University of Miami to Pay $22 Million to Settle Claims Involving Medically Unnecessary Laboratory Tests and Fraudulent Billing Practices

The University of Miami (UM) has agreed to pay $22 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary laboratory tests, and submitting false claims through its laboratory and off campus hospital based facilities (“Hospital Facilities”).

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For example, the memo did not address how State would coordinate internally on the cybersecurity aspects of digital economy policy issues with cyber diplomacy functions split between CSET and EB. The memo also did not specify how State would develop consolidated positions and set priorities for State's international cyberspace efforts, given the separation of these issues. Moreover, neither the briefing nor the action memo contained analyses supporting the additional details laid out in State's 2019 notification to Congress on CSET, including support for proposed resource allocations for the new bureau. Without developing data and evidence to support its proposal for the new bureau, State lacks assurance that its proposal will effectively set priorities and allocate appropriate resources for the bureau to achieve its intended goals. State needs to develop these areas further to better ensure the success of any new organizational arrangement. The United States and its allies are facing expanding foreign cyber threats as international trade, communication, and critical infrastructure become increasingly dependent on cyberspace. State leads U.S. government international efforts to advance the full range of U.S. interests in cyberspace. The Cyber Diplomacy Act of 2019 (H.R. 739, 116th Cong.), co-sponsored by 29 members of Congress, proposed the establishment of a new office within State that would have consolidated responsibility for digital economy and internet freedom issues, together with international cybersecurity issues. While the House Foreign Affairs Committee reported out this bill in March 2019, the full House of Representatives did not consider the bill prior to expiration of the 116th Congress. State subsequently notified Congress in June 2019 of its plan to establish CSET, with a narrower focus on cyberspace security and emerging technologies. On January 7, 2021, State announced that the Secretary had approved the creation of CSET and directed the department to move forward with establishing the bureau. However, as of the date of this report, State had not created CSET. GAO was asked to review State's efforts to advance U.S. interests in cyberspace. This report examines the extent to which State used data and evidence to develop and justify its proposal to establish CSET. GAO reviewed available documentation and interviewed State officials. To determine the extent to which State used data and evidence to develop and justify its proposal to establish CSET, GAO assessed State's documentation against a relevant key practice for agency reforms compiled in GAO's June 2018 report on government reorganization. The Secretary of State should ensure that State uses data and evidence to justify its current proposal, or any new proposal, to establish the Bureau of Cyberspace Security and Emerging Technologies to enable the bureau to effectively set priorities and allocate resources to achieve its goals. While State disagreed with GAO's characterization of its use of data and evidence to develop its proposal for CSET, it agreed that reviewing such information to evaluate program effectiveness can be useful. State commented that it has provided GAO with appropriate material on its decision to establish CSET and has not experienced challenges in coordinating cyberspace security policy across the department while the CSET proposal has been in discussion. State concluded that this provides assurance that CSET will allow the new bureau to effectively set priorities and allocate resources. The documents State provided in response to GAO's requests, including a set of briefing slides and an action memo to the Secretary, did not sufficiently demonstrate that it used data and evidence in developing its proposal. In addition, State's comment that it has not experienced coordination challenges in recent years is not sufficient evidence that the potential for such challenges does not exist. Without evidence to support the creation of the new bureau, State lacks needed assurance that the bureau will effectively set priorities and allocate appropriate resources to achieve its intended goals. For more information, contact Brian M. Mazanec at (202) 512-5130 or MazanecB@gao.gov, or Nick Marinos at (202) 512-9342 or MarinosN@gao.gov.
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    What GAO Found The Department of Homeland Security (DHS) has established a five-step process for developing and overseeing the implementation of binding operational directives, as authorized by the Federal Information Security Modernization Act of 2014 (FISMA). The process includes DHS coordinating with stakeholders early in the directives' development process and validating agencies' actions on the directives. However, in implementing the process, DHS did not coordinate with stakeholders early in the process and did not consistently validate agencies' self-reported actions. In addition to being a required step in the directives process, FISMA requires DHS to coordinate with the National Institute of Standards and Technology (NIST) to ensure that the directives do not conflict with existing NIST guidance for federal agencies. However, NIST officials told GAO that DHS often did not reach out to NIST on directives until 1 to 2 weeks before the directives were to be issued, and then did not always incorporate the NIST technical comments. More recently, DHS and NIST have started regular coordination meetings to discuss directive-related issues earlier in the process. Regarding validation of agency actions, DHS has done so for selected directives, but not for others. DHS is not well-positioned to validate all directives because it lacks a risk-based approach as well as a strategy to check selected agency-reported actions to validate their completion. Directives' implementation often has been effective in strengthening federal cybersecurity. For example, a 2015 directive on critical vulnerability mitigation required agencies to address critical vulnerabilities discovered by DHS cyber scans of agencies' internet-accessible systems within 30 days. This was a new requirement for federal agencies. While agencies did not always meet the 30-day requirement, their mitigations were validated by DHS and reached 87 percent compliance by 2017 (see fig. 1). DHS officials attributed the recent decline in percentage completion to a 35-day partial government shutdown in late 2018/early 2019. Nevertheless, for the 4-year period shown in the figure below, agencies mitigated within 30 days about 2,500 of the 3,600 vulnerabilities identified. Figure 1: Critical Vulnerabilities Mitigated within 30 days, May 21, 2015 through May 20, 2019 Agencies also made reported improvements in securing or replacing vulnerable network infrastructure devices. Specifically, a 2016 directive on the Threat to Network Infrastructure Devices addressed, among other things, several urgent vulnerabilities in the targeting of firewalls across federal networks and provided technical mitigation solutions. As shown in figure 2, in response to the directive, agencies reported progress in mitigating risks to more than 11,000 devices as of October 2018. Figure 2: Federal Civilian Agency Vulnerable Network Infrastructure Devices That Had Not Been Mitigated, September 2016 through January 2019 Another key DHS directive is Securing High Value Assets, an initiative to protect the government's most critical information and system assets. According to this directive, DHS is to lead in-depth assessments of federal agencies' most essential identified high value assets. However, an important performance metric for addressing vulnerabilities identified by these assessments does not account for agencies submitting remediation plans in cases where weaknesses cannot be fully addressed within 30 days. Further, DHS only completed about half of the required assessments for the most recent 2 years (61 of 142 for fiscal year 2018, and 73 of 142 required assessments for fiscal year 2019 (see fig. 3)). In addition, DHS does not plan to finalize guidance to agencies and third parties, such as contractors or agency independent assessors, for conducting reviews of additional high value assets that are considered significant, but are not included in DHS's current review, until the end of fiscal year 2020. Given these shortcomings, DHS is now reassessing key aspects of the program. However, it does not have a schedule or plan for completing this reassessment, or to address outstanding issues on completing required assessments, identifying needed resources, and finalizing guidance to agencies and third parties. Figure 3: Department of Homeland Security Assessments of Agency High Value Assets, Fiscal Years (FY) 2018 through 2019 Why GAO Did This Study DHS plays a key role in federal cybersecurity. FISMA authorized DHS, in consultation with the Office of Management and Budget, to develop and oversee the implementation of compulsory directives—referred to as binding operational directives—covering executive branch civilian agencies. These directives require agencies to safeguard federal information and information systems from a known or reasonably suspected information security threat, vulnerability, or risk. Since 2015, DHS has issued eight directives that instructed agencies to, among other things, (1) mitigate critical vulnerabilities discovered by DHS through its scanning of agencies' internet-accessible systems; (2) address urgent vulnerabilities in network infrastructure devices identified by DHS; and (3) better secure the government's highest value and most critical information and system assets. GAO was requested to evaluate DHS's binding operational directives. This report addresses (1) DHS's process for developing and overseeing the implementation of binding operational directives and (2) the effectiveness of the directives, including agencies' implementation of the directive requirements. GAO selected for review the five directives that were in effect as of December 2018, and randomly selected for further in-depth review a sample of 12 agencies from the executive branch civilian agencies to which the directives apply. In addition, GAO reviewed DHS policies and processes related to the directives and assessed them against FISMA and Office of Management and Budget requirements; administered a data collection instrument to selected federal agencies; compared the agencies' responses and supporting documentation to the requirements outlined in the five directives; and collected and analyzed DHS's government-wide scanning data on government-wide implementation of the directives. GAO also interviewed DHS and selected agency officials.
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