September 28, 2021

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Pain doctor pays to settle allegations arising from false billing

15 min read
A 44-year-old physician from Laredo has paid $340,437.68 to resolve allegations he falsely billed Medicare for the use of electro-acupuncture devices

Read full article at: https://www.justice.gov June 11, 2021

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  • Department of Energy: Improved Performance Planning Could Strengthen Technology Transfer
    In U.S GAO News
    The Department of Energy (DOE) and its national labs have taken several steps to address potential barriers to technology transfer—the process of providing DOE technologies, knowledge, or expertise to other entities. GAO characterized these barriers as (1) gaps in funding, (2) legal and administrative barriers, and (3) lack of alignment between DOE research and industry needs. For example, the “valley of death” is a gap between the end of public funding and start of private-sector funding. DOE partly addresses this gap with its Technology Commercialization Fund, which provides grants of $100,000 to $1.5 million to DOE researchers to advance promising technologies with private-sector partners. Further, DOE's Energy I-Corps program trains researchers to commercialize new technologies and to identify industry needs and potential customers. However, DOE has not assessed how many and which types of researchers would benefit from such training. Without doing so, DOE will not have the information needed to ensure its training resources target the researchers who would benefit most. Illustration of Funding Gap for Commercializing New Technologies DOE plans and tracks the performance of its technology transfer activities by setting strategic goals and objectives and annually collecting department-wide technology transfer measures, such as the number of patented inventions and licenses. However, the department does not have objective and measurable performance goals to assess progress toward the broader strategic goals and objectives it developed. For example, without a performance goal for the number of DOE researchers involved in technology transfer activities and a measure of such involvement, DOE cannot assess the extent to which it has met its objective to encourage national laboratory personnel to pursue technology transfer activities. Internal control standards for government agencies call for management to define objectives in measurable terms, either qualitative or quantitative, so that performance toward those objectives can be assessed. Moreover, DOE has not aligned the 79 existing measures that it collects with its goals and objectives, nor has it prioritized them. Some lab stakeholders said that collecting and reporting these measures is burdensome. Prior GAO work has found that having a large number of performance measures may risk creating a confusing excess of data that will obscure rather than clarify performance issues. Researchers at DOE and its 17 national labs regularly make contributions to new energy technologies, such as more efficient batteries for electric vehicles. Technology transfer officials at the labs help these researchers license intellectual property and partner with private-sector companies to bring these technologies to market. However, several recent reports have highlighted barriers and inconsistencies in technology transfer at DOE, including a 2015 commission report that found barriers related to the costs of collaboration and low maturity level of many DOE technologies. This report examines (1) steps DOE has taken to address barriers to technology transfer and (2) the extent to which DOE plans and tracks the performance of its technology transfer and commercialization activities. GAO analyzed DOE documents on technology transfer and spoke with officials at DOE and seven national labs, as well as with representatives of universities and private-sector companies. GAO selected labs across a range of DOE activities and based on their technology transfer activities. GAO recommends that DOE assess researchers' needs for commercialization training and develop objective, quantifiable, and measurable performance goals and a limited number of related performance measures for its technology transfer efforts. DOE concurred with the recommendations. For more information, contact Candice Wright at (202) 512-6888 or WrightC@gao.gov.
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  • Supplement Retailers Plead Guilty in Cases Involving Distribution of Designer Steroids as Dietary Supplements
    In Crime News
    Two men and a California business each pleaded guilty this week to conspiring to distribute consumer products that contained designer anabolic steroids.
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  • Operation Legend Expanded to Cleveland, Detroit, and Milwaukee
    In Crime News
    Today, the expansion of Operation Legend was announced in Cleveland, Detroit, and Milwaukee. Operation Legend is a sustained, systematic and coordinated law enforcement initiative in which federal law enforcement agencies work in conjunction with state and local law enforcement officials to fight violent crime. The Operation was first launched on July 8 in Kansas City, Missouri, and expanded on July 22, 2020, to Chicago and Albuquerque. Operation Legend is named in honor of four-year-old LeGend Taliferro, who was shot and killed while he slept early in the morning of June 29 in Kansas City. The first federal arrest under Operation Legend was announced on July 20.
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  • Secretary Antony J. Blinken and Ukrainian Prime Minister Denys Shmyhal Before Their Meeting
    In Crime Control and Security News
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  • Farm Programs: USDA Should Take Additional Steps to Ensure Compliance with Wetland Conservation Provisions
    In U.S GAO News
    What GAO Found The U.S. Department of Agriculture's (USDA) Natural Resources Conservation Service (NRCS) has taken steps to increase the consistency of their determinations about where wetlands exist on farmers' lands. For example, NRCS state offices formed teams to make such determinations in the prairie pothole region (see fig.), which covers parts of Iowa, Minnesota, North Dakota, and South Dakota. These offices also standardized their wetland determination procedures and included more details, such as the types of data that can be used to identify wetland boundaries. Under wetland conservation provisions in federal law, to receive the benefits of certain USDA farm programs, farmers must not convert wetlands to cropland. Wetlands and Cropland in the Prairie Pothole Region NRCS's primary method to ensure compliance with wetland conservation provisions is conducting annual compliance checks of selected tracts of land for farmers in USDA programs. To select tracts, NRCS draws a national random sample. The sample is to include about 1 percent of tracts subject to wetland the provisions nationally, so many tracts are not sampled for years. For 2014 through 2018, NRCS identified fewer than five farmers with wetland conservation violations per year on the approximately 417,000 tracts in North Dakota and South Dakota—the states with the most wetland acres. Agency officials said NRCS has limited resources to conduct more checks. However, some USDA agencies emphasize risk-based criteria, rather than a random sample, in selecting tracts to check for compliance with other provisions. Doing so makes the checks more efficient by targeting the tracts most likely to have violations. If NRCS used a risk-based approach for its compliance checks (e.g., using information on acres cultivated annually on tracts), it could more efficiently ensure compliance with wetland conservation provisions. If NRCS finds violations, USDA's Farm Service Agency (FSA) may withhold program benefits from farmers, or it may grant waivers to farmers who acted in good faith, without intent to commit violations. FSA granted 243 of 301 requests for good-faith waivers from 2010 to 2018, according to FSA data. FSA relies on committees of fellow farmers to decide on waivers by considering factors such as prior violations. GAO found that some committees relied on weak justification to grant waivers even if farmers had prior violations and that FSA had not specified what is adequate justification. By specifying what constitutes adequate justification, FSA could better ensure it provides benefits only to eligible farmers. Why GAO Did This Study Wetlands perform vital ecological functions, and draining them can harm water quality and wildlife habitat. Many wetlands were drained for farming before enactment of wetland conservation provisions in 1985. However, millions of acres of wetlands, known as potholes, remain in the prairie pothole region. NRCS determines where wetlands exist on the land of farmers who participate in USDA farm programs, and it identifies violations of wetland provisions. FSA administers farm program benefits. In 2017, USDA's Office of Inspector General reported that NRCS had implemented wetland determination procedures in the prairie pothole region inconsistently. GAO was asked to review USDA's implementation of wetland conservation provisions in the prairie pothole region. This report examines, among other objectives, the steps NRCS has taken to increase the consistency of wetland determinations and the approaches NRCS and FSA use to ensure compliance with the provisions. GAO reviewed agency manuals, data, and files on wetland determinations and waivers, and interviewed agency officials and stakeholder groups.
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  • United States Announces Nearly $180 Million in Humanitarian Assistance for the Rakhine State/Rohingya Refugee Crisis
    In Crime Control and Security News
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  • Science & Tech Spotlight: Agile Software Development
    In U.S GAO News
    Why This Matters Agile software development has the potential to save the federal government billions of dollars and significant time, allowing agencies to deliver software more efficiently and effectively for American taxpayers. However, the transition to Agile requires an investment in new tools and processes, which can be costly and time consuming. The Methodology What is it? Agile is an approach to software development that encourages collaboration across an organization and allows requirements to evolve as a program progresses. Agile software development emphasizes iterative delivery; that is, the development of software in short, incremental stages. Customers continuously provide feedback on the software's functionality and quality. By engaging customers early and iterating often, agencies that adopt Agile can also reduce the risks of funding failing programs or outdated technology. Figure 1. Cycle of Agile software development How does it work? Agile software development is well suited for programs where the end goal is known, but specific details about their implementation may be refined along the way. Agile is implemented in different ways. For example, Scrum is a framework focused on teams, Scaled Agile Framework focuses on scaling Agile to larger groups, and DevOps extends the Agile principle of collaboration and unites the development and operation teams. Scrum, one of the most common Agile frameworks, organizes teams using defined roles, such as the product owner, who represents the customer, prioritizes work, and accepts completed software. In Scrum, development is broken down into timed iterations called sprints, where teams commit to complete specific requirements within a defined time frame. During a sprint, teams meet for daily stand-up meetings. At the end of a sprint, teams present the completed work to the product owner for acceptance. At a retrospective meeting following each sprint, team members discuss lessons learned and any changes needed to improve the process. Sprints allow for distinct, consistent, and measurable progress of prioritized software features. How mature is it? Organizations have used versions of incremental software development since the 1950s, with various groups creating Agile frameworks in the 1990s, including Scrum in 1995. In 2001, a group of software developers created the Agile Manifesto, which documents the guiding principles of Agile. Following this, Agile practitioners introduced new frameworks, such as Kanban, which optimizes work output by visualizing its flow. The Federal Information Technology Acquisition Reform Act (FITARA), enacted in 2014, includes a provision for the Office of Management and Budget to require the Chief Information Officers of covered agencies to certify that IT investments are adequately implementing incremental development. This development approach delivers capabilities more rapidly by dividing an investment into smaller parts. As a result, more agencies are now adopting an incremental, Agile, approach to software development. For example, in 2016, the Department of Homeland Security announced five Agile pilot programs. In 2020, at least 22 Department of Defense major defense acquisition programs reported using Agile development methods.  As the federal government continues to adopt Agile, effective oversight of these programs will be increasingly crucial. Our GAO Agile Assessment Guide, released in 2020, takes a closer look at the following categories of best practices: Agile adoption. This area focuses on team dynamics, program operations, and organization environments. One best practice for teams is to have repeatable processes in place such as continuous integration, which automates parts of development and testing. At the program operations level, staff should be appropriately trained in Agile methods. And at an organizational level, a best practice is to create a culture that supports Agile methods. Requirements development and management. Requirements—sometimes called user stories—are important in making sure the final product will function as intended. Best practices in this area include eliciting and prioritizing requirements and ensuring work meets those requirements. Acquisition strategy. Contractors may have a role in an Agile program in government. However, long timelines to award contracts and costly changes are major hurdles to executing Agile programs. One way to clear these hurdles is for organizations to create an integrated team with personnel from contracting, the program office, and software development. Clearly identifying team roles will alleviate bottlenecks in the development process. Figure 2. Different roles come together to make an Agile software development team. Program monitoring and control. Many Agile documents may be used to generate reliable cost and schedule estimates throughout a program’s life-cycle. Metrics. It is critical that metrics align with and prioritize organization-wide goals and objectives while simultaneously meeting customer needs. Such metrics in Agile include the number of features delivered to customers, the number of defects, and overall customer satisfaction.  Opportunities Flexibility. An Agile approach provides flexibility when customers’ needs change and as technology rapidly evolves. Risk reduction. Measuring progress during frequent iterations can reduce technical and programmatic risk. For example, routine retrospectives allow the team to reflect upon and improve the development process for the next iteration. Quicker deliveries. Through incremental releases, agencies can rapidly determine if newly produced software is meeting their needs. With Agile, these deliveries are typically within months, instead of alternative development methods, which can take years. Challenges GAO has previously reported on challenges the federal government faces in applying Agile methods; for the full report see GAO-12-681. Lack of organizational commitment. For example, organizations need to create a dedicated Agile team, which is a challenge when there is an insufficient number of staff, or when staff have several simultaneous duties. Resources needed to transition to Agile. An organization transitioning to Agile may need to invest in new tools, practices, and processes, which can be expensive and time consuming. Mistrust in iterative solutions. Customers who typically see a solution as a whole may be disappointed by the delivery of a small piece of functionality. Misaligned agency practices. Some agency practices, such as procurement, compliance reviews, federal reporting, and status tracking are not designed to support Agile software development. Policy and Context Questions In what ways can Agile help the federal government improve the management of IT acquisitions and operations, an area GAO has identified as high risk for the federal government? How can policymakers implement clear guidance about the use of Agile software development, such as reporting metrics, to better support Agile methods? How might resources need to shift to accommodate the adoption of Agile in federal agencies? What risks could those shifts pose? What updates to agency practices are worth pursuing to support Agile software development? For more information, contact Tim Persons at (202) 512-6888 or personst@gao.gov.
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    In Travel
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  • North Carolina Tax Preparer Sentenced to Prison for Conspiring to Defraud the IRS
    In Crime News
    A North Carolina return preparer was sentenced today to 15 months in prison for conspiring to defraud the IRS.
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  • Chemical Assessments: Annual EPA Survey Inconsistent with Leading Practices in Program Management
    In U.S GAO News
    The Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) Program has not produced timely chemical assessments, and most of its 15 ongoing assessments have experienced delays. As we reported in March 2019, the IRIS Program has taken some actions to make the assessment process more transparent, such as increasing communication with EPA offices and releasing supporting documentation for review earlier in the draft development process, but the need for greater transparency in some steps of the assessment process remains. Specifically, the IRIS Program does not publicly announce when assessment drafts move to certain steps in their development process or announce reasons for delays in producing specific assessments. Without such information, stakeholders who may be able to help fill data and analytical gaps are unable to contribute. This could leave EPA without potential support that could help overcome delays. Delays of Milestones by Quarter for a Selection of the Integrated Risk information System's Assessments in Development 2019 - 2024 In mid-2018, EPA's Office of Research and Development (ORD) instituted changes to the way it solicits nominations for chemical assessments prepared by the IRIS Program but did so without providing sufficient guidance or criteria, raising questions about its ability to meet EPA user needs. For example, ORD issued a new survey to EPA program and regional offices but did not provide them with guidance for selecting chemicals for nomination, and ORD did not make explicit the criteria it was using for selecting nominations to include in the IRIS Program's list of assessments in development. Furthermore, despite a significant decline in survey participation between 2018 and 2019, EPA did not indicate whether the agency has assessed the quality of information generated by the survey. Leading program management practices state that agency management should internally communicate the necessary, quality information to achieve the entity's objectives and should monitor and evaluate program activities. Without evaluating the quality of the information produced by the survey, ORD cannot know if the survey is achieving its intended purpose and whether ORD has the information necessary to meet user needs. EPA's IRIS Program prepares chemical toxicity assessments that contain EPA's scientific position on the potential human health effects of exposure to chemicals; at present, the IRIS database contains more than 570 chemical assessments. In March 2019, GAO reported on the IRIS Program's changes to increase transparency about its processes and methodologies, including the use of systematic review. However, GAO also found that EPA decreased the number of ongoing assessments in December 2018 from 22 to 13 and continued to face challenges in producing timely assessments. This report evaluates (1) EPA's progress in completing IRIS chemical assessments since 2018; and (2) EPA's recent actions to manage the IRIS Program, and the extent to which these actions help the Program meet EPA user needs. GAO reviewed and analyzed EPA documents and interviewed officials from EPA; GAO also selected three standards for program management, found commonalities among them, and compared ORD's management of the IRIS Program against these leading practices. GAO is making five recommendations, including that EPA provide more information publicly about where chemical assessments are in the development process; and issue guidance for selecting chemicals for nomination and criteria for selecting nominations for assessment. EPA partially agreed with two of our recommendations and disagreed with the other three. For more information, contact J. Alfredo Gómez at (202) 512-3841 or gomezj@gao.gov.
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  • The President’s Emergency Presidential Determination on Refugee Admissions for Fiscal Year 2021
    In Crime Control and Security News
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  • Arrests Made in Conspiracy to Illegally Manufacture Firearms
    In Crime News
    On Oct. 20, 2020, a former United States Marine Lance Corporal, recently stationed at Camp Lejeune in Jacksonville, North Carolina, and two co-defendants were arrested in Boise, Idaho on the federal charge of conspiracy to unlawfully manufacture, possess, and distribute various weapons, ammunition, and suppressors.  Liam Montgomery Collins, 21, and Paul James Kryscuk, 35, recently of Boise, were charged via an indictment, while Jordan Duncan, 25, a North Carolina native also currently residing in Boise, was charged via a complaint, both obtained in the Eastern District of North Carolina.
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  • Pregnant Women in DOJ Custody: U.S. Marshals Service and Bureau of Prisons Should Better Align Policies with National Guidelines
    In U.S GAO News
    GAO analyses of available data show that from calendar year 2017 through 2019, there were at least 1,220 pregnant women in U.S. Marshals Service (USMS) custody and 524 pregnant women in Bureau of Prisons (BOP) custody. Pregnant Women in USMS and BOP Custody: Number, Age, Race, and Length of Time in Custody from 2017 through 2019 aUSMS does not track pregnancy outcomes, so length of time in custody may include time when the women were not pregnant. For BOP, the length of time represents only the period of pregnancy. GAO analyses also show that pregnant women were held at a variety of facility types from 2017 through 2019. For example, pregnant women spent 68 percent of their time in USMS custody in non-federal facilities where USMS has an intergovernmental agreement. BOP data show that pregnant women spent 21 percent of their time in BOP custody while pregnant at Carswell—BOP's only female Federal Medical Center. While USMS and BOP both have policies that address the treatment and care of pregnant women, not all policies fully align with national guidance recommendations on 16 pregnancy-related care topics. For example, national guidance recommends specialized nutrition and when needed, mental health care. USMS policies fully align on three of 16 care topics and BOP policies fully align on eight of 16. By taking steps to more closely align agency standards and policies with national guidance as feasible, USMS and BOP would be better positioned to help ensure the health of pregnant women in their custody. USMS and BOP data show that the agencies provide a variety of medical care and special accommodations to pregnant women, and both agencies track the use of restraints. For example, USMS data show that women receive prenatal care and BOP data show that women receive prenatal vitamins and lower bunk assignments, among other things. However, USMS could do more to collect data on pregnant and postpartum women in their custody who are placed in restrictive housing. While USMS requests that facilities that hold USMS prisoners submit data on a regular basis indicating which prisoners were placed in restrictive housing, facilities are not required to indicate if any of these prisoners are pregnant or postpartum. In addition, USMS does not have a requirement for facilities to immediately notify USMS when such women are placed in restrictive housing. By requiring these notifications and data collection, USMS would be better positioned to ensure that facilities are complying with its USMS Detention Standards and Department of Justice (DOJ) guidance that state pregnant and postpartum women should not be placed in restrictive housing except in rare situations. Policymakers and advocacy groups have raised questions about the treatment of incarcerated pregnant women, including the use of restrictive housing—removal from the general prisoner population with the inability to leave the cell for the majority of the day—and restraints. Within DOJ, USMS is responsible for prisoners awaiting trial or sentencing. BOP is responsible for sentenced prisoners. GAO was asked to review issues related to pregnant women in USMS and BOP custody. This report examines (1) what DOJ data indicate about pregnant women in USMS and BOP custody; (2) the extent to which USMS and BOP policies align with national guidance on pregnancy-related care; and (3) what is known about the care provided and the extent to which USMS and BOP track when pregnant women are placed in restrictive housing or restraints. GAO analyzed available agency data from calendar years 2017 through 2019, which were the most recent data available; compared agency policies to relevant national guidance; and interviewed officials and a non-generalizable sample of prisoners who had been pregnant in USMS or BOP custody. GAO is making six recommendations, including that USMS and BOP take steps to more closely align their policies with national guidance on pregnancy-related care as feasible, and that USMS require facilities to collect data on and notify USMS when pregnant or postpartum women are placed in restrictive housing. DOJ concurred with our recommendations. For more information, contact Gretta L. Goodwin at (202) 512-8777 or goodwing@gao.gov.
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  • Justice Department Releases Report On Modernizing The Administrative Procedure Act
    In Crime News
    WASHINGTON – The Justice Department released a report today on the need for Congress to update and improve the Administrative Procedure Act (APA), the 74-year-old statute setting forth the procedures agencies must follow when regulating individuals, businesses, non-profits, and state and local government entities. The report, entitled Modernizing the Administrative Procedure Act, discusses how the administrative state has developed in ways not foreseen by the APA in 1946, how the APA might be legislatively improved, and how this Administration’s improvements to agencies’ regulatory processes could inform modernizing the APA. The Justice Department, which significantly shaped the original APA, hopes that the ideas and insights discussed in the report will encourage and inform much needed action by Congress to modernize the APA.
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  • Kroger Shooter Pleads Guilty to Federal Hate Crimes and Firearm Offenses
    In Crime News
    A Kentucky man pleaded guilty today to federal hate crimes and firearm charges arising out of the racially motivated shootings of Black individuals at a grocery store.
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  • Joint Press Statement of the United States, the European Union, the United Kingdom, and the United Nations High Commissioner for Refugees
    In Crime Control and Security News
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  • Secretary Blinken’s Call with the United Arab Emirates Minister of Foreign Affairs and International Cooperation Sheikh Abdullah bin Zayed Al Nahyan
    In Crime Control and Security News
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  • Former Army Green Beret Sentenced for Russian Espionage Conspiracy
    In Crime News
    A Virginia man and former Army Green Beret was sentenced today to XX years in prison for conspiring with Russian intelligence operatives to provide them with U.S. national defense information.
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  • North Carolina Risk Consultant Sentenced to Prison for Tax Fraud and Illegally Possessing a Firearm
    In Crime News
    A North Carolina businessman was sentenced today to three years in prison for tax fraud and illegal possession of a firearm.
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  • Senior State Department Official On Security Implications of the Climate Crisis in Advance of Secretary Blinken’s Participation in the UN Security Council Open Debate on Climate and Security
    In Crime Control and Security News
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