Woman First in the Nation Charged with Misappropriating Monies Designed for COVID Medical Provider Relief

A Michigan woman was indicted on allegations that she intentionally misappropriated government funds that were designed to aid medical providers in the treatment of patients suffering from COVID-19 and used them for her own personal expenses.

More from: February 11, 2021

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  • Private Health Insurance: Markets Remained Concentrated through 2018, with Increases in the Individual and Small Group Markets
    In U.S GAO News
    Enrollment in private health insurance plans in the individual (coverage sold directly to individuals), small group (coverage offered by small employers), and large group (coverage offered by large employers) markets has historically been highly concentrated among a small number of issuers. GAO found that this pattern continued in 2017 and 2018. For example: For each market in 2018, at least 43 states (including the District of Columbia) were highly concentrated. Overall individual and small group markets have become more concentrated in recent years. The national median market share of the top three issuers increased by approximately 8 and 5 percentage points, respectively, from 2015 through 2018. With these increases, the median concentration was at least 94 percent in both markets in 2018. Number of States and District of Columbia Where the Three Largest Issuers Had at Least 80 Percent of Enrollment, by Market, 2011-2018 GAO found similar patterns of high concentration across the 39 states in 2018 that used federal infrastructure to operate individual market exchanges— marketplaces where consumers can compare and select among insurance plans sold by participating issuers—established in 2014 by the Patient Protection and Affordable Care Act (PPACA) and known as federally facilitated exchanges. From 2015 through 2018, states that were already highly concentrated became even more concentrated, often because the number of issuers decreased or the existing issuers accrued the entirety of the market share within a state. In 2017 and 2018 all 39 states were highly concentrated. GAO received technical comments on a draft of this report from the Department of Health and Human Services and incorporated them as appropriate. GAO previously reported that, from 2011 through 2016, enrollment in the individual, small group, and large group health insurance markets was concentrated among a few issuers in most states (GAO-19-306). GAO considered states' markets or exchanges to be highly concentrated if three or fewer issuers held at least 80 percent of the market share. GAO also found similar concentration on the health insurance exchanges established in 2014 by PPACA. A highly concentrated health insurance market may indicate less issuer competition and could affect consumers' choice of issuers and the premiums they pay for coverage. PPACA included a provision for GAO to periodically study market concentration. This report describes changes in the concentration of enrollment among issuers in the overall individual, small group, and large group markets; and individual market federally facilitated exchanges. GAO determined market share in the overall markets using enrollment data from 2017 and 2018 that issuers are required to report annually to the Centers for Medicare & Medicaid Services (CMS). GAO determined market share in the individual market federally facilitated exchanges in 2018 using enrollment data from CMS. For all analyses, GAO used the latest data available. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.
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  • Social Security Disability: Process Needed to Review Productivity Expectations for Administrative Law Judges
    In U.S GAO News
    What GAO Found The Social Security Administration's (SSA) administrative law judges review, process, and adjudicate requests for hearings on disability benefits. In 2007, the agency set an expectation—which SSA reported was based on trend data and some regional managers' input—for judges to issue 500-700 dispositions (decisions and dismissals) each year, and the extent to which they have met this expectation has varied over time. SSA did not document the expectation-setting process in 2007, nor has it formally reviewed the expectation since. Judges in discussion groups held by GAO questioned the basis of the expectation and 87 percent of judges GAO surveyed (47 of 54) said the expectation was too high. The extent to which judges met the annual and related expectations has fluctuated over the years (see figure). Without periodic reviews, SSA cannot be assured that its expectations appropriately allow judges to balance productivity with other expectations, such as quality, given changing conditions over time. Administrative Law Judges Who Met or Exceeded SSA's Annual Productivity Expectation, Fiscal Years 2014-2020 Judges in selected hearing offices cited a variety of factors affecting their ability to meet the annual expectation. The top factor cited by judges GAO surveyed was the size of case files, which have increased five-fold on average since the expectation was established, according to SSA data. The COVID-19 pandemic introduced other factors in 2020, resulting in fewer hearings being conducted. SSA monitors judges' productivity and takes various actions when expectations are not met, ranging from informal conversations to formal discipline. In addition, judges in 11 of 13 discussion groups viewed telework restrictions as a consequence for not meeting expectations. Additionally, judges GAO surveyed reported feeling pressured to meet the expectations. For instance, 87 percent of judges surveyed (47 of 54) said that SSA placed too much emphasis on productivity, and some expressed concerns about their work quality and work-life balance. SSA officials said they do not formally seek feedback from judges on the expectations. However, without feedback or other gauges of pressure, SSA lacks information that could help it appropriately balance timely case processing while maintaining high-quality work and employee morale. Why GAO Did This Study SSA's approximately 1,350 judges play a major role in processing and adjudicating requests for hearings to help ensure individuals who do not agree with the determination on their claim for Social Security disability benefits receive due process. SSA receives hundreds of thousands of hearing requests each year and has historically had a large backlog. GAO was asked to review SSA's productivity expectations for its judges. This report examines (1) how SSA set productivity expectations for judges and the extent to which judges have met them over time, (2) reported factors affecting the ability of judges in selected offices to meet the annual productivity expectation, and (3) SSA's management of judges' productivity. GAO obtained and analyzed SSA data on judges' productivity from fiscal years 2005-2020; surveyed and held 13 virtual discussion groups with judges in six hearing offices selected for geographic location, average productivity, and average case size; reviewed relevant federal laws and agency policies and documents; and interviewed officials from SSA and the association representing judges.
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  • The Nation’s Fiscal Health: Information on the Spending and Revenue Implications of Potential Debt Targets
    In U.S GAO News
    The COVID-19 pandemic has necessitated major federal spending to respond to the national public health emergency and resulting economic turmoil. This response and the severe economic contraction from the pandemic have led to increased federal debt. Once the COVID-19 pandemic abates and the economy has substantially recovered, Congress and the administration will need to address the federal government’s fiscal challenges. To help change the long-term fiscal path, in September 2020 GAO recommended that Congress consider establishing a long-term fiscal plan that includes fiscal rules and targets, such as a debt-to-gross domestic product (GDP) target. In this report, GAO analyzed the changes in spending and revenue needed to reach six potential debt-to-GDP targets at the end of a 30-year period (2020-2049). To reach any of the targets, policymakers will need to cut program spending, increase revenue, or, most likely, a combination of both (see table). Illustrative Examples of Changes Needed to Achieve Debt-to-GDP Targets Debt target, percent of GDP (end of 30 years) Spending and revenue: total change over 30 years Program spending alone: Immediate and permanent decrease needed in annual projected program spendinga Revenue alone: Immediate and permanent increase needed in annual projected revenue Percent Dollars, trillions Percent Percent 140 25.4 13.8 18.5 120 31.2 16.9 22.8 100 37 20 27 80 42.8 23.1 31.2 60 48.5 26.3 35.4 0 (paying off all debt) 65.9 35.7 48.1 Source: GAO simulation. | GAO-21-211. Note: The simulation used for this analysis generally reflect historical trends, such as the extension of tax provisions scheduled to expire. It does not account for potential macroeconomic effects of fiscal policy changes over time. aProgram spending consists of all spending except interest payments on debt held by the public. When considering the spending and revenue changes needed to achieve various debt-to-GDP targets, policymakers may also consider how changes in assumptions about key variables—such as discretionary spending, revenue, and GDP—affect these fiscal outcomes. For example, if GDP growth is greater than expected, policymakers may have to make smaller spending cuts or revenue increases to reach a selected debt-to-GDP target than those that would be needed based on GAO’s standard assumptions. GAO created an interactive web tool accompanying this report to allow users to enter different assumptions for each of these variables. This tool illustrates how these changes would affect the different debt-to-GDP targets over time, as well as the changes in spending and revenue needed to achieve various targets. This tool can be found at https://www.gao.gov/products/GAO-21-211. Even before the fiscal and economic effects resulting from COVID-19, an imbalance between federal revenue and spending that is built into current law and policy was contributing to the growing federal debt. The Congressional Budget Office projects that by 2023 federal debt held by the public will reach 107 percent of GDP, its highest point in U.S. history. This situation—in which federal debt grows faster than GDP—means that our nation is on an unsustainable fiscal path. GAO was asked to review issues related to fiscal rules and targets and the federal fiscal condition. In response to this request, in September 2020, GAO issued a report (GAO-20-561) on key considerations for the design, implementation, and enforcement of fiscal rules and targets. This report supplements that work and describes how changes in assumptions of future spending and revenue affect the federal government’s projected fiscal condition. GAO updated its long-term simulations of federal revenue and spending to (1) analyze six potential debt-to-GDP targets and (2) measure the fiscal gap—the policy change needed to reach a given debt-to-GDP fiscal target from the start to the end of 30-years. GAO also analyzed how changes in key variables affected the debt-to-GDP targets and the fiscal gap. For more information, contact Jeff Arkin at (202) 512-6806 or arkinj@gao.gov.
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    Fourteen members of the transnational criminal organization, QQAAZZ, were charged by a federal grand jury in the Western District of Pennsylvania in an indictment unsealed today.  A related indictment unsealed in October 2019 charged five members of QQAAZZ.  One additional conspirator, a Russian national, was arrested by criminal complaint in late March 2020 while visiting the United States, bringing the total number of charged defendants to 20.  Acting Assistant Attorney General Brian C. Rabbitt of the U.S. Department of Justice’s Criminal Division and U.S. Attorney Scott W. Brady for the Western District of Pennsylvania, made the announcement today.
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  • Cyber Diplomacy: State Should Use Data and Evidence to Justify Its Proposal for a New Bureau of Cyberspace Security and Emerging Technologies
    In U.S GAO News
    The Department of State (State) did not demonstrate that it used data and evidence to develop its proposal for establishing a new Bureau of Cyberspace Security and Emerging Technologies (CSET). In response to GAO requests for such data and evidence, State provided GAO with briefing slides outlining different options for the new bureau and an action memo, approved by the Secretary of State. The memo recommended that CSET focus on cyberspace security and the security aspects of emerging technologies and report to the Under Secretary for Arms Control and International Security, while the Bureau of Economic and Business Affairs (EB) would continue to have responsibility for digital economy issues. However, State did not explain how it would address any challenges associated with the decision on CSET's organizational placement. 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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  • VA Health Care: Community Living Centers Were Commonly Cited for Infection Control Deficiencies Prior to the COVID-19 Pandemic
    In U.S GAO News
    The Department of Veterans Affairs (VA) is responsible for overseeing the quality of nursing home care provided to residents in VA-owned and -operated community living centers (CLC). VA models its oversight process on the methods used by the Centers for Medicare & Medicaid Services, which uses inspections of nursing homes to determine whether the home meets federal quality standards. These standards require, for example, that CLCs establish and maintain an infection prevention and control program. VA uses a contractor to conduct annual inspections of the CLCs, and these contractors cite CLCs with deficiencies if they are not in compliance with quality standards. Infection prevention and control deficiencies cited by the inspectors can include situations where CLC staff did not regularly use proper hand hygiene or failed to correctly use personal protective equipment. Many of these practices can be critical to preventing the spread of infectious diseases, including COVID-19. GAO analysis of VA data shows that infection prevention and control deficiencies were the most common type of deficiency cited in inspected CLCs, with 95 percent (128 of the 135 CLCs inspected) having an infection prevention and control deficiency cited in 1 or more years from fiscal year 2015 through 2019. GAO also found that over the time period of its review, a significant number of inspected CLCs—62 percent—had infection prevention and control deficiencies cited in consecutive fiscal years, which may indicate persistent problems. An additional 19 percent had such deficiencies cited in multiple, nonconsecutive years. Why GAO Did This Study COVID-19 is a new and highly contagious respiratory disease causing severe illness and death, particularly among the elderly. Because of this, the health and safety of the nation’s nursing home residents—including veterans receiving nursing home care in CLCs—has been a particular concern.  GAO was asked to review the quality of care at CLCs. In this report, GAO describes the prevalence of infection prevention and control deficiencies in CLCs prior to the COVID-19 pandemic. Future GAO reports will examine more broadly the quality of care at CLCs and VA’s response to COVID-19 in the nursing home settings for which VA provides or pays for care. For this report, GAO analyzed VA data on deficiencies cited in CLCs from fiscal years 2015 through 2019. Using these data, GAO determined the most common type of deficiency cited among CLCs, the number of CLCs that had infection prevention and control deficiencies cited, and the number of CLCs with repeated infection prevention and control deficiencies over the period from fiscal years 2015 through 2019. GAO also obtained and reviewed inspection reports and corrective action plans to describe examples of the infection prevention and control deficiencies cited at CLCs and the CLCs’ plans to remedy the noncompliance. For more information, contact Sharon M. Silas at (202) 512-7114 or SilasS@gao.gov.
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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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  • DOD Health Care: DOD Should Monitor Implementation of Its Clinical Practice Guidelines
    In U.S GAO News
    As of October 2020, the Departments of Defense (DOD) and Veterans Affairs (VA) had jointly developed 22 clinical practice guidelines (VA/DOD CPG) that address specific health conditions, including those related to chronic diseases, mental health issues, pain management, and rehabilitation. Such guidelines are important as military and veteran populations may have different health care needs than civilians due to involvement in combat or occupational exposures (e.g., fumes from burn pits) that may amplify physical and psychological stresses. GAO found that DOD and VA considered the health care needs of these populations throughout the guideline development process and that the guidelines include information about these health care needs in different sections. In some cases, the guidelines include treatment recommendations that specifically address the health care needs of the military and veteran populations. In other instances, they may include information about the prevalence of a specific condition for these populations, among other information. Each of the military services (Army, Air Force, and Navy) has its own process for distributing VA/DOD CPGs to providers at their military treatment facilities (MTF). However, DOD's Defense Health Agency (DHA) is in the process of assuming administrative operations—to include distributing guidelines—for all of the military services' MTFs through an incremental transition process that is to be completed by the end of September 2021. While DHA officials acknowledged that they need to develop a uniform distribution process for the guidelines once they complete the transition, MTF providers can currently access the guidelines through VA's designated website and DOD's electronic health record systems. Congress directed DOD to implement VA/DOD CPGs, using means such as providing education and training, and to monitor MTFs' implementation of them. However, GAO found that DHA and the military services are not systematically monitoring MTFs' implementation of these guidelines. While the Army tracks VA/DOD CPG education and training at its MTFs, officials with DHA, the Navy, and the Air Force explained that they have not been monitoring MTF implementation of these guidelines. DHA officials acknowledged that they need to develop a monitoring process as they assume administrative and oversight responsibilities for the military services' MTFs, but have not yet developed a plan to do so. Without a systematic process to monitor MTF implementation of these guidelines, DHA does not know the extent to which MTF providers may be using VA/DOD CPGs to reduce the variability and improve the quality of health care services provided—factors that may contribute to better health outcomes across the military health system. Through DOD's TRICARE program, eligible beneficiaries may receive care from providers at MTFs or from civilian providers. The National Defense Authorization Act for Fiscal Year 2017 required DOD to establish a program to develop, implement, update, and monitor clinical practice guidelines, which are evidence-based treatment recommendations to improve the consistency and quality of care delivered by MTF providers. The Act also included a provision for GAO to assess issues related to the military health system, including the process of ensuring that providers adhere to clinical practice guidelines, and to report annually for 4 years. This is GAO's fourth report based on the Act. This report describes (1) how the process for developing the guidelines considers the health care needs of the military and veteran populations, (2) how they are distributed by the military services to their providers and how providers access them, and (3) the extent to which DHA and the military services monitor MTF implementation of them, among other things. GAO reviewed relevant policies and guidance; analyzed each of the 22 CPGs; and interviewed officials with DOD, the military services, and VA. GAO recommends that DHA work with the military services to develop and implement a systematic process to monitor MTFs' implementation of VA/DOD CPGs. DOD concurred with this recommendation. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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  • Acting Attorney General Jeffrey A. Rosen’s Video Statement on the Seizure of the U.S. Capitol
    In Crime News
    Acting Attorney General Jeffrey A. Rosen delivered the following video statement on the seizure of the U.S. Capitol:
    [Read More…]
  • Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care
    In U.S GAO News
    The Department of Veterans Affairs (VA) established an appointment scheduling process for the Veterans Community Care Program (VCCP) that allows up to 19 days to complete several steps from VA providers creating a referral to community care staff reviewing that referral. However, as the figure shows, VA has not specified the maximum amount of time veterans should have to wait to receive care through the program. GAO previously recommended in 2013 the need for an overall wait-time measure for veterans to receive care under a prior VA community care program. Subsequent to VA not implementing this recommendation, GAO again recommended in 2018 that VA establish an achievable wait-time goal as part of its new community care program (the VCCP). Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the VCCP through routine referrals (non-emergent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf. VA has not yet implemented GAO's 2018 recommendation that VA establish an achievable wait-time goal. Under the VA MISSION Act, VA is assigned responsibility for ensuring that veterans' appointments are scheduled in a timely manner—an essential component of quality health care. Given VA's lack of action over the prior 7 years implementing wait-time goals for various community care programs, congressional action is warranted to help achieve timely health care for veterans. Regarding monitoring of the initial steps of the scheduling process, GAO found that VA is using metrics that are remnants from the previous community care program, which are inconsistent with the time frames established in the VCCP scheduling process. This limits VA's ability to determine the effectiveness of the VCCP and to identify areas for improvement. In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner. GAO was asked to review VCCP appointment scheduling. This report examines, among other issues, the VCCP appointment scheduling process VA established and VA's monitoring of that process. GAO reviewed documentation, such as scheduling policies, and referral data related to the VCCP and assessed VA's relevant processes. GAO conducted site visits to five VAMCs in the first region to transition to VA's new provider network, and interviewed VAMC staff and a non-generalizable sample of community providers receiving referrals from those VAMCs. GAO also interviewed VA and contractor officials. GAO recommends that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO is also making three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with one of GAO's recommendations related to aligning monitoring metrics to VCCP scheduling policy time frames. GAO continues to believe this recommendation is valid, as discussed in the report. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
    [Read More…]
  • Department of Justice Releases Report on its Efforts to Disrupt, Dismantle, and Destroy MS-13
    In Crime News
    Today, the Department of Justice released “Full Scale Response: A Report on the Department’s Efforts to Combat MS-13 from 2016-2020.”  This report describes the Department’s work to dismantle La Mara Salvatrucha (MS-13) in the United States and abroad.  The data show that since 2016, the Department has prosecuted approximately 749 MS-13 gang members.  So far, more than 500 of these MS-13 gang members have been convicted, including 37 who received life sentences.  Department prosecutors are using more than 20 federal criminal statutes to prosecute MS-13 members, including, for the first time, filing terrorism charges against MS-13’s leadership.  The data also show that for decades MS-13 has exploited weaknesses in border enforcement policies, as approximately 74 percent of the defendants prosecuted were unlawfully present in the United States.  The report also describes the Department’s efforts to combat MS-13 internationally through increased partnerships with law enforcement in Mexico and Central America.  Through international cooperation, hundreds of MS-13 members have been arrested abroad and more than 50 MS-13 members have been extradited to the United States.
    [Read More…]