Justice Department Seeks to Shut Down Illinois Tax Return Preparer

The United States has filed a complaint in the U.S. District Court for the Northern District of Illinois seeking to bar a Rockford area tax return preparer from preparing federal income tax returns for others.

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  • Long Island Car Wash Owner Pleads Guilty to Tax Evasion
    In Crime News
    A Coram, New York, car wash owner pleaded guilty today to tax evasion, announced Acting Deputy Assistant Attorney General Stuart M. Goldberg of the Justice Department’s Tax Division and Acting U.S. Attorney Seth D. DuCharme for the Eastern District of New York. According to court documents and statements made in court, Nicholas Pascullo, 56, operated a car wash and detailing business called H2O Car Wash & Exotic Detailing LLC (H2O), based in Lindenhurst, New York. From 2012 to 2017, Pascullo attempted to evade income and employment taxes owed by him and H2O for calendar years 2012 through 2016. As part of the scheme, Pascullo filed false partnership and individual income tax returns with the IRS that underreported the gross receipts earned by H2O and the flow-through income received by Pascullo and his partners.
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  • Military Personnel: Perspectives on DOD’s and the Military Services’ Use of Borrowed Military Personnel
    In U.S GAO News
    Policies on the use of borrowed military personnel vary among military services. Borrowed military personnel refers to military personnel used for duties outside their assigned positions, such as security protection. DOD policy acknowledges that there may be instances in which military personnel can be used to appropriately satisfy a near-term demand but that DOD must be vigilant in ensuring that military personnel are not inappropriately utilized, particularly in a manner that may degrade readiness. Additionally, the Army and the Marine Corps have their own policies that describes how military personnel may be used on a temporary basis. DOD and the Army, Navy, and Air Force do not centrally track their use of borrowed military personnel, nor do they assess any impacts of that use on the readiness of units and personnel to accomplish their assigned missions. According to DOD and Army officials, the relatively limited use of borrowed military manpower, their limited impacts on readiness, and the existence of other readiness reporting mechanisms serve to obviate the need to collect and analyze this information centrally—especially given the resources that would be required to establish and maintain such a reporting process. The House Armed Services Committee has questioned whether DOD continues to divert servicemembers from their unit assignments to perform nonmilitary functions that could be performed by civilian employees. House Report 116-120, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to assess the levels and impacts of borrowed military personnel. This report examines DOD's and the military services' policies on the use of borrowed military personnel, the tracking and reporting of their use of borrowed military personnel, and any impacts of that use on readiness. For more information, contact Cary Russell at (202)512-5431 or RussellC@gao.gov.
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  • Former Police Officer and Gangster Disciples Member Sentenced to Prison
    In Crime News
    A former DeKalb County, Georgia, police officer and member of the Gangster Disciples was sentenced to 15 years in prison followed by five years of supervised release for racketeering conspiracy involving murder, announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division and U.S. Attorney Byung J. “BJay” Pak of the Northern District of Georgia.
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  • Immigration Detention: Actions Needed to Improve Planning, Documentation, and Oversight of Detention Facility Contracts
    In U.S GAO News
    In fiscal year 2019, U.S. Immigration and Customs Enforcement (ICE) had detention contracts or agreements with 233 facilities, 185 of which it used to hold detainees, as shown below. U.S. Immigration and Customs Enforcement (ICE) Detention Space Acquisition Methods, Fiscal Year 2019 Acquisition method Total facilities Facilities that held detainees Percentage of average daily population held in facility Intergovernmental service agreement 133 108 59 U.S. Marshals Service rider 85 62 17 Federal Acquisition Regulation-based contract 15 15 24 Total 233 185 100 Source: GAO analysis of ICE data. | GAO-21-149 ICE primarily uses intergovernmental service agreements (IGSA) to acquire detention space. Officials said IGSAs offer several benefits over contracts, including fewer requirements for documentation or competition. ICE has a process for obtaining new detention space, but it did not follow this process for most of its recent acquisitions and does not have a strategic approach to using guaranteed minimum payments in its detention contracts and agreements. From fiscal year 2017 through May 11, 2020, ICE entered into 40 contracts and agreements for new detention space. GAO's review of ICE's documentation found that 28 of 40 of these contracts and agreements did not have documentation from ICE field offices showing a need for the space, outreach to local officials, or the basis for ICE's decisions to enter into them, as required by ICE's process. Until ICE consistently uses its process, it will not have reasonable assurance that it is making cost-effective decisions that best meet its operational needs. ICE has increasingly incorporated guaranteed minimum payments into its contracts and agreements, whereby ICE agrees to pay detention facility operators for a fixed number of detention beds regardless of whether it uses them. However, ICE has not taken a strategic approach to these decisions and has spent millions of dollars a month on unused detention space. Planning for detention space needs can be challenging, according to ICE officials, because the agency must respond to factors that are dynamic and difficult to predict. A strategic approach to using guaranteed minimums could help position ICE to balance these factors and make more effective use of federal funds. ICE relies on Contracting Officer's Representatives (COR) to oversee detention contracts and agreements, but the COR's supervisory structure—where field office management, rather than headquarters, oversee COR work and assess COR performance—does not provide sufficient independence for effective oversight. CORs in eight of 12 field offices identified concerns including lacking resources or support, as well as supervisors limiting their ability to use contract enforcement tools and bypassing CORs' oversight responsibilities in contracting matters. Revising its supervisory structure could help ICE ensure that detention contract and agreement terms are enforced. The Department of Homeland Security's ICE detained approximately 48,500 foreign nationals a day, on average, for 72 hours or more in fiscal year 2019. ICE was appropriated about $3.14 billion in fiscal year 2020 to operate the immigration detention system. ICE has three ways of acquiring detention space—IGSAs with state or local government entities; agreements with Department of Justice U.S. Marshals Service to join an existing contract or agreement (known as a “rider”); or contracts. This report examines (1) what data show about the characteristics of contracts and agreements; (2) the extent to which ICE developed and implemented processes and a strategic approach to acquire space; and (3) the extent to which ICE has overseen and enforced contracts and agreements. GAO reviewed documentation of acquisition and oversight efforts at facilities used to hold detainees for 72 hours or more; analyzed ICE data for the last 3 fiscal years—2017 through 2019; conducted site visits to new and long-standing detention facilities; and interviewed ICE officials. GAO is making five recommendations, including that ICE include stakeholder input and document decision-making for new detention space acquisitions; implement a strategic approach to using guaranteed minimums; and revise its supervisory structure for contract oversight. DHS concurred with four recommendations and disagreed with revising its supervisory structure. GAO believes the recommendation remains valid, as discussed in the report. For more information, contact Rebecca Gambler at (202) 512-8777 or gamblerr@gao.gov.
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    In Crime News
    COLAS Djibouti SARL (Colas Djibouti) ¬has agreed to resolve for $3.9 million civil allegations that it violated the False Claims Act by selling substandard concrete used to construct U.S. Navy airfields in the Republic of Djibouti, the Department of Justice announced today. Colas Djibouti, a French limited liability company, is a wholly owned subsidiary of Colas SA, a French civil engineering company.
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  • Child Care: Subsidy Eligibility and Receipt, and Wait Lists
    In U.S GAO News
    An estimated 1.9 million children received child care subsidies in fiscal year 2017, representing approximately 14 percent of all children estimated to be eligible under federal rules – and 22 percent of all children estimated to be eligible under state rules -- in an average month. These figures are from the Department of Health and Human Services' (HHS) analysis of fiscal year 2017 data, the most recent year for which such analysis is available. Generally, fewer families qualify for subsidies under state eligibility rules than under federal eligibility rules since most states use flexibility provided by HHS to set their income eligibility limits below the federal maximum. Health and Human Services’ Estimated Number of Children Eligible Under Federal and State Rules, and Estimated Number Receiving Child Care Subsidies, Fiscal Year 2017 GAO found that the extent to which children who meet federal child care eligibility requirements also meet state eligibility requirements varies by state as does the share of eligible children who receive Child Care and Development Fund (CCDF) subsidies. Under state requirements, the CCDF subsidy receipt rate ranged from 5 percent to 32 percent of eligible children. Under federal requirements, the CCDF subsidy receipt rate ranged from 4 percent to 18 percent of federally eligible children. According to HHS estimates, among families who met federal child care eligibility criteria, children from lower-income families were more likely to receive child care subsidies compared to children from higher-income families. These estimates also showed that preschool-age children were more likely to receive subsidies compared to older, school-age children and that Black children were more likely to receive subsidies compared to children of other races / ethnicities. As reported in previous GAO work, states have varied strategies for managing their wait lists. Some states have a single statewide list while others have sub-state lists that allow sub-state areas to have their own policies. Some states conduct full or partial eligibility determinations prior to placing families on wait lists, and many states require periodic reviews of their wait lists. According to state administrators GAO interviewed, the strategies that states use to manage their wait lists pose certain challenges. For example, state administrators told GAO that sub-state lists can contain duplication, making state-wide estimates of families in need difficult. And administrators told GAO that maintaining up-to-date contact information is challenging, in part due to insufficient technology. The Coronavirus Disease 2019 (COVID-19) pandemic has impacted child care in several ways, including cost, eligibility and subsidy receipt, according to some members of the National Association of State Child Care Administrators (NASCCA). These members told GAO that despite initial declines in the number of families receiving subsidies, some states are seeing their child care costs increase due to, for example, more school-age children using full-day care; increased expenses for additional health and safety measures; paying for more absences and for parent co-pays; and families applying for subsidies for relative care. NASCCA members noted that some states have made changes to policies to help families and providers. To help families access child care, some states have increased income eligibility for subsidies to 85 percent of the state median income; temporarily waived work requirements to receive subsidies; and covered family fees for parents when a family must quarantine due to a COVID-19 exposure. Changes to some state policies aimed at helping providers include providing funds to providers to help with increased costs, such as personal protective equipment (PPE) and additional cleaning supplies; paying providers based on their pre-COVID-19 level authorized enrollments; and raising the state's provider reimbursement rate to help providers cover overhead costs. The federal child care subsidy program known as CCDF is one of the primary sources of federal funding dedicated to assisting low-income families with child care who are working or participating in education and training. Funding for CCDF, which is administered by HHS at the federal level, comes from two funding streams: discretionary funding in the form of block grants authorized by the Child Care and Development Block Grant (CCDBG Act) of 1990, as amended, and mandatory and matching funding authorized under section 418 of the Social Security Act. CCDF was appropriated more than $8 billion in federal funds in 2019. For more information, contact Kathryn Larin at (202) 512-7215 or larink@gao.gov.
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  • Duff to Retire as Administrative Office Director; Judge Mauskopf Named as Successor
    In U.S Courts
    James C. Duff has announced he will retire as the director of the Administrative Office of the U.S. Courts on Jan. 31. Chief Justice John G. Roberts, Jr., has appointed Chief Judge Roslynn R. Mauskopf, of the Eastern District of New York, as his successor, effective Feb. 1.
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    On October 1, President Donald J. Trump signed into law a continuing resolution that contains the Antitrust Criminal Penalty Enhancement and Reform Permanent Extension Act (the “Act”).  The Act reauthorizes the Antitrust Criminal Penalty Enhancement and Reform Act (ACPERA) and repeals the sunset provision therein.
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    Criminal complaints have been unsealed charging two Ecuadorian citizens for their alleged roles in a bribery and money laundering scheme involving Ecuador’s public police pension fund (ISSPOL).
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  • Taxpayer Service: IRS Could Improve the Taxpayer Experience by Using Better Service Performance Measures
    In U.S GAO News
    The Internal Revenue Service's (IRS) mission and strategic plan state expectations for IRS to improve the taxpayer experience and services it provides. However, IRS and its divisions that manage programs serving the largest taxpayer groups—the Wage and Investment (W&I) and the Small Business/Self-Employed (SB/SE) divisions—did not have performance goals to specify the desired improvements. For example, W&I aligned its service programs to IRS's strategic objectives for taxpayer services that state broad types of management activities such as monitoring the taxpayer experience and addressing issues. However, it did not have performance goals that specify outcomes to improve the taxpayer experience, such as reducing taxpayer wait times for telephone assistance. Because IRS and these two divisions do not have performance goals for improving the taxpayer experience, IRS does not have related performance measures. IRS has many performance measures—including more than 80 for W&I and SB/SE—for assessing the services it provides, such as related to timeliness and accuracy of information provided to taxpayers. However, these existing measures do not assess improvements to the taxpayer experience, such as whether tax processes were simpler or specific services met taxpayers' needs. The division-level measures also lack targets for improving the taxpayer experience. Further, the existing measures do not capture all of the key factors identified in Office of Management and Budget guidance for how customers experience federal services, including customer satisfaction and how easy it was to receive the services. As a result, IRS does not have complete information about how well it is satisfying taxpayers and improving their experiences. IRS analyzes its taxpayer service measures to compare performance with targets but the analyses provide few insights and no recommendations to improve the taxpayer experience, such as to provide more timely tax filing guidance. Also, IRS does not have a process to use service measures to guide decisions on allocating resources to improve the taxpayer experience. As a result, IRS is challenged to use performance data to balance resource allocation for efforts to improve the taxpayer experience compared with other IRS efforts. Finally, IRS reports limited information to the public about performance related to the taxpayer experience for transparency and accountability. The table below summarizes important management practices that IRS did not fully follow to provide taxpayers a top-quality service experience. According to IRS, providing top-quality service is a critical part of its mission to help taxpayers understand and meet their tax responsibilities. Congress, the National Taxpayer Advocate, and the administration have recognized the importance of improving how taxpayers experience IRS services. Setting goals and objectives with related performance measures and targets are important tools to focus an agency's activities on achieving mission results. GAO was asked to review IRS's customer service performance measures. This report assesses IRS's (1) goals and objectives to improve the taxpayer experience; (2) performance measures to support improved experiences; and (3) use of performance information to improve the experience, allocate resources, and report performance. To assess IRS's goals, measures, targets, and use of them, GAO compared IRS's practices to key practices in results-oriented management. GAO is making 7 recommendations, including that IRS identify performance goals, measures, and targets; as well as analyze performance; develop processes to make decisions on resources needed; and report performance on improving the taxpayer experience. IRS indicated that it generally agreed with the recommendations, but that details around their implementation were under consideration and would be provided at a later date. For more information, contact Jessica Lucas-Judy at (202) 512-9110 or LucasJudyJ@gao.gov.
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    Good morning.  Today, I’m joined by FBI Director Chris Wray and, remotely, by the  Acting U.S. Attorney for the Eastern District of New York, Seth DuCharme, to announce charges against eight individuals for acting as agents of the People’s Republic of China while taking part in an illegal Chinese law enforcement operation known as Fox Hunt here in the United States.  Five of these individuals were arrested across the country this morning.  The rest, we believe, are in China.
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  • Department of Defense: Eating Disorders in the Military
    In U.S GAO News
    The Department of Defense (DOD) screens for eating disorders for all applicants entering into the military but does not specifically screen servicemembers for eating disorders after entrance. However, after joining the military, servicemembers receive annual health screenings, and medical personnel may be able to diagnose eating disorders during in-person physical exams. Service branch behavioral health specialists told GAO that DOD medical personnel are trained to notice signs of eating disorders, such as changes in vital signs and emaciated appearance. DOD is examining ways to improve its screening of eating disorders in the military and recently expanded the available research funding for eating disorders in its Peer-Reviewed Medical Research Program (PRMRP). DOD provides health care services to approximately 9.5 million eligible beneficiaries, including services to treat those diagnosed with eating disorders, through TRICARE, DOD’s regionally structured health care system. Servicemembers can obtain these services at military treatment facilities—referred to as direct care—or receive care purchased from civilian providers—referred to as purchased care. DOD officials told us that the specialized level of care necessary to treat eating disorders is available to TRICARE beneficiaries through purchased care, rather than direct care. The Defense Health Agency (DHA), which oversees the TRICARE program, uses two contractors to develop regional provider networks. According to the two TRICARE contractors’ data for purchased care, as of spring 2020, there were 166 eating disorder facilities located in 32 states throughout the country and the District of Columbia. The facilities vary by geographic location, population served, and level of treatment provided: Geography: About half of the 166 facilities (79) are located in the following five states: California (24), Florida (18), Illinois (15), Texas (13), and Virginia (nine).  Population: Of the 166 eating disorder facilities, over three-quarters provide treatment to both adult (132 facilities) and child and adolescent (132 facilities) populations. Level of Treatment: Most facilities provide inpatient hospitalization programs, which are for serious cases requiring medical stabilization (81 facilities); partial hospitalization, which are day programs providing treatment 5 to 7 days a week (133 facilities); or intensive outpatient programs, which are treatment programs providing therapy 2 to 6 days a week (107 facilities). About one-fifth of the facilities (35) provide residential treatment services, which are living accommodations providing intensive therapy and 24-hour supervision. TRICARE contractors have met with some challenges entering into contracts with eating disorder treatment facilities in certain areas of the country, according to DHA officials and both contractors. However, both contractors told GAO they consider it their responsibility to ensure beneficiaries receive the care they need regardless of the location of the facility. No access-to-care complaints related to eating disorder treatment were reported by TRICARE beneficiaries, according to the most recent DHA data for years 2018 through 2019. Eating disorders are complex conditions affecting millions of Americans and involve dangerous eating behaviors, such as the restriction of food intake. They can have a severe impact on heart, stomach, and brain functionality, and they significantly raise the risk of mortality. Many with eating disorders also experience co-occurring conditions such as depression. Research has yielded a range of estimates of the number of servicemembers with an eating disorder, due to differences in research methods. For example, a 2018 DOD study concluded that servicemembers likely experienced eating disorders at rates that are comparable to rates in the general population, while other survey-based research suggested the number of servicemembers with eating disorders may be higher than those with a medical diagnoses of such disorders. The potential effects that eating disorders can have on the health and combat readiness of servicemembers and their dependents underscores the importance of screening and treating this population. GAO was asked to provide information on eating disorders among servicemembers and their dependents. To describe how DOD screens for eating disorders among servicemembers, GAO reviewed DOD policies related to health screening and interviewed behavioral health specialists from the military branches. To understand approaches and challenges with implementing screening in a military environment, any planned or ongoing DOD-sponsored research related to this topic, and available eating disorder treatment, GAO interviewed representatives from the Eating Disorder Coalition, Uniformed Services University of Health Sciences, and the University of Kansas. To describe how DOD provides eating disorder treatment to servicemembers and their dependents, GAO interviewed DHA officials and TRICARE contractors and reviewed the TRICARE policy manual to identify the types of eating disorder diagnoses and treatments that are covered through direct and purchased care. GAO received data from the two TRICARE contractors related to the availability of eating disorder treatment services as of spring 2020. For more information, contact Sharon Silas at (202) 512-7114 or Silass@gao.gov.
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  • Justice Department Settles with Gates Chili Central School District to Ensure Equal Access for Students with Service Animals
    In Crime News
    The Justice Department announced today that it reached an agreement with the Gates Chili Central School District in Rochester, New York, to resolve the department’s lawsuit alleging disability discrimination in violation of the Americans with Disabilities Act (ADA).
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  • K-12 Education: Observations on States’ School Improvement Efforts
    In U.S GAO News
    Many states use flexibilities in the Elementary and Secondary Education Act (ESEA), as amended, in identifying low-performing schools and student subgroups (e.g., students from major racial and ethnic groups and low-income students) that need support and improvement. For example, states must identify all public high schools failing to graduate at least one-third of their students. According to GAO's state plan analysis, four states used ESEA's flexibilities to set higher graduation rates (i.e., 70-86 percent) for purposes of state accountability. Similarly, while ESEA requires states to identify schools in which students in certain subgroups are consistently underperforming, 12 states assess the performance of additional student subgroups. Although states are generally required to set aside a portion of their federal education funding for school improvement activities (see figure), states have some discretion in how they allocate these funds to school districts. According to GAO's survey, 27 states use a formula to allocate funds. GAO also found that in at least 34 states, all school districts that applied for federal funds received them in school year 2018-2019, but states had discretion regarding which schools within those districts to fund and at what level. Funding for School Improvement through the Elementary and Secondary Education Act (ESEA) Title I, Part A Note: For more details, see figure 2 in GAO-21-199. A majority of the 50 states and the District of Columbia responding to our survey reported having at least moderate capacity to support school districts' school improvement activities. Education provides various types of technical assistance to build local and state capacity such as webinars, in-person training, guidance, and peer networks. About one-half of states responding to GAO's survey sought at least one type of technical assistance from Education's program office and various initiatives, and almost all of those found it helpful. For example, Education's Regional Educational Laboratories (REL) help states use data and evidence, access high-quality research to inform decisions, identify opportunities to conduct original research, and track progress over time using high-quality data and methods. Several states most commonly reported finding the following assistance by RELs to be helpful: in-person training (26), webinars (28), and reviews of existing research studies to help select interventions (24). The Elementary and Secondary Education Act (ESEA) requires states to have statewide accountability systems to help provide all children significant opportunity to receive a fair, equitable, and high-quality education, and to close educational achievement gaps high-quality education. These systems must meet certain federal requirements, but states have some discretion in how they design them. For example, ESEA requires states to identify low-performing schools and student subgroups for support and improvement. Senate Report 115-289 accompanying the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2019, includes a provision for GAO to review states' school improvement activities. This report addresses (1) how states identify and allocate funds for schools identified for support and improvement; and (2) the extent to which states have capacity to support districts' school improvement activities and how helpful states find Education's technical assistance. GAO analyzed the most current approved state accountability plans from all 50 states and the District of Columbia as of September 2020. The information in these plans predates the COVID-19 pandemic and represents a baseline from which to compare school improvement activities going forward. GAO also surveyed and received responses from all 50 states and the District of Columbia. GAO also conducted follow-up interviews with officials in three states selected based on variation in reported capacity and geographic diversity. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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  • Justice Department Settles with Minnesota-Based Company to Resolve Discrimination Claims Under the Immigration and Nationality Act
    In Crime News
    The Department of Justice announced today that it reached a settlement with WinCraft, Incorporated (WinCraft), a Minnesota-based sports manufacturing company with locations in Iowa, Florida, and Washington. The settlement resolves claims that WinCraft violated the Immigration and Nationality Act (INA) by requiring lawful permanent residents to provide specific work authorization documentation without any legal justification because of their immigration status. 
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  • Owner of Seafood Processor Sentenced to Prison for Tax Evasion
    In Crime News
    A Rhode Island man was sentenced to three years in prison today for tax evasion, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division, U.S. Attorney Aaron L. Weisman for the District of Rhode Island, and Special Agent in Charge Kristina O’Connell of IRS Criminal Investigation.
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    In Crime News
    The Justice Department, in an announcement by Assistant Attorney General for the Civil Rights Division Eric S. Dreiband, Principal Deputy Assistant Attorney General of the Office of Justice Programs (OJP) Katharine T. Sullivan, and U.S. Attorney for the District of Minnesota Erica H. MacDonald, unveiled a new National Response Center Initiative and offered the assistance to the Minneapolis Police Department (MPD) to support law enforcement, and review, enhance and reform policies and practices to prevent the use of excessive force. The BJA Law Enforcement Training and Technical Assistance Response Center will be a national resource for all state, local, and tribal law enforcement agencies.
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  • Riverside, California Man Who Admitted Planning Mass Casualty Attacks and Purchasing Firearms Later Used in 2015 Terrorist Attack in San Bernardino Ordered to Serve 20-Year Federal Prison Sentence
    In Crime News
    A Riverside man was sentenced today to 20 years in federal prison for conspiring to commit terrorist attacks in the Inland Empire and for providing assault rifles later used in the 2015 San Bernardino terrorist attack that killed 14 people.
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  • Private Health Insurance: Markets Remained Concentrated through 2018, with Increases in the Individual and Small Group Markets
    In U.S GAO News
    Enrollment in private health insurance plans in the individual (coverage sold directly to individuals), small group (coverage offered by small employers), and large group (coverage offered by large employers) markets has historically been highly concentrated among a small number of issuers. GAO found that this pattern continued in 2017 and 2018. For example: For each market in 2018, at least 43 states (including the District of Columbia) were highly concentrated. Overall individual and small group markets have become more concentrated in recent years. The national median market share of the top three issuers increased by approximately 8 and 5 percentage points, respectively, from 2015 through 2018. With these increases, the median concentration was at least 94 percent in both markets in 2018. Number of States and District of Columbia Where the Three Largest Issuers Had at Least 80 Percent of Enrollment, by Market, 2011-2018 GAO found similar patterns of high concentration across the 39 states in 2018 that used federal infrastructure to operate individual market exchanges— marketplaces where consumers can compare and select among insurance plans sold by participating issuers—established in 2014 by the Patient Protection and Affordable Care Act (PPACA) and known as federally facilitated exchanges. From 2015 through 2018, states that were already highly concentrated became even more concentrated, often because the number of issuers decreased or the existing issuers accrued the entirety of the market share within a state. In 2017 and 2018 all 39 states were highly concentrated. GAO received technical comments on a draft of this report from the Department of Health and Human Services and incorporated them as appropriate. GAO previously reported that, from 2011 through 2016, enrollment in the individual, small group, and large group health insurance markets was concentrated among a few issuers in most states (GAO-19-306). GAO considered states' markets or exchanges to be highly concentrated if three or fewer issuers held at least 80 percent of the market share. GAO also found similar concentration on the health insurance exchanges established in 2014 by PPACA. A highly concentrated health insurance market may indicate less issuer competition and could affect consumers' choice of issuers and the premiums they pay for coverage. PPACA included a provision for GAO to periodically study market concentration. This report describes changes in the concentration of enrollment among issuers in the overall individual, small group, and large group markets; and individual market federally facilitated exchanges. GAO determined market share in the overall markets using enrollment data from 2017 and 2018 that issuers are required to report annually to the Centers for Medicare & Medicaid Services (CMS). GAO determined market share in the individual market federally facilitated exchanges in 2018 using enrollment data from CMS. For all analyses, GAO used the latest data available. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.
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  • Private Health Coverage: Results of Covert Testing for Selected Offerings
    In U.S GAO News
    GAO performed 31 covert tests to selected sales representatives and stated that we had pre-existing conditions, such as diabetes or heart disease, and we requested coverage for these conditions to see if the sales representative directed GAO's undercover agents to a comprehensive Patient Protection and Affordable Care Act (PPACA)-compliant plan, or a PPACA-exempt plan that does not cover what we requested. As part of these tests, GAO gauged whether sales representatives engaged in potentially deceptive practices, such as making false or misleading statements about coverage or omitting material information about coverage. The results of the covert tests ranged from sales representatives appropriately explaining to GAO's undercover agents that a PPACA-exempt plan would not cover the pre-existing condition the undercover agents stated that they had, to engaging in potentially deceptive marketing practices that misrepresented or omitted information about the products they were selling. Specifically, in 21 of 31 covert tests, the sales representative appropriately referred undercover agents to a PPACA-compliant plan. In two of 31 covert tests, the sales representatives did not appear to engage in deceptive marketing practices but were not always consistent or clear in their explanation of the type of coverage and plans they were selling. In the remaining eight of 31 covert tests, the sales representatives engaged in potentially deceptive marketing practices, such as claiming the pre-existing condition was covered when the health plan documents GAO received after purchase said otherwise. GAO plans to refer these eight cases of potential deceptive marketing practices to the Federal Trade Commission (FTC) and corresponding state insurance commissioners' offices for follow-up as appropriate. Millions of Americans obtain health insurance coverage in the individual market, which consists mainly of private plans sold directly to consumers without access to group coverage. While generally regulated by states, starting in 2014, PPACA established a number of new federal requirements for the individual health insurance market. For example, PPACA prohibited insurers from excluding coverage or charging higher premiums for pre-existing conditions and required that individual market plans cover a set of essential health benefits, including coverage for mental health and substance abuse disorder services, prescription drugs, and maternity and newborn care. Certain types of health coverage arrangements that can be sold directly to consumers do not have to comply with some or all of PPACA's individual market requirements and, as a result, may be less expensive, but also offer more limited benefits compared to PPACA-compliant plans. Recent changes to federal law and regulations could result in the increased use of PPACA-exempt health coverage arrangements as alternatives to PPACA-compliant plans in the individual market. For example, in 2018, federal regulations expanded the availability of short term, limited duration insurance (STLDI) plans, a type of PPACA-exempt arrangement. In addition, starting January 1, 2019, individuals who fail to maintain "minimum essential coverage," as required by PPACA, no longer face a tax penalty. Further, the devastating economic effects of the Coronavirus Disease 2019 (COVID-19) pandemic could create additional demand for affordable health coverage, including PPACA-exempt plans.  With these changes, and because of their lower relative costs, PPACA-exempt health coverage arrangements may be attractive to consumers, particularly those who find it difficult to afford PPACA-compliant plans. However, such arrangements generally do not need to follow PPACA's requirement that plans in the individual market be presented to consumers in defined categories outlining the extent to which they are expected to cover medical care. As a result, depending on how they are marketed and sold, PPACA-exempt arrangements could present risks for consumers, if, for example, they buy them mistakenly believing that coverage is as comprehensive as for PPACA-compliant plans. GAO was asked to obtain insights on the marketing and sales practices of insurance sales representatives who sell PPACA-exempt plans. In this report, GAO describes the results of covert tests we conducted involving selected sales representatives, when contacted by individuals stating that they had pre-existing conditions. In this regard, GAO agents performed a number of covert tests (i.e., undercover phone calls) from November 2019 through January 2020 posing as individuals needing to purchase health insurance to cover pre-existing conditions. GAO also discussed the marketing and oversight of PPACA-exempt arrangements with senior officials from federal agencies, including the FTC, and Centers of Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS), as well as the National Association of Insurance Commissioners (NAIC)5. GAO provided a draft of this product to FTC, HHS, and NAIC for review and comment. FTC, HHS, and NAIC provided technical comments, which GAO incorporated as appropriate. HHS provided additional written comments on a draft of this report. For more information, contact Seto Bagdoyan at (202)-6722 or bagdoyans@gao.gov.
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