Justice Department Resolves Antitrust Case Against Leading Central Pennsylvania Health Care Providers

The Department of Justice announced today that it has reached a settlement with Geisinger Health (Geisinger) and Evangelical Community Hospital (Evangelical) that will resolve the department’s ongoing civil antitrust litigation challenging Geisinger’s partial acquisition of Evangelical. Among other terms, the settlement requires Geisinger to cap its ownership interest in Evangelical at a 7.5% passive interest and eliminates additional entanglements between the two competing hospitals.

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    In U.S GAO News
    Few of the 23 civilian Chief Financial Officers Act agencies had implemented seven selected foundational practices for managing information and communications technology (ICT) supply chain risks. Supply chain risk management (SCRM) is the process of identifying, assessing, and mitigating the risks associated with the global and distributed nature of ICT product and service supply chains. Many of the manufacturing inputs for these ICT products and services originate from a variety of sources throughout the world. (See figure 1.) Figure 1: Examples of Locations of Manufacturers or Suppliers of Information and Communications Technology Products and Services None of the 23 agencies fully implemented all of the SCRM practices and 14 of the 23 agencies had not implemented any of the practices. The practice with the highest rate of implementation was implemented by only six agencies. Conversely, none of the other practices were implemented by more than three agencies. Moreover, one practice had not been implemented by any of the agencies. (See figure 2.) Figure 2: Extent to Which the 23 Civilian Chief Financial Officers Act Agencies Implemented Information and Communications Technology (ICT) Supply Chain Risk Management (SCRM) Practices As a result of these weaknesses, these agencies are at a greater risk that malicious actors could exploit vulnerabilities in the ICT supply chain causing disruption to mission operations, harm to individuals, or theft of intellectual property. For example, without establishing executive oversight of SCRM activities, agencies are limited in their ability to make risk decisions across the organization about how to most effectively secure their ICT product and service supply chains. Moreover, agencies lack the ability to understand and manage risk and reduce the likelihood that adverse events will occur without reasonable visibility and traceability into supply chains. Officials from the 23 agencies cited various factors that limited their implementation of the foundational practices for managing supply chain risks. The most commonly cited factor was the lack of federal SCRM guidance. For example, several agencies reported that they were waiting for federal guidance to be issued from the Federal Acquisition Security Council—a cross-agency group responsible for providing direction and guidance to executive agencies to reduce their supply chain risks—before implementing one or more of the foundational practices. According to Office of Management and Budget (OMB) officials, the council expects to complete this effort by December 2020. While the additional direction and guidance from the council could further assist agencies with the implementation of these practices, federal agencies currently have guidance to assist with managing their ICT supply chain risks. Specifically, the National Institute of Standards and Technology (NIST) issued ICT SCRM-specific guidance in 2015 and OMB has required agencies to implement ICT SCRM since 2016. Until agencies implement all of the foundational ICT SCRM practices, they will be limited in their ability to address supply chain risks across their organizations effectively. Federal agencies rely extensively on ICT products and services (e.g., computing systems, software, and networks) to carry out their operations. However, agencies face numerous ICT supply chain risks, including threats posed by counterfeiters who may exploit vulnerabilities in the supply chain and, thus, compromise the confidentiality, integrity, or availability of an organization's systems and the information they contain. For example, in September 2019, the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency reported that federal agencies faced approximately 180 different ICT supply chain-related threats. To address threats such as these, agencies must make risk-based ICT supply chain decisions about how to secure their systems. GAO was asked to conduct a review of federal agencies' ICT SCRM practices. The specific objective was to determine the extent to which federal agencies have implemented foundational ICT SCRM practices. To do so, GAO identified seven practices from NIST guidance that are foundational for an organization-wide approach to ICT SCRM and compared them to policies, procedures, and other documentation from the 23 civilian Chief Financial Officers Act agencies. This is a public version of a sensitive report that GAO issued in October 2020. Information that agencies deemed sensitive was omitted and GAO substituted numeric identifiers that were randomly assigned for the names of the agencies due to sensitivity concerns. The foundational practices comprising ICT SCRM are: establishing executive oversight of ICT activities, including designating responsibility for leading agency-wide SCRM activities; developing an agency-wide ICT SCRM strategy for providing the organizational context in which risk-based decisions will be made; establishing an approach to identify and document agency ICT supply chain(s); establishing a process to conduct agency-wide assessments of ICT supply chain risks that identify, aggregate, and prioritize ICT supply chain risks that are present across the organization; establishing a process to conduct a SCRM review of a potential supplier that may include reviews of the processes used by suppliers to design, develop, test, implement, verify, deliver, and support ICT products and services; developing organizational ICT SCRM requirements for suppliers to ensure that suppliers are adequately addressing risks associated with ICT products and services; and developing organizational procedures to detect counterfeit and compromised ICT products prior to their deployment. GAO also interviewed relevant agency officials. In the sensitive report, GAO made a total of 145 recommendations to the 23 agencies to fully implement foundational practices in their organization-wide approaches to ICT SCRM. Of the 23 agencies, 17 agreed with all of the recommendations made to them; two agencies agreed with most, but not all of the recommendations; one agency disagreed with all of the recommendations; two agencies neither agreed nor disagreed with the recommendations, but stated they would address them; and one agency had no comments. GAO continues to believe that all of the recommendations are warranted, as discussed in the sensitive report. For more information, contact Carol C. Harris at (202) 512-4456 or harrisCC@gao.gov.
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    In U.S GAO News
    In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials. Most Children Living with Kin Are Not in Foster Care, 2018 Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists. The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunities to help states better support kin caregivers. Grandparents and other kin often step in to provide stability and security when parents cannot care for their children. Taking on this responsibility can lead to significant hardships, especially for older caregivers. GAO was asked to study the challenges faced by grandparents and other older kin when becoming primary caregivers. This report examines (1) what is known about the numbers of grandparents and other kin serving as primary caregivers for children, and the reasons for that care; (2) challenges kin caregivers face and how officials report addressing them in selected communities; and (3) the extent to which HHS has supported states' efforts to use relevant federal programs and initiatives. GAO analyzed U.S. Census Bureau survey and HHS administrative data; reviewed relevant literature, federal laws, regulations, guidance, and other documents; and interviewed officials from HHS, national organizations, and in four states (Mississippi, New Mexico, New York, and Ohio) and communities, selected for their relatively large numbers of grandparent caregivers and to reflect geographic and demographic diversity. GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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    A Canadian national pleaded guilty today to conspiracy to bring aliens to the United States for private financial gain in connection with his role in a scheme to smuggle aliens from Sri Lanka through the Caribbean and into the United States.
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    William M. Kelly Inc. and Omega Imaging Inc., together, operate 11 radiology facilities in Southern California, have agreed to pay the United States $5 million to resolve allegations that they violated the False Claims Act (FCA) by knowingly submitting claims to Medicare and the military healthcare program, TRICARE, for unsupervised radiology services and services provided at unaccredited facilities, the Department of Justice announced today.
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    Assistant Attorney General for National Security John C. Demers, Audrey Strauss, the Acting U.S. Attorney for the Southern District of New York, and Jonathan Carson, Special Agent in Charge of the New York Field Office of the U.S. Department of Commerce, Office of Export Enforcement (OEE), announced the arrests today of Chong Sik Yu, a/k/a “Chris Yu,” and Yunseo Lee.  Yu and Lee are charged with conspiring to unlawfully export dual-use electronics components, in violation of the Export Control Reform Act, and to commit wire fraud, bank fraud, and money laundering.  Yu and Lee were arrested this morning and are expected to be presented later today before U.S. Magistrate Judge Kevin Nathaniel Fox in Manhattan federal court.
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    A federal court in the Southern District of Florida has permanently enjoined a West Palm Beach tax return preparer and her business from preparing federal income tax returns for others, the Justice Department announced today. According to the court’s order, it issued the injunction in response to violations of a prior order in the case that had allowed the preparer and her business to prepare returns subject to certain restrictions. In April 2017, the United States filed a complaint against Lena D. Cotton and Professional Accounting LDC, LLC, that alleged the defendants prepared returns with improper education credits, manipulated filing statuses, and improper vehicle deductions, among other issues. In November 2017, the court permanently enjoined both defendants from this and other specific conduct and required defendants to engage a “neutral monitor” to “determin[e] and/or secur[e] compliance” with injunction.
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    A Nevada woman was arrested today for her alleged role in a multi-year scheme to commit visa fraud and money laundering, and to illegally bring Chinese nationals into the United States for financial gain.
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  • Lake Ontario-St. Lawrence River Plan: Improved Communication and Adaptive Management Strategy Could Help Address Stakeholder Concerns
    In U.S GAO News
    The International Joint Commission's (IJC) process for developing and selecting the Lake Ontario-St. Lawrence River Plan 2014 (Plan 2014) was generally consistent with relevant essential elements of risk-informed decision-making. During the 18-year process, IJC took steps to define objectives and performance measures to be used in its decision-making, identify various options, assess uncertainties like climate change, and engage with stakeholders, among other steps. These steps are all essential elements of risk-informed decision making. Plan 2014 Affects Various Users of Lake Ontario and the St. Lawrence River, Including (from Left to Right) Commercial Navigation, Coastal Development, and Recreational Boating, Including Marinas IJC uses two mechanisms—a communications committee and a strategic communication plan—and a variety of methods—such as its website, social media, and public meetings—to communicate with stakeholders about its implementation of Plan 2014. Nevertheless, 12 of the 14 stakeholders GAO interviewed expressed concerns about IJC's communication. GAO found that IJC's strategic communication plan and related documents partially align with best practices. For example, the communication plan and related documents do not comprehensively identify target audiences or include mechanisms to monitor and evaluate the effectivness of their communication efforts. Updating its strategic communication plan to align with best practices and principles for risk communication could help IJC ensure improved stakeholder communication. Of the 14 stakeholders interviewed, nine expressed concerns about the rules and criteria in Plan 2014 and 10 expressed concerns about its implementation. For example, seven stakeholders told us that they do not believe that the Plan allows IJC to act proactively in anticipation of future water conditions. IJC has taken initial steps to develop an adaptive management process that may help address stakeholder concerns and approved a long-term adaptive management strategy in March 2020. However, the document does not fully incorporate the key elements and essential characteristics of an adaptive management process that could help IJC transparently and effectively assess Plan 2014 and adjust future actions to achieve the plan's objectives. For example, the Plan does not fully incorporate a communication strategy for engaging stakeholders throughout the process or information on how IJC will determine if adjustments to the Plan's rules and criteria are warranted. Water releases from Lake Ontario into the St. Lawrence River are determined by a set of regulatory rules and criteria called Plan 2014—issued pursuant to IJC's Supplementary Order of Approval and the Boundary Waters Treaty of 1909. The IJC—a binational commission—developed and issued the Plan and Order with the concurrence of the United States and Canada. The rules affect a variety of users of the waterway, including ecosystems, hydropower, and municipal and industrial water use. After flooding from the lake and river in 2017, GAO was asked to examine the process IJC used to develop and evaluate Plan 2014 and how IJC has addressed stakeholder concerns. This report examines (1) the extent to which IJC's process to develop and select Plan 2014 was consistent with essential elements of risk-informed decision-making, (2) actions IJC has taken to communicate with stakeholders about its implementation of Plan 2014 and stakeholder concerns regarding IJC's communication, and (3) stakeholder concerns about Plan 2014 and the extent to which IJC has developed a process to assess and adjust Plan 2014. GAO reviewed Plan 2014 and other IJC documents, interviewed IJC and federal officials and a nongeneralizable sample of 14 stakeholders, selected for a variety of user interests and stakeholder types. GAO is making three recommendations, including that the U.S. Section of the IJC work with its Canadian counterpart to ensure that the communication plan aligns with best practices and the adaptive management strategy fully incorporates key elements. IJC agreed with our recommendations. For more information, contact J. Alfredo Gómez at (202) 512-3841 or gomezj@gao.gov.
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  • Six Men Charged for Roles in Scheme to Defraud Businesses of Luxury Goods and Services
    In Crime News
    Six men were charged in an indictment unsealed on Wednesday for their alleged participation in a nation-wide scheme to defraud dozens of businesses across the United States of luxury goods and services announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department's Criminal Division and U.S. Attorney Andrew Lelling of the District of Massachusetts.
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    In U.S GAO News
    The Department of Defense (DOD) relies on contractors to provide a wide array of services, including support for management, information technology, and weapon systems. DOD obligated about $190 billion on service acquisitions in fiscal year 2019 (see figure). Department of Defense Obligations for Service Acquisitions by Military Department and Defense Agencies and Field Activities, Fiscal Year 2019 Since 2001, GAO has highlighted service acquisitions as an issue for oversight within the DOD Contract Management area in its High-Risk List. Among other things, the High-Risk List and GAO's prior work have identified that: DOD's service requirements reviews were narrowly focused on individual contracts rather than entire capability portfolios, DOD's efforts to use its inventory of contracted services to inform management decisions were hindered by data collection issues, and DOD's budget exhibits did not clearly identify service acquisitions. In October 2020, DOD issued a report to Congress describing its current mechanisms and plans for managing and overseeing service contracts. GAO found that this report addresses some of the key issues identified in GAO's High-Risk List, but does not address others. Requirement reviews. The DOD report summarizes guidance the department issued in January 2020 that links requirements reviews to budget trade-offs, and clarifies the relationship between service acquisition management and category management activities. Category management is an Office of Management and Budget-led, government-wide initiative to reorganize government spending around fewer, larger contracts and use the government's purchasing power to buy like a single enterprise. These efforts have the potential to improve how requirements reviews support budget trade-off decisions within and across capability portfolios. Inventory of contracted services. The DOD report discusses the department's recent transition to the government-wide system other federal agencies use to collect data for their inventories of contracted services, and explains that this transition is intended to reduce the burden of data collection for defense contractors and improve compliance. However, the report does not discuss how DOD plans to use this data to inform decision-making and workforce planning, the key issues GAO has identified in past work. Future-year spending plans. The DOD report does not discuss our finding in a prior report that DOD could improve its ability to strategically manage service acquisitions by improving visibility on future budgetary requirements. Instead, DOD's report states that DOD plans to address capability gaps in budget planning for service contracts in a separate effort in response to a provision in the National Defense Authorization Act for Fiscal Year 2020 that might address GAO's recommendations. DOD officials told GAO they are working to better understand that provision before initiating their effort. The Senate report on the National Defense Authorization Act for Fiscal Year 2020 included a provision for the Secretary of Defense to submit a report to the congressional defense committees on current mechanisms for overseeing defense service contracts, and for GAO to assess this report. DOD issued its report to Congress in the second week of October 2020. This GAO report assesses the extent to which that DOD report addresses service acquisition issues identified in GAO's High-Risk List and other products. GAO reviewed DOD's report to Congress on defense service acquisitions and GAO's past reports on defense service acquisitions, including GAO's 2019 High-Risk List and 11 other products issued between 2011 and 2018. GAO collected and assessed additional documentation from DOD offices and military departments, and interviewed officials from these offices and departments to collect additional information about DOD plans to improve service acquisitions. For more information, contact Timothy DiNapoli at (202) 512-4841 or DiNapoliT@gao.gov.
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    In U.S GAO News
    What GAO Found In March 2020, the Census Bureau (Bureau) delayed the start of field data collection because of COVID-19 safety, and then revised several operational timelines in response to the pandemic and Department of Commerce (Commerce) decisions. Nationally the Bureau reported completing more than 99 percent of nonresponse follow-up cases (households that have not responded to the census) by October 15, 2020. The Bureau attributes the use of technology as among the reasons it completed the work by this date. The Bureau, however, had lower completion percentages ranging between 94 and 99 for 10 local geographic areas, in part because of natural disasters and COVID-19. For example, according to the Bureau, in Shreveport, Louisiana, short-term closures stemming from the hurricane impacted data collection for 82,863 housing units. As a mitigation strategy, the Bureau shifted the Shreveport operation to telephone enumeration and brought in more than 1,200 enumerators from travel teams. Despite these efforts, the Bureau was unable to complete 22,588 cases in Shreveport before data collection ended. For these cases the Bureau will need to rely on alternate methods including imputation, which draws data from similar nearby households to determine whether a housing unit exists, whether it is occupied, and, if so, by how many people. In addition to the challenges brought on by natural disasters, the Bureau encountered other difficulties during nonresponse follow-up, such as, the inability of supervisors to reassign open cases in a timely fashion. GAO found that census field supervisors did not have the authority to reassign cases and had to wait for the field manager to make those reassignments. Bureau officials told GAO it would consider the reassignment of cases as it moves towards planning for the 2030 Census. To monitor nonresponse follow-up, the Bureau used quality control procedures, such as real-time monitoring of enumerator activities by supervisors and training assessments. However, GAO found the Bureau did not have proper controls in place, allowing some enumerators to work without having passed the required training assessment. The Bureau agreed that additional controls were necessary. The Bureau planned to count individuals living in group quarters, such as skilled-nursing and correctional facilities, between April 2, 2020, and June 5, 2020, but revised those dates to July 1, 2020, through September 3, 2020. The pandemic made it difficult to count group quarters. For example, Bureau staff found it challenging to locate a point of contact at some group quarters because facilities were closed due to the pandemic. Bureau officials told us that in December 2020 they decided to re-contact more than 24,000 out of approximately 272,000 group quarter facilities to collect data, and that imputation would be used to count individuals at the remaining facilities still reporting a zero population count. The Bureau is updating plans to assess operations and identify resulting lessons learned from the 2020 Census. As part of its planning for 2030, it will be important for the Bureau to assess the impact of the 2020 late design changes and the operations' challenges that arose. Why GAO Did This Study The 2020 Census was conducted under extraordinary circumstances. In response to the COVID-19 pandemic and related Commerce decisions, the Bureau made a series of late changes to the design of the census. As GAO previously reported, these changes introduced risks to the quality of data that the Bureau provides for congressional apportionment and redistricting purposes. GAO was asked to review the Bureau's implementation of the 2020 Census. This report assesses the Bureau's implementation of the: (1) nonresponse follow-up operation, (2) group quarters enumeration, and (3) plans to assess those operations. To address these objectives, GAO conducted a series of surveys of all 248 census offices during the collection of data for those operations. GAO also monitored the cost and progress of operations and interviewed census field supervisors for each operation.
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    In U.S GAO News
    In the years before the economic shock from the COVID-19 pandemic, the Financial Stability Oversight Council (FSOC) and others assessed the potential risks to financial stability that leveraged loans and collateralized loan obligation (CLO) securities may pose. Generally, leveraged loans are those made to businesses with poor credit and high debt, and CLO securities are backed by these loans. FSOC and others found that riskier borrower profiles and looser underwriting standards left leveraged lending market participants vulnerable to losses in the event of a downturn. After the COVID-19 shock in March 2020, loans suffered record downgrades and increased defaults, but the highest-rated CLO securities remained resilient. Although regulators monitoring the effects of the pandemic remain cautious, as of September 2020, they had not found that leveraged lending presented significant threats to financial stability. Based on regulators' assessments, leveraged lending activities had not contributed significantly to the distress of any large financial entity whose failure could threaten financial stability. Large banks' strong capital positions have allowed them to manage their leveraged lending exposures, and the exposure of insurers and other investors also appeared manageable. Mutual funds experienced redemptions by investors but were able to meet them in part by selling leveraged loan holdings. While this may have put downward pressure on already-distressed loan prices, based on regulators' assessments, distressed leveraged loan prices did not pose a potential threat to financial stability. Present-day CLO securities appear to pose less of a risk to financial stability than did similar securities during the 2007–2009 financial crisis, according to regulators and market participants. For example, CLO securities have better investor protections, are more insulated from market swings, and are not widely tied to other risky, complex instruments. FSOC monitors leveraged-lending-related risks primarily through its monthly Systemic Risk Committee meetings, but opportunities exist to enhance FSOC's abilities to respond to financial stability threats. FSOC identified leveraged lending activities as a source of potential risk to financial stability before the COVID-19 shock and recommended continued monitoring and analysis. However, FSOC does not conduct tabletop or similar scenario-based exercises where participants discuss roles and responses to hypothetical emergency scenarios. As a result, FSOC is missing an opportunity to enhance preparedness and test members' coordinated response to financial stability risks. Further, as GAO reported in 2016, FSOC does not generally have clear authority to address broader risks that are not specific to a particular financial entity, such as risks from leveraged lending. GAO recommended that Congress consider better aligning FSOC's authorities with its mission to respond to systemic risks, but Congress had not done so as of September 2020. GAO maintains that changes such as broader designation authority would help FSOC respond to risks from activities that involve many regulators, such as leveraged lending. The market for institutional leveraged loans grew from an estimated $0.5 trillion in 2010 to $1.2 trillion in 2019, fueled largely by investor demand for CLO securities. Some observers and regulators have drawn comparisons to the pre-2008 subprime mortgage market, noting that loan origination and securitization may similarly spread risks to the financial system. These fears are being tested by the COVID-19 pandemic, which has significantly affected leveraged businesses. This report examines assessments by regulators, FSOC, and others—both before and after the COVID-19 shock to the economy—of the potential risks to financial stability stemming from leveraged lending activities, and the extent to which FSOC monitors and responds to risks from broad-based activities like leveraged lending, among other objectives. GAO examined agency and private data on market size and investor exposures; reviewed agency, industry, and international reports; and interviewed federal financial regulators and industry participants. GAO recommends that the Secretary of the Treasury, as Chairperson of FSOC, conduct scenario-based exercises intended to evaluate capabilities for responding to crises. GAO also reiterates its 2016 recommendation (GAO-16-175) that Congress consider legislative changes to align FSOC's authorities with its mission. FSOC neither agreed nor disagreed with the recommendation, but said that it would take further actions if it determined necessary. For more information, contact Michael E. Clements at (202) 512-8678 or ClementsM@gao.gov.
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