A letter report issued by the Government Accountability Office with an abstract that begins "Medicare spending on home health totaled $12.9 billion in 2006, up 44 percent from 2002. Concerns have been raised that improper payments from practices indicating fraud and abuse may have contributed to Medicare home health spending and utilization. The Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, is responsible for minimizing improper payments made on behalf of Medicare beneficiaries. GAO was asked to examine the growth in Medicare home health spending and utilization and the benefit's vulnerability to improper payments. GAO focused on states with the highest growth in Medicare home health spending or utilization; fraudulent and abusive practices contributing to recent spending and utilization; and administrative issues that make it vulnerable to improper payments. GAO analyzed Medicare claims data; reviewed Medicare laws and regulations and CMS documents; and interviewed stakeholders and contractors that administer and protect the home health benefit."

A letter report issued by the Government Accountability Office with an abstract that begins "The Nuclear Regulatory Commission (NRC) relies on its staff's professional judgment in implementing its processes for overseeing the safety of U.S. commercial nuclear power reactors. In implementing this oversight, NRC allocates specific roles and responsibilities to resident inspectors assigned to each plant, regional officials at one of four regional offices responsible for most oversight activities, headquarters officials, and the nuclear power industry. NRC also builds into its processes incentives for plant managers to identify concerns about reactor safety, report those concerns to NRC, and take prompt actions to correct them. NRC's processes for identifying and assessing findings and violations are based on prescribed agency procedures and include several points where NRC staff must exercise their professional judgment, such as determining whether issues of concern identified during physical inspections constitute findings or violations and the risk significance of any findings or the severity of any violations, among other things."

A letter report issued by the Government Accountability Office with an abstract that begins "Generally consistent with the views of key stakeholders we interviewed, state and school district officials cited 17 federal requirements as most burdensome for them. These requirements were related to the Elementary and Secondary Education Act (ESEA) Title I, Part A; the Individuals with Disabilities Education Act (IDEA) Part B; national school meals programs; or other requirements related to the receipt of federal funds. Officials described the burdens associated with these requirements as complicated, time-intensive, and duplicative, among other things, and characterized most of the requirements as being burdensome in multiple ways. For example, several officials told us that collecting data for IDEA reporting requirements—such as the number of data elements collected—takes a significant amount of time and resources. State and district officials also noted benefits of some requirements, for example, that the process to create individualized education programs can help protect the rights of students with disabilities."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO previously reported that, in 2012, upward payment adjustments affected the vast majority of hospitals paid under Medicare's inpatient prospective system (IPPS). (See GAO-13-334). For this report, GAO found that, of the 3,455 IPPS hospitals in the prior review, the proportion of hospitals qualifying for at least one of four categories of payment adjustments was higher among nonprofit and government hospitals than among for-profit hospitals. On average, 97 percent of government-owned hospitals and 90 percent of nonprofit hospitals received at least one form of increased payment in 2012. In contrast, 80 percent of for-profit hospitals qualified for at least one category of payment adjustment that year. In addition, for-profit hospitals were more likely to receive no, or only one form of, additional payment, whereas government-owned and nonprofit hospitals were more likely to receive two or three forms of additional payment."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) has sought improved efficiencies and cost reductions in its delivery of services that could be provided by the private sector, using both competitions with private companies and processes to create high performing organizations (HPO). The Office of Management and Budget's (OMB) Circular A-76 establishes federal policy for the competition of commercial activities. According to the circular, the longstanding policy of the federal government has been to rely on the private sector for needed commercial services. To ensure that the American people receive maximum value for their tax dollars, it is the federal government's policy that commercial activities should be subject to the forces of competition. As the largest federal agency, DOD has conducted more A-76 competitions than any other federal agency. However, the A-76 process has drawn criticism from both the public and private sectors. These criticisms largely center on the costs and length of time required to conduct competitions and the manner in which long-term savings are calculated. In light of these concerns, a panel of public and private sector experts convened in 2001 to identify ways in which the federal government …

A letter report issued by the Government Accountability Office with an abstract that begins "In 2005 Medicare paid over $1.4 billion for anesthesia services. These services are generally provided by anesthesia practitioners, such as anesthesiologists and certified registered nurse anesthetists (CRNAs). A government-sponsored study found that Medicare payments for anesthesia services are lower than private payments. Congress is concerned that this difference may create regional discrepancies in the supply of anesthesia practitioners, and asked GAO to explore this issue. GAO examined (1) the extent to which Medicare payments for anesthesia services were lower than private payments across Medicare payment localities in 2004, (2) whether the supply of anesthesia practitioners across Medicare payment localities in 2004 was related to the differences between Medicare and private payments for anesthesia services or the concentration of Medicare beneficiaries, and (3) compensation levels for anesthesia practitioners in 2005 and trends in graduate training. GAO used claims data from two anesthesia service billing companies that bill private insurance payers and Medicare to calculate payments by payer for seven anesthesia services in 41 Medicare payment localities. GAO also used data from the Centers for Medicare & Medicaid Services (CMS) and other sources to determine practitioner supply and …

A letter report issued by the Government Accountability Office with an abstract that begins "The 64-million-acre Prairie Pothole Region in the north-central United States provides breeding grounds for over 60 percent of key migratory bird species in the United States. During much of the 20th century, the draining of wetlands and the conversion of prairie to cropland has reduced bird habitat. Under the Small Wetlands Acquisition Program, the Department of the Interior's U.S. Fish and Wildlife Service (the Service) aims to sustain remaining migratory bird populations by permanently protecting high-priority habitat. Some habitat is temporarily protected under the Department of Agriculture's Conservation Reserve Program. In this context, GAO examined (1) the status of the Service's acquisition program in the region, (2) the Service's habitat protection goals for the region, and (3) challenges to achieving these goals. To answer these objectives, GAO examined Service land acquisition data and projected rates of habitat loss."

A letter report issued by the Government Accountability Office with an abstract that begins "GAO identified 32 practices and approaches as effective for applying Agile software development methods to IT projects. The practices generally align with five key software development project management activities: strategic planning, organizational commitment and collaboration, preparation, execution, and evaluation. Officials who have used Agile methods on federal projects generally agreed that these practices are effective. Specifically, each practice was used and found effective by officials from at least one agency, and ten practices were used and found effective by officials from all five agencies. The ten practices are:"

Correspondence issued by the General Accounting Office with an abstract that begins "GAO reviewed the financial statement audit reports for the Women's Army Corps Veterans' Association for fiscal year 1999. GAO found no reportable instances of noncompliance with the requirements of the law, and the audit report included the auditor's opinion that the financial statements of the corporation were presented fairly in accordance with generally accepted accounting principles."

Correspondence issued by the Government Accountability Office with an abstract that begins "Effective human capital planning can enable the Department of Defense (DOD) to have the right people, with the right skills, doing the right jobs, in the right places, at the right time by making flexible use of its internal workforce and appropriately using contractors. According to the department, as of March 2010, DOD's total civilian workforce included about 718,000 full-time civilians, including more than 2,900 civilians in the senior management, functional, and technical personnel workforce (hereafter referred to as senior leader workforce). Further, DOD reported that, as of the end of September 2009, there were more than 118,000 civilians in DOD's acquisition workforce. DOD has acknowledged, however, that with approximately 30 percent of its workforce eligible to retire by March 31, 2015, and the need to reduce its reliance on contractors to augment the current workforce, it faces a number of significant challenges. For example, in its 2010 Quadrennial Defense Review (QDR), DOD stressed the need for leadership in human capital management, to improve its capabilities for contributing to civilian-led activities and operations supporting "unity of effort" in homeland security, and an appropriately sized cadre of acquisition personnel …

Correspondence issued by the Government Accountability Office with an abstract that begins "The United States depends on space assets to support national security activities as well as civil and commercial activities. The Department of Defense (DOD) depends on space assets to support a wide range of military missions to include intelligence collection; battlefield surveillance and management; global command, control, and communications; and navigation assistance. This operational dependence on space has placed new and increasing demands on current space systems and organizations to meet Joint Force Commanders' needs. Moreover, concerns have increased regarding emerging threats that could affect the United States' and other countries' access to the free use of space. GAO plans to issue a report regarding ORS acquisition issues by April 2008, and by July 2008 we will issue a report regarding how ORS is being developed to satisfy warfighter needs. However, GAO is providing Congress this letter because during the course of our work on how Operationally Responsive Space (ORS) is being developed to satisfy warfighter needs, GAO learned that the National Security Space Office developed a National Security Space Strategy in 2004, but it has not been issued. GAO is bringing this matter to Congress' attention because …

A letter report issued by the General Accounting Office with an abstract that begins "To ensure that essential government services are available in emergencies--such as terrorist attacks, severe weather, or building-level emergencies-- federal agencies are required to develop continuity of operations (COOP) plans. Responsibility for formulating guidance on these plans and for assessing executive branch COOP capabilities lies with the Federal Emergency Management Agency (FEMA), under the Department of Homeland Security. FEMA guidance, Federal Preparedness Circular (FPC) 65 (July 1999), provides elements of a viable COOP capability, including the requirement that agencies identify their essential functions. GAO was asked to determine the extent to which (1) major civilian executive branch agencies have identified their essential functions and (2) these agencies' COOP plans follow FEMA guidance."

A letter report issued by the Government Accountability Office with an abstract that begins "In Georgia, quality and sustainability issues jeopardize the long-term usefulness of the Samtskhe-Javakheti road project. The Millennium Challenge Corporation (MCC) funded the rehabilitation of about 217 kilometers of road linking the previously isolated Samtskhe-Javakheti region with Tbilisi, the country’s capital, and reducing the driving time from 8 ¼ hours to 2 ¾ hours. The project was intended to increase exports from the region, integrate people in the region with the rest of Georgia, and expand trade with Turkey and Armenia. However, the urgency to meet fixed time frames resulted in problems implementing the project’s quality assurance framework. For example, the construction supervisor did not have enough staff to properly monitor construction and ensure quality. Despite several recommendations from MCC’s independent engineer, MCC and its Georgian counterpart, the Millennium Challenge Account (MCA-Georgia), did not adequately increase the number of construction supervisors, which resulted in pavement defects in parts of 5 of the 11 road sections and deterioration of structures such as drainage and retaining walls. One 15-kilometer section contained enough defects that the road had to be completely repaved. Furthermore, much of the repair work was to …

Correspondence issued by the General Accounting Office with an abstract that begins "The 1990 amendments to the Clean Air Act require that an additive be added to gasoline in areas with excessive carbon monoxide or ozone pollution. Specifically, those areas with "severe" ozone pollution are required to use reformulated gasoline, which contains at least two percent oxygen by weight. In California, as in other areas of the country, oil refining companies primarily use the oxygenate methyl tertiary butyl ether (MTBE) to meet that requirement. Because MTBE has been detected in ground water, the governor of California has banned MTBE in the state's gasoline by the end of 2002. If California decides to use ethanol to replace MTBE, ethanol production capacity from 2003 through 2005 could likely satisfy U.S. consumption. However, if other states also banned MRBE and moved to ethanol, consumption could increase and affect the industry's ability to meet demand. Moreover, production capacity projections may be overstated because they include not only existing plants and plants under construction, but also new plants being planned, which may not materialize. Although prices have been relatively stable so far, ethanol price spikes could occur in California if supplies were disrupted by either …

A letter report issued by the Government Accountability Office with an abstract that begins "Federal agencies have used a variety of mechanisms to implement interagency collaborative efforts, such as the President appointing a coordinator, agencies co-locating within one facility, or establishing interagency task forces. These mechanisms can be used to address a range of purposes including policy development; program implementation; oversight and monitoring; information sharing and communication; and building organizational capacity, such as staffing and training. Frequently, agencies use more than one mechanism to address an issue. For example, climate change is a complex, crosscutting issue, which involves many collaborative mechanisms in the Executive Office of the President and interagency groups throughout government."

Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO reviewed: (1) the total amount of the District of Columbia (DC) Court's reported fiscal year (FY) 1999 obligations for the Criminal Justice Act (CJA), Counsel on Child Abuse and Neglect (CCAN), and Guardianship programs; (2) whether the reported FY 1999 obligations appear to have been lawfully incurred; and (3) whether the reported obligations exceeded DC Court's obligational authority available to pay such amounts."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Homeland Security (DHS) fiscal year 2006 appropriations act provided $40.15 million for the Immigration and Customs Enforcement's (ICE) program to modernize its information technology (IT) infrastructure. As mandated by the appropriations act, the department is to develop and submit for approval an expenditure plan for the program, referred to as "Atlas," that satisfies certain legislative conditions, including a review by GAO. In performing its review of the Atlas plan, GAO (1) determined whether the plan satisfies certain legislative conditions and (2) provided other observations about the plan and management of the program. To do this, GAO analyzed the fiscal year 2006 Atlas expenditure plan and supporting documents against the legislative conditions, federal requirements, and related best practices. GAO also interviewed relevant DHS officials."

A letter report issued by the Government Accountability Office with an abstract that begins "Cloud computing, an emerging form of computing where users have access to scalable, on-demand capabilities that are provided through Internet-based technologies, has the potential to provide information technology services more quickly and at a lower cost, but also to introduce information security risks. Accordingly, GAO was asked to (1) identify the models of cloud computing, (2) identify the information security implications of using cloud computing services in the federal government, and (3) assess federal guidance and efforts to address information security when using cloud computing. To do so, GAO reviewed relevant publications, white papers, and other documentation from federal agencies and industry groups; conducted interviews with representatives from these organizations; and surveyed 24 major federal agencies."

Correspondence issued by the Government Accountability Office with an abstract that begins "As a follow-up to our 2005 and 2002 reports on the competitiveness of the small group health insurance market, Congress requested updated information on each state and the District of Columbia. Specifically, this report provides information from states and the District of Columbia (hereafter referred to as a state) on the number of carriers licensed in the small group market, the largest carriers, and their market share."