A letter report issued by the Government Accountability Office with an abstract that begins "Concierge care is an approach to medical practice in which physicians charge their patients a membership fee in return for enhanced services or amenities. The recent emergence of concierge care has prompted federal concern about how the approach might affect beneficiaries of Medicare, the federal health insurance program for the aged and some disabled individuals. Concerns include the potential that membership fees may constitute additional charges for services that Medicare already pays physicians for and that concierge care may affect Medicare beneficiaries' access to physician services. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed GAO to study concierge care and its relationship to Medicare. Using a variety of methods, including a nationwide literature search and telephone interviews, GAO identified 146 concierge physicians and surveyed concierge physicians in fall 2004. GAO analyzed responses from 112 concierge physicians. GAO also reviewed relevant laws, policies, and available data on access to physician services and interviewed officials at the Department of Health and Human Services (HHS) and representatives of Medicare beneficiary advocacy groups."

A letter report issued by the Government Accountability Office with an abstract that begins "The Federal Aviation Administration (FAA) performs critical functions that contribute to ensuring safe, orderly, and efficient air travel in the national airspace system. To that end, it operates and relies extensively on an array of interconnected automated information systems and networks that comprise the nation's air traffic control systems. These systems provide information to air traffic controllers and aircraft flight crews to help ensure the safe and expeditious movement of aircraft. Interruptions of service by these systems could have a significant adverse impact on air traffic nationwide. Effective information security controls are essential for ensuring that the nation's air traffic control systems are adequately protected from inadvertent or deliberate misuse, disruption, or destruction. Accordingly, GAO was asked to evaluate the extent to which FAA has implemented information security controls for these systems."

A letter report issued by the Government Accountability Office with an abstract that begins "Between 2002 and 2012 nearly 850,000 jobs will open in the construction industry; experts predict that there will not be enough skilled workers to fill them. This has heightened concerns about program outcomes and program quality in the nation's apprenticeship system and the U.S. Department of Labor's oversight of it. GAO assessed (1) the extent to which Labor monitors registered apprenticeship programs in the states where it has direct oversight, (2) its oversight activities in states that do their own monitoring, and (3) the outcomes for construction apprentices in programs sponsored by employers and unions in relation to programs sponsored by employers alone."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates one of the nation's largest health care systems. In 1999, GAO reported on VA's aged, obsolete capital assets, noting that better management of these assets could significantly reduce VA's operating costs. GAO also noted that VA could reinvest the savings to enhance veterans' health care. In response, VA initiated its Capital Asset Realignment for Enhanced Services (CARES) process to identify what health care services it should provide in which locations through fiscal year 2022. CARES resulted in decisions to realign inpatient services at some VA facilities and to leave services as currently aligned at others. VA did not complete inpatient alignment decisions across VA for long-term care and mental health services and for inpatient services at some facilities because VA lacked sufficient information on demand for such care and other factors. GAO was asked to examine key challenges VA will face in completing and implementing CARES. This report discusses three key challenges: (1) developing information to complete inpatient alignment decisions, (2) improving management of excess property, and (3) determining priorities for purchasing care to improve access. GAO's analysis is …

A letter report issued by the Government Accountability Office with an abstract that begins "The Indian Health Service (IHS), located within the Department of Health and Human Services, is responsible for arranging health care services for Native Americans (American Indians and Alaska Natives). IHS services include primary care (medical, dental, and vision); ancillary services, such as laboratory and pharmacy; and specialty care, including services provided by physician specialists. IHS provides some services through direct care at hospitals, health centers, and health stations, which may be federally or tribally operated. When services are not available--that is, both offered and accessible--on site, IHS offers them, as funds permit, through contract care furnished by outside providers. Concerns persist that some Native Americans are experiencing gaps in necessary health care. GAO was asked to examine the availability of (1) primary care services and (2) ancillary and specialty services for Native Americans. Additionally, GAO examined the underlying factors associated with variations in the availability of services and strategies used by facilities to increase service availability. GAO conducted site visits to 13 facilities and interviewed IHS officials from all 12 IHS areas, which cover all or part of 35 states. GAO received written comments from IHS. …

A letter report issued by the Government Accountability Office with an abstract that begins "Three agencies of the Department of Homeland Security (DHS) have primary responsibility for securing the nation's borders--the U.S. Coast Guard (USCG), Customs and Border Protection (CBP), and Immigration and Customs Enforcement (ICE). Together, they enforce security across 7,500 miles of land border between the United States and Mexico and Canada, and protect more than 361 seaports and 95,000 miles of coastline. To fulfill their missions, these agencies deploy a variety of valuable air and marine assets. In this report, GAO analyzed (1) what efforts DHS has undertaken to facilitate coordination of the air and marine assets of the three agencies and (2) how the agencies' local air and marine units have, in selected areas, coordinated the use of assets and what challenges they faced."

A letter report issued by the Government Accountability Office with an abstract that begins "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) significantly reformed contracting for the administration of claims for Part A, Medicare's hospital insurance, and Part B, which covers outpatient services such as physicians' care. The MMA required the Centers for Medicare & Medicaid Services (CMS)--the agency within the Department of Health and Human Services (HHS) that administers Medicare--to conduct full and open competition for all of its claims administration contracts and to transfer the work to Medicare administrative contractors (MAC) by October 2011. The MMA required the Secretary of HHS to submit a report to the Congress and GAO on the plan for implementing Medicare contracting reform and for GAO to evaluate the plan. To address this mandate, GAO reviewed the extent to which (1) the plan provides an appropriate framework for implementing Medicare contracting reform and (2) the plan's cost and savings estimates are sound enough to support decisions on implementation."

A letter report issued by the Government Accountability Office with an abstract that begins "The burden of cleaning up Superfund and other hazardous waste sites is increasingly shifting to taxpayers, particularly since businesses handling hazardous substances are no longer taxed under Superfund and the backlog of sites needing cleanup is growing. While key environmental laws rely on the "polluter pays" principle, the extent to which liable parties cease operations or restructure--such as through bankruptcy--can directly affect the cleanup costs faced by taxpayers. GAO was asked to (1) determine how many businesses with liability under federal law for environmental cleanups have declared bankruptcy, and how many such cases the government has pursued in bankruptcy court; (2) identify challenges the Environmental Protection Agency (EPA) faces in holding bankrupt and other financially distressed businesses responsible for their cleanup obligations; and (3) identify actions EPA could take to better ensure that such businesses pay for their cleanups."

Correspondence issued by the Government Accountability Office with an abstract that begins "Alaska currently holds 35 trillion cubic feet of proven recoverable natural gas resources, about 19 percent of total U.S. reserves. Efforts to construct a pipeline to transport this natural gas from Alaska's North Slope to the lower 48 states have been stalled since 1982. The recent increase in natural gas prices has renewed interest in completing the pipeline, a project that is estimated to cost up to $20 billion. In addition to providing access to significant natural gas reserves, some expect the project to generate thousands of jobs and billions of dollars in revenues for the federal government and the State of Alaska. This report responds to a mandate in the Alaska Natural Gas Pipeline Act (the Pipeline Act) that we conduct a study to determine the extent to which small business concerns have participated in the construction of oil and gas pipelines. The Pipeline Act includes a "sense of Congress" provision that the sponsors of the Alaska natural gas pipeline should maximize the participation of small business concerns in contracts and subcontracts awarded for the project. This provision, while setting out a statement of congressional opinion, does …

A letter report issued by the Government Accountability Office with an abstract that begins "Problems in the supply distribution system dating back to the Persian Gulf War have impeded the ability of the Department of Defense (DOD) to provide effective and timely logistics support to the warfighter. DOD has taken actions to improve the distribution system by assigning new organizational responsibilities, including designating U.S. Transportation Command as the "Distribution Process Owner" (DPO); issuing a new logistics transformation strategy; and undertaking specific improvement initiatives. GAO's objectives were to (1) assess DOD's organizational structure and transformation strategy to improve the distribution system and (2) determine the status of, and timelines for completing, specific DOD distribution initiatives. agreed with the latter two."

Correspondence issued by the Government Accountability Office with an abstract that begins "On June 28, 2005, GAO testified before Congress at a hearing on "Access Delayed: Fixing the Security Clearance Process." This letter responds to a Congressional request that GAO provide answers to Senator Frank R. Lautenberg's questions for the record."

A letter report issued by the Government Accountability Office with an abstract that begins "Prescription drug spending has been the fastest growing segment of national health expenditures. As the federal government assumes greater financial responsibility for prescription drug expenditures with the introduction of Medicare part D, federal policymakers are increasingly concerned about prescription drug prices. GAO was asked to examine the change in retail prices and other pricing benchmarks for drugs frequently used by Medicare beneficiaries and other individuals with health insurance from 2000 through 2004. To examine the change in retail prices from 2000 through 2004, we obtained usual and customary (U&C) prices from two state pharmacy assistance programs for drugs frequently used by Medicare beneficiaries and non-Medicare enrollees in the 2003 Blue Cross and Blue Shield (BCBS) Federal Employee Program (FEP). The U&C price is the price an individual without prescription drug coverage would pay at a retail pharmacy. Additionally, we compared the change in U&C prices for brand drugs from 2000 through 2004 to the change in two pricing benchmarks: average manufacturer price (AMP), which is the average of prices paid to manufacturers by wholesalers for drugs distributed to the retail pharmacy class of trade, and average …

A letter report issued by the Government Accountability Office with an abstract that begins "The debate over reauthorization of the Temporary Assistance for Needy Families (TANF) block grant has focused on work requirements and brought attention to the measure of TANF work participation. The measure is used to assess states' performance and determine whether a state is subject to penalty for not meeting TANF work requirements. The 2003 work participation rates ranged from 9 to 88 percent for the 50 states based on data they submit to the U.S. Department of Health and Human Services (HHS). To help Congress understand these rates, GAO looked at (1) how selected states are defining the categories of work activities, (2) whether selected states have implemented internal controls over the work participation data, and (3) what guidance and oversight HHS has provided states."

A letter report issued by the Government Accountability Office with an abstract that begins "The Congress has required the administration to report annually on federal spending on climate change. The Office of Management and Budget (OMB) reports funding in four categories: technology (to reduce greenhouse gas emissions), science (to better understand the climate), international assistance (to help developing countries), and tax expenditures (to encourage reductions in emissions). The Climate Change Science Program (CCSP), which coordinates many agencies' activities, reports only on science. To measure funding, OMB and CCSP use budget authority, the authority provided in law to enter into financial obligations that will result in government outlays. GAO was asked to examine federal climate change funding for 1993 through 2004, as reported by both agencies, including (1) how total funding and funding by category changed and whether funding data are comparable over time and (2) how funding by agency changed and whether funding data are comparable over time."

A letter report issued by the Government Accountability Office with an abstract that begins "Since its creation, the National Aeronautics and Space Administration (NASA) has operated passenger aircraft services. These operations have been questioned in several prior audit reports. GAO was asked to perform a series of audits of NASA's controls to prevent fraud, waste, and abuse of taxpayer dollars. In this audit, GAO assessed (1) the relative cost of NASA passenger aircraft services in comparison with commercial costs, (2) whether NASA aircraft services were retained and operated in accordance with governmentwide guidance, and (3) the effectiveness of NASA's oversight and management of this program."

A letter report issued by the Government Accountability Office with an abstract that begins "As the frontline regulator of mutual funds, the Securities and Exchange Commission (SEC) plays a key role in protecting the nearly half of all U.S. households owning mutual funds, valued around $8 trillion in 2005. Mutual fund abuses raised questions about the integrity of the industry and quality of oversight provided by SEC and self-regulatory organizations (SRO) that regulate broker-dealers selling funds. This report assesses (1) changes SEC has made to, or is planning for, its mutual fund exam program; (2) key aspects of SEC's quality control framework for routine fund exams; and (3) the adequacy of SEC's oversight of NASD and the New York Stock Exchange in protecting shareholders from mutual fund sales abuses."

A letter report issued by the Government Accountability Office with an abstract that begins "The Temporary Assistance for Needy Families (TANF) program introduced specific work requirements and benefit time limits. However, the Family Violence Option (FVO) requires states that adopt the FVO to screen TANF clients for domestic violence and grant waivers from program requirements for clients in domestic violence situations. TANF also allows the use of TANF funds for marriage and responsible fatherhood programs. Given states' broad discretion in implementing the TANF program, including most aspects of the FVO and marriage and responsible fatherhood programs, this report examines (1) how states identify victims of domestic violence among TANF recipients, (2) how states address domestic violence among TANF recipients once they are identified, and (3) the extent to which states spend TANF funds on marriage and responsible fatherhood programs, and how, if at all, these programs are addressing domestic violence."

A letter report issued by the Government Accountability Office with an abstract that begins "In December 2002, the U.S. Department of State (State) established the Middle East Partnership Initiative (MEPI) to promote democracy in the Middle East and North Africa. MEPI provides assistance for political, economic, and educational reform and women's empowerment. In fiscal years 2002-2004, State and the U.S. Agency for International Development (USAID) reviewed U.S. bilateral economic assistance programs in the region to ensure they were aligned with the new U.S. policy focus on promoting democracy and reform. In this report, GAO (1) describes MEPI's structure for managing projects and allocating funding, (2) examines MEPI's uses of the reviews, and (3) evaluates MEPI's project monitoring."

A letter report issued by the Government Accountability Office with an abstract that begins "The opportunity for employment is one of the most important magnets attracting illegal immigrants to the United States. Immigration experts state that strategies to deter illegal immigration require both a reliable employment eligibility verification process and a worksite enforcement capacity to ensure that employers comply with immigration-related employment laws. This report examines (1) the current employment verification (Form I-9) process and challenges, if any, facing verification; and (2) the priorities and resources of U.S. Immigration and Customs Enforcement's (ICE) worksite enforcement program and any challenges in implementing the program."

A letter report issued by the Government Accountability Office with an abstract that begins "The National Defense Authorization Act for FY 2004 mandated that we assess the management of threat reduction and nonproliferation programs that the Departments of Defense and Energy each administer. The objective of this report is to assess how the Department of Energy's National Nuclear Security Administration (NNSA) implements management controls, which we define here to be the processes ensuring that work done under a contract meets contract specifications and that payments go to contractors as intended."

A letter report issued by the Government Accountability Office with an abstract that begins "Data mining--a technique for extracting knowledge from large volumes of data--is being used increasingly by the government and by the private sector. Many federal data mining efforts involve the use of personal information, which can originate from government sources as well as private sector organizations. The federal government's increased use of data mining since the terrorist attacks of September 11, 2001, has raised public and congressional concerns. As a result, GAO was asked to describe the characteristics of five federal data mining efforts and to determine whether agencies are providing adequate privacy and security protection for the information systems used in the efforts and for individuals potentially affected by these data mining efforts."

A letter report issued by the Government Accountability Office with an abstract that begins "The trend toward globalization has intensified the debate about the proper role of business and government in global "corporate social responsibility" (CSR),which involves business efforts to address the social and environmental concerns associated with business operations. The growth in global trade and the dramatic increase in foreign direct investment in developing countries raise questions regarding CSR-related issues such as labor, environment, and human rights. U.S. firms with operations in many countries employ millions of foreign workers and conduct a range of CSR activities to address these issues. However, there is controversy as to the proper government role. GAO describes (1) federal agency policies and programs relating to global CSR and (2) different perspectives regarding the appropriate U.S. government role and views on the impact of current federal activities on corporate global CSR efforts."

A letter report issued by the Government Accountability Office with an abstract that begins "In 2005, Americans will pay about $2.1 trillion in combined federal taxes, including income, payroll, and excise taxes, or about 16.8 percent of Gross Domestic Product (GDP). However, the amount of taxes paid does not reflect the total cost to taxpayers of the federal tax system. In addition to taxes paid, taxpayers also bear compliance costs and efficiency costs. Understanding the magnitude of these additional costs is important because every dollar spent on compliance and lost due to inefficiency represents a dollar that society could have spent for other purposes. In response to a congressional request for information on the magnitude of the compliance and efficiency costs of the current federal tax system, this study describes the nature of these costs, presents the difficulties associated with estimating them, and summarizes existing estimates of their magnitude. GAO did not make independent estimates of compliance or efficiency costs nor did we replicate any of the studies. GAO is not making any recommendations in this report."

A letter report issued by the Government Accountability Office with an abstract that begins "This report responds to section 112, Division B, of the Consolidated Appropriations Act of 2004, which directs GAO to review federal programs benefiting rural communities in Alaska. After discussions with congressional staff, GAO agreed to examine federal programs benefiting Alaska Native villages. Specifically, this report (1) provides information on the amount of federal assistance provided to Alaska Native villages during fiscal years 1998 through 2003, (2) describes how selected federal funds have been used to assist Alaska Native villages, and (3) provides data on the number and average cost of houses built by villages and Alaska Native regional housing authorities."