, the Justice Department announced today. 
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    In Crime News
    A Florida couple pleaded guilty for their participation in a scheme to file four fraudulent loan applications seeking more than $1.1 million in forgivable Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
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  • New Jersey Man Sentenced to Prison for Tax Fraud Conspiracy
    In Crime News
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    In Crime News
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  • United States Files False Claims Act Complaint Against Drug Maker Teva Pharmaceuticals Alleging Illegal Kickbacks
    In Crime News
    The United States has filed a False Claims Act complaint against Teva Pharmaceuticals USA Inc. and Teva Neuroscience Inc. (Teva), alleging that they illegally paid the Medicare co-pays for their multiple sclerosis (MS) product, Copaxone, through purportedly independent foundations that the companies used as conduits in violation of the Anti-Kickback Statute, the Department of Justice announced today. 
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  • Intellectual Property: Additional Agency Actions Can Improve Assistance to Small Businesses and Inventors
    In U.S GAO News
    The U.S. Patent and Trademark Office (USPTO) offers multiple programs that help small businesses and inventors with acquiring intellectual property protections, which can help protect creative works or ideas. These programs, such as the Inventors Assistance Center, are aimed at assisting the public, especially small businesses and inventors, with intellectual property protections. Several stakeholders GAO interviewed said that USPTO programs have been helpful, but they were also not aware of some USPTO programs. Although these programs individually evaluate how they help small businesses and inventors, the agency does not collect and evaluate overall information on whether these programs are effectively reaching out to and meeting the needs of these groups. Under federal internal control standards, an agency should use quality information to achieve its objectives. Without an agency-wide approach to collect information to help evaluate the extent to which its programs serve small businesses and inventors, USPTO may not have the quality information needed to fully evaluate the effectiveness of its outreach and assistance for these groups and thus make improvements where necessary. Although the Small Business Administration (SBA) coordinates with USPTO through targeted efforts to provide intellectual property training to small businesses, it has not fully implemented some statutory requirements that can further enhance this coordination. While SBA and the Small Business Development Centers (SBDCs) coordinate with USPTO programs at the local level to train small businesses on intellectual property protection (see figure), this coordination is inconsistent. For example, two of the 12 SBDCs that GAO interviewed reported working primarily with USPTO to help small businesses protect their intellectual property, but the other 10 did not. The Small Business Innovation Protection Act of 2017 requires SBA and USPTO to coordinate and build on existing intellectual property training programs, and requires that SBA's local partners, specifically the SBDCs, provide intellectual property training, in coordination with USPTO. SBA officials reported that they are in the process of implementing requirements of this act. Incorporating selected leading practices for collaboration, such as documenting the partnership agreement and clarifying roles and responsibilities, could help SBA and USPTO fully and consistently communicate their existing resources to their partners and programs, enabling them to refer these resources to small businesses and inventors. Figure: The Small Business Administration (SBA) and the U.S. Patent and Trademark Office (USPTO) Coordinate at the Local Level, but Are Inconsistent Small businesses employ about half of the U.S. private workforce and create approximately two-thirds of the nation's jobs. For many small businesses, intellectual property aids in building market share and creating jobs. Among the federal agencies assisting small businesses with intellectual property are USPTO, which grants patents and registers trademarks, and SBA, which assists small businesses on a variety of business development issues, including intellectual property. GAO was asked to review resources available to help small businesses and inventors protect intellectual property, and their effectiveness. This report examines, among other things, (1) the extent to which USPTO evaluates the effectiveness of its efforts to assist small businesses and (2) SBA's coordination with USPTO to assist small businesses. GAO analyzed agency documents and interviewed officials who train and assist small businesses. GAO also interviewed stakeholders, including small businesses, and, among other things, reviewed federal internal control standards and selected leading practices for enhancing interagency collaboration. GAO is making four recommendations, including that USPTO develop an agency-wide approach to evaluate the effectiveness of its efforts to help small businesses and inventors, and that SBA document its partnership agreement with USPTO and clarify roles and responsibilities for coordinating with USPTO to provide training. Both agencies agreed with GAO's recommendations. For more information, contact John Neumann, (202) 512-6888, NeumannJ@gao.gov. 
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    In U.S GAO News
    What GAO Found Since fiscal year 2015, the Department of Homeland Security (DHS) Office of Inspector General (OIG) has not adhered to a number of professional standards for federal OIGs and key practices for effective management. Frequent leadership turnover and associated shifts in leadership priorities have contributed to DHS OIG's long-standing management and operational weaknesses and impeded efforts to address them. DHS OIG senior leaders acknowledge that various challenges have contributed to these weaknesses, and have taken steps to begin to address some of them, as follows: Organizational performance management: DHS OIG has operated for 4 of the past 6 years without a strategic plan. This limits its ability to implement other organizational performance management activities, such as annual planning and performance assessment. In the absence of a strategic plan, GAO found that DHS OIG staff may not understand its oversight priorities and goals, which can negatively affect operations and staff performance. In 2020, DHS OIG contracted with a nonprofit academy of government experts to develop a strategic plan for fiscal years 2021–2025, with expected completion in June 2021. Quality assurance: DHS OIG has not developed or implemented organization-wide roles and responsibilities for quality assurance. DHS OIG retracted some reports in recent years because they did not adhere to professional standards. Because there is no overarching system of internal quality assurance for audit, inspection, evaluation, and other work, DHS OIG cannot know if its internal processes ensure that its work (1) adheres to its policies and (2) meets established standards of performance. Report timeliness: Project time frames have increased in recent years, and DHS OIG has not taken steps to understand the causes of such increases or determine how to address them. For example, in the Office of Audits, eight of 102 projects completed in fiscal year 2017 took more than 18 months, compared to more than half (35 of 67) of projects completed in fiscal year 2020. Without timely DHS OIG reports, DHS's ability to respond to such oversight efforts and Congress's ability to conduct effective oversight of DHS operations are limited. Coordination with DHS: DHS OIG does not have a consistent process for coordinating with DHS components to receive and respond to technical and management comments on DHS OIG audit, inspection, and evaluation work. Further, DHS officials do not have confidence in DHS OIG's processes to (1) correct factual errors before finalizing reports and (2) redact sensitive but unclassified information before publicly issuing reports. As a result, the process by which DHS OIG resolves DHS's comments is at risk of miscommunication and misunderstandings. These and additional weaknesses GAO identified are of particular concern given that OIGs need to maintain high standards of professionalism and integrity in light of their mission, according to quality standards for federal OIGs. Without addressing these and other long-standing management and operational weaknesses, DHS OIG is not well positioned to fulfill its oversight mission. Why GAO Did This Study DHS OIG plays a critical role in overseeing DHS, which encompasses multiple components and programs and has tens of billions of dollars in annual budgetary resources. However, DHS OIG has faced a number of long-standing management and operational challenges that have affected its ability to carry out its oversight mission effectively. GAO was asked to review DHS OIG's management and operations. This report addresses the extent to which DHS OIG adheres to professional standards and key practices in its management and operations, among other objectives. GAO reviewed DHS OIG management and operations from fiscal year 2015 through fiscal year 2020. GAO evaluated DHS OIG's processes against quality standards for federal OIGs, relevant federal standards for internal control, and human capital and organizational change leading practices. To do so, GAO reviewed DHS OIG documents, interviewed officials, and analyzed DHS OIG data and published reports.
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  • Department of Defense: Actions Needed to Improve Accounting of Intradepartmental Transactions
    In U.S GAO News
    The Department of Defense (DOD) has a long-standing material weakness related to intradepartmental transactions. Intradepartmental transactions occur when trading partners within the same department engage in business activities—such as the Department of the Army as a seller and the Department of the Navy as a buyer within DOD. As part of the standard process of preparing department-wide financial statements, intradepartmental transaction amounts are eliminated to avoid overstating accounts for DOD. For the fourth quarter of fiscal year 2019, DOD eliminated approximately $451 billion of net intradepartmental activity. Auditors continue to report a material weakness related to DOD's processes for recording and reconciling intradepartmental transaction amounts that are necessary to eliminate the transactions and prepare reliable consolidated financial statements. DOD has identified implementation of the Government Invoicing (G-Invoicing) system as its long-term solution to account for and support its intradepartmental activities. In fiscal year 2020, DOD issued a policy requiring all DOD components to use G-Invoicing's General Terms and Conditions (GT&C) functionality for initiating and approving GT&C agreements—a necessary step for using subsequent G-Invoicing functionalities (see figure). GAO found the use of this functionality varied among selected DOD components because of issues such as inconsistency in DOD policies and numerous changes to G-Invoicing system specifications. If DOD components do not implement the GT&C functionality, there is an increased risk of delay in full implementation of G-Invoicing to help remediate the intradepartmental eliminations material weakness. General Terms and Conditions Agreement Process in Government Invoicing Although DOD has identified G-Invoicing as its long-term solution, GAO found that DOD has not implemented an overall department-wide strategy to address its intradepartmental eliminations material weakness in the short term. Further, GAO found that while DOD issued a department-wide policy in May 2019 with new requirements for reconciling intradepartmental transactions, the Defense Finance and Accounting Service and selected DOD components have not updated their policies or implemented several of the new requirements. Without a short-term strategy that includes identifying the causes of issues and consistently implementing department-wide policies across DOD, DOD's efforts to resolve differences in intradepartmental transaction amounts—including its efforts in the long term—will likely be inefficient and ineffective. Since 1995, GAO has designated DOD financial management as high risk because of pervasive weaknesses in its financial management systems, controls, and reporting. DOD's long-standing intradepartmental eliminations material weakness reflects DOD's inability to adequately record and reconcile its intradepartmental transactions, and has affected DOD's ability to prepare auditable financial statements. GAO was asked to evaluate DOD's process for performing intradepartmental eliminations. This report examines the extent to which DOD has (1) identified and taken steps to address issues related to intradepartmental eliminations and (2) established and implemented policies and procedures related to intradepartmental eliminations. GAO interviewed DOD officials about intradepartmental eliminations processes and reviewed DOD policies and procedures to identify the extent to which procedures have been implemented to record and reconcile intradepartmental transactions. GAO is making five recommendations to DOD, including that DOD should (1) take actions to ensure that its components follow its policy for using G-Invoicing's GT&C functionality and (2) develop short-term solutions that address causes for trading partner differences before G-Invoicing is fully implemented. DOD agreed with all five recommendations and cited actions to address them. For more information, contact Kristen Kociolek at (202) 512-2989 or kociolekk@gao.gov.
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  • State Department Employee and Spouse Plead Guilty to Trafficking in Counterfeit Goods from U.S. Embassy
    In Crime News
    A U.S. Department of State employee and his spouse pleaded guilty today to one count of conspiracy to traffic in counterfeit goods. The guilty pleas took place before U.S. District Judge Michael J. McShane, who has scheduled sentencing for March 18, 2021, for both defendants.
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    In Crime News
    The Department of Justice announced today that it has seized virtual currency worth an estimated $24 million on behalf of the Brazilian government.
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  • Cybersecurity: DHS and Selected Agencies Need to Address Shortcomings in Implementation of Network Monitoring Program
    In U.S GAO News
    Selected agencies—the Federal Aviation Administration, Indian Health Services, and Small Business Administration—had generally deployed tools intended to provide cybersecurity data to support the Department of Homeland Security's (DHS) Continuous Diagnostics and Mitigation (CDM) program. As depicted in the figure, the program relies on automated tools to identify hardware and software residing on agency networks. This information is aggregated and compared to expected outcomes, such as whether actual device configuration settings meet federal benchmarks. The information is then displayed on an agency dashboard and federal dashboard. Continuous Diagnostics and Mitigation Program Data Flow from Agencies to the Federal Dashboard However, while agencies reported that the program improved their network awareness, none of the three agencies had effectively implemented all key CDM program requirements. For example, the three agencies had not fully implemented requirements for managing their hardware. This was due in part to contractors, who install and troubleshoot the tools, not always providing unique identifying information. Accordingly, CDM tools did not provide an accurate count of the hardware on their networks. In addition, although most agencies implemented requirements for managing software, they were not consistently comparing configuration settings on their networks to federal core benchmarks intended to maintain a standard level of security. The agencies identified various challenges to implementing the program, including overcoming resource limitations and not being able to resolve problems directly with contractors. DHS had taken numerous steps to help manage these challenges, including tracking risks of insufficient resources, providing forums for agencies to raise concerns, and allowing agencies to provide feedback to DHS on contractor performance. In 2013, DHS established the CDM program to strengthen the cybersecurity of government networks and systems by providing tools to agencies to continuously monitor their networks. The program, with estimated costs of about $10.9 billion, intends to provide capabilities for agencies to identify, prioritize, and mitigate cybersecurity vulnerabilities. GAO was asked to review agencies' continuous monitoring practices. This report (1) examines the extent to which selected agencies have effectively implemented key CDM program requirements and (2) describes challenges agencies identified in implementing the requirements and steps DHS has taken to address these challenges. GAO selected three agencies based on reported acquisition of CDM tools. GAO evaluated the agencies' implementation of CDM asset management capabilities, conducted semi-structured interviews with agency officials, and examined DHS actions. GAO is making six recommendations to DHS, including to ensure that contractors provide unique hardware identifiers; and nine recommendations to the three selected agencies, including to compare configurations to benchmarks. DHS and the selected agencies concurred with the recommendations. For more information, contact Vijay A. D'Souza at (202) 512-6240 or dsouzav@gao.gov.
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  • Bank Supervision: FDIC Could Better Address Regulatory Capture Risks
    In U.S GAO News
    The Federal Deposit Insurance Corporation (FDIC) has designed policies to address the risk of regulatory capture by reducing the potential benefit to industry of capturing the examination process, reducing avenues of inducement, and promoting a culture of independence and public service (see figure). Framework for Reducing Risk and Minimizing Consequences of Regulatory Capture FDIC has several policies for documenting bank examination decisions that help promote transparent decision-making and assign responsibility for decisions. Such policies are likely to help reduce benefits to industry of capturing the examination process. However, GAO found that some examinations were not implemented consistent with FDIC policies and that gaps in FDIC policies limited their effectiveness. For example, GAO found that managers sometimes did not clearly document how they concluded that banks had addressed recommendations. By improving adherence to agency policies, FDIC management could better address threats to capture in the examination process. GAO found that FDIC has policies to address potential conflicts of interest that could help block or reduce avenues of inducement. For example, FDIC has post-employment conflict-of-interest policies designed to prevent former employees from exerting undue influence on FDIC and to reduce industry's ability to induce current FDIC employees with prospective employment arrangements. One such policy requires the agency to review the workpapers of examiners-in-charge who accept employment with banks they examined in the prior 18 months. However, FDIC has not fully implemented a process for identifying when to review the workpapers of departing examiners to assess whether independence has been compromised. In particular, FDIC does not have a process for collecting information about departing employees' future employment. By revising its examiner-departure processes, the agency could better identify when to initiate workpaper reviews. FDIC has identified regulatory capture as a risk as part of its enterprise risk management process. The agency has documented 11 mitigation strategies that could help address that risk. Identified mitigation strategies include rotating examiners-in-charge, national examination training, and ethics requirements. FDIC supervises about 3,300 financial institutions to evaluate their safety and soundness. Some analyses by academic researchers have identified regulatory capture in supervision as one potential factor contributing to the 2007–2009 financial crisis. Regulatory capture is defined as a regulator acting in the interest of the regulated industry rather than in the public interest. GAO was asked to review regulatory capture in financial regulation. This report examines FDIC's (1) processes for encouraging transparency and accountability in the bank examination process, (2) processes to minimize potential conflicts of interest among examination staff, and (3) agency-wide efforts to address the risks of regulatory capture and compromised independence. GAO reviewed FDIC's policies and enterprise risk management framework, analyzed bank examination workpapers, and interviewed supervisory staff. GAO is making four recommendations to FDIC related to managing the risk of regulatory capture, including improving documentation of banks' progress at addressing FDIC recommendations and revising examiner-departure processes. FDIC neither agreed nor disagreed with these recommendations, but described actions it would take in response to them. FDIC's actions, if fully implemented, would address two of the four recommendations. For more information, contact Michael Clements at (202) 512-8678 or clementsm@gao.gov.
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  • Tax Administration: Better Coordination Could Improve IRS’s Use of Third-Party Information Reporting to Help Reduce the Tax Gap
    In U.S GAO News
    Information returns are forms filed by third parties, such as employers and financial institutions that provide information about taxable transactions. These forms are submitted to the Internal Revenue Service (IRS), the Social Security Administration, and taxpayers. Fifty unique types of information returns provide information on individual taxpayers and have a variety of purposes, such as reporting on wages earned or amounts paid that qualify for a tax credit or deduction. IRS identifies mismatches between information returns and tax returns for potential additional review, including enforcement actions. According to IRS research, taxpayers are more likely to misreport income when little or no third-party information reporting exists than when substantial reporting exists. Overview of Internal Revenue Service's (IRS) Process for Matching Information Returns IRS's ability to process and use information returns is limited by its outdated legacy information technology (IT) systems. In 2017, IRS developed a plan to modernize its information return processing systems; however, IRS paused its efforts due to, according to IRS, resource constraints. IRS has an opportunity to capitalize on prior planning efforts by re-evaluating and updating these efforts and integrating them into its broader IT modernization efforts. IRS does not have a coordinated approach with cross-agency leadership that strategically considers how information reporting could be improved to promote compliance with the tax code. While information returns affect many groups across IRS and support multiple compliance programs, no one office has broad responsibility for coordinating these efforts. A formalized collaborative mechanism, such as a steering committee, could help provide leadership and ensure that IRS acts to address issues among the intake, processing, and compliance groups. For example, IRS has not undertaken a broad review of individual information returns to determine if thresholds, deadlines, or other characteristics of the returns continue to meet the needs of the agency. For tax year 2018, IRS received and processed more than 3.5 billion information returns that it used to facilitate compliance checks on more than 150 million individual income tax returns. By matching information reported by taxpayers against information reported by third parties, IRS identifies potential fraud and noncompliance. GAO was asked to review IRS's use of information returns. This report provides an overview of information returns and assesses the extent to which IRS has a coordinated approach to identifying and responding to risks related to the use of information returns in the tax system, among other objectives. GAO reviewed IRS documents and data on information returns filing, processing, and use, and interviewed cognizant officials. GAO compared IRS's efforts in this area to federal internal control standards, and IRS's strategic plan. GAO is making nine recommendations to IRS, including that IRS revise its modernization plans for its information returns processing systems and incorporate it into broader IT modernization efforts and develop a collaborative mechanism to improve coordination among IRS groups that use information returns. IRS neither agreed, nor disagreed with the recommendations; however, IRS outlined actions it plans to take to address the recommendations. Social Security Administration had no comments. For more information, contact James R. McTigue at (202) 512-9110 or McTigueJj@gao.gov.
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    The Department of Justice (DOJ) today announced the protection activities undertaken by the FBI to counter the threat posed by Unmanned Aircraft Systems (UAS) at certain National Special Security Events (NSSEs), Special Events Assessment Rating (SEAR) events, and select mass gatherings throughout the country over the past fiscal year. DOJ and the FBI are publicizing protection activities in an effort to deter careless and criminal UAS operators in light of an anticipated increase in enforcement activity in response to the misuse of UAS.
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  • Cybersecurity: Clarity of Leadership Urgently Needed to Fully Implement the National Strategy
    In U.S GAO News
    Federal entities have a variety of roles and responsibilities for supporting efforts to enhance the cybersecurity of the nation. Among other things, 23 federal entities have roles and responsibilities for developing policies, monitoring critical infrastructure protection efforts, sharing information to enhance cybersecurity across the nation, responding to cyber incidents, investigating cyberattacks, and conducting cybersecurity-related research. To fulfill their roles and responsibilities, federal entities identified activities undertaken in support of the nation's cybersecurity. For example, National Security Council (NSC) staff, on behalf of the President, and the National Institute of Standards and Technology, have developed policies, strategies, standards, and plans to guide cybersecurity efforts. The Department of Homeland Security has helped secure the nation's critical infrastructure through developing security policy and coordinating security initiatives, among other efforts. Other agencies have established initiatives to gather intelligence and share actual or possible cyberattack information. Multiple agencies have mechanisms in place to assist in responding to cyberattacks, and law enforcement components, including the Federal Bureau of Investigation, are responsible for investigating them. The White House's September 2018 National Cyber Strategy and the NSC's accompanying June 2019 Implementation Plan detail the executive branch's approach to managing the nation's cybersecurity. When evaluated together, these documents addressed several of the desirable characteristics of national strategies, but lacked certain key elements for addressing others. National Cyber Strategy and Implementation Plan are Missing Desirable Characteristics of a National Strategy Characteristic Cyber Strategy and Plan Coverage of Issue Purpose, scope, and methodology Addressed Organizational roles, responsibilities, and coordination Addressed Integration and implementation Addressed Problem definition and risk assessment Did not fully address Goals, subordinate objectives, activities, and performance measures Did not fully address Resources, investments, and risk management Did not fully address Source: GAO analysis of 2018 National Cyber Strategy and 2019 Implementation Plan . | GAO-20-629 For example, the Implementation Plan details 191 activities that federal entities are to undertake to execute the priority actions outlined in the National Cyber Strategy. These activities are assigned a level, or tier, based on the coordination efforts required to execute the activity and the extent to which NSC staff is expected to be involved. Thirty-five of these activities are designated as the highest level (tier 1), and are coordinated by a functional entity within the NSC . Ten entities are assigned to lead or co-lead these critical activities while also tasked to lead or co-lead lower tier activities. Leadership Roles for Federal Entities Assigned as Leads or Co-Leads for National Cyber Strategy Implementation Plan Activities Entity Tier 1 Activities Tier 2 Activities Tier 3 Activities National Security Council 15 7 3 Department of Homeland Security 14 19 15 Office of Management and Budget 7 6 5 Department of Commerce 5 9 35 Department of State 2 5 11 Department of Defense 1 6 17 Department of Justice 1 10 5 Department of Transportation 1 0 5 Executive Office of the President 1 0 0 General Services Administration 1 2 1 Source: GAO analysis of 2018 National Cyber Strategy and 2019 Implementation Plan . | GAO-20-629 Although the Implementation Plan defined the entities responsible for leading each of the activities; it did not include goals and timelines for 46 of the activities or identify the resources needed to execute 160 activities. Additionally, discussion of risk in the National Cyber Strategy and Implementation Plan was not based on an analysis of threats and vulnerabilities. Further, the documents did not specify a process for monitoring agency progress in executing Implementation Plan activities. Instead, NSC staff stated that they performed periodic check-ins with responsible entities, but did not provide an explanation or definition of specific level of NSC staff involvement for each of the three tier designations. Without a consistent approach to engaging with responsible entities and a comprehensive understanding of what is needed to implement all 191 activities, the NSC will face challenges in ensuring that the National Cyber Strategy is efficiently executed. GAO and others have reported on the urgency and necessity of clearly defining a central leadership role in order to coordinate the government's efforts to overcome the nation's cyber-related threats and challenges. The White House identified the NSC staff as responsible for coordinating the implementation of the National Cyber Strategy . However, in light of the elimination of the White House Cybersecurity Coordinator position in May 2018, it remains unclear which official ultimately maintains responsibility for not only coordinating execution of the Implementation Plan , but also holding federal agencies accountable once activities are implemented. NSC staff stated responsibility for duties previously attributed to the White House Cyber Coordinator were passed to the senior director of NSC's Cyber directorate; however, the staff did not provide a description of what those responsibilities include. NSC staff also stated that federal entities are ultimately responsible for determining the status of the activities that they lead or support and for communicating implementation status to relevant NSC staff. However, without a clear central leader to coordinate activities, as well as a process for monitoring performance of the Implementation Plan activities, the White House cannot ensure that entities are effectively executing their assigned activities intended to support the nation's cybersecurity strategy and ultimately overcome this urgent challenge. Increasingly sophisticated cyber threats have underscored the need to manage and bolster the cybersecurity of key government systems and the nation's cybersecurity. The risks to these systems are increasing as security threats evolve and become more sophisticated. GAO first designated information security as a government-wide high-risk area in 1997. This was expanded to include protecting cyber critical infrastructure in 2003 and protecting the privacy of personally identifiable information in 2015. In 2018, GAO noted that the need to establish a national cybersecurity strategy with effective oversight was a major challenge facing the federal government. GAO was requested to review efforts to protect the nation's cyber critical infrastructure. The objectives of this report were to (1) describe roles and responsibilities of federal entities tasked with supporting national cybersecurity, and (2) determine the extent to which the executive branch has developed a national strategy and a plan to manage its implementation. To do so, GAO identified 23 federal entities responsible for enhancing the nation's cybersecurity. Specifically, GAO selected 13 federal agencies based on their specialized or support functions regarding critical infrastructure security and resilience, and 10 additional entities based on analysis of its prior reviews of national cybersecurity, relevant executive policy, and national strategy documents. GAO also analyzed the National Cyber Strategy and Implementation Plan to determine if they aligned with the desirable characteristics of a national strategy. GAO is making one matter for congressional consideration, that Congress should consider legislation to designate a leadership position in the White House with the commensurate authority to implement and encourage action in support of the nation's cybersecurity. GAO is also making one recommendation to the National Security Council to work with relevant federal entities to update cybersecurity strategy documents to include goals, performance measures, and resource information, among other things. The National Security Council neither agreed nor disagreed with GAO's recommendation. For more information, contact Nick Marinos at (202) 512-9342 or marinosn@gao.gov.
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    The Defense Health Agency (DHA) within the Department of Defense (DOD) has established processes for preventing and responding to quality and safety concerns about individual providers delivering health care in military treatment facilities (MTF). Specifically, DHA's August 2019 policy standardized processes for managing health care quality in the Military Health System, which superseded the policies of each of the military services (Air Force, Army, and Navy). These processes include 1) initial and ongoing monitoring of providers; 2) taking action to deny, limit, or remove individual providers' ability to practice, known as adverse privileging action; and 3) reviewing the care delivered by individual providers involved in certain patient safety events, known as potentially compensable event reviews. For example, DHA policy establishes requirements for taking adverse privileging actions against a provider that either limit the care a provider is allowed to deliver at a facility or prevent the provider from delivering care altogether, when warranted. In particular, DHA policy specifies that the provider's privileges should be placed in summary suspension—a temporary removal of all or a portion of the provider's privileges—while a peer conducts an investigation of the concerns. DHA policy also specifies that summary suspensions lasting greater than 30 days, as well as any final adverse privileging actions, must be reported to the National Practitioner Data Bank (NPDB). The NPDB is an electronic repository that collects and releases information on certain adverse actions and medical malpractice payments related to providers. According to DOD officials, 27 DOD providers were reported to the NPDB for a summary suspension lasting greater than 30 days between February 1, 2020—when this requirement was implemented—and September 30, 2020. DHA supports the delivery of health care to servicemembers and their families throughout the Military Health System. As in all health care delivery settings, concerns may arise about the quality and safety of care delivered by individual health care providers at MTFs. For example, patient safety events—incidents that could have resulted or did result in harm to a patient—may occur during the course of providing health care services and may raise questions about the quality and safety of care delivered. DHA is responsible for ensuring the quality and safety of health care delivered by military and civilian health care providers, including contractors, through its clinical quality management program. The National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review aspects of DOD's clinical quality management program, including its processes for reviewing the quality and safety of providers' care. This report describes DHA's processes for preventing and responding to quality and safety concerns about individual health care providers at MTFs. In future work, GAO will examine the implementation of these processes at MTFs. GAO reviewed documentation that contains policy and guidance for these processes, including DHA's August 2019 procedure manual for managing clinical quality management in the Military Health System. GAO also interviewed officials from DHA and each of the military services. We provided a draft of this report to DOD for review and comment. DOD concurred with our report and provided technical comments, which we incorporated as appropriate. For more information, contact Sharon M. Silas at(202)512-7114 or Silass@gao.gov.
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    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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GAO's analysis of available data from SSA and the Administrative Office of the U.S. Courts (AOUSC) found that from fiscal years 2014 through 2019, about 48,000 individuals filed for bankruptcy while awaiting a final decision on their disability appeals. This represents about 1.3 percent of the approximately 3.6 million disability applicants who filed appeals during those years. The applicants who filed for bankruptcy while awaiting a disability appeals decision were disproportionately female, older, and had more than a high school education as compared to the total population of disability applicants who filed appeals. Bankruptcies among individuals who were awaiting decisions about disability appeals may have been unrelated to the applicant's claimed disability. GAO's analysis of SSA disability administrative data and death data found that of the approximately 9 million disability applicants who filed an appeal from fiscal year 2008 through 2019, 109,725 died prior to receiving a final decision on their appeal. This represents about 1.2 percent of the total number of disability applicants who filed an appeal during those years. The annual death rate of applicants awaiting a final disability decision has increased in recent years. From fiscal years 2011 through 2018, the annual death rate for applicants pursuing appeals increased from 0.52 percent to 0.72 percent. Applicants who filed their initial disability claim during years of peak wait times and appealed their initial decision died at a higher rate while awaiting a final decision than applicants who filed their initial claim in years with shorter wait times. Disability applicants awaiting a final decision about their appeal who were male died at higher rates than applicants who were female and those who were older died at higher rates than those who were younger. Death rates were largely similar across reported education levels. Deaths among individuals who were awaiting decisions about disability appeals may have been unrelated to the applicant's claimed disability. The Social Security Administration (SSA) manages two large disability benefit programs–Disability Insurance (DI) and Supplemental Security Income (SSI). As of December 2019, these programs provided benefits to approximately 12.3 million adults living with disabilities and their eligible dependents. A disability applicant who is dissatisfied with SSA's initial disability determination can appeal the decision to multiple escalating levels of review. From fiscal years 2008 through 2019, SSA received approximately 9 million appeals of initial DI or SSI decisions. GAO has previously reported that applicants who appeal a benefits denial can potentially wait years to receive a final decision, during which time an applicant's health or financial situation could deteriorate. Given the heightened risk of worsening medical and financial conditions for disability applicants, GAO was asked to examine the incidence of such events while applicants await a final decision on their disability claim. This report examines the status of disability applicants while they awaited a final benefits decision including 1) their total wait times across all levels of disability appeals within SSA, 2) their incidence of bankruptcy, and 3) their incidence of death. For wait times, bankruptcies, and deaths, GAO also examined variations across certain demographic characteristics of applicants. GAO obtained administrative data from SSA for all adult disability applicants from fiscal years 2008 through 2019 who filed an appeal to their initial disability determination. GAO used these data to calculate wait times across appeals levels, rates of approvals and denials, and appeals caseloads, and examined changes in these three areas over time. To describe the incidence of bankruptcy among individuals awaiting a disability appeals decision, GAO matched SSA disability data to AOUSC bankruptcy data for fiscal years 2014 through 2019. To describe the incidence of death among individuals awaiting a disability appeals decision, GAO matched the disability data to SSA's Death Master File. For all of these analyses, GAO also examined variations across demographic characteristics of applicants, including age, sex, and reported education level. GAO also reviewed relevant policies, federal laws and regulations, and agency publications, and interviewed agency officials. For more information, contact Elizabeth Curda at (202) 512-7215 or CurdaE@gao.gov.
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