LPR admits to smuggling fentanyl and heroin through Laredo

A 37-year-old legal permanent resident (LPR) of Mexico has pleaded guilty to participating in a drug importation conspiracy

Read full article at: https://www.justice.gov May 12, 2021

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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DHA's August 2019 policy standardized processes for managing health care quality in the Military Health System, which superseded the policies of each of the military services (Air Force, Army, and Navy).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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    GAO found that the Patient-Centered Outcomes Research Institute (PCORI)—a federally funded, nonprofit corporation—and the Department of Health and Human Services (HHS) have continued to perform comparative clinical effectiveness research (CER) activities required by law since our prior report issued in 2015. CER evaluates and compares health outcomes, risks, and benefits of medical treatments, services, or items. The requirements direct PCORI and HHS to, among other things, fund CER and disseminate and facilitate the implementation of CER findings. GAO's analysis of PCORI and HHS documents show that they allocated a total of about $3.6 billion for CER activities and program support during fiscal years 2010 through 2019 from the Patient Centered Outcomes Research Trust Fund (Trust Fund). Specifically, PCORI allocated about $2 billion for research awards and another $542 million for other awards, to be paid over multiple years. HHS allocated about $598 million for activities such as the dissemination and implementation of CER findings. PCORI and HHS also allocated about $470 million for program support. PCORI and HHS Allocations for Comparative Clinical Effectiveness Research (CER) Activities, Fiscal Years 2010 through 2019 aTotals may not add up due to rounding. bPCORI and HHS allocated $457 million and $13 million for program support, respectively. PCORI assessed the effectiveness of its activities using performance measures and targets. Since fiscal year 2017, when early CER projects were completed, PCORI officials reported that the institute met its performance targets, such as an increased number of research citations of its CER findings in news and online sources. HHS described accomplishments or assessed the effectiveness of its dissemination and implementation activities. PCORI and HHS officials told GAO they are planning comprehensive evaluations of their CER dissemination and implementation activities as part of their strategic plans for the next 10 years. The 2010 Patient Protection and Affordable Care Act (PPACA) authorized establishment of PCORI to conduct CER and improve its quality and relevance. PPACA also established new requirements for HHS to, among other things, disseminate findings from federally funded CER and coordinate federal programs to build data capacity for this research. To fund CER activities, PPACA established the Trust Fund, which provided a total of about $3.6 billion to PCORI and HHS for CER activities during fiscal years 2010 through 2019. The Further Consolidated Appropriations Act, 2020, added new CER requirements and extended funding at similar levels through fiscal year 2029. PPACA and the Appropriations Act 2020 included provisions that GAO review PCORI and HHS's CER activities. This report describes (1) the CER activities PCORI and HHS carried out to meet legislative requirements, (2) how PCORI and HHS allocated funding to those CER activities, and (3) PCORI and HHS efforts to evaluate the effectiveness of their CER dissemination and implementation activities, such as changes in medical practice. GAO reviewed legislative requirements and PCORI and HHS documentation and data for fiscal years 2010-2019. GAO also interviewed PCORI and HHS officials and obtained information from nine selected stakeholder groups that were familiar with PCORI's or HHS's CER activities. These groups included payer, provider, and patient organizations. GAO incorporated technical comments from PCORI and HHS as appropriate. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.
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    In U.S GAO News
    Under the Jones Act, vessels carrying merchandise between two points in the U.S. must be built and registered in the United States. Developers are planning a number of offshore wind projects along the U.S. east coast, where many states have set targets for offshore wind energy production. Stakeholders described two approaches to using vessels to install offshore wind energy projects in the U.S. Either approach may lead to the construction of new vessels that comply with the Jones Act. Under one approach, a Jones Act-compliant wind turbine installation vessel (WTIV) would carry components from a U.S. port to the site and also install the turbines. WTIVs have a large deck, legs that allow the vessel to lift out of the water, and a tall crane to lift and place turbines. Stakeholders told GAO there are currently no Jones Act-compliant vessels capable of serving as a WTIV. One company, however, has announced a plan to build one. Under the second approach, a foreign-flag WTIV would install the turbines with components carried to the site from U.S. ports by Jones Act-compliant feeder vessels (see figure). While some potential feeder vessels exist, stakeholders said larger ones would probably need to be built to handle the large turbines developers would likely use. Example of an Offshore Wind Installation in U.S. Waters Using a Foreign-Flag Installation Vessel and Jones Act-Compliant Feeder Vessels Stakeholders identified multiple challenges—which some federal programs address—associated with constructing and using Jones Act-compliant vessels for offshore wind installations. For example, stakeholders said that obtaining investments in Jones Act-compliant WTIVs—which may cost up to $500 million—has been challenging, in part due to uncertainty about the timing of federal approval for projects. According to officials at the Department of the Interior, which is responsible for approving offshore wind projects, the Department plans to issue a decision on the nation's first large-scale offshore wind project in December 2020. Some stakeholders said that if this project is approved, investors may be more willing to move forward with vessel investments. While stakeholders also said port infrastructure limitations could pose challenges to using Jones Act-compliant vessels for offshore wind, offshore wind developers and state agencies have committed to make port investments. Offshore wind, a significant potential source of energy in the United States, requires a number of oceangoing vessels for installation and other tasks. Depending on the use, these vessels may need to comply with the Jones Act. Because Jones Act-compliant vessels are generally more expensive to build and operate than foreign-flag vessels, using such vessels may increase the costs of offshore wind projects. Building such vessels may also lead to some economic benefits for the maritime industry. A provision was included in statute for GAO to review offshore wind vessels. This report examines (1) approaches to use of vessels that developers are considering for offshore wind, consistent with Jones Act requirements, and the extent to which such vessels exist, and (2) the challenges industry stakeholders have identified associated with constructing and using such vessels to support U.S. offshore wind, and the actions federal agencies have taken to address these challenges. GAO analyzed information on vessels that could support offshore wind, reviewed relevant laws and studies, and interviewed officials from federal agencies and industry stakeholders selected based on their involvement in ongoing projects and recommendations from others. For more information, contact Andrew Von Ah at (202) 512-2834 or vonaha@gao.gov.
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    In U.S GAO News
    GAO's previous work has shown that a number of opportunities exist for the Department of Defense (DOD) to strengthen management of defense spending, which would help the department address the challenges it faces, especially in a constrained budget environment. These opportunities include: Improving budgeting execution of funds. DOD does not fully obligate the funds appropriated to it and can improve both its budgeting for and its use of the resources that are provided to it. For example, GAO found that DOD has left billions of dollars in appropriated amounts unspent over the past 10 fiscal years. Better estimating annual budget requirements and obligating appropriations provided by Congress within the period of availability established by Congress would help DOD minimize these cases of under-execution. More clearly determining future resource requirements related to overseas contingency operations. DOD and Congress need a clearer determination of DOD's future resource requirements, in particular how and whether to incorporate enduring Overseas Contingency Operations (OCO) costs—costs that will endure beyond ongoing contingency operations—into DOD's base budget. These costs could total tens of billions of dollars a year. However, few details exist as to what makes up these enduring costs or how they were derived, raising questions about how much should be included as future requirements. Reducing improper payments. Addressing improper payments—payments that should not have been made or were made in an incorrect amount—is an area where better financial management could save DOD billions of dollars. In its fiscal year 2020 agency financial report, DOD estimated that it paid about $11.4 billion in improper payments, or about 1.7 percent of all payments it made that year. DOD has taken steps to reduce improper payments in some areas, but DOD's estimates of its improper payments in other areas indicate more remains to be done. Sustaining and refining department-wide business reform efforts. DOD must transform its overall business operations so that it can more efficiently and effectively use its resources. In recent years, DOD reported notable achievements from its most recent department-wide business reform efforts, including $37 billion in savings from fiscal years 2017 to 2021 as a result of these efforts. However, GAO previously found that while DOD's reported savings were largely reflected in its budget materials, the analyses underlying these estimates were not always well documented and the savings were not always the result of business reform. Moreover, uncertainty about the leadership structure at DOD for overseeing and reforming business operations, including the recent elimination of the Chief Management Officer position, calls into question whether efforts to fundamentally transform how the department does business can be realized and sustained. GAO has previously highlighted the importance of DOD providing clear department-wide guidance on roles, responsibilities, authorities, and resources for business reform efforts will be necessary for DOD to make progress in these efforts. Decisions by DOD and Congress regarding long-term defense needs will have a meaningful impact on the nation's fiscal future. As the single largest category of discretionary spending, defense spending is likely to play a large role in any discussion of future federal spending. GAO and others have found that DOD faces challenges that are likely to put pressure on its budget moving forward. DOD is the only major federal agency that has been unable to receive a clean audit opinion on its financial statements. This testimony provides information on how DOD can better manage defense spending, specifically related to its ability to (1) accurately estimate its budgetary requirements and execute its appropriated funds, (2) determine resource requirements related to overseas contingency operations, (3) reduce improper payments, and (4) sustain and refine department-wide reform efforts. For this testimony, GAO reviewed and summarized its recent work on DOD budget and financial management issues and departmental reform efforts. In prior work on which this testimony is based, GAO made recommendations that DOD take steps to better estimate its annual budget requirements and future fiscal needs for OCO, reduce improper payments, and refine and formalize its departmental reform efforts. DOD generally concurred with these recommendations and is working toward implementing them. For more information, contact Elizabeth A. Field at (202) 512-2775 or fielde1@gao.gov.
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  • DHS Employee Morale: Some Improvements Made, but Additional Actions Needed to Strengthen Employee Engagement
    In U.S GAO News
    The Department of Homeland Security (DHS) and each of its major components face the same key drivers of employee engagement—as measured by the Office of Personnel Management's Federal Employee Viewpoint Survey (OPM FEVS)—as the rest of the federal government (see table). Higher scores on the OPM FEVS indicate that an agency has the conditions that lead to higher employee engagement, a component of morale. Key Drivers of Employee Engagement across the Federal Government, the Department of Homeland Security (DHS), and within Each DHS Component Agency DHS has implemented department-wide employee engagement initiatives, including efforts to support DHS employees and their families. Additionally, DHS's major operational components, such as U.S. Customs and Border Protection and the Transportation Security Administration, among others, have developed annual action plans to improve employee engagement. However, DHS has not issued written guidance on action planning and components do not consistently include key elements in their plans, such as outcome-based performance measures. Establishing required action plan elements through written guidance and monitoring the components to ensure they use measures to assess the results of their actions to adjust, reprioritize, and identify new actions to improve employee engagement would better position DHS to make additional gains in this area. In addition, approval from the DHS Office of the Chief Human Capital Officer (OCHCO) and component leadership for these plans would help ensure department-wide commitment to improving employee engagement. DHS has faced challenges with low employee morale and engagement—an employee's sense of purpose and commitment—since it began operations in 2003. DHS has made some progress in this area, but data from the 2019 OPM FEVS show that DHS continues to rank lowest among similarly-sized federal agencies. GAO has reported that increasing employee engagement can lead to improved agency performance, and it is critical that DHS do so given the importance of its missions. GAO was asked to review DHS employee morale. This report addresses (1) drivers of employee engagement at DHS and (2) the extent that DHS has initiatives to improve employee engagement and ensures effective engagement action planning. To answer these objectives, GAO used regression analyses of 2019 OPM FEVS data to identify the key drivers of engagement at DHS. GAO also reviewed component employee engagement action plans and met with officials from DHS and component human capital offices as well as unions and employee groups. GAO is making three recommendations. DHS OCHCO should, in its anticipated written guidance, establish the elements required in employee engagement action plans and the approval process for these plans. OCHCO should also monitor components' action planning to ensure they review and assess the results of their actions to improve employee engagement. DHS concurred with GAO's recommendations. For more information, contact Chris Currie at (404) 679-1875 or CurrieC@gao.gov.
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  • Rule of Law Assistance: State and USAID Could Improve Monitoring Efforts
    In U.S GAO News
    The Department of State (State) Bureau of International Narcotics and Law Enforcement Affairs (State/INL) and the U.S. Agency for International Development (USAID) provided sufficient documentation for GAO to conclude that they followed most key practices for monitoring rule of law assistance for the awards we reviewed from selected countries. However, the agencies did not provide sufficient documentation demonstrating that they followed other key practices. Overall, State/INL followed these practices in most cases and USAID did so in almost all cases. Specifically, GAO's review of 19 State/INL and USAID projects found that USAID in all cases, and State/INL in most cases, followed key practices for planning a monitoring approach, such as developing project goals, objectives, and performance indicators. However, State/INL did not consistently demonstrate that project representatives included project goals and objectives in monitoring plans, and did not consistently identify risks in those plans (see fig.). Furthermore, neither agency could demonstrate that project representatives consistently assessed and approved monitoring reports from implementing partners. Following key monitoring practices helps to ensure that agencies stay well-informed of project performance and take corrective action when necessary, and that projects achieve their intended results. Without complete documentation, management cannot be sure that these practices are being followed. State/INL and USAID Alignment with Key Practices for Monitoring Rule of Law Assistance State and USAID have various processes to conduct, share, and use rule of law project evaluations to improve future efforts. Both agencies disseminate evaluations through online systems, briefings, and presentations, and have established approaches to track the implementation of evaluation recommendations, such as through spreadsheets or other documentation. The agencies use these evaluations in various ways to inform project design and strategic planning. Rule of law strengthens protection of fundamental rights and serves as a foundation for democratic governance and economic growth. According to State, strengthening judicial and legal systems in certain countries is vital to U.S. national security interests. State and USAID allocated over $2.7 billion for rule of law assistance overseas from fiscal years 2014 through 2018. GAO was asked to review monitoring and evaluation of U.S. rule of law assistance around the world. This report examines, among other objectives, the extent to which the agencies followed key practices for monitoring rule of law projects in selected countries, and processes agencies have in place to use evaluations to inform future rule of law assistance. GAO analyzed relevant laws and agency policies and other documents, and interviewed officials in Washington, D.C., and four countries—Colombia, Kosovo, Liberia, and the Philippines—selected based on funding amounts and other factors. GAO recommends that State/INL establish procedures to ensure project goals, objectives, and risks are identified in monitoring plans. GAO also recommends that State/INL establish and USAID enhance procedures to ensure project staff assess and approve monitoring reports. State and USAID concurred with GAO's recommendations. For more information, contact Chelsa Kenney Gurkin at (202) 512-2964 or gurkinc@gao.gov.
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