Physician Pleads Guilty in Medicaid Fraud Conspiracy

A California man pleaded guilty today to conspiracy to commit health care fraud.

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    In U.S GAO News
    What GAO Found Nationwide data from the Centers for Disease Control and Prevention's (CDC) Pregnancy Mortality Surveillance System from 2011-2016, the most recent data available at the time of GAO's review, indicate that deaths during pregnancy or up to 1 year postpartum due to pregnancy-related causes—are higher in rural areas compared to metropolitan areas. See figure. CDC data also showed higher mortality in underserved areas (areas with lower numbers of certain health care providers per capita). Pregnancy-Related Mortality Ratios in Rural and Metropolitan Areas, 2011-2016 Note: Micropolitan areas include counties with populations of 2,500 to 49,999. Noncore areas include nonmetropolitan counties that do not qualify as micropolitan. GAO also analyzed the most recent annual data available from the Agency for Healthcare Research and Quality for 2016-2018 on severe maternal morbidity (SMM)—unexpected outcomes of labor and delivery resulting in significant health consequences. Nationwide, these data showed higher estimated rates of SMM in metropolitan areas (72.6 per 10,000 delivery hospitalizations) compared to rural areas (62.9 per 10,000). CDC and another Department of Health and Human Services (HHS) agency, the Health Resources and Services Administration (HRSA), fund several maternal health programs that aim to reduce maternal mortality and SMM, including some that target rural or underserved areas. CDC and HRSA collect program data, such as the percentage of women who received postpartum visits, to track progress in improving maternal health, but they do not systematically disaggregate and analyze program data by rural and underserved areas. By taking these actions, CDC and HRSA could help better ensure that program funding is being used to help address any needs in these areas. HHS has taken actions to improve maternal health through its funding of various programs and releasing an action plan in 2020. HHS also has two workgroups that aim to coordinate across HHS agencies on maternal health efforts, such as program activities that aim to reduce maternal mortality and SMM. Officials from HHS's two workgroups said they coordinated in developing the action plan, but they do not have a formal relationship established to ensure ongoing coordination. Officials from one of the workgroups noted that they often have competing priorities and do not always coordinate their efforts. By more formally coordinating their efforts, HHS's workgroups may be in a better position to identify opportunities to achieve HHS's action plan goal for reducing maternal mortality and objectives that target rural and underserved areas. Why GAO Did This Study Each year in the United States, hundreds of women die from pregnancy-related causes, and thousands more experience SMM. Research suggests there is a greater risk of maternal mortality and SMM among rural residents and that underserved areas may lack needed health services. GAO was asked to review maternal mortality and SMM outcomes in rural and underserved areas. This report examines, among other objectives, what is known about these outcomes; selected CDC and HRSA programs that aim to reduce these outcomes, as well as actions to collect and use relevant data; and the extent to which HHS is taking actions to improve maternal health and monitoring progress on its efforts. GAO analyzed HHS data, agency documentation, literature, and interviewed officials from a non-generalizable sample of three states and stakeholders to capture various perspectives.
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  • Lead Paint in Housing: HUD Has Not Identified High-Risk Project-Based Rental Assistance Properties
    In U.S GAO News
    During fiscal years 2018 and 2019, the Department of Housing and Urban Development (HUD) obligated about $421 million through two grant programs to state and local governments to help identify and control lead paint hazards in housing for low-income households. HUD also issued guidelines for evaluating and controlling lead paint hazards, generally encouraging abatement (such as replacing building components containing lead) as the preferred long-term solution. HUD has supported research on lead paint hazard control and provided education and outreach to public housing agencies, property owners, and the public through publications and training events. HUD monitors lead paint-related risks in its Project-Based Rental Assistance Program, one of HUD's three largest rental assistance programs, through management reviews and periodic physical inspections, but has not conducted a comprehensive risk assessment to identify properties posing the greatest risk to children under the age of 6. HUD's management reviews include assessing property owners' compliance with lead paint regulations—such as by reviewing lead disclosure forms, records of lead inspections, and plans to address lead paint hazards. Inspectors from HUD's Real Estate Assessment Center also assess the physical condition of properties, including identifying damaged paint that could indicate lead paint risks. According to HUD officials, they have not conducted risk assessments in project-based rental assistance housing because they believe the program has relatively few older and potentially riskier properties. However, GAO's analysis of HUD data found that 21 percent of project-based rental assistance properties have at least one building constructed before 1978 (when lead paint was banned in homes) and house over 138,000 children under the age of 6. If HUD used available program data to inform periodic risk assessments, HUD could identify which of the properties pose the greatest risk of exposure to lead paint hazards for children under the age of 6. Unless HUD develops a strategy for managing the risks associated with lead paint and lead paint hazards in project-based rental assistance housing, it may miss the opportunity to prevent children under the age of 6 from being inadvertently exposed to lead paint in those properties. Project-Based Rental Assistance Properties with at Least One Building Built before 1978 and That House Children under Age 6, as of December 31, 2019 Note: Children under the age of 6 are at the greatest risk of lead exposure because they have frequent hand-to-mouth contact, often crawl on the floor, and ingest nonfood items. Lead paint exposure in children under the age of 6 can cause brain damage, slowed development, and learning and behavioral problems. Exposure to lead paint hazards can cause serious harm to children under 6 years old. HUD is required by law to reduce the risk of lead paint hazards in HUD-assisted rental housing—including project-based rental assistance (subsidies to make privately owned multifamily properties affordable to low-income households). The 2019 Consolidated Appropriations Act Joint Explanatory Statement includes a provision for GAO to review, among other things, HUD's oversight of lead paint and related hazards in affordable rental housing. This report (1) describes how HUD programs and guidance address lead paint hazards in HUD-assisted and other low-income rental housing, and (2) examines HUD's oversight procedures for assessing risk for lead paint hazards in project-based rental assistance housing. GAO reviewed HUD and Environmental Protection Agency (EPA) lead paint regulations and documents on lead programs and methods for addressing lead paint hazards. GAO reviewed HUD oversight policies and procedures and analyzed HUD data on building and tenant age. GAO interviewed staff at HUD, EPA, and organizations that advocate for safe affordable housing. GAO recommends that HUD (1) conduct periodic risk assessments for the Project-Based Rental Assistance Program and (2) develop and implement plans to proactively manage identified lead paint risks. HUD agreed to conduct periodic risk assessments and develop and implement a plan to proactively manage risks. For more information, contact John H. Pendleton at (202) 512-8678 or pendletonj@gao.gov.
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  • Medicaid: CMS Needs More Information on States’ Financing and Payment Arrangements to Improve Oversight
    In U.S GAO News
    States and the federal government share in financing Medicaid, a health care program for low-income and medically needy individuals. States finance the nonfederal share with state general funds and other sources, such as taxes on health care providers and funds from local governments. GAO's analysis showed a change in how states finance their Medicaid programs. In particular, states relied on provider taxes and local government funds for about 28 percent, or $63 billion, of the estimated $224 billion total nonfederal share of Medicaid payments in state fiscal year 2018—7 percentage points more than state fiscal year 2008. Nonfederal Share of Medicaid Payments from Provider Taxes and Local Government Funds, State Fiscal Years 2008 and 2018 Note: Percentages do not add up due to rounding. Furthermore, GAO estimated that states' reliance on provider taxes and local government funds decreased states' share of net Medicaid payments (total state and federal payments) and effectively increased the federal share of net Medicaid payments by 5 percentage points in state fiscal year 2018. It also resulted in smaller net payments to some providers after the taxes and local government funds they contribute to their payments are taken into account. While net payments are smaller, the federal government's contribution does not change. This effectively shifts responsibility for a larger portion of Medicaid payments to the federal government and away from states. The Centers for Medicare & Medicaid Services (CMS)—which oversees Medicaid—collects some information on states' sources of funds and payments, but it is not complete, consistent, or sufficiently documented, which hinders the agency's oversight. For example, CMS does not require states to report on the source of the nonfederal share for all payments. Absent complete, consistent, and sufficiently documented information about all Medicaid payments, CMS cannot adequately determine whether payments are consistent with statutory requirements for economy and efficiency, and with permissible financing, such as the categories of services on which provider taxes may be imposed. Medicaid cost $668 billion in fiscal year 2019. GAO has previously reported on concerns about states' use of various funding sources for the nonfederal share. Although such financing arrangements are allowed under certain conditions, they can also result in increasing the share of net costs paid by the federal government and decreasing reliance on state general funds. GAO was asked to review the sources of funds states used for Medicaid and the types of payments made to providers. This report describes states' reliance on provider and local government funds for these arrangements; the estimated effect of these arrangements on the federal share of net Medicaid payments; and the extent to which CMS collects information on these arrangements. To do this work, GAO reviewed CMS information; administered a questionnaire to all state Medicaid agencies; analyzed the estimated effects of reliance on provider and local government funds; and interviewed CMS officials, as well as Medicaid officials in 11 states selected, in part, on Medicaid spending and geographic diversity. The Administrator of CMS should collect and document complete and consistent information about the sources of funding for the nonfederal share of payments to providers. CMS neither agreed nor disagreed with GAO's recommendation, but acknowledged the need for additional financing and payment data for Medicaid oversight. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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  • Long Island Car Wash Owner Pleads Guilty to Tax Evasion
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    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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  • Intellectual Property: CBP Has Taken Steps to Combat Counterfeit Goods in Small Packages but Could Streamline Enforcement
    In U.S GAO News
    The European Union (EU) and U.S. approaches to enforcing intellectual property rights (IPR) differ with respect to counterfeit goods in small packages, which are often sent through express carrier services or international mail. The EU uses a streamlined, application-based procedure to destroy suspected counterfeits in small packages. Through this procedure, rights holders request that member state customs authorities take action against such packages. The procedure allows customs authorities to bill rights holders for certain associated costs, and gives customs authorities discretion in sharing data with rights holders. In the U.S., U.S. Customs and Border Protection (CBP)—a component of the Department of Homeland Security (DHS)—is required to seize any goods it determines to be counterfeit, and typically destroys such goods, regardless of shipment size. CBP does not bill rights holders for the cost of enforcement, and is required to provide specific information to rights holders after seizure of goods. EU and U.S. customs officials reported common challenges in combating the flow of counterfeit goods in small packages. For example, EU and U.S. officials said the large volume of small packages makes it difficult for customs agencies to prioritize resources among competing needs such as drug enforcement and security. EU and U.S. officials also reported that a lack of adequate data on these packages is a challenge in taking enforcement action against them. Bags of Small Packages at Mail Facilities in Germany and France While CBP has taken steps to address these challenges, its primary enforcement processes are not tailored to combat counterfeit goods in small packages. According to CBP officials, from 2014 to 2018, CBP piloted a program to help address the volume of such packages by facilitating the abandonment of goods that it suspected—but had not determined—to be counterfeit. In 2019, CBP initiated a program to obtain additional data, and as of July 2020 had begun using these data to assess the risk that such packages contained counterfeit goods. However, CBP officials said that the seizure and forfeiture processes they are required to use for goods determined to be counterfeit are time and resource intensive. In April 2019, the White House required DHS to identify changes, including enhanced enforcement actions, to mitigate the trafficking of counterfeit goods. In January 2020, DHS proposed several actions that CBP could take, but CBP has not decided which to pursue to streamline its enforcement. Without taking steps to develop a streamlined enforcement approach, CBP will continue to face difficulty in addressing the influx of counterfeit goods in small packages. Counterfeit goods infringe on IPR, and can harm the U.S. economy and threaten consumer safety. CBP, the U.S. agency tasked with enforcement against counterfeits at the border, has reported that the annual number of small packages sent to the U.S. since fiscal year 2013 more than doubled, and small packages seized often contain counterfeit goods. The European Union Intellectual Property Office noted similar economic and consumer safety impacts in Europe, as well as increases in counterfeit goods in small packages. GAO was asked to review IPR enforcement practices in other advanced economies, and the extent to which CBP could apply those practices. This report examines: (1) how elements of the EU and U.S. approaches to combating counterfeit goods in small packages compare, (2) any enforcement challenges posed by these goods, and (3) the extent to which CBP has taken steps to address these challenges. GAO reviewed agency documents; interviewed CBP and customs officials in the EU; and met with private sector stakeholders, such as express carriers. GAO recommends that CBP take steps to develop a streamlined enforcement approach against counterfeit goods in small packages. CBP concurred with the recommendation. For more information, contact Kimberly Gianopoulos at (202) 512-8612 or gianopoulosk@gao.gov.
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  • Close Air Support: Actions Needed to Enhance Friendly Force Tracking Capabilities and Fully Evaluate Training
    In U.S GAO News
    The Department of Defense (DOD) has made progress implementing initiatives to enhance capabilities that are used to identify friendly force locations during close air support (CAS) missions, but GAO identified additional actions that are needed to strengthen these efforts. Specifically, DOD has made limited progress in implementing 10 changes the department approved to address gaps in the interoperability of digital communications systems used to conduct CAS, hindering efforts to improve the speed and accuracy of information exchanges. DOD's efforts to assess the interoperability of digital systems used to perform CAS have been limited in scope. GAO found that DOD had formally assessed two out of 10 approved changes during joint service and multinational events, and these assessments were not conducted in a training environment that replicated capabilities of near-peer adversaries. DOD implemented a new capability in the U.S. Central Command area of responsibility to help identify the positions of friendly forces during CAS missions. However, GAO found that DOD did not provide adequate training for personnel who operate it or conduct an evaluation to resolve implementation challenges that have hampered its performance. DOD conducts evaluations of training programs for forces that participate in CAS missions, but GAO identified two areas where DOD can improve its efforts. First, the Army and Marine Corps have not systematically evaluated the effectiveness of periodic training for ground observers providing targeting information due to a lack of centralized systems for tracking training data and the absence of designated entities to monitor service-wide training. Second, the use of contract aircraft for training increased substantially between 2017 and 2019, but DOD has not fully evaluated the use of non-military contract aircraft to train air controllers for CAS (see fig.). GAO found that differences between U.S. military aircraft and contract aircraft (e.g., airspeed) can result in a misalignment of aircraft capabilities for certain types of training events. Without evaluating CAS training fully, DOD cannot have assurance that its forces are prepared to conduct CAS missions safely and effectively. Number of Hours Non-Military Aircraft Were Used to Train for Close Air Support for Fiscal Years 2017 through 2019 The use of ordnance delivered by aircraft to support U.S. military forces that are in close proximity to enemy forces on the ground requires detailed planning, seamless communications, and effective training. Mistakes in communications or procedures used to identify and maintain an awareness of the positions of friendly forces on the battlefield during CAS can result in the loss of U.S. military personnel. Senate Report 116-48 and House Report 116-120, accompanying bills for the National Defense Authorization Act for Fiscal Year 2020, included provisions for GAO to evaluate issues related to friendly-force identification capabilities in CAS missions. Among other things, this report evaluates the extent to which DOD has (1) implemented initiatives to enhance friendly-force identification capabilities during CAS, and (2) evaluated training for forces that participate in CAS. GAO analyzed documentation and interviewed officials regarding DOD efforts to develop and implement friendly force tracking capabilities for CAS; reviewed CAS training programs; and analyzed training data, including the number of hours that DOD used non-military contract aircraft for CAS training from 2017 through 2019. GAO is making 11 recommendations to DOD, including that DOD implement and assess initiatives to improve the interoperability of digital systems used in CAS and take additional steps to evaluate the training for certain forces that participate in CAS missions. DOD concurred with the recommendations. For more information, contact Cary Russell at (202) 512-5431 or RussellC@gao.gov.
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    In U.S GAO News
    What GAO Found The Department of Veterans Affairs (VA) Financial Management Business Transformation (FMBT) program has begun implementing the Integrated Financial and Acquisition Management System (iFAMS), with the first deployment of certain capabilities at the National Cemetery Administration (NCA) on November 9, 2020. FMBT program officials identified various challenges, such as FMBT program funding shortfalls, which represent the difference between VA's original requirement and the President's budget request, and coordination with other major initiatives. VA has taken various steps to address its challenges. For example, because of the COVID-19 pandemic, VA postponed the initial NCA deployment 4 months and converted planning, training, and testing activities to virtual events. In addition, the FMBT program and Veterans Health Administration (VHA) worked together to address the FMBT program funding shortfall by postponing iFAMS implementation at VHA for at least 2 years to coordinate with the implementation of a new logistics system. Following information technology (IT) management best practices on major transformation efforts, such as the FMBT program, can help build a foundation for ensuring responsibility, accountability, and transparency. VA has generally met such practices for program governance, Agile project management, and testing and defect management. However, it has not fully met certain best practices for developing and managing cost and schedule estimates. As a result, its estimates were not reliable. Specifically, VA's estimates substantially met one, and partially or minimally met three of the four characteristics associated with reliable cost and schedule estimates, respectively. For example, VA minimally met the “credible” characteristic associated with reliable cost estimates, in part, because it did not compare its cost estimate to an independently developed estimate. GAO Assessment of VA Cost and Schedule Estimates against Best Practice Characteristics Cost estimate characteristic Assessment of cost estimate Schedule estimate characteristic Assessment of schedule estimate Comprehensive Partially met Comprehensive Partially met Well-documented Substantially met Well-constructed Partially met Accurate Partially met Credible Partially met Credible Minimally met Controlled Substantially met Legend: substantially met = VA provided evidence that satisfies a large portion of the criterion; partially met = VA provided evidence that satisfies about one-half of the criterion; minimally met = VA provided evidence that satisfies a small portion of the criterion Source: GAO assessment of the Department of Veterans Affairs Financial Management Business Transformation program documentation. | GAO-21-227 Reliable cost and schedule estimates provide a road map for project execution and are critical elements to delivering large-scale IT systems. Without reliable estimates, VA management may not have the information necessary for informed decision-making. Further, following cost and schedule best practices helps minimize the risk of cost overruns and schedule delays and would better position the FMBT program for effective and successful implementation on future deployments. Why GAO Did This Study VA's core financial system is approximately 30 years old and is not integrated with other relevant IT systems, resulting in inefficient operations and complex work-arounds. The FMBT program is VA's current effort and third attempt to replace its aging financial and acquisition systems with one integrated system. The first two attempts were unsuccessful after years of development and hundreds of millions of dollars in cost. GAO was asked to review the progress of the FMBT program. This report (1) describes the status of the FMBT program, including steps VA has taken to address challenges it has identified, and (2) examines the extent to which VA has followed certain IT management best practices. GAO summarized FMBT program risks and challenges that VA identified, reviewed FMBT program documentation and compared it with relevant guidance and best practices, and interviewed cognizant VA officials.
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    In Crime News
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    In Crime News
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    In Crime News
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    In Crime News
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  • IRS Reorganization: Planning Addressed Key Reform Practices, but Goals and Measures for the Plan Have Not Been Finalized
    In U.S GAO News
    GAO identified advantages of, challenges related to, and options for improving the Internal Revenue Service's (IRS) current organizational structure, based on GAO's review of prior work and interviews with IRS officials and stakeholders. For example, one advantage of the current structure, according to several interviewees, is that IRS's divisions have developed specialized expertise on different types of taxpayers with similar needs, such as small businesses. Several interviewees also believed that addressing some of IRS's challenges may not require significant changes to IRS's organizational structure. GAO and others have identified challenges and options to improve IRS's structure, processes, and operations in the following areas: (1) customer service; (2) communication and coordination within IRS; (3) technology; and (4) strategic human capital management and training. While developing its reorganization plan required by the Taxpayer First Act, IRS addressed or partially addressed all six of the key practices for agency reforms that GAO reviewed (see table below). GAO Assessment of IRS's Reorganization Planning Process against Key Reform Practices Key reform practice Extent addressed Establishing goals and outcomes ◑ Involving employees and key stakeholders ● Using data and evidence ● Addressing fragmentation, overlap, and duplication ◑ Addressing high-risk areas and long-standing management challenges ◑ Leadership focus and attention ● Legend: ● Generally addressed ◑ Partially addressed ○ Not addressed Source: GAO analysis of Internal Revenue Service (IRS) information. | GAO-21-18 IRS established a senior-level team—the Taxpayer First Act Office—to lead the reorganization planning, involved employees and key stakeholders, and used multiple sources of data and evidence to inform its planning. Although IRS has developed preliminary goals for the plan, it has not yet finalized and communicated the goals and performance measures for the plan. IRS has also researched potential actions it could take to address long-standing management challenges at IRS, such as those related to areas of fragmentation, overlap, duplication, and high risk that GAO has identified. However, IRS has not yet decided on specific actions to address those areas in its plan. IRS officials told us that they intend to take these additional steps, but COVID-19 delayed the completion of their reorganization plan to December 2020. As a result, it is still unclear whether the reorganization plan will have outcome-oriented goals and performance measures or whether it will identify specific actions to address long-standing management challenges. Taking these steps could help IRS identify and achieve the intended outcomes of the reorganization plan, and identify reforms that can create long-term gains in efficiency and effectiveness. The Taxpayer First Act required that a comprehensive written plan to redesign IRS be submitted to Congress by September 30, 2020. Reforming and reorganizing a federal agency as large and complex as IRS is not an easy task. However, a potential reorganization could provide IRS with an opportunity to address emerging and long-standing challenges. GAO was asked to review IRS's organizational structure and IRS's plans to reform it. This report examines (1) reported advantages of, challenges related to, and options for potentially improving IRS's organizational structure; and (2) the extent to which IRS's reorganization planning process is consistent with selected leading practices. GAO reviewed documents from IRS and other sources; interviewed IRS officials and stakeholders, including three former IRS commissioners; and assessed IRS's reorganization planning process against selected key practices for agency reform efforts developed by GAO. GAO is making three recommendations to IRS as it finalizes its reorganization plan, including that IRS should finalize goals and performance measures, and identify specific actions to address long-standing management challenges. IRS responded that it plans to implement GAO's recommendations when it submits its final reorganization plan to Congress in December 2020. For more information, contact James R. McTigue, Jr. at (202) 512-9110 or mctiguej@gao.gov.
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  • Electricity Grid: Opportunities Exist for DOE to Better Support Utilities in Improving Resilience to Hurricanes
    In U.S GAO News
    Since 2012, utilities have taken steps to improve grid resilience to severe hurricanes, such as (1) implementing storm hardening measures to enable the grid to better withstand the effects of hurricanes; (2) adopting technologies to enhance operational capacity and help quickly restore service following disruptions; and (3) participating in mutual aid programs with other utilities and training and planning exercises. For example, utilities have implemented storm hardening measures that include elevating facilities and constructing flood walls to protect against storm surges. Utilities have also adopted technologies that enhance communication capabilities and monitor systems to detect, locate, and repair sources of disruptions. However, these utilities reported challenges justifying grid resilience investments to obtain regulatory approval, and some utilities have limited resources to pursue such enhancements. Example of Hurricane Resilience Improvement: Elevated Substation Various federal agencies can provide funding for efforts to enhance grid resilience to hurricanes, including the Department of Agriculture (USDA) and the Federal Emergency Management Agency (FEMA). However, eligibility for most federal funding for grid resilience, including some USDA and FEMA funding, is limited to publicly owned utilities and state, tribal, and local governments. The Department of Energy (DOE) does not provide direct funding for grid resilience improvements, but it has efforts under way, including through its National Laboratories, to provide technical assistance and promote research and collaboration with utilities. DOE has also initiated preliminary efforts to develop tools for resilience planning, including resilience metrics and other tools such as a framework for planning, but DOE does not have a plan to guide these efforts. Without a plan to guide DOE efforts to develop tools for resilience planning, utilities may continue to face challenges justifying resilience investments. In addition, DOE lacks a formal mechanism to inform utilities about the efforts of its National Laboratories. Such a mechanism would help utilities leverage existing resources for improving grid resilience to hurricanes. Hurricanes pose significant threats to the electricity grid in some U.S. coastal areas and territories and are a leading cause of major power outages. In recent years, hurricanes have impacted millions of customers in these areas. Adoption of technologies and other measures could improve the resilience of the grid so that it is better able to withstand and rapidly recover from severe weather; this could help mitigate the effects of hurricanes. This report examines (1) measures utilities in selected states have adopted to enhance grid resilience following major hurricanes since 2012 and any challenges utilities face funding such measures; and (2) federal efforts to support the adoption of measures to enhance grid resilience to hurricanes and any opportunities that exist to improve these efforts. For this report, GAO assessed agency and industry actions; reviewed relevant reports, policies, and documents; and interviewed federal, industry, and local officials. GAO recommends that DOE (1) establish a plan to guide its efforts to develop tools for resilience planning, and (2) develop a mechanism to better inform utilities about grid resilience efforts at the National Laboratories. DOE agreed in principle with these recommendations, but its proposed actions do not fully address GAO's concerns. For more information, contact Frank Rusco at (202) 512-3841 or ruscof@gao.gov.
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  • Comparative Effectiveness Research: Patient-Centered Outcomes Research Institute and HHS Continue Activities and Plan New Efforts
    In U.S GAO News
    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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  • Intelligence Community: Additional Actions Needed to Strengthen Workforce Diversity Planning and Oversight
    In U.S GAO News
    The Office of the Director of National Intelligence (ODNI) reported that the representation of some demographic groups within the Intelligence Community (IC) workforce increased from fiscal years 2011 through 2019—the latest available data. Over this period, the proportion of women, racial or ethnic minorities, and persons with disabilities changed by .7, 3.3, and 6.2 percentage points, respectively. However, the representation of women, racial or ethnic minorities, and persons with disabilities remained below comparable benchmarks and declined among higher ranks in fiscal year 2019. IC elements report taking steps to address leading practices for managing workforce diversity, but report gaps in diversity planning. GAO found that most IC elements report taking steps to address seven of nine leading practices for diversity management. For the remaining two leading practices—strategic planning and measurement—most elements report taking one or no steps. Number of Intelligence Community (IC) Elements and the Steps They Report Taking to Implement Leading Practices for Workforce Diversity Management, as of August 2020 GAO leading practices Number of IC elements that report taking steps Leadership commitment 17 of 17 IC elements report taking multiple steps Recruitment 14 of 17 IC elements report taking multiple steps, and three IC elements report taking one step Employee involvement 14 of 17 IC elements report taking multiple steps, two IC elements report taking one step, and one IC element reports taking no step Diversity training 14 of 17 IC elements report taking multiple steps, and three IC elements report taking one step Performance 12 of 17 IC elements linked diversity management with enhanced performance while five IC elements did not Succession planning 9 of 17 IC elements report taking multiple steps, and eight IC elements report taking one step Accountability 9 of 17 IC elements report taking multiple steps, seven IC elements report taking one step, and one IC element reports taking no steps Strategic planning 3 of 17 IC elements have current and complete strategic plans Measurement 6 of 17 IC elements have diversity-related performance measures Source: GAO analysis of IC element documents and GAO leading practices for diversity management. | GAO-21-83 Further, while all IC elements report having a process to identify barriers to diversity, nine IC elements report not completing required barrier assessments. Without fully implementing leading practices for managing workforce diversity and conducting routine barrier assessments, the IC may miss opportunities to develop effective and efficient diversity policies and programs. ODNI's Office of Intelligence Community Equal Employment Opportunity and Diversity (IC EEOD) is meeting seven of eight leading practices for enhancing and sustaining the coordination of diversity initiatives across the 17 IC elements. However, IC EEOD partially met the practice to reinforce agency accountability. Specifically, IC EEOD has not established IC-wide implementation objectives and timeframes to demonstrate progress. As a result, IC EEOD risks not holding IC elements accountable for enhancing workforce diversity. The 2019 National Intelligence Strategy states that the IC will recruit, develop, and retain a diverse, inclusive, and expert workforce to enable mission success. ODNI reports that the IC is taking steps to increase the representation of diverse groups, such as issuing new strategies to enhance workforce planning. However, barriers to establishing a diverse workforce exist across the IC, according to an ODNI 2017 analysis. GAO was asked to review the IC's progress in enhancing workforce diversity. This report (1) summarizes ODNI annual demographic reports on the proportion of women, racial or ethnic minorities, and persons with disabilities; and assesses the extent to which (2) IC elements report taking steps to address leading practices for managing workforce diversity and to identify potential barriers to maintaining a diverse workforce; and (3) ODNI is addressing leading practices for coordinating IC workforce diversity initiatives. GAO reviewed IC-wide and IC element specific policies and guidance; interviewed ODNI, and other IC officials; and administered a questionnaire to all 17 IC elements to obtain information on diversity strategies and challenges. GAO is making seven recommendations, including that the Director of National Intelligence issue or update guidance to ensure IC elements maintain diversity strategic plans, assess and take steps to eliminate barriers to diversity, and establish implementation objectives and timeframes to hold IC elements accountable. ODNI agreed with the recommendations. For more information, contact Brian M. Mazanec at (202) 512-5130 or mazanecb@gao.gov.
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  • DHS Office of Inspector General: Actions Needed to Address Long-Standing Management Weaknesses
    In U.S GAO News
    What GAO Found Since fiscal year 2015, the Department of Homeland Security (DHS) Office of Inspector General (OIG) has not adhered to a number of professional standards for federal OIGs and key practices for effective management. Frequent leadership turnover and associated shifts in leadership priorities have contributed to DHS OIG's long-standing management and operational weaknesses and impeded efforts to address them. DHS OIG senior leaders acknowledge that various challenges have contributed to these weaknesses, and have taken steps to begin to address some of them, as follows: Organizational performance management: DHS OIG has operated for 4 of the past 6 years without a strategic plan. This limits its ability to implement other organizational performance management activities, such as annual planning and performance assessment. In the absence of a strategic plan, GAO found that DHS OIG staff may not understand its oversight priorities and goals, which can negatively affect operations and staff performance. In 2020, DHS OIG contracted with a nonprofit academy of government experts to develop a strategic plan for fiscal years 2021–2025, with expected completion in June 2021. Quality assurance: DHS OIG has not developed or implemented organization-wide roles and responsibilities for quality assurance. DHS OIG retracted some reports in recent years because they did not adhere to professional standards. Because there is no overarching system of internal quality assurance for audit, inspection, evaluation, and other work, DHS OIG cannot know if its internal processes ensure that its work (1) adheres to its policies and (2) meets established standards of performance. Report timeliness: Project time frames have increased in recent years, and DHS OIG has not taken steps to understand the causes of such increases or determine how to address them. For example, in the Office of Audits, eight of 102 projects completed in fiscal year 2017 took more than 18 months, compared to more than half (35 of 67) of projects completed in fiscal year 2020. Without timely DHS OIG reports, DHS's ability to respond to such oversight efforts and Congress's ability to conduct effective oversight of DHS operations are limited. Coordination with DHS: DHS OIG does not have a consistent process for coordinating with DHS components to receive and respond to technical and management comments on DHS OIG audit, inspection, and evaluation work. Further, DHS officials do not have confidence in DHS OIG's processes to (1) correct factual errors before finalizing reports and (2) redact sensitive but unclassified information before publicly issuing reports. As a result, the process by which DHS OIG resolves DHS's comments is at risk of miscommunication and misunderstandings. These and additional weaknesses GAO identified are of particular concern given that OIGs need to maintain high standards of professionalism and integrity in light of their mission, according to quality standards for federal OIGs. Without addressing these and other long-standing management and operational weaknesses, DHS OIG is not well positioned to fulfill its oversight mission. Why GAO Did This Study DHS OIG plays a critical role in overseeing DHS, which encompasses multiple components and programs and has tens of billions of dollars in annual budgetary resources. However, DHS OIG has faced a number of long-standing management and operational challenges that have affected its ability to carry out its oversight mission effectively. GAO was asked to review DHS OIG's management and operations. This report addresses the extent to which DHS OIG adheres to professional standards and key practices in its management and operations, among other objectives. GAO reviewed DHS OIG management and operations from fiscal year 2015 through fiscal year 2020. GAO evaluated DHS OIG's processes against quality standards for federal OIGs, relevant federal standards for internal control, and human capital and organizational change leading practices. To do so, GAO reviewed DHS OIG documents, interviewed officials, and analyzed DHS OIG data and published reports.
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  • Littoral Combat Ship: Unplanned Work on Maintenance Contracts Creates Schedule Risk as Ships Begin Operations
    In U.S GAO News
    What GAO Found The Littoral Combat Ship (LCS) is a class of small surface ships with two unique design variants. Both LCS variants carry smaller crews and rely more on contractors for maintenance than any other Navy ship. While this strategy was intended to reduce operating costs, it contributes to challenges in the Navy's strategy for contracted maintenance. Specifically: Contractor travel. U.S. law states that foreign contractors generally cannot conduct certain types of LCS maintenance. This results in the Navy paying for contractors to regularly travel overseas to perform routine maintenance. GAO's sample of 18 delivery orders showed estimated travel costs for the orders reviewed ranged from a few thousand dollars to over $1 million. Heavy reliance on original equipment manufacturers. LCS includes numerous commercial-based systems that are not used on other Navy ships. However, the Navy lacks sufficient manufacturer technical data to maintain many of these systems. This can lead to longer maintenance periods due to extra coordination needed for the manufacturers to assist with or complete the work. Although the Navy is establishing teams of its personnel to take on routine maintenance, contractors will continue performing some of this work. Littoral Combat Ship Variants under Maintenance The Navy is beginning to implement contracting approaches for LCS maintenance in order to help mitigate schedule risk, while taking steps to avoid it in the future. GAO found in the 18 LCS maintenance delivery orders it reviewed that the Navy had to contract for more repair work than originally planned, increasing the risk to completing LCS maintenance on schedule. A majority of this unplanned work occurred because the Navy did not fully understand the ship's condition before starting maintenance. The Navy has begun taking steps to systematically collect and analyze maintenance data to determine the causes of unplanned work, which could help it more accurately plan for maintenance. The Navy has also recently begun applying some contracting approaches to more quickly incorporate unplanned work and mitigate the schedule risk, such as (1) setting a price for low-dollar value unplanned work to save negotiation time and (2) procuring some materials directly instead of waiting for contractors to do so. Such measures will be important to control cost and schedule risks as additional LCS enter the fleet in the coming years. Why GAO Did This Study The Navy plans to spend approximately $61 billion to operate and maintain LCS, a class of small surface ships equipped with interchangeable sensors and weapons. With limited operations to date, these ships have entered the Navy's maintenance cycle. Since 2005, GAO has reported extensively on LCS issues, including ships delivered late and with increased costs and less capability than planned. The Navy also encountered problems as LCS entered the fleet, including higher than expected costs for contractor maintenance and numerous mechanical failures. In 2020, GAO reported that major maintenance on other surface ships using the same contracting approach as LCS was 64 days late, on average. The Navy acknowledges the importance of reducing maintenance delays in order to improve the readiness of its surface fleet. A House Report included a provision for GAO to review long-term contracting strategies and challenges for LCS repair and maintenance. This report (1) describes the effect of the LCS program's acquisition and sustainment strategies on its contracted maintenance and (2) assesses the extent to which the Navy is using contracting approaches to address any cost and schedule risks in maintaining LCS. To conduct this assessment, GAO reviewed relevant Navy documentation, including a sample of 18 delivery orders for LCS maintenance from fiscal year 2018 through April 2020 selected to cover each availability type and each LCS variant. GAO also interviewed Navy officials and contractor representatives. For more information, contact Shelby S. Oakley at (202) 512-4841 or OakleyS@gao.gov.
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  • Internet of Things: Information on Use by Federal Agencies
    In U.S GAO News
    Many federal agencies (56 of 90) responding to GAO's survey reported using Internet of Things (IoT) technologies. Most often, agencies reported using IoT to: (1) control or monitor equipment or systems (42 of 56); (2) control access to devices or facilities (39 of 56); or (3) track physical assets (28 of 56) such as fleet vehicles or agency property. Agencies also reported using IoT devices to perform tasks such as monitoring water quality, watching the nation's borders, and controlling ships in waterway locks. Furthermore, IoT use by federal agencies may increase in the future, as many agencies reported planning to begin or expand the use of IoT. However, 13 agencies not using IoT technologies reported they did not plan to use the technologies for a range of reasons, including insufficient return on investment. Example of Government's Use of Internet of Things Technology: Environmental Protection Agency's (EPA) Water Monitoring Buoy Surveyed agencies most frequently reported increasing data collection (45 of 74), and increasing operational efficiency (43 of 74) as benefits of using IoT technologies. Increasing data collection can aid decision-making and support technology development; increased efficiencies may allow agencies to accomplish more with existing resources. According to EPA officials, sensors are able to transmit data eliminating the need for employees to visit sites to collect data. The Saint Lawrence Seaway Development Corporation reported that IoT technologies helped improve transit times through its locks. Agencies most frequently reported cybersecurity issues (43 of 74) and interoperability (30 of 74) as the most significant challenges to adopting IoT technologies. For example, the Transportation Security Administration's officials told us they could not ensure the security and privacy of passenger information and subsequently took its network-connected security equipment offline until they developed a solution. Most agencies' officials responding to GAO's survey (54 of 72), as well as officials interviewed as part of the case studies, reported using information technology (IT) policies developed by their agency, versus internal IoT-specific policies, to manage IoT technologies. Some agencies reported their IT policies were sufficient for the current challenges and risks associated with adopting IoT technologies, including cybersecurity. The Office of Management and Budget's officials stated they do not typically make policies for specific IT components but if needed would work with the National Institute of Standards and Technology and others to develop such policies. IoT generally refers to devices—from sensors in vehicles to building thermostats— that collect information, communicate it to a network, and may complete a task based on that information. Although IoT technologies may present an opportunity for the federal government to operate more efficiently and effectively, federal agencies may also face challenges in acquiring and using IoT. GAO was asked to review the federal government's experience with IoT. This report describes (1) IoT technologies selected federal agencies are using, (2) the benefits and challenges of using IoT technologies, and (3) policies and guidance selected agencies follow in using and acquiring IoT technologies. GAO surveyed 115 Chief Information Officers (CIO) and senior IT officials at federal agencies and subcomponents based on, in part, agency membership in the federal CIO Council; 90 responded. However, not all agencies replied to each question. GAO also selected the Department of Commerce, the Department of Homeland Security, EPA, and the National Aeronautics and Space Administration as case studies. GAO selected these agencies based on, among other things, their fiscal year 2020 IT budgets and examples of IoT use from literature. For each case study, GAO reviewed documents and interviewed officials from the Office of the CIO from the agency and officials from selected sub-components that use the IoT technologies. For more information, contact Andrew Von Ah at (202) 512-2834 or vonaha@gao.gov.
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