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gao_GAO-18-407
gao_GAO-18-407_0
Background The goal of federal government industrial security is to ensure that contractors’ security programs detect, deter, and counter the threat posed by adversaries seeking classified information. The National Industrial Security Program was established by executive order in 1993 to replace industrial secu...
Why GAO Did This Study Industrial security addresses the information systems, personnel, and physical security of facilities and their cleared employees who have access to or handle classified information. The National Industrial Security Program was established in 1993 to safeguard federal government classified infor...
gao_GAO-17-790T
gao_GAO-17-790T_0
Background In 1990, GAO began a program to report on government operations that we identified as “high risk.” Since then, generally coinciding with the start of each new Congress, we have reported on the status of progress addressing previously identified high-risk areas and have updated the High-Risk List to add...
Why GAO Did This Study GAO's High-Risk Series identifies federal program areas needing attention from Congress and the executive branch. GAO added federal management of programs that serve Indian tribes and their members to its February 2017 biennial update of high-risk areas in response to serious problems with manag...
gao_GAO-18-646T
gao_GAO-18-646T_0
About One-Third of Covered Entities Had One or More Contract Pharmacies, and Pharmacy Characteristics Varied We found that as of July 1, 2017, about one-third of the more than 12,000 covered entities in the 340B Program had contract pharmacies. A higher percentage of hospitals (69.3 percent) had at least one contra...
Why GAO Did This Study This testimony summarizes the information contained in GAO's June 2018 report, entitled Drug Discount Program: Federal Oversight of Compliance at 340B Contract Pharmacies Needs Improvement ( GAO-18-480 ). What GAO Found The 340B Drug Pricing Program (340B Program), which is administered by the...
gao_GAO-18-260T
gao_GAO-18-260T_0
Selected VA Medical Centers’ Reviews of Providers’ Clinical Care Were Not Always Documented or Timely We found that from October 2013 through March 2017, the five selected VA medical centers required reviews of a total of 148 providers’ clinical care after concerns were raised about their care, but officials at the...
Why GAO Did This Study This testimony summarizes the information contained in GAO's November 2017 report, entitled VA Health Care: Improved Policies and Oversight Needed for Reviewing and Reporting Providers for Quality and Safety Concerns ( GAO-18-63 ). What GAO Found Department of Veterans Affairs (VA) medical cen...
gao_GAO-19-50
gao_GAO-19-50_0
Background The Military Health System is responsible for, among other things, assuring the overall oral health of all uniformed DOD personnel. As part of this health system, each service’s dental corps provides dental care for its servicemembers. The Army, the Navy, and the Air Force Dental Corps include approxim...
Why GAO Did This Study DOD has taken steps to modernize its Military Health System to ensure that it operates efficiently. For example, in September 2013, the Defense Health Agency was created, in part, to implement common clinical and business processes across the services. Essential to this effort are the services' ...
gao_GAO-19-82
gao_GAO-19-82_0
Background Coast Guard’s Organizational Approach to Managing Its Shore Infrastructure Portfolio Coast Guard shore infrastructure includes buildings and structures, which it has organized into 13 asset types, known as asset lines. Table 1 provides information on Coast Guard asset lines, including examples of ass...
Why GAO Did This Study The Coast Guard, within the Department of Homeland Security (DHS), owns or leases more than 20,000 shore facilities, such as piers, docks, boat stations, air stations, and housing units, at more than 2,700 locations. In June 2017, the Coast Guard testified to Congress that it had a $1.6 billion ...
gao_GAO-18-379
gao_GAO-18-379_0
Background Effective communications are vital to first responders’ ability to respond to emergencies and ensure the safety of both their personnel and the public. In particular, first responders use communications systems to gather information, coordinate a response, and request additional resources and assistanc...
Why GAO Did This Study During emergencies, reliable communications are critical. Disasters, such as 2017's hurricanes, continue to test the nation's emergency communications capabilities. As disasters can cross jurisdictional boundaries, collaboration within and across regions is very important. GAO was asked to revie...
gao_GAO-18-203
gao_GAO-18-203_0
Background Restitution Roles and Responsibilities DOJ and its components, as well as the judiciary, play important roles in requesting and collecting restitution. DOJ and select components: Prosecutors in DOJ’s Criminal Division and the Criminal Divisions of the 94 USAOs are responsible for overseeing criminal ...
Why GAO Did This Study One of the goals of federal criminal restitution is to restore victims of federal crimes to the position they occupied before the crime was committed by providing compensation. Various entities within the federal government are involved in the process of requesting, ordering, and collecting rest...
gao_GAO-18-545
gao_GAO-18-545_0
Background NIH Institutes and Centers and Biomedical Research NIH, which had total budgetary resources of $32 billion in fiscal year 2016, is comprised of the Office of the Director and 27 institutes and centers that focus on specific diseases, particular organs, or stages in life, such as childhood or old age....
Why GAO Did This Study NIH's success depends on its ability to attract, retain, develop, and otherwise support biomedical investigators—including those employed in its intramural research program as well as those working in its extramural program at universities, academic health centers, and other research institution...
gao_GAO-18-480
gao_GAO-18-480_0
Background The 340B Program was created in 1992 following the enactment of the Medicaid Drug Rebate Program and gives 340B covered entities discounts on outpatient drugs comparable to those made available to state Medicaid agencies. HRSA is responsible for administering and overseeing the 340B Program. 340B Pr...
Why GAO Did This Study Covered entities can provide 340B drugs to eligible patients and generate revenue by receiving reimbursement from patients' insurance. The number of pharmacies covered entities have contracted with has increased from about 1,300 in 2010 to nearly 20,000 in 2017. GAO was asked to provide informat...
gao_GAO-19-41
gao_GAO-19-41_0
Background SAMHSA defines a peer provider as “a person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind-body recovery and resilience.” Generally, peer providers are known...
Why GAO Did This Study As the peer support workforce has grown, there has been increased attention to standardizing the competencies of peer support specialists through certification. The 21st Century Cures Act included a provision for GAO to conduct a study to identify best practices related to training and certifica...
gao_GAO-19-47
gao_GAO-19-47_0
Background RFS Greenhouse Gas Emissions Goals and Requirements EPA states that one goal of the RFS is to reduce greenhouse gas emissions. Specifically, the RFS is designed to reduce these emissions by increasingly replacing petroleum-based fuels with biofuels that have lower associated greenhouse gas emissions ...
Why GAO Did This Study Congress established the RFS in 2005 and expanded it 2 years later. The RFS generally mandates that transportation fuels—typically gasoline and diesel—sold in the United States contain increasing amounts of biofuels. In addition, the RFS is designed to reduce greenhouse gas emissions by replacin...
gao_GAO-18-200
gao_GAO-18-200_0
Background GSA maintains custody and control of real property for many civilian federal agencies and has a large portfolio of federally owned and leased properties that GSA rents to its federal agency customers. It is responsible for approximately 1,600 federally owned buildings, and the agency generally provides...
Why GAO Did This Study To help comply with federal policies aimed at improving federal building energy and environmental management, GSA has implemented a smart buildings program nationwide in federally owned buildings under its custody and control. Two key technologies included in the program are Internet-connected a...
gao_GAO-19-19
gao_GAO-19-19_0
Background According to the National Inventory of Dams, as of January 2016 there are approximately 90,500 dams in the United States and about 2.5 percent of these (approximately 2,100 dams) are associated with hydropower projects. Hydropower projects are owned and operated by both non-federal entities—such as pri...
Why GAO Did This Study In February 2017, components of California's Oroville Dam failed, leading to the evacuation of nearly 200,000 nearby residents. FERC is the federal regulator of the Oroville Dam and over 2,500 other dams associated with nonfederal hydropower projects nationwide. FERC issues and renews licenses—w...
gao_GAO-19-228
gao_GAO-19-228_0
Background History of the Distressed Asset Stabilization Program The National Housing Act authorized HUD’s Office of Housing to accept assignment of and sell defaulted single-family mortgage loans. Additionally, Office of Management and Budget (OMB) Circular No. A-11 (2016) states that under the Debt Collection...
Why GAO Did This Study HUD insures single-family mortgage loans and is authorized to sell defaulted loans under the National Housing Act. In fiscal years 2010–2016, FHA auctioned off approximately 111,000 loans to private purchasers under DASP. DASP helped reduce a backlog of federally insured defaulted loans stemming...
gao_GAO-18-135
gao_GAO-18-135_0
Background Coast Guard Organizational Structure for TAP Coast Guard staffing for the TAP program reflects the organizational structure of its Health, Safety, and Work-Life Directorate, which oversees TAP policy. The Coast Guard’s TAP managers are assigned to 13 installations where Health, Safety, and Work-Life ...
Why GAO Did This Study Thousands of Coast Guard servicemembers have left the military and transitioned into civilian life, and some of these new veterans may face significant challenges, such as finding and maintaining employment. To help them prepare, federal law mandated that DHS provide separating Coast Guard servi...
gao_GAO-18-330
gao_GAO-18-330_0
Background Contracted Services Data Collection and Inventory Requirements and Process In part to improve the information available and management of DOD’s acquisition of services, Congress enacted section 2330a of title 10 of the U.S. Code in 2001, which required the Secretary of Defense to establish a data col...
Why GAO Did This Study DOD obligated about $150 billion on contracted services—such as information technology support and maintenance of defense facilities—in fiscal year 2016. DOD has faced long-standing challenges in effectively managing its service acquisitions. The National Defense Authorization Act for Fiscal Yea...
gao_GAO-18-481
gao_GAO-18-481_0
Background To participate in federal student aid programs, postsecondary schools must be 1) certified by Education as eligible to participate in federal student aid programs, 2) accredited by a recognized accrediting agency— generally nongovernmental, nonprofit entities—and 3) authorized by the state in which the...
Why GAO Did This Study Education provided over $122 billion in grants, loans and work study funds to help students pay for college at about 6,000 schools in fiscal year 2017. Education is responsible for certifying that these schools are eligible for and capable of properly administering federal student aid funds. Sch...
gao_GAO-18-248
gao_GAO-18-248_0
Background Social Security Disability Insurance (SSDI) In recent decades, economic and demographic factors have contributed to an increase in the number of SSDI beneficiaries and increased program costs, which has reduced the size of the Disability Insurance Trust Fund reserves from a peak of $215.8 billion in ...
Why GAO Did This Study SSDI, which is administered by SSA, provides financial and other assistance to qualifying individuals who are unable to work due to their disabilities. SSDI is primarily funded by employee and employer payroll taxes that are placed in the Disability Insurance Trust Fund, which is currently proje...
gao_GAO-19-231
gao_GAO-19-231_0
Background Advance Directives and POLST Forms Decisions about end-of-life care are based on an individual’s personal beliefs and values. Advance care planning documents, including advance directives and POLST forms, allow individuals to express their wishes for end-of-life care. These documents serve different ...
Why GAO Did This Study Many individuals receive medical care for a serious or life-limiting condition during the last months of life, which may involve making difficult decisions about life-sustaining treatment. Advance care planning helps ensure that physicians, families, and friends have documentation outlining indi...
gao_GAO-19-160
gao_GAO-19-160_0
Background Air Force Aircraft Maintenance Specialties Air Force aircraft maintainers are assigned to a specific maintenance specialty and, in some cases, also to a specific aircraft on which they are qualified to perform maintenance. As of April 2018, the Air Force had 37 enlisted maintenance specialties, each ...
Why GAO Did This Study Air Force aircraft maintainers are responsible for ensuring that the Air Force's aircraft are operationally ready and safe for its aviators—duties critical to successfully executing its national security mission. With more than 100,000 maintainers across the Air Force's active and reserve compon...
gao_GAO-18-257
gao_GAO-18-257_0
Background Federal agencies’ personal property may include commonly used items, such as computers, office equipment, and furniture, and more specialized property reflective of their mission, such as scientific devices, fire control equipment, heavy machinery, precious metals, generators, and chemicals. Some items...
Why GAO Did This Study The federal government owns billions of dollars of personal property—such as office furniture, scientific equipment, and industrial machinery. By law, each agency is required to follow GSA's disposal process so that an agency's unneeded property can be used by other agencies or certain non-feder...
gao_GAO-18-500
gao_GAO-18-500_0
Background Many consumer products—such as deodorants, shaving products, and hair care products—are differentiated to appeal specifically to men or women through differences in packaging, scent, or other product characteristics (see fig. 1). These differences related to gender can affect manufacturing and marketin...
Why GAO Did This Study Gender-related price differences occur when consumers are charged different prices for the same or similar goods and services because of factors related to gender. While variation in costs and consumer demand may give rise to such price differences, some policymakers have raised concerns that ge...
gao_GAO-18-613T
gao_GAO-18-613T_0
DHS Has Made Progress Addressing Past Challenges, But Some Actions are Still In Progress Our past work has identified progress and challenges in a number of areas related to DHS’s management of the CFATS program including (1) the process for identifying high risk chemical facilities; (2) how it assesses risk and p...
Why GAO Did This Study Thousands of facilities have hazardous chemicals that could be targeted or used to inflict mass casualties or harm surrounding populations in the United States. In accordance with the DHS Appropriations Act, 2007, DHS established the CFATS program in 2007 to, among other things, identify and ass...
gao_GAO-18-8
gao_GAO-18-8_0
Background USMS mission areas include fugitive apprehension, witness protection, and federal prisoner transportation, among others. There are 94 U.S. Marshals—one for each federal judicial district—who are presidentially appointed and direct agency operations in each district. U.S. Marshals are considered to gene...
Why GAO Did This Study USMS mission areas include fugitive apprehension, witness protection, and federal prisoner transportation, among others. USMS whistleblowers recently alleged that USMS officials engaged in improper promotion practices—such as routinely preselecting favored candidates. Investigations have substan...
gao_GAO-18-156T
gao_GAO-18-156T_0
State Has Worked with UNHCR on Various Measures Designed to Ensure the Integrity of the Resettlement Referral Process In July 2017, we found that State and UNHCR have worked together on several measures designed to ensure integrity in the process through which UNHCR refers refugees to USRAP for potential resettleme...
Why GAO Did This Study According to UNHCR, as of June 2017, more than 21 million people were refugees worldwide. State manages the U.S. Refugee Admissions Program (USRAP) and coordinates with UNHCR, which refers the most applicants to USRAP, and USCIS, which adjudicates refugee applications. Deterring and detecting fr...
gao_GAO-18-546
gao_GAO-18-546_0
Background The DATA Act was enacted May 9, 2014, for purposes that include expanding on previous federal transparency legislation by requiring the disclosure of federal agency expenditures and linking agency spending information to federal program activities, so that both policymakers and the public can more effe...
Why GAO Did This Study The DATA Act was enacted to increase accountability and transparency and, among other things, expanded on the required federal spending information that agencies are to submit to Treasury for posting to a publicly available website. The act also includes provisions requiring a series of oversigh...
gao_GAO-17-775
gao_GAO-17-775_0
Background GPRAMA significantly enhances GPRA, the centerpiece of a statutory framework that Congress put in place during the 1990s to help resolve longstanding performance and management problems in the federal government and provide greater accountability for results. Congress passed GPRAMA in 2010 to address a...
Why GAO Did This Study Full implementation of GPRAMA could facilitate efforts to reform the federal government and make it more effective. GPRAMA includes a provision for GAO to review the act's implementation. This report assesses how GPRAMA implementation has affected the federal government's progress in resolving k...
gao_GAO-18-153T
gao_GAO-18-153T_0
Background The mission of IRS, a bureau within the Department of the Treasury, is to (1) provide America’s taxpayers top quality service by helping them understand and meet their tax responsibilities and (2) enforce the law with integrity and fairness to all. In carrying out its mission, IRS annually collects ove...
Why GAO Did This Study The IRS, a bureau of the Department of the Treasury, relies extensively on IT to annually collect more than $3 trillion in taxes, distribute more than $400 billion in refunds, and carry out its mission of providing service to America's taxpayers in meeting their tax obligations. For fiscal year ...
gao_GAO-19-80
gao_GAO-19-80_0
Background Grade-Crossing-Safety Trends Grade-crossing safety has improved significantly since 1975, but since 2009, the number of crashes and fatalities at grade crossings has plateaued (see fig. 1). The yearly number of grade-crossing crashes declined from 12,126 in 1975 to 2,117 in 2017. In that time frame, ...
Why GAO Did This Study Crashes at highway-rail grade crossings are one of the leading causes of railroad-related deaths. According to FRA data, in 2017, there were more than 2,100 crashes resulting in 273 fatalities. Since 2009 crashes have occurred at a fairly constant rate. The federal government provides states fun...
gao_GAO-19-199
gao_GAO-19-199_0
Background History of the CMO Position DOD first took steps to establish a CMO role in May 2007, when it designated the Deputy Secretary of Defense as the department’s CMO. Subsequently, Congress included a provision in the NDAA for Fiscal Year 2008 to codify the Deputy Secretary of Defense as the DOD CMO, est...
Why GAO Did This Study DOD spends billions of dollars each year to maintain key enterprise business operations intended to support the warfighter, including systems and processes related to the management of contracts, finances, the supply chain, and support infrastructure. The 2018 National Defense Strategy identifie...
gao_GAO-19-70
gao_GAO-19-70_0
Background CDC—an operating division of the Department of Health and Human Services (HHS)—serves as the national focal point for disease prevention and control, environmental health, and promotion and education activities designed to improve the health of Americans. The agency is also responsible for leading nati...
Why GAO Did This Study CDC is responsible for detecting and responding to emerging health threats and controlling dangerous substances. In carrying out its mission, CDC relies on information technology systems to receive, process, and maintain sensitive data. Accordingly, effective information security controls are es...
gao_GAO-18-148
gao_GAO-18-148_0
Background Investments in federal IT have the potential to make agencies more efficient in fulfilling their missions. However, as we have previously reported, these investments too often result in failed projects that incur cost overruns and schedule slippages, while contributing little to mission- related outcome...
Why GAO Did This Study Investments in federal IT too often result in failed projects that incur cost overruns and schedule slippages. Recognizing the severity of issues related to government-wide IT management, Congress enacted federal IT acquisition reform legislation in December 2014. Among other things, the law sta...
gao_GAO-18-697T
gao_GAO-18-697T_0
Available Data Indicate Native American Youth Involvement in Justice Systems Declined from 2010 through 2016 and Differed in Some Ways from That of Non-Native American Youth In our September 2018 report, we found that from 2010 through 2016 the number of Native American youth in federal and state and local justice ...
Why GAO Did This Study This testimony summarizes the information contained in GAO's September 2018 report, entitled Native American Youth: Involvement in Justice Systems and Information on Grants to Help Address Juvenile Delinquency ( GAO-18-591 ). What GAO Found GAO's analysis of available data found that the numbe...
gao_GAO-19-161
gao_GAO-19-161_0
Background Trucking Industry In 2016, commercial trucks transported about 70 percent of all U.S. freight, and over 250,000 heavy trucks were sold in the same year. These trucks operate within a diverse industry that can be distinguished in several ways: Long-haul vs. local-haul. Long-haul trucking operations ar...
Why GAO Did This Study Automated vehicle technology may eventually make commercial trucking more efficient and safer, but also has the potential to change the employment landscape for nearly 1.9 million heavy and tractor-trailer truck drivers, among others. GAO was asked to examine the potential workforce effects of a...
gao_GAO-18-591
gao_GAO-18-591_0
Background Native American Population and Indian Country Over 4 million people in the United States identified as Native American based on 2016 United States Census estimates, of which 29 percent were youth. As of June 2018, there were 573 federally recognized Indian tribes. According to BIA, as of June 2018, t...
Why GAO Did This Study Native American youth face unique challenges when it comes to their contact with justice systems. Research shows that risk factors such as high rates of poverty and substance abuse make them susceptible to being involved with justice systems at the federal, state and local, and tribal levels. GA...
gao_GAO-18-544
gao_GAO-18-544_0
Background Noncompliance, including fraud, does not have a single source, but occurs across different types of taxes and taxpayers. It includes unintentional errors as well as intentional evasion, such as intentionally underreporting income, intentionally over-reporting expenses, and engaging in abusive tax shelt...
Why GAO Did This Study Tax noncompliance, including refund fraud, threatens the integrity of the tax system and costs the federal government hundreds of billions of dollars annually. RRP is IRS's primary pre-refund system for detecting and preventing the issuance of invalid refunds. IRS reported that between January 2...
gao_GAO-17-801T
gao_GAO-17-801T_0
Background Many of our reports and testimonies include recommendations that, if acted upon, may result in tangible benefits for the U.S. taxpayer by improving the federal government’s efficiency, effectiveness, and accountability. Implemented recommendations can result in financial or nonfinancial benefits for th...
Why GAO Did This Study EPA's mission is to protect human health and the environment. To accomplish this mission, EPA develops and enforces environmental regulations; awards grants; and studies environmental issues, among other things. GAO has conducted reviews focused on various aspects of EPA's operations and program...
gao_GAO-19-132
gao_GAO-19-132_0
Background Senior Army leadership has acknowledged that the service must change how it develops requirements and acquires weapon systems in order to be successful in future wars. However, the Army’s history of failed, costly weapon system procurements to replace aging weaponry is due, in part, to requirements tha...
Why GAO Did This Study In order for the Army to maintain its technological edge over potential adversaries, it plans to invest in near- and long-term modernization efforts. However, the Army has struggled with modernization initiatives in the past. For example, the Future Combat System was canceled after a cost of $21...
gao_GAO-18-229
gao_GAO-18-229_0
Background Law Enforcement Interaction with Individuals with Mental Illness Since the 1960s, the percentage of individuals with mental illness being treated in a hospitalized setting has decreased dramatically in an effort to move care away from institutional settings into a wider range of community-based treat...
Why GAO Did This Study Law enforcement encounters with individuals with mental illness may require special training and skills and can sometimes involve volatile situations, risking tragic injuries or even death. The 21st Century Cures Act includes a provision for GAO to review the practices that federal first respond...
gao_GAO-19-232
gao_GAO-19-232_0
Background Overview of Federal Disaster Response Federal agencies can respond to a disaster when effective response and recovery are beyond the capabilities of the affected state and local governments. In such cases, the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) permits the ...
Why GAO Did This Study The 2017 hurricanes (Harvey, Irma, and Maria) caused an estimated $265 billion in damage, primarily in Texas, Florida, Puerto Rico, and the U.S. Virgin Islands. As of February 2019, Congress had provided over $35 billion to HUD for CDBG-DR grants to help communities recover. Communities may use ...
gao_GAO-18-619
gao_GAO-18-619_0
Background This section provides an overview of 1) DOE’s administration of its advanced fossil energy R&D program, and 2) DOE’s Loan Guarantee Program (LGP). DOE’s Administration of Its Advanced Fossil Energy R&D Projects Within DOE, FE carries out DOE’s program for fossil energy R&D, which includes federal re...
Why GAO Did This Study One aspect of DOE's mission is to secure U.S. leadership in energy technologies. To that end, DOE funds R&D for energy projects, including for advanced fossil energy (innovative technologies for coal, natural gas, and oil). DOE provides funding for R&D projects, including large projects designed...
gao_GAO-18-199
gao_GAO-18-199_0
Background Forms and Distribution of Arsenic Arsenic is a naturally occurring element that is widely distributed in the earth’s crust in two general forms—organic and inorganic. It commonly enters the body through ingestion of food or water. Most data reported for arsenic in food describe the levels of total ar...
Why GAO Did This Study Arsenic, an element in the earth's crust, can be harmful to human health and may be present in water and certain foods, such as rice. Rice may be more susceptible to arsenic contamination than other crops due to the flooded conditions in which it is typically grown. FDA and USDA work to address ...
gao_GAO-19-31
gao_GAO-19-31_0
Background OPA amended the Clean Water Act and established provisions expanding and consolidating the federal government’s authority to prevent and respond to oil spills. This includes providing the federal government with the authority to perform cleanup immediately after a spill using federal resources, monitor...
Why GAO Did This Study The Exxon Valdez and Deepwater Horizon oil spills are two of the largest offshore oil spills in U.S. history, causing long-lasting damage to marine and coastal resources. OPA includes provisions to prevent and respond to such oil spills by authorizing (1) federal-state trustee councils that mana...
gao_GAO-19-16
gao_GAO-19-16_0
Background Phased retirement arrangements are programs that allow older workers to reduce their working hours to transition into retirement, rather than stopping working abruptly at a given age. The option to transition into retirement through phased retirement encourages older workers who might otherwise retire ...
Why GAO Did This Study In response to an aging workforce, countries around the world have developed policies to encourage older workers to work longer to improve the financial sustainability of national pension systems and address shortages of skilled workers. Phased retirement is one option that can be used to encour...
gao_GAO-18-37
gao_GAO-18-37_0
Background The Social Security Administration’s (SSA) Disability Insurance (DI) and Supplemental Security Income (SSI) programs are the two largest federal programs providing cash assistance to people with disabilities. The DI program, established in 1956, provides monthly payments to working-age adults (and their...
Why GAO Did This Study Individuals who do not agree with the initial decision on a claim for Social Security disability benefits can ultimately appeal the decision by requesting a hearing before one of SSA's approximately 1,500 administrative law judges. However, the rate at which these judges have allowed benefits ha...
gao_GAO-18-183
gao_GAO-18-183_0
Background Federal agencies implement specific elements of laws through regulations, which typically require or prohibit certain actions. Congresses and Presidents have required agencies to comply with multiple procedural and analytical requirements prior to issuing regulations. Administrative Procedure Act (APA)....
Why GAO Did This Study The Presidential Transitions Improvements Act of 2015 includes a provision for GAO to assess multiple characteristics of final significant regulatory actions promulgated by executive departments during presidential transition periods (September 23 through January 20) at the end of Presidents Cli...
gao_GAO-19-220
gao_GAO-19-220_0
Background State is the lead agency involved in implementing American foreign policy and representing the United States abroad. According to State and USAID’s joint strategic plan for fiscal years 2018 through 2022, State’s goals are to (1) protect America’s security at home and abroad, (2) renew America’s compet...
Why GAO Did This Study State staffs Foreign Service employees to more than 270 embassies and consulates worldwide to advance U.S. foreign policy and economic interests. In 2009 and 2012, GAO identified ongoing Foreign Service staffing gaps. GAO was asked to review State's Foreign Service staffing. This report examines...
gao_GAO-18-447
gao_GAO-18-447_0
Background Patriot Weapon System and Equipment The Patriot weapon system is a mobile Army surface-to-air missile system designed to counter tactical ballistic missiles; cruise missiles; and other threats such as airplanes, helicopters, and unmanned aerial vehicles. The Patriot system was first deployed in the e...
Why GAO Did This Study Patriot is a mobile Army surface-to-air missile system deployed worldwide to defend critical assets and forces. The Army plans to extend the life of Patriot equipment until at least 2048 through maintaining and modernizing the system. To achieve this, the Army performs two maintenance processes,...
gao_GAO-19-147T
gao_GAO-19-147T_0
Long-Term Strategic Planning in Acquisitions Enables Better Tradeoff Decisions Key elements of strategic planning include establishing long-term goals and strategies for how those goals are to be achieved. Specifically for managing Coast Guard acquisitions, we have noted that a long-term plan that includes acquisi...
Why GAO Did This Study Both the Coast Guard—a component of the Department of Homeland Security (DHS)—and the Department of Commerce's National Oceanic and Atmospheric Administration (NOAA) are investing significant resources to recapitalize their aging fleets of ships. Ensuring that the Coast Guard and NOAA maintain t...
gao_GAO-19-131
gao_GAO-19-131_0
Background Although the federal government has undertaken numerous initiatives to better manage the billions of dollars that federal agencies annually invest in IT, these investments too frequently fail or incur cost overruns and schedule slippages, while contributing little to mission-related outcomes. We have p...
Why GAO Did This Study Congress has long recognized that IT has the potential to enable federal agencies to accomplish their missions more quickly, effectively, and economically. However, fully exploiting this potential has presented challenges to covered agencies, and the federal government's management of IT has pro...
gao_GAO-18-123
gao_GAO-18-123_0
Background The RAD program was authorized by Congress and signed into law by the President in November 2011 under the Consolidated and Further Continuing Appropriations Act, 2012 with amendments in 2014, 2015, 2016, and 2017. The RAD program consists of two components. The first component of the RAD program—and t...
Why GAO Did This Study HUD administers the Public Housing program, which provides federally assisted rental units to low-income households through PHAs. In 2010, HUD estimated its aging public housing stock had $25.6 billion in unmet capital needs. To help address these needs, the RAD program was authorized in fiscal ...
gao_GAO-18-269
gao_GAO-18-269_0
Background The exchanges (including the FFE and those operated by individual states) provide a seamless, single point of access for eligible individuals to enroll in qualified health plans. For the FFE, CMS established a website—Healthcare.gov—as the public portal through which individuals may apply for coverage ...
Why GAO Did This Study CMS has noted that it is important for enrollees to maintain continuous health insurance coverage to ensure the stability of the FFE. Certain rules allow for enrollment flexibilities—such as special enrollment periods and a 3-month grace period that is allowed before coverage is terminated for r...
gao_GAO-18-629T
gao_GAO-18-629T_0
Coast Guard Faces Challenges in Effectively Managing its Acquisition Portfolio Short-term Prioritization through the Annual Budget Process and the 5-Year Capital Investment Plan Limit Effective Planning We found in September 2012, and in our July 2018 review, that the Coast Guard’s approach of relying on the annu...
Why GAO Did This Study The Coast Guard, a component within DHS, is spending billions of dollars to acquire assets, such as cutters and aircraft. This portfolio of major acquisition programs is intended to help the Coast Guard accomplish its missions—including interdicting illegal drugs and search and rescue missions. ...
gao_GAO-19-162
gao_GAO-19-162_0
Background U.S.-bound Air Cargo and the Air Cargo Supply Chain In fiscal year 2017, about 13 billion pounds of cargo was transported on aircraft to the United States—over 5 billion pounds was transported on passenger aircraft (e.g., Delta and United Airlines), and about 8 billion pounds was transported on all-c...
Why GAO Did This Study According to TSA, the federal agency responsible for securing the nation's civil aviation system, the introduction of explosive devices in air cargo shipments is a significant threat. To mitigate this threat, TSA is to review the security procedures carried out by all air carriers with U.S.-boun...
gao_GAO-18-364
gao_GAO-18-364_0
Background The ACV is being developed as a partial or full replacement for the AAV, which is a tracked (non-wheeled) vehicle with capability to launch from ships to reach the shore carrying up to 21 Marines at a speed of up to approximately 6 knots. This speed effectively limits its range for traveling from ship ...
Why GAO Did This Study In June 2018, the United States Marine Corps plans to select a contractor and begin low-rate production for the ACV, a vehicle used to transport Marines from ship to shore under hostile conditions. The ACV will replace all or part of the current Assault Amphibious Vehicle fleet. The National Def...
gao_GAO-18-194
gao_GAO-18-194_0
Background Congressional Actions Related to DOD’s Organizational and Management Challenges DOD has historically faced organizational and management challenges that can limit effective and efficient coordination across the department to fulfill its mission, and Congress has taken steps to address these challenge...
Why GAO Did This Study DOD continues to confront organizational challenges that hinder collaboration. To address these challenges, section 911 of the NDAA for Fiscal Year 2017 directed the Secretary of Defense to issue an organizational strategy that identifies critical objectives which span multiple functional bounda...
gao_GAO-18-63
gao_GAO-18-63_0
Background Identifying Concerns about Providers’ Clinical Care As part of the credentialing and privileging process, VAMC officials are responsible for monitoring each provider’s performance on an ongoing basis and identifying any concerns about clinical care that may warrant further review. VAMCs can identify ...
Why GAO Did This Study Nearly 40,000 providers hold privileges in VHA's 170 VAMCs. VAMCs must identify and review any concerns that arise about the clinical care their providers deliver. Depending on the findings from the review, VAMC officials may take an adverse privileging action against a provider that either limi...
gao_GAO-18-616T
gao_GAO-18-616T_0
Background Since 1990, generally every 2 years at the start of a new Congress, we call attention to agencies and program areas that are high risk due to their vulnerability to mismanagement or that are most in need of transformation. Our high-risk program is intended to help inform the congressional oversight age...
Why GAO Did This Study GAO's High Risk List identifies federal program areas that are high risk due to their vulnerability to mismanagement, among other things. GAO added the federal management of programs that serve Indian tribes and their members to its February 2017 biennial update of high-risk areas in response to...
gao_GAO-18-48
gao_GAO-18-48_0
Background Misconduct can occur in any workplace. When employee misconduct happens, an agency may incur a number of direct and indirect costs depending on how the agency chooses to address misconduct. For the agency, direct costs can mean potentially significant time and resource investments, including investigat...
Why GAO Did This Study Misconduct is generally considered an action by an employee that impedes the efficiency of the agency's service or mission. Misconduct incidents can affect other aspects of employee morale and performance and impede an agency's efforts to achieve its mission. GAO was asked to examine how executi...
gao_GAO-18-141T
gao_GAO-18-141T_0
Background The cost of the census has been escalating over the last several decennials. The 2010 decennial was the costliest U.S. Census in history at about $12.3 billion, and was about 31 percent more costly than the $9.4 billion 2000 Census (in 2020 dollars). The average cost for counting a housing unit increas...
Why GAO Did This Study One of the Bureau's most important functions is to conduct a complete and accurate decennial census of the U.S. population, which is mandated by the Constitution and provides vital data for the nation. A complete count of the nation's population is an enormous undertaking as the Bureau seeks to ...
gao_GAO-18-207
gao_GAO-18-207_0
Background The SBIR program was initiated in 1982 and has four main purposes: (1) use small businesses to meet federal R&D needs, (2) stimulate technological innovation, (3) increase commercialization of innovations derived from federal R&D efforts, and (4) encourage participation in technological innovation by s...
Why GAO Did This Study Through the SBIR and STTR programs, federal agencies have awarded about 162,000 contracts and grants totaling $46 billion to small businesses to help them develop and commercialize new technologies. Eleven federal agencies participate in the SBIR program, and 5 agencies also participate in the S...
gao_GAO-19-211
gao_GAO-19-211_0
Background The appropriation and execution of DOD’s base and OCO amounts is part of the broader federal budget process. In this process, Congress, the President, and federal agencies take a number of steps to formulate a budget, enact appropriation acts, and execute the federal budget for each fiscal year. A summ...
Why GAO Did This Study Since 2001, DOD has received more than $1.8 trillion in OCO funds. DOD defines “contingency operations” as small, medium, or large-scale military operations, while “base” activities include operating support for installations, civilian pay, and other costs that would be incurred, regardless of c...
gao_GAO-18-557
gao_GAO-18-557_0
Background Working Capital Funds DOD uses working capital funds to focus management’s attention on the total costs of carrying out critical business operations and encourage DOD support organizations to provide quality goods and services at the lowest cost. The ability of working capital funds to operate on a b...
Why GAO Did This Study TRANSCOM reported spending about $81 billion flying personnel and cargo worldwide in fiscal years 2007-2017. TRANSCOM manages the Transportation Working Capital Fund (TWCF) to provide air, land, and sea transportation for the Department of Defense (DOD). TRANSCOM sets some rates it charges below...
gao_GAO-18-389
gao_GAO-18-389_0
Background During a disease outbreak, including the Zika virus, HHS is the lead federal agency for public health and medical response, and it leverages national public health and medical resources to prepare for and respond to the outbreak. Zika Virus Transmission and Prevention The Zika virus is primarily tra...
Why GAO Did This Study Zika—a virus primarily transmitted through mosquito bites—can cause symptoms that include fever, rash, and joint and muscle pain. In pregnant women, the Zika virus can be passed to the fetus and cause severe brain defects. In response to an outbreak in the United States and its territories, Cong...
gao_GAO-18-91
gao_GAO-18-91_0
Background Title 5 Special Payment Authorities Generally, federal agencies have seven broadly applicable special payment authorities available government-wide under Title 5 of the United States Code (hereinafter “Title 5”)—listed below in table 1—for recruitment and retention. Table 1 describes each authority’s...
Why GAO Did This Study Federal agencies can provide additional compensation by using seven broadly available special payment authorities to recruit and retain employees to address needed skills. Though special payments can help fill mission-critical skills gaps, agencies also face constrained budgets, which underscore...
gao_GAO-18-300
gao_GAO-18-300_0
Background U.S. Army’s Joint Trauma System Defense Center of Excellence Since the mid-2000s, DOD and the military health system have worked to decrease trauma-related morbidity and mortality by improving trauma care in DOD’s military treatment facilities and by conducting research on providing trauma care. As p...
Why GAO Did This Study Traumatic injury is a major cause of death and disability in the military, but improved trauma care has the potential to improve these outcomes. DOD has worked to improve trauma care over time, such as by establishing a Joint Trauma System Defense Center of Excellence to examine trauma care and ...
gao_GAO-19-54
gao_GAO-19-54_0
Background FAR Part 15 describes the use of several competitive source selection processes to meet agency needs, which include the LPTA process and tradeoff process on a best value continuum (see fig. 1). The FAR states that when using the LPTA process, tradeoffs are not permitted. DOD may elect to use the LPTA pr...
Why GAO Did This Study When awarding a contract competitively, DOD may use the LPTA process, under which the lowest price is the determining factor when selecting an offer. Section 813, as amended, contained a provision for GAO to submit four annual reports on DOD's use of the LPTA process for contracts exceeding $5 m...
gao_GAO-18-209T
gao_GAO-18-209T_0
Background Strategic Petroleum Reserve The Energy Policy and Conservation Act (EPCA) of 1975 authorized the SPR, partly in response to the Arab oil embargo of 1973 to 1974 that caused a shortfall in the international oil market. The SPR is owned by the federal government, managed by DOE’s Office of Petroleum R...
Why GAO Did This Study Over 4 decades ago, Congress authorized the SPR—the world's largest government-owned stockpile of emergency oil—to release oil to the market during supply disruptions and protect the U.S. economy from damage. The SPR is managed by DOE. According to DOE's strategic plan, the SPR benefits the nati...
gao_GAO-18-700T
gao_GAO-18-700T_0
Background EPA regulates drinking water contaminants by issuing legally enforceable standards under the Safe Drinking Water Act that generally limit the levels of these contaminants in public water systems. EPA has issued such regulations for approximately 90 drinking water contaminants. Public water systems, inc...
Why GAO Did This Study According to health experts, exposure to elevated levels of PFOS and PFOA could cause increased cancer risk and other health issues in humans. DOD has used firefighting foam containing PFOS, PFOA, and other PFAS since the 1970s to quickly extinguish fires and ensure they do not reignite. EPA has...
gao_GAO-18-461
gao_GAO-18-461_0
Background The U.S. pipeline network includes both interstate and intrastate pipelines, the vast majority of which fall into the latter category: Interstate pipelines: Interstate pipelines are primarily large-volume transmission pipelines that carry gas or hazardous liquid–sometimes over hundreds of miles—to comm...
Why GAO Did This Study PHMSA oversees the safety of interstate and intrastate natural gas and hazardous liquid pipelines. PHMSA certifies states to oversee intrastate pipelines, and some states also act as PHMSA's “agents” to supplement the federal inspection workforce for interstate pipelines. In recent years PHMSA h...
gao_GAO-18-492
gao_GAO-18-492_0
Background Export credit agencies such as the Bank are usually government agencies, although some private institutions operate export credit programs on their respective governments’ behalf, according to a Bank report on global export credit competition. These agencies offer financing for domestic companies to ma...
Why GAO Did This Study According to the Bank, it serves as a financier of last resort for U.S. firms seeking to sell to foreign buyers but that cannot obtain private financing for their deals. Its programs support tens of thousands of American jobs and enable billions of dollars in U.S. export sales annually, the Bank...
gao_GAO-18-432T
gao_GAO-18-432T_0
Background SSA Programs and Functions The scope of SSA’s operations and responsibilities is vast. One of SSA’s key responsibilities is to provide financial benefits to eligible individuals through three benefit programs: Old-Age and Survivors Insurance (OASI)—provides retirement benefits to older individuals an...
Why GAO Did This Study SSA provides vital benefits and services that affect the lives of many Americans. In fiscal year 2017, it paid out nearly $1 trillion in retirement and disability benefits to 67 million beneficiaries, and an average of 420,000 people call or visit one of its 1,200 field offices each day. However...
gao_GAO-17-789
gao_GAO-17-789_0
Background Naval Forces Involved in Amphibious Operations An amphibious operation is a military operation launched from the sea by an amphibious force, embarked in ships or craft, with the primary purpose of introducing a landing force ashore to accomplish an assigned mission. An amphibious force is comprised o...
Why GAO Did This Study The Navy and Marine Corps have identified a need to improve their ability to conduct amphibious operations—an operation launched from the sea by an amphibious force. Senate and House reports accompanying bills for the National Defense Authorization Act for Fiscal Year 2017 included provisions fo...
gao_GAO-19-60
gao_GAO-19-60_0
Background The Secret Service plays a critical role in protecting the President, Vice President, their immediate families, and national leaders, among others. In addition, the component is responsible for safeguarding the nation’s currency and financial payment systems. To accomplish its mission, Secret Service o...
Why GAO Did This Study Commonly known for protecting the President, the Secret Service also plays a leading role in investigating and preventing financial and electronic crimes. To accomplish its mission, the Secret Service relies heavily on the use of IT infrastructure and systems. In 2009, the component initiated th...
gao_GAO-18-240
gao_GAO-18-240_0
Background GME Training Following medical school, GME training provides the clinical training required for a physician to be eligible for licensure and board certification to practice medicine independently in the United States. Physicians pursue GME training within a variety of specialties or subspecialties. ...
Why GAO Did This Study An adequate, well-trained physician workforce is essential for providing access to quality health care. While a number of factors affect the supply and distribution of physicians, GME is a significant determinant. A significant portion of GME training funds come from federal programs and states....
gao_GAO-18-291
gao_GAO-18-291_0
Background In accordance with the Improper Payments Information Act of 2002 (IPIA), as amended, and OMB guidance, CMS developed the PERM to estimate the national Medicaid improper payment rate. CMS has other mechanisms to review and assess program integrity risks in state Medicaid managed care programs, and it us...
Why GAO Did This Study The improper payment rate is a sentinel measure of program integrity risks for the Medicaid program. CMS and the states oversee Medicaid, whose size, structure, and diversity make it vulnerable to improper payments. CMS estimates the Medicaid improper payment rate annually through its PERM, whic...
gao_GAO-18-539
gao_GAO-18-539_0
Background The growth of the “sharing economy” has begun to impact public transportation. DOT describes the sharing economy as a developing phenomenon based on sharing, renting, and borrowing goods and services, rather than owning them. One facet of the sharing economy is shared mobility, meaning the shared use o...
Why GAO Did This Study The public transit landscape is changing, as advances in technology have enabled more on-demand mobility services, such as ridesourcing and bike-share services. In response, some transit agencies have started to partner with private mobility companies with the aim of offering public transit ride...
gao_GAO-19-144
gao_GAO-19-144_0
Background Federal agencies and our nation’s critical infrastructures—such as energy, transportation systems, communications, and financial services— are dependent on computerized (cyber) information systems and electronic data to carry out operations and to process, maintain, and report essential information. The...
Why GAO Did This Study A key component of mitigating and responding to cyber threats is having a qualified, well-trained cybersecurity workforce. The act requires OPM and federal agencies to take several actions related to cybersecurity workforce planning. These actions include categorizing all IT, cybersecurity, and ...
gao_GAO-18-417
gao_GAO-18-417_0
Background The Defense Laboratories The National Defense Authorization Act (NDAA) for Fiscal Year 1995 authorized the Secretary of Defense to conduct personnel demonstration projects at the department’s laboratories designated as Science and Technology Reinvention Laboratories. The demonstration projects were ...
Why GAO Did This Study DOD's defense labs help sustain, among other things, U.S. technological superiority and the delivery of technical capabilities to the warfighter. Over time Congress has granted unique flexibilities—such as the ability to hire qualified candidates who meet certain criteria using direct hire autho...
gao_GAO-19-84
gao_GAO-19-84_0
Background This section describes (1) NNSA’s weapons design and production sites; (2) the framework for managing LEPs, known as the Phase 6.X process, and NNSA’s program execution instruction; and (3) NNSA’s technology development and assessment process. NNSA Weapons Design and Production Sites NNSA oversees t...
Why GAO Did This Study The Department of Defense and NNSA have sought for nearly a decade to replace the capabilities of the aging W78 nuclear warhead used by the U.S. Air Force. NNSA undertakes LEPs to refurbish or replace the capabilities of nuclear weapons components. In fiscal year 2014, NNSA was directed to suspe...
gao_GAO-18-290
gao_GAO-18-290_0
Background STEM Education The term “STEM education” includes educational activities across all grade levels—from preschool to graduate school. STEM education programs have a variety of primary objectives, which include preparing students for STEM coursework, providing postsecondary students with grants or fell...
Why GAO Did This Study Education programs in STEM fields are intended to enhance the nation's global competitiveness. GAO reported in 2012 that there were more than 200 federal STEM education programs in fiscal year 2010. Since then, this portfolio of programs has changed. GAO was asked to review the landscape of fede...
gao_GAO-19-57
gao_GAO-19-57_0
Background ISO 55000 defines asset management as “the coordinated activity of an organization to realize value from assets.” This approach includes, for example: developing an understanding of how each of an organization’s assets contributes to its success; managing and investing in those assets in such a way as t...
Why GAO Did This Study The federal government is the largest real property owner in the United States and spends billions of dollars to operate and maintain these assets, which include buildings, roads, bridges, and utility systems. Federal agencies are responsible for developing asset management policies, processes, ...
gao_GAO-18-606
gao_GAO-18-606_0
Background Federal Grant Programs The federal government uses grants to address national priorities—such as substance use prevention, treatment, and recovery—through nonfederal parties, including state and local governments, federally recognized tribes, educational institutions, and nonprofit organizations. Wh...
Why GAO Did This Study According to the Surgeon General, adolescence and young adulthood are critical at-risk periods for illicit substance use, and such use can harm the developing brain. Congress included a provision in law for GAO to review how federal agencies, through grants, are addressing substance use preventi...
gao_GAO-18-348
gao_GAO-18-348_0
Background The EFMP provides support to families with special needs at their current and proposed locations. Servicemembers relocate frequently, generally moving every 3 years if in the Army, Marine Corps, and Navy, and every 4 years if in the Air Force. In fiscal year 2016, the Military Services relocated approx...
Why GAO Did This Study Military families with special medical and educational needs face unique challenges because of their frequent moves. To help assist these families, DOD provides services plans, which document the support a family member requires. The National Defense Authorization Act for Fiscal Year 2017 includ...
gao_GAO-18-449
gao_GAO-18-449_0
Background Global Train and Equip Authority to Build Foreign Partner Capacity DOD has used the Global Train and Equip program to provide training, equipment, and small-scale military construction activities intended to build the capacity of partner nations’ military forces to conduct counterterrorism operations...
Why GAO Did This Study The United States has undertaken several efforts, including DOD's Global Train and Equip program, to help foreign partners strengthen their security capacity. Presidential Policy Directive 23 states that agencies should target security assistance where it can be effective and highlights the impo...
gao_GAO-19-44
gao_GAO-19-44_0
Background The Judgment Fund is a permanent, indefinite appropriation, statutorily created in 1956, available to pay many types of eligible monetary claims that may be judicially or administratively ordered against the U.S. government. The Judgment Fund is also available to pay interest and costs on claims in cer...
Why GAO Did This Study The Treasury Judgment Fund, managed by Fiscal Service, annually pays billions of dollars of claims on behalf of federal agencies. Transparent and reliable information is important for Congress to provide effective oversight of the Judgment Fund. In May 2017, the Committee requested that Treasury...
gao_GAO-18-356
gao_GAO-18-356_0
Background VHA’s patient advocacy program is intended to provide veterans with a means to provide feedback about health care services they receive at VAMCs. VHA sets forth minimum expectations for VAMCs’ administration of the program, including that veterans must have easy access to a patient advocate and must ha...
Why GAO Did This Study VHA has designated patient advocates at each VAMC to receive and document feedback from veterans or their representatives, including requests for information, compliments, and complaints. In recent years, the importance of a strong patient advocacy program has taken on new significance given con...
gao_GAO-19-93
gao_GAO-19-93_0
Background The 2017 Hurricanes and California Wildfires In 2017, three major hurricanes made landfall in the United States and historic wildfires struck California. According to FEMA, the 2017 hurricanes and wildfires collectively affected 47 million people—nearly 15 percent of the nation’s population. See figu...
Why GAO Did This Study Following Hurricane Katrina, Congress required FEMA to establish advance contracts for goods and services to enable the government to quickly and effectively mobilize resources in the aftermath of a disaster, like those that affected the United States in 2017. GAO was asked to review the federal...
gao_GAO-18-56
gao_GAO-18-56_0
Background Forest Service Mission and Structure The Forest Service’s mission includes sustaining the nation’s forests and grasslands; managing the productivity of those lands for the benefit of citizens; conserving open space; enhancing outdoor recreation opportunities; and conducting research and development i...
Why GAO Did This Study The Forest Service, an agency within USDA, performs a variety of tasks as steward of 193 million acres of public forests and grasslands. Its budget execution process for carrying out its mission includes (1) allotments, which are authorizations by an agency to incur obligations within a specifie...
gao_GAO-19-67
gao_GAO-19-67_0
Background Medicare Payment for Individual and Panel Tests before PAMA’s Implementation in 2018 Medicare pays for laboratory tests that are performed individually or in a group. For individual tests, laboratories submit claims to Medicare for each test they perform that is on the CLFS; tests are identified using...
Why GAO Did This Study Medicare paid $7.1 billion for 433 million laboratory tests in 2017. These tests help health care providers prevent, diagnose, and treat diseases. PAMA included a provision for GAO to review CMS's implementation of new payment rates for these tests. This report addresses, among other objectives,...
gao_GAO-18-61
gao_GAO-18-61_0
Background Skin Cancer and Sunscreen How Sunscreen Works Most sunscreen products work by absorbing, reflecting, or scattering sunlight. Sunscreen contains chemicals that interact with the skin to protect it from ultraviolet (UV) rays. UV rays are an invisible form of radiation from the sun, tanning beds, and...
Why GAO Did This Study Using sunscreen as directed with other sun protective measures may help reduce the risk of skin cancer—the most common form of cancer in the United States. In the United States, sunscreen is considered an over-the-counter drug, which is a drug available to consumers without a prescription. Some ...
gao_GAO-18-279
gao_GAO-18-279_0
Background As reported by the United Nations, the International Criminal Police Organization, and other organizations, wildlife trafficking networks span the globe. These organizations have attempted to measure the value of illegally traded wildlife, but available estimates are subject to uncertainty. In 2016, fo...
Why GAO Did This Study Wildlife trafficking—the poaching and illegal trade of plants, fish, and wildlife—is a multibillion-dollar, global criminal activity that imperils thousands of species. FWS and NOAA enforce laws prohibiting wildlife trafficking that authorize the agencies to pay financial rewards for information...
gao_GAO-18-323
gao_GAO-18-323_0
Background The rail industry was one of the first to pioneer private pensions for its employees in the late 19th century, and by the 1930s, these pensions were more developed than in most other industries. However, according to RRB, these private rail pensions had serious defects that were magnified by the effect...
Why GAO Did This Study RRB collects payroll taxes and administers retirement, disability, and Medicare benefits for rail workers and their families. A financial interchange exists between RRB, SSA, and HHS in order to put the trust funds for these benefits in the same financial position as if Social Security covered r...
gao_GAO-19-25
gao_GAO-19-25_0
Background This section discusses (1) the history and status of the MOX project; (2) the roles of DOE, NNSA, and the contractor in managing and overseeing the MOX project; (3) project management lessons learned; and (4) DOE’s and NNSA’s recurring project management problems. History and Status of the MOX Projec...
Why GAO Did This Study The MOX project, located at DOE's Savannah River Site in South Carolina and overseen by NNSA, experienced significant cost increases and schedule delays following the start of construction in 2007. After spending nearly $6 billion, NNSA terminated the project in October 2018. While DOE and NNSA ...
gao_GAO-18-473
gao_GAO-18-473_0
Background This section provides an overview of the (1) San Francisco Bay Delta watershed, (2) multiple water demands in the watershed, (3) selected laws and agreements related to restoration efforts in the watershed, and (4) funding for restoration efforts in the watershed. San Francisco Bay Delta Watershed T...
Why GAO Did This Study The San Francisco Bay Delta watershed—which drains a vast area of California from the Sierra Nevada Mountains to the Pacific Ocean—supplies drinking water for 25 million people and provides irrigation for about half the nation's fruit and vegetable production. Decades of development and agricult...
gao_GAO-18-452T
gao_GAO-18-452T_0
Background The Freedom of Information Act establishes a legal right of access to government information on the basis of the principles of openness and accountability in government. Before FOIA’s enactment in 1966, an individual seeking access to federal records faced the burden of establishing a “need to know” be...
Why GAO Did This Study FOIA requires federal agencies to provide the public with access to government records and information based on the principles of openness and accountability in government. Each year, individuals and entities file hundreds of thousands of FOIA requests for information on numerous topics that con...
gao_GAO-18-410
gao_GAO-18-410_0
Background Long Island Sound is an estuary, a body of water where fresh water from rivers draining from the land mixes with salt water from the ocean, in this case the Atlantic Ocean. The Sound is 113 miles long and 21 miles across at its widest point, with an average depth of 63 feet and a deepest point of 320 f...
Why GAO Did This Study Long Island Sound, an estuary bordered by Connecticut and New York, provides numerous economic and recreational benefits. However, development and pollution have resulted in environmental impacts, such as the degradation of water quality. EPA partnered with both states to create the Study to res...
gao_GAO-19-103
gao_GAO-19-103_0
Background This section provides an overview of FMD, as well as information on the potential impact of an outbreak in the United States; USDA activities to respond to outbreaks of diseases, including FMD; federal, state, tribal, and industry roles in FMD control; and FMD vaccines. Overview of FMD FMD is a high...
Why GAO Did This Study FMD is a highly contagious viral disease that causes painful lesions on the hooves and mouths of some livestock, making it difficult for them to stand or eat, thus greatly reducing meat and milk production. The United States has not had an FMD outbreak since 1929, but FMD is present in much of t...
gao_GAO-18-494
gao_GAO-18-494_0
Background CFIUS was established by executive order in 1975 to monitor the effect of and to coordinate U.S. policy on foreign investment in the United States. In 1988, Congress enacted the Exon-Florio amendment adding section 721 to the Defense Production Act of 1950, which authorized the President to investigate...
Why GAO Did This Study Foreign acquisitions of U.S. companies can pose challenges for the U.S. government as it balances the economic benefits of foreign direct investment with the need to protect national security. CFIUS is an interagency group, led by Treasury, that reviews certain transactions—foreign acquisitions ...