A letter report issued by the General Accounting Office with an abstract that begins "For the past 50 years, the federal government has had a metropolitan area program designed to provide a nationally consistent set of standards for collecting, tabulating, and publishing federal statistics for geographic areas in the United States and Puerto Rico. Before each decennial census, the Office of Management and Budget (OMB) reviews the standards to ensure their continued usefulness and relevance and, if warranted, revises them. While designed only for statistical purposes, various federal programs use the statistical areas to determine eligibility and to allocate federal funds. OMB advises agencies to carefully review program goals to ensure that appropriate geographic entities are used in making these decisions. GAO was asked to examine the process used for developing the OMB standards issued in 2000 and their effects on certain federal programs. Specifically, GAO agreed to report on (1) the process used to develop the 2000 standards, (2) how the 2000 standards differed from the 1990 standards, (3) how the application of the standards affected the geographic distribution of counties into statistical areas, and (4) the effect of standards on the eligibility and funding allocations for four federal …

A letter report issued by the Government Accountability Office with an abstract that begins "Congress is concerned about the health care spending burden facing the Federal Employees Health Benefits Program (FEHBP), the largest private health insurance program in the country. Health care spending per person varies geographically, and the underlying causes for the spending variation have not been fully explored. Understanding market forces and other factors that may influence health care spending may contribute to efforts to moderate health care spending. Health care spending varies across the country due to differences in its components, the utilization and price of health care services. A wide body of research describes extensive geographic variation in utilization. However, less is known about private sector geographic variation in prices. This report examined prices and spending in FEHBP Preferred Provider Organizations (PPOs) to determine (1) the extent to which hospital and physician prices varied geographically, (2) which factors were associated with geographic variation in hospital and physician prices, and (3) the extent to which hospital and physician price variation contributed to geographic variation in spending. We analyzed claims data from several large national PPOs participating in FEHBP. We used 2001 data, the most current data available …

A letter report issued by the General Accounting Office with an abstract that begins "Breast cancer is the second leading cause of cancer deaths among American women. In 2001, 192,200 new cases of breast cancer were diagnosed and 40,200 women died from the disease. The probability of survival increases significantly, however, when breast cancer is discovered in its early stages. Currently, the most effective technique for early detection of breast cancer is screening mammography, an X-ray procedure that can detect small tumors and breast abnormalities up to two years before they can be detected by touch. Nationwide data indicate that mammography services are generally adequate to meet the growing demand. Between 1998 and 2000, both the population of women 40 and older and the extent to which they were screened increased by 15 percent. Although mammography services are generally available, women in some locations have problems obtaining timely mammography services in some metropolitan areas. However, the greatest losses in capacity have come in rural counties. In all, 121 counties, most of them rural, have experienced a drop of more than 25 percent in the number of mammography machines in the last three years. Officials from 37 of these counties reported …

A letter report issued by the General Accounting Office with an abstract that begins "This interim report reviews the implementation of the Department of Defense (DOD) Medicare Subvention Demonstration. GAO found that the demonstration sites were successful in operating Medicare managed care plans. Officials put substantial effort into meeting Medicare managed care requirements and, according to Health Care Financing Administration reviewers, were generally as successful as other new Medicare managed care plans in this regard. Most sites reached the enrollment limits they had established for retirees already covered by Medicare. DOD officials indicated that the demonstration's effect was positive. Enrollees received a broader range of services from DOD than in the past, when they got care only when space was available in DOD facilities. Officials also noted that providing more comprehensive care to seniors helped sharpen the skills of military clinical staff, which contributed to their readiness for supporting combat or other military missions. Some challenges encountered in the demonstration reflect larger DOD managed care issues and may have implications for DOD managed care generally. Although access to care was generally good, the demonstration experienced some problems in maintaining adequate clinical staff."

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Defense's (DOD) Medicare subvention demonstration tested alternate approaches to health care coverage for military retirees. Retirees could enroll in new DOD-run Medicare managed care plans, known as TRICARE Senior Prime, at six sites. The demonstration plan offered enrollees the full range of Medicare-covered services as well as additional TRICARE services, with minimal copayments. During the demonstration period, the program parameters were changed, allowing military retirees age 65 and older to become eligible for TRICARE coverage as of October 1, 2001, and Senior Prime was extended for one year. The demonstration showed that retirees were interested in enrolling in low-cost military health plans and that DOD was able to satisfy its Senior Prime enrollees. By the close of the initial demonstration period, about 33,000 retirees were enrolled in Senior Prime, and more were on waiting lists. When nonenrollees were asked why they did not join Senior Prime, more than 60 percent said that they were satisfied with their existing health coverage; few said that they disliked military care. Although the demonstration had positive results for enrollees, it also highlighted three challenges confronting the military …

A letter report issued by the General Accounting Office with an abstract that begins "Most major U.S. airlines began realizing net operating losses early in the 2001, and all of the major U.S. passenger carriers except Southwest Airlines reported losses for the year. Travelers throughout the nation shared in the difficulties. In October 2000, the typical or median small community that GAO analyzed had service from two airlines, with a total of nine daily departing flights. Forty-one percent of the communities were served by only one airline with size being the most obvious factor for service limitations. However, the level of service also varied by the level of local economic activity. The total number of daily departures from these small communities declined by 19 percent between October 2000 and October 2001. Although carriers had reduced total departure levels at small communities before September 11th, airlines made even more reductions after that date. Because profitability is so critical to airline decisions about what markets to serve and how to serve them, the changes in service levels in small communities can be traced to economic factors. Two such factors--the economic decline that began in early 2001 and the collapse of airline passenger …

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO provided information on the Department of Defense's (DOD) implementation of its Medicare Subvention Demonstration program, focusing on: (1) progress in establishing the ground rules for program operation, receiving Health Care Financing Administration (HCFA) approval, attracting enrollment, and starting to deliver health services; (2) the useful practices and operational difficulties that emerged during program start-up; and (3) issues for the future."

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO provided information on the Medicare Subvention Demonstration Program, focusing on the sufficiency of the Department of Defense's (DOD) data systems for: (1) determining DOD's historical level of effort (LOE) and Medicare payments; and (2) managing the demonstration and assessing its cost effects."

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the impact of electronic commerce (e-commerce) growth on state and local government sales tax collections, focusing on: (1) how taxes associated with the sale of goods and services over the Internet differ from taxes associated with sales by other remote sellers and in-store sellers; (2) the extent to which each state relies on sales and use tax revenues to fund the services they provide; (3) how much revenue state and local governments are losing this year by not being able to collect sales and use taxes on sales made by all remote sellers and, particularly, by Internet sellers; and (4) how much revenue state and local governments would likely lose in 2003 under various growth scenarios for all remote and Internet sales."

A letter report issued by the Government Accountability Office with an abstract that begins "Congress, policy analysts, and groups representing physicians have raised questions about beneficiary access to Medicare physician services. At the same time, high levels of spending for health care in some parts of the country, and rapid increases in spending for physician services, have been identified as factors that threaten the long-term fiscal sustainability of the Medicare program. GAO was asked to assess beneficiary access to physician services and to identify indicators of potential overutilization of physician services. In this report, GAO (1) examines whether, from 2000 through 2008, beneficiaries had problems accessing physician services; (2) identifies areas of the country in which Medicare beneficiaries are potentially overserved by physicians; and (3) describes characteristics that distinguish the potentially overserved areas from other areas in the nation. GAO analyzed the most recent data available from several sources, including an annual Centers for Medicare & Medicaid Services (CMS) survey of fee-for-service (FFS) Medicare beneficiaries, Medicare physician claims for services provided in April of each year from 2000 through 2008, the Health Resources and Services Administration's Area Resource File, and the U.S. Census Bureau."

A letter report issued by the General Accounting Office with an abstract that begins "Identity theft or identity fraud generally involves "stealing" another person's personal identifying information--such as Social Security Number (SSN), date of birth, and mother's maiden name--and then using the information to fraudulently establish credit, run up debt, or take away existing financial accounts. The Identity Theft and Assumption Deterrence Act of 1998 made identity theft a separate crime against the person whose identity was stolen, broadened the scope of the offense to include the misuse of information as well as documents and provided punishment--generally a fine or imprisonment or both. GAO found no comprehensive or centralized data on enforcement results under the federal Identity Theft Act. However, according to a Deputy Assistant Attorney General, federal prosecutors are using the 1998 federal law. As with the federal act, GAO found no centralized or comprehensive data on enforcement results under state identity theft statutes. However, officials in the 10 states selected for study provided examples of actual investigations or prosecutions under these statutes. Generally, the prevalence of identity theft and the frequently multi- or cross-jurisdictional nature of such a crime underscore the importance of promoting cooperation or coordination among …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) provides health care and mental health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through TRICARE Prime, an option that includes the use of civilian provider networks and requires enrollment. TRICARE beneficiaries who do not enroll in this option may obtain care from nonnetwork providers through TRICARE Standard, or from network providers through TRICARE Extra. In addition, qualified National Guard and Reserve servicemembers may purchase TRICARE Reserve Select, a plan whose care options are similar to those of TRICARE Standard and TRICARE Extra. We refer to servicemembers who use TRICARE Standard, TRICARE Extra, or TRICARE Reserve Select as nonenrolled beneficiaries. The National Defense Authorization Act for Fiscal Year 2008 directed GAO to analyze the adequacy of DOD's surveys of TRICARE beneficiaries and providers and report what the surveys' results indicate about access to care for nonenrolled beneficiaries. To do so, GAO evaluated the surveys' methodology by interviewing DOD officials and reviewing relevant documentation, including the Office of Management and Budget's (OMB) survey standards. GAO also assessed the surveys' results by interviewing DOD officials, obtaining relevant documentation, and analyzing …

A chapter report issued by the General Accounting Office with an abstract that begins "This report discusses the Drug Enforcement Administration's (DEA) Mobile Enforcement Team Program. GAO found that since the program was established in 1995, DEA has enhanced its management of the program and provided for greater headquarters oversight and monitoring. In implementing the program and carrying out deployments, the field division METs generally complied with some of the pertinent requirements and guidelines that GAO reviewed. However, some DEA headquarters files did not contain adequate documentation, GAO could not determine whether the METs consistently and adequately assessed the requesting local law enforcement agencies' abilities to address, on their own, the drug and related violence problems for which DEA's program assistance was requested. DEA expects the program to focus on specific, targeted gangs in the areas in which the METs are deployed and that deployments will generally continue until the targeted individuals are arrested and the targeted drug gangs have been disrupted or dismantled. Consistent with the nature and objectives of the program, investigators focused primarily on street-level drug dealers and were mostly local and regional in scope. DEA collects data on various performance measures to assess the results of …

A letter report issued by the General Accounting Office with an abstract that begins "In the Balanced Budget Act of 1997, Congress established a three-year demonstration, called Medicare subvention, to improve the access of Medicare-eligible military retirees to care at military treatment facilities (MTF). The demonstration allowed Medicare-eligible retirees to get their health care largely at MTFs by enrolling in a Department of Defense (DOD) Medicare managed care organization known as TRICARE Senior Prime. During the subvention demonstration, access to health care for many retirees who enrolled in Senior Prime improved, while access to MTF care for some of those who did not enroll declined. Many enrollees in Senior Prime said they were better able to get care when they needed it. They also reported better access to doctors in general as well as care at MTFs. Enrollees generally were more satisfied with their care than before the demonstration. However, the demonstration did not improve enrollees' self-reported health status. In addition, compared to nonenrollees, enrollees did not have better health outcomes, as measured by their mortality rates and rates of "preventable" hospitalizations. Moreover, DOD's costs were high, reflecting enrollees' heavy use of hospitals and doctors."

A letter report issued by the General Accounting Office with an abstract that begins "The Railroad Revitalization and Regulatory Reform Act of 1976 and the Staggers Rail Act of 1980 gave freight railroads increased freedom to price their services according to market conditions. A number of shippers are concerned that freight railroads have used these pricing freedoms to unreasonably exercise their market power in setting rates for shippers with fewer alternatives to rail transportation. This report updates the rate information in GAO's 1999 report (RCED-99-93) using selected commodities and with effective competitive transportation alternatives. From 1997 through 2000, rail rates generally decreased, both nationwide and for many of the specific commodities and markets that GAO examined. However, rail rates for some commodities and distance categories--such as wheat moving long distances and coal moving short distances--have stayed about the same or increased. In other instances, such as wheat moving medium distances, rail rates stayed about the same or decreased. Overall, the proportion of rail shipments above the Surface Transportation Board's statutory jurisdictional threshold for considering rate relief actions--where railroad revenues for the shipment exceed 180 percent of variable costs--stayed relatively constant at 30 percent from 1997 through 2000. However, the proportion …

A chapter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on: (1) the environment within which railroad rates have been set since 1990; (2) how railroad rates have changed since 1990; (3) how railroad service quality has changed since 1990; and (4) actions taken by the Surface Transportation Board and others to address railroad service quality problems."

A letter report issued by the Government Accountability Office with an abstract that begins "Of the 9,215 veterans who entered the Department of Veterans Affairs' (VA) Independent Living (IL) track within the Vocational Rehabilitation and Employment (VR&E) program in fiscal years 2008 to 2011, most were male Vietnam era veterans in their 50s or 60s. Almost 60 percent served in the U.S. Army, and fewer than 1 percent served in the National Guard or Reserve. The most prevalent disabilities among these veterans were post-traumatic stress disorder and tinnitus. GAO's review of 182 IL cases from fiscal year 2008 found that VR&E provided a range of IL benefits to veterans. Among these cases, the most common benefits were counseling services and computers. Less common benefits included gym memberships, camping equipment, and a boat. GAO estimated that VR&E spent nearly $14 million on benefits for veterans entering the IL track in fiscal year 2008--an average of almost $6,000 per IL veteran."

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO reviewed and updated its previous work on airfares and service and reexamined the effect that certain barriers have had on these measures, focusing on: (1) how airfares have changed since 1990 for travel to and from 171 airports serving various U.S. communities; (2) how the quality of air service has changed since 1978 for travel to and from these airports; and (3) the extent to which certain barriers to entry--restrictive gate-leasing arrangements, controls on the number of allowable takeoffs and landings at some airports, and the limits on the distance that flights from some airports can be--influence competition at affected airports."

A letter report issued by the Government Accountability Office with an abstract that begins "Major changes in the mailing industry have reinforced the need for the U.S. Postal Service (USPS) to reduce costs and increase efficiency. In its 2002 Transformation Plan, USPS proposed doing so by realigning its mail processing network. The objectives of this requested report are to (1) describe the status of the initiatives USPS has developed for realignment; (2) evaluate how the planning, impacts, and results of these initiatives align with realignment goals; and (3) evaluate USPS's communication practices with stakeholders in making realignment decisions."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO has issued reports on the U.S. Postal Service's (USPS) strategy for realigning its mail processing network and improving delivery performance information. These reports recommended that the Postmaster General (1) strengthen planning and the overall integration of its realignment efforts, and enhance accountability by establishing measurable targets and evaluating results, (2) improve delivery service standards and performance measures, and (3) improve communication with stakeholders by revising its Area Mail Processing (AMP) Communication Plan to improve public notice, engagement, and transparency. The 2006 postal reform act required USPS to develop a network plan by June 2008 that described its vision and strategy for realigning its network; the anticipated costs, cost savings, and other benefits of its realignment initiatives; performance measures for its delivery service standards, and its communication procedures for consolidating AMP operations. This testimony discusses USPS's actions toward addressing GAO recommendations to (1) strengthen network realignment planning and accountability, (2) improve delivery performance information, and (3) improve communication with stakeholders. This testimony is based on prior GAO work, a review of USPS's 2008 Network Plan and revised AMP Communication Plan, and updated information from USPS officials. USPS did …

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the Department of Veterans Affairs' (VA) and Department of Defense's (DOD) shared health care resources, focusing on: (1) the benefits gained from sharing; (2) the extent to which VA and DOD are sharing health care resources; and (3) barriers and challenges VA and DOD face in their efforts to share health resources."

Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the Environmental Protection Agency's (EPA) use of funds for its brownfield-related initiatives, focusing on the: (1) amount of funds that EPA actually obligated in fiscal years (FY) 1997-1999; (2) amount it plans to obligate in FY 2000; and (3) number of grants and agreements that EPA awarded or plans to award with these funds, along with the recipients of these awards."

A letter report issued by the Government Accountability Office with an abstract that begins "In 2008, GAO reported that 1,088 oil industry mergers occurred between 2000 and 2007. Given the potential for price effects, GAO recommended that the Federal Trade Commission (FTC), the agency with the authority to maintain petroleum industry competition, undertake more regular retrospective reviews of past petroleum industry mergers, and FTC said it would consider this recommendation. GAO was asked to conduct such a review of its own to determine how mergers and market concentration--a measure of the number and market shares of firms in a market--affected wholesale gasoline prices since 2000. GAO examined the effects of mergers and market concentration using an economic model that ruled out the effects of many other factors. GAO consulted with a number of experts and used both public and private data in developing the model. GAO tested the model under a variety of assumptions to address some of its limitations. GAO also interviewed petroleum market participants."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO reported in 2005 on major changes in the mailing industry that have reinforced the need for the U.S. Postal Service (USPS) to reduce costs and increase efficiency. To address these changes and become more efficient, USPS is implementing initiatives aimed at realigning its mail processing network. In a follow-up review, GAO recently reported that USPS has made progress in implementing these initiatives, yet challenges such as maintaining delivery standards and addressing stakeholder and community resistance remain. In July 2006, GAO also reported on USPS's progress in improving delivery performance information. This testimony describes (1) the changes that have affected USPS's processing network, (2) GAO's concerns related to USPS's strategy for realigning its mail processing network and implementing its area mail processing consolidations, and (3) GAO's concerns related to USPS's progress in improving delivery performance information. This testimony is based on prior GAO reports."