September 28, 2021

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Physician Pleads Guilty in Medicaid Fraud Conspiracy

16 min read
<div>A California man pleaded guilty today to conspiracy to commit health care fraud.</div>
A California man pleaded guilty today to conspiracy to commit health care fraud.

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    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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  • Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue
    In U.S GAO News
    What GAO FoundOverlap and fragmentation among government programs or activities can be harbingers of unnecessary duplication. In this report we include 81 areas for consideration drawn from GAO's prior and ongoing work. We present 34 areas where agencies, offices, or initiatives have similar or overlapping objectives or provide similar services to the same populations; or where government missions are fragmented across multiple agencies or programs. We also present 47 additional areas—beyond those directly related to duplication, overlap, or fragmentation—describing other opportunities for agencies or Congress to consider taking action that could either reduce the cost of government operations or enhance revenue collections for the Treasury. All of these areas span a range of agencies and government missions: agriculture, defense, economic development, energy, general government, health, homeland security, international affairs, and social services. Collectively, by reducing or eliminating duplication, overlap, or fragmentation and addressing these other cost savings opportunities, the federal government could potentially save billions of tax dollars annually and help agencies provide more efficient and effective services—but these actions will require some difficult decisions.Go to Report at a Glance to view the table summarizing all 81 areas we include in this report. The areas identified in this report are not intended to represent the full universe of duplication, overlap, or fragmentation within the federal government.Why GAO Did This StudyThis is GAO's first annual report to Congress in response to a new statutory requirement that GAO identify federal programs, agencies, offices, and initiatives, either within departments or governmentwide, which have duplicative goals or activities. Congress asked GAO to conduct this work and to report annually on our findings. (See Pub. L. No. 111-139, § 21, 124 Stat. 29 (2010), 31 U.S.C. § 712 Note.) This work will inform government policymakers as they address the rapidly building fiscal pressures facing our national government.Objectives(1) identify federal programs or functional areas where unnecessary duplication, overlap, or fragmentation exists, the actions needed to address such conditions, and the potential financial and other benefits of doing so(2) highlight opportunities for additional potential savings or increased revenues.
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  • Border Security: CBP’s Response to COVID-19
    In U.S GAO News
    What GAO Found According to data from the Department of Homeland Security's U.S. Customs and Border Protection (CBP), through February 2021, over 7,000 Office of Field Operations (OFO) and U.S. Border Patrol employees reported being infected with COVID-19, and 24 died due to COVID-19-related illnesses. In addition, over 20,000 OFO and Border Patrol employees were unable to work at some point due to COVID-19-related illnesses or quarantining in the same time period. OFO officials noted that employee absences due to COVID-19 did not generally have a significant impact on port operations, given relatively low travel volumes. In contrast, officials interviewed by GAO at three of four Border Patrol locations said that COVID-19 absences had impacted operations to some extent. COVID-19 Cases within Customs and Border Protection, through February 2021 CBP regularly updated guidance, used workplace flexibilities, and implemented safety precautions against COVID-19. Between January and December 2020, CBP updated guidance on COVID-19 precautions and how managers should address possible exposures. CBP also used a variety of workplace flexibilities, including telework and weather and safety leave to minimize the number of employees in the workplace, when appropriate. Meanwhile, CBP field locations moved some processing functions outdoors, encouraged social distancing, and provided protective equipment to employees and the public. In addition, some field locations took steps to modify infrastructure to prevent the spread of COVID-19, such as installing acrylic barriers or improving airflow in facilities. Challenges implementing operational changes included insufficient equipment for telework at three field locations, and shortages of respirators at a quarter of the ports of entry GAO contacted. CBP adjusted operations in response to COVID-19 and executive actions. As travel and trade volumes declined, some ports of entry reallocated personnel to other operations, such as cargo processing. In contrast, starting in May 2020 Border Patrol encounters with noncitizens steadily increased. As a result, Border Patrol requested additional resources. It also shifted its deployment strategy to operate as closely to the border as practical to intercept individuals who could be infected with COVID-19. Accordingly, some Border Patrol sectors modified interior operations, such as limiting resources at immigration checkpoints. CBP also assisted in implementing a Centers for Disease Control order that provided the ability to quickly expel apprehended individuals. Why GAO Did This Study The COVID-19 pandemic impacted nearly all aspects of society, including travel to and from the U.S. In response to COVID-19, the administration issued executive actions with the intention of decreasing the number of individuals entering the U.S. and reducing transmission of the virus. Within CBP, OFO is responsible for implementing these actions at ports of entry through which travelers enter the U.S., and Border Patrol is responsible for patrolling the areas between ports of entry to prevent individuals and goods from entering the U.S. illegally. Based on their role in facilitating legitimate travel and trade and securing the borders, CBP employees risk exposure to COVID-19 in the line of duty. GAO was asked to review how CBP managed its field operations in response to the COVID-19 pandemic. This report describes: (1) available data on the number of CBP employees diagnosed with COVID-19 and unable to work; (2) actions CBP has taken related to protecting its workforce and the public from COVID-19; and (3) the extent to which CBP adjusted operations in response to the pandemic and related travel restrictions. GAO reviewed key guidance documents and analyzed data on travel and trade at ports of entry, Border Patrol enforcement, and COVID-19 exposures among CBP employees. GAO also interviewed officials at CBP headquarters, employee unions' representatives, and 12 CBP field locations, selected for factors such as geographic diversity, traffic levels, and COVID-19 infection rates. For more information, contact Rebecca Gambler at (202) 512-8777 or GamblerR@gao.gov.
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    A federal grand jury in the Central District of California returned an indictment Wednesday charging a Deputy U.S. Marshal with conspiracy to commit cyberstalking, cyberstalking, and perjury.
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  • Seven MS-13 Gang Members Indicted in Violent Crime and Drug Distribution Conspiracy
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    A federal grand jury in Nashville, Tennessee, returned a 16-count superseding indictment Wednesday, charging seven MS-13 gang members with conspiracy to distribute cocaine and marijuana and serious firearm-related offenses, announced Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division and U.S. Attorney Don Cochran for the Middle District of Tennessee.
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  • Former Veterans Affairs Doctor Pleads Guilty to Three Civil Rights Offenses
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    A doctor of osteopathic medicine who formerly worked at the Veterans Affairs (VA) Medical Center in Beckley, West Virginia, pleaded guilty today to three counts of depriving veterans of their civil rights under color of law by sexually abusing them.
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  • Military Personnel: Army Needs to Better Enforce Requirements and Improve Record Keeping for Soldiers Whose Medical Conditions May Call for Significant Duty Limitations
    In U.S GAO News
    The increasing need for warfighters for the Global War on Terrorism has meant longer and multiple deployments for soldiers. Medical readiness is essential to their performing needed duties, and an impairment that limits a soldier's capacities represents risk to the soldier, the unit, and the mission. Asked to review the Army's compliance with its guidance, GAO examined the extent to which the Army is (1) adhering to its medical and deployment requirements regarding decisions to send soldiers with medical conditions to Iraq and Afghanistan, and (2) deploying soldiers with medical conditions requiring duty limitations, and assigning them to duties suitable for their limitations. GAO reviewed Army guidance, and medical records for those preparing to deploy between April 2006 and March 2007; interviewed Army officials and commanders at Forts Benning, Stewart, and Drum, selected for their high deployment rates; and surveyed deployed soldiers with medical limitations.Army guidance allows commanders to deploy soldiers with medical conditions requiring duty limitations, subject to certain requirements, but the Army lacks enforcement mechanisms to ensure that all requirements are met, and medical record keeping problems obstruct the Army's visibility over these soldiers' conditions. A soldier diagnosed with an impairment must be given a physical profile form designating numerically the severity of the condition and, if designated 3 or higher (more severe), must be evaluated by a medical board. Commanders must then determine proper duty assignments based on soldiers' profile and commanders' staffing needs. From a random projectable sample, GAO estimates that 3 percent of soldiers from Forts Benning, Stewart, and Drum who had designations of 3 did not receive required board evaluations prior to being deployed to Iraq or Afghanistan for the period studied. In some cases, soldiers were not evaluated because commanders lacked timely access to profiles; in other cases, commanders did not take timely actions. The Army also had problems with retention and completeness of profiles; although guidance requires that approved profiles be retained in soldiers' medical records, 213 profiles were missing from the sample of 685 records reviewed. The Army was not consistent in assigning numerical designations reflecting soldiers' abilities to perform functional activities. GAO estimates from a random projectable sample that 7 percent of soldiers from these three installations had profiles indicating their inability to perform certain functional activities, yet carrying numerical designators below 3. While medical providers can "upgrade" numerical designations discretionarily based on knowledge of soldiers' conditions, the upgrades can mask limitations and cause commanders to deploy soldiers without needed board evaluations. While GAO found no evidence of widespread revision in profile designations, some soldiers interviewed or surveyed disagreed with their designations yet were reluctant to express concerns for fear of prejudicial treatment. The Army has instituted a program to provide ombudsmen to whom soldiers can bring medical concerns, but it is targeted at returning soldiers and is not well publicized as a resource for all soldiers with medical conditions. Without timely board evaluations and retention of profile information for deploying soldiers with medical conditions, the Army lacks full visibility and commanders must make medical readiness, deployment, and duty assignment decisions without being fully informed of soldiers' medical limitations. GAO estimates that about 10 percent of soldiers with medical conditions that could require duty limitations were deployed from the three installations, but survey response was too limited to enable GAO to project the extent to which they were assigned to suitable duties. Along with interviews, however, responses suggest that both soldiers and commanders believe soldiers are generally assigned to duties that accommodate their medical conditions. Occasional exceptions have occurred when a profile did not reflect all necessary medical information or a soldier's special skill was difficult to replace. Officials said soldiers sometimes understate their conditions to be deployed with their units, or overstate them to avoid deployment.
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