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Medicare Part B Imaging Services: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices
A letter report issued by the Government Accountability Office with an abstract that begins "The Centers for Medicare & Medicaid Services (CMS)--an agency within the Department of Health and Human Services (HHS)--and the Congress, through the Deficit Reduction Act of 2005 (DRA), recently acted to constrain spending on imaging services, one of the fastest growing set of services under Medicare Part B, which covers physician and other outpatient services. GAO was asked to provide information to help the Congress evaluate imaging services in Medicare. In this report, GAO provides information on (1) trends in Medicare spending on imaging services from 2000 through 2006, (2) the relationship between spending growth and the provision of imaging services in physicians' offices, and (3) imaging management practices used by private payers that may have lessons for Medicare. To do this work, GAO analyzed Medicare claims data from 2000 through 2006, interviewed private health care plans, and reviewed health services literature."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Information on Immigration Enforcement and Supervisory Promotions in the Department of Homeland Security's Immigration and Customs Enforcement and Customs and Border Protection
Correspondence issued by the Government Accountability Office with an abstract that begins "After the creation of the Department of Homeland Security (DHS) in March 2003, two legacy enforcement agencies--the former Immigration and Naturalization Service (INS) and the U.S. Customs Service (USCS)--were among the 22 federal agencies brought together within DHS. This transformation in turn merged the legacy INS and USCS investigators into the U.S. Immigration and Customs Enforcement (ICE) Office of Investigations (OI), and legacy INS and USCS inspectors, among others, into Customs and Border Protection (CBP). It has been nearly 3 years since the merger and efforts to integrate thousands of federal employees within ICE and CBP continue. Congress raised questions about ongoing human capital challenges brought about by the integration of legacy enforcement employees within ICE and CBP. In prior work, we have reported on the management and human capital challenges DHS faces as it merges the workforces of legacy agencies, including the need to clarify the roles and responsibilities of the new agencies, the difficulty of legacy staff operating from separate locations, and how it decides to allocate investigative resources. This report addresses the following objectives: (1) How many investigative work years were dedicated to immigration enforcement …
Date:
June 13, 2006
Creator:
United States. Government Accountability Office.
Object Type:
Text
System:
The UNT Digital Library
Federal Records: National Archives and Selected Agencies Need to Strengthen E-Mail Management
A letter report issued by the Government Accountability Office with an abstract that begins "Federal agencies are increasingly using electronic mail (e-mail) for essential communication. In doing so, they are potentially creating messages that have the status of federal records, which must be managed and preserved in accordance with the Federal Records Act. Under the act, both the National Archives and Records Administration (NARA) and federal agencies have responsibilities for managing federal records, including e-mail records. In view of the importance that e-mail plays in documenting government activities, GAO was asked, among other things, to review the extent to which NARA provides oversight of federal records management, describe selected agencies' processes for managing e-mail records, and assess these agencies' e-mail policies and key practices. To do so, GAO examined NARA guidance, regulations, and oversight activities, as well as e-mail policies at four agencies (of contrasting sizes and structures) and the practices of selected officials."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Chemical Regulation: Options Exist to Improve EPA's Ability to Assess Health Risks and Manage Its Chemical Review Program
A letter report issued by the Government Accountability Office with an abstract that begins "Chemicals play an important role in everyday life, but some may be harmful to human health and the environment. Chemicals are used to produce items widely used throughout society, including consumer products such as cleansers, paints, plastics, and fuels, as well as industrial solvents and additives. However, some chemicals, such as lead and mercury, are highly toxic at certain doses and need to be regulated because of health and safety concerns. In 1976, the Congress passed the Toxic Substances Control Act (TSCA) to authorize the Environmental Protection Agency (EPA) to control chemicals that pose an unreasonable risk to human health or the environment. GAO reviewed EPA's efforts to (1) control the risks of new chemicals not yet in commerce, (2) assess the risks of existing chemicals used in commerce, and (3) publicly disclose information provided by chemical companies under TSCA."
Date:
June 13, 2005
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Medicare: Thousands of Medicare Providers Abuse the Federal Tax System
A letter report issued by the Government Accountability Office with an abstract that begins "Under the Medicare program, the Centers for Medicare & Medicaid Services (CMS) and its contractors paid over $400 billion in Medicare benefits in calendar year 2006. GAO was asked to determine if Medicare providers have unpaid federal taxes and, if so, to (1) determine the magnitude of such debts, (2) identify examples of Medicare providers that have engaged in abusive or potentially criminal activities, and (3) determine whether CMS prevents delinquent taxpayers from enrolling in Medicare or levies payments to pay taxes. To determine amount of unpaid taxes owed by Medicare providers, GAO compared claim payment data from CMS and tax debt data from the Internal Revenue Service (IRS). In addition, GAO reviewed policies, procedures, and regulations related to Medicare. GAO also performed additional investigative activities."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Child Welfare: Better Data and Evaluations Could Improve Processes and Programs for Adopting Children with Special Needs
A letter report issued by the Government Accountability Office with an abstract that begins "On September 30, 2002, the most recent date for which Department of Health and Human Services (HHS) data were available, about 126,000 foster children were waiting to be adopted. Estimates suggest that a significant portion of these children had one or more special needs, such as a medical condition or membership in a minority group, that may discourage or delay their adoption. Federal support in the form of adoption subsidies and incentive payments to states is available to promote special needs adoption. This report (1) identifies the major challenges to placing and keeping special needs children in adoptive homes, (2) examines what states and HHS have done to facilitate special needs adoptions, and (3) assesses how well the Adoption Assistance Program and the Adoption Incentives Program have worked to facilitate special needs adoptions, and determines if changes might be needed."
Date:
June 13, 2005
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Federal Real Property: Property Conveyances between the District of Columbia and the Federal Government Await Completion, and Development Will Take Many Years
A letter report issued by the Government Accountability Office with an abstract that begins "The Federal and District of Columbia Government Real Property Act of 2006 (Public Law 109-396) mandated GAO's review of the property exchange between the District and the federal government. None of the conveyances had occurred by the beginning of GAO's audit phase. After consulting with the congressional committees specified in the law, GAO developed research questions that reflect an assessment of property exchanges and development progress to date. GAO's objectives were to determine (1) the status of the conveyances and transfers of the properties identified in the law; (2) what steps the District and the federal government have taken toward completing the conveyances, what factors have affected their completion, and what additional steps remain; (3)what preliminary development has occurred on the properties exchanged between the District and the federal government, and what are the current plans for use of these properties; and (4)what development challenges the District and federal government face going forward. GAO analyzed planning and property documents; conducted site visits; and interviewed senior officials from the District and the Department of the Interior (DOI) among others. DOI and the General Services Administration agreed with …
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Small Business Administration: Management Practices Have Improved for the Women's Business Center Program
Correspondence issued by the General Accounting Office with an abstract that begins "This report evaluates how the Small Business Administration (SBA) has managed its Women's Business Center Program. GAO found that the two offices that run the program--the Office of WOmen's Business Ownership (program office) and the Office of Procurement and Grants (grants office)--have addressed the weaknesses cited in GAO's 1999 report. For example, files from the program office that GAO reviewed were generally complete, and the few documents that GAO could not locate were provided promptly. The program office was also able to provide various historical documents for 1999 and 2000, and the program office and grants office had tried to improve coordination with each other, such as through better recordkeeping."
Date:
June 13, 2001
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library
Global War on Terrorism: Reported Obligations for the Department of Defense
Correspondence issued by the Government Accountability Office with an abstract that begins "Since 2001, Congress has provided the Department of Defense (DOD) with hundreds of billions of dollars in supplemental and annual appropriations for military operations in support of the Global War on Terrorism (GWOT). DOD's reported annual obligations for GWOT have shown a steady increase from about $0.2 billion in fiscal year 2001 to about $139.8 billion in fiscal year 2007. To continue GWOT operations, the President requested $189.3 billion in appropriations for DOD in fiscal year 2008. As of May 2008, Congress has provided DOD with about $86.8 billion of this request, including $16.8 billion for Mine Resistant Ambush Protected vehicles. Congress has not finalized action on the remaining $102.5 billion. In addition, the President also requested about $66 billion in appropriations for DOD in fiscal year 2009 for GWOT, which was submitted along with DOD's annual budget request. The United States' commitments to GWOT will likely involve the continued investment of significant resources, requiring decision makers to consider difficult trade-offs as the nation faces an increasing long-range fiscal challenge. The magnitude of future costs will depend on several direct and indirect cost variables and, in some cases, …
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Text
System:
The UNT Digital Library
Nursing Homes: Quality of Care More Related to Staffing than Spending
Correspondence issued by the General Accounting Office with an abstract that begins "Costs for nursing home care have almost doubled since 1990, from $53 billion to $92 billion in 2000. Much of that spending has been financed with public monies. Under the Medicare and Medicaid programs, the federal government financed 39 percent of the nation's nursing home spending in 2000, up from 28 percent in 1990. As federal outlays have grown, Congress has focused attention on the quality of care delivered and the level of staffing in nursing homes. Nursing home expenditures per resident day varied considerably across Ohio, Mississippi, and Washington--the 3 states covered in GAO's survey. Although the total level of spending varied, the average share devoted to resident-care activities, such as nursing care and medical supplies, was relatively stable. The share of spending devoted to buildings and equipment, by comparison, was more variable. Homes in Ohio and Washington that provided more nursing hours per resident day, especially nurses' aide hours, were less likely than homes providing fewer nursing hours to have repeated serious or potentially life-threatening quality problems. However, GAO found no clear relationship between a nursing home's spending per resident day and the number of serious …
Date:
June 13, 2002
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library
Department of Homeland Security: Progress and Challenges in Implementing the Department's Acquisition Oversight Plan
A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Homeland Security (DHS), the third largest department in federal procurement spending in fiscal year 2006, has faced ongoing cost, schedule, and performance problems with major acquisitions and procurement of services. In December 2005, DHS established an acquisition oversight program to provide insight into and improve components' acquisition programs. In 2006, GAO reported that DHS faced challenges in implementing its program. Congress mandated that DHS develop an oversight plan and tasked GAO with analyzing the plan. GAO (1) evaluated actions DHS and its components have taken to implement the acquisition oversight plan and (2) identified implementation challenges. GAO also identified opportunities for strengthening oversight conducted through the plan. GAO reviewed relevant DHS documents and GAO and DHS Inspector General reports and interviewed officials in the office of the Chief Procurement Officer (CPO) and nine DHS components."
Date:
June 13, 2007
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Emergency Preparedness: States Are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources
A letter report issued by the Government Accountability Office with an abstract that begins "Potential terrorist attacks and the possibility of naturally occurring disease outbreaks have raised concerns about the "surge capacity" of the nation's health care systems to respond to mass casualty events. GAO identified four key components of preparing for medical surge: (1) increasing hospital capacity, (2) identifying alternate care sites, (3) registering medical volunteers, and (4) planning for altering established standards of care. The Department of Health and Human Services (HHS) is the primary agency for hospital preparedness, including medical surge. GAO was asked to examine (1) what assistance the federal government has provided to help states prepare for medical surge, (2) what states have done to prepare for medical surge, and (3) concerns states have identified related to medical surge. GAO reviewed documents from the 50 states and federal agencies. GAO also interviewed officials from a judgmental sample of 20 states and from federal agencies, as well as emergency preparedness experts."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Contract Management: Comments on Selected Provisions of the Services Acquisition Reform Act of 2003, H.R. 1837
Correspondence issued by the General Accounting Office with an abstract that begins "This is a follow up to our April 30, 2003, testimony on the proposed Services Acquisition Reform Act of 2003 (SARA). Because our testimony was based on a section-by-section analysis of the proposed legislation, the House Committee on Government Reform requested that we review the specific provisions of the bill as introduced and provide any additional comments."
Date:
June 13, 2003
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library
GAO's Electronic Database of China's World Trade Organization Commitments
Correspondence issued by the General Accounting Office with an abstract that begins "China's December 2001 accession to the World Trade Organization (WTO) signified that the world's seventh largest economy and the United State's fourth largest trading partner would be subject to the multilateral organization's trade liberalizing requirements. China's accession agreement is a set of legal documents totaling more than 800 pages. In order to fulfill its WTO commitments, China will have to undertake numerous actions over the next 10 years, ranging from reducing or eliminating tariffs to improving the transparency of trade-related rules and regulations. GAO released its database of its analysis to assist Congress in analyzing, monitoring, and enforcing China's WTO commitments."
Date:
June 13, 2003
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library
Tax Debt Collection: IRS Has a Complex Process to Attempt to Collect Billions of Dollars in Unpaid Tax Debts
A letter report issued by the Government Accountability Office with an abstract that begins "The Internal Revenue Service (IRS) estimated that $33 billion in income tax assessments was not paid in 2001. If not collected, annual unpaid taxes keep accumulating each year along with penalty and interest charges to create an inventory of "tax debts," which approached $300 billion at the end of fiscal year 2007. IRS has shelved or delayed collection of billions of dollars of this tax debt. Congress and others have questioned IRS's collection process's effectiveness. As requested, GAO is reporting on (1) the process IRS uses to collect unpaid tax debts; (2) trends in the unpaid tax debt inventory, collections, and other resolutions from fiscal years 2002 through 2007; and (3) the performance measures and goals available to assess how well the collection process works overall. To meet these objectives, GAO interviewed IRS officials and reviewed IRS's unpaid assessments database, documentation on the collection process and factors used in managing it, and IRS's highest-level collection measures."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Los Alamos National Laboratory: Long-Term Strategies Needed to Improve Security and Management Oversight
A letter report issued by the Government Accountability Office with an abstract that begins "In 2006, a Los Alamos National Laboratory (LANL) contract employee unlawfully removed classified information from the laboratory. This was the latest in a series of high-profile security incidents at LANL spanning almost a decade. LANL conducts research on nuclear weapons and other national security areas for the National Nuclear Security Administration (NNSA). GAO was asked to (1) identify LANL's major programs and activities and how much they rely on classified resources; (2) identify initiatives LANL is taking to reduce and consolidate its classified resources and physical footprint and the extent to which these initiatives address earlier security concerns; and (3) determine whether its new management approaches will sustain security improvements over the long-term. To carry out its work, GAO analyzed LANL data; reviewed policies, plans, and budgets; and interviewed officials."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Telecommunications: FCC Needs to Improve Performance Management and Strengthen Oversight of the High-Cost Program
A letter report issued by the Government Accountability Office with an abstract that begins "In the Telecommunications Act of 1996 (1996 Act), the Congress said that consumers in "rural, insular, and high-cost areas" should have access to services and rates that are "reasonably comparable" to those in urban areas. To implement the 1996 Act, the Federal Communications Commission (FCC) modified and expanded the high-cost program. The program provides funding to some telecommunications carriers, facilitating lower telephone rates in rural areas. GAO was asked to review (1) the effect that the program structure has on the level of support and types of services in rural areas, (2) the extent to which FCC has developed performance goals and measures for the program, and (3) the extent to which FCC has implemented internal control mechanisms. GAO reviewed relevant documents; interviewed federal and state officials, industry participants, and experts; conducted 11 state site visits; and conducted a survey of state regulators, available online at GAO-08-662SP."
Date:
June 13, 2008
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Credit Derivatives: Confirmation Backlogs Increased Dealers' Operational Risks, but Were Successfully Addressed after Joint Regulatory Action
A letter report issued by the Government Accountability Office with an abstract that begins "Over-the-counter (OTC) credit derivatives are privately negotiated contracts that allow a party to transfer the risk of default on a bond or loan to another party without transferring ownership. After trading in these products grew dramatically in recent years, backlogs of thousands of trades developed for which dealers had yet to formally confirm the trade terms with end-users--such as hedge funds, pension funds, and insurance companies--and other dealers. Not confirming these trades raised the risk that losses could arise. GAO was asked to review (1) what caused the trade confirmation backlogs and how they were being addressed and (2) how U.S. financial regulators were overseeing dealers' credit derivative operations, including the security and resiliency of the information technology systems used for these products. GAO analyzed data on credit derivatives operations that dealers submitted to regulators, reviewed regulatory examination reports and work papers, and interviewed regulators, dealers, end-users, and industry organizations."
Date:
June 13, 2007
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
Capital Gains Tax Gap: Requiring Brokers to Report Securities Cost Basis Would Improve Compliance if Related Challenges Are Addressed
A letter report issued by the Government Accountability Office with an abstract that begins "For tax year 2001, the Internal Revenue Service (IRS) estimated a tax gap of at least $11 billion from individual taxpayers misreporting income from capital assets (generally those owned for investment or personal purposes). IRS did not estimate the portion of this gap from securities (e.g., stocks, bonds, and mutual fund capital gains distributions). GAO was asked for information on (1) the extent and types of noncompliance for individual taxpayers that misreport securities capital gains, (2) actions IRS takes to reduce the securities tax gap, and (3) options with the potential to improve taxpayer voluntary compliance and IRS's ability to address noncompliant taxpayers. For estimates of noncompliance, GAO analyzed a probability sample of examination cases for tax year 2001 from the most recent IRS study of individual tax compliance."
Date:
June 13, 2006
Creator:
United States. Government Accountability Office.
Object Type:
Report
System:
The UNT Digital Library
DOD and VA Health Care: Access for Dual Eligible Beneficiaries
Correspondence issued by the General Accounting Office with an abstract that begins "The Department of Defense (DOD) reported that under its current policy, beneficiaries eligible for both TRICARE and the Department of Veterans Affairs' (VA) health care (dual eligible beneficiaries) are not allowed to utilize the services offered by both health care systems for treatment for the same episode of care. For example, if a beneficiary experiences back pain and seeks treatment from VA, the beneficiary must then receive all care related to that back pain from VA. Should the beneficiary then decide to seek treatment for the back pain from TRICARE, any claims related to that care would be denied. According to DOD, this policy was established to ensure continuity of care for beneficiaries and to ensure that there was no duplication of care or of payments from TRICARE or VA. Under the policy, if beneficiaries are dissatisfied with the care provided by VA, they are unable to switch to TRICARE to receive services for the same episode of care. On April 16, 2003, DOD reported to the Congress on a proposal to change its policy and promulgate regulations for coordinating care between DOD and VA. As agreed, we …
Date:
June 13, 2003
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library
Tax Compliance: Challenges to Corporate Tax Enforcement and Options to Improve Securities Basis Reporting
Testimony issued by the Government Accountability Office with an abstract that begins "Corporate income taxes are expected to bring in about $277 billion in 2006 to help fund the activities of the federal government. Besides raising revenue, the tax alters investment decisions and raises concerns about competitiveness in an environment of increasing global interdependency. The complexity of the tax breeds tax avoidance, including an estimated $32 billion of noncompliance detected by the Internal Revenue Service (IRS). This testimony provides information on trends in corporate taxes and opportunities to improve corporate tax compliance. Congress also asked that GAO discuss recent work on the misreporting of capital gains income from securities sales and options to improve compliance. This statement is based largely on previously published GAO work."
Date:
June 13, 2006
Creator:
United States. Government Accountability Office.
Object Type:
Text
System:
The UNT Digital Library
Deep Injection Wells: EPA Needs to Involve Communities Earlier and Ensure That Financial Assurance Requirements Are Adequate
A letter report issued by the General Accounting Office with an abstract that begins "Billions of gallons of hazardous liquid waste are injected into underground wells each year. These Class I hazardous deep injection wells are designed to inject waste into an area below the lowermost underground source of drinking water. EPA and the states grant permits to commercial operators to construct and operate these wells and must obtain public comments on the permits. Communities often raise concerns about well safety and other matters. GAO examined the extent to which EPA and the states (1) address these community concerns, (2) consider environmental justice issues, and (3) ensure that financial assurances adequately protect the taxpayer if bankruptcy occurs. GAO, among other things, examined the permit process in the four states that have commercial Class I wells."
Date:
June 13, 2003
Creator:
United States. General Accounting Office.
Object Type:
Report
System:
The UNT Digital Library
Medicaid Financial Management: Better Oversight of State Claims for Federal Reimbursement Needed
Testimony issued by the General Accounting Office with an abstract that begins "The Medicaid program served 33.4 million low-income families as well as elderly, blind, and disabled persons at a cost of $119 billion to the federal government and $88 billion to the states in fiscal year 2000. States are responsible for safeguarding Medicaid funds by making proper payments to providers, recovering misspent funds, and accurately reporting costs for federal reimbursement. At the federal level, the Centers for Medicare and Medicaid Services (CMS) is responsible for overseeing state financial activities and ensuring the propriety of expenditures reported for federal reimbursement. Audits of state Medicaid finances have identified millions of dollars of questionable or unallowable costs. In addition, annual financial statement audits have identified many internal control weaknesses in CMS oversight of state Medicaid operations. CMS has only recently begun to assess areas at greatest risk for improper payments. As a result, controls that focus on the highest risk areas and resources had not yet been deployed for areas of greatest risk. Since 1998, auditors have noted that CMS failed to institute an oversight process that effectively reduced the risk of inappropriate medical claims and payments. CMS attributed most of the …
Date:
June 13, 2002
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library
Telecommunications: Metropolitan Area Acquisition Program Implementation and Management
Testimony issued by the General Accounting Office with an abstract that begins "This testimony discusses the implementation and management of the General Services Administration's (GSA) Metropolitan Area Acquisition (MAA) program, which encourages competition for telecommunication services in large cities. GAO found that as of June 2001, GSA had awarded 37 MAA contracts for 20 metropolitan areas. Existing GSA contracts were to become MAA contracts within nine months after contractors were authorized to begin work. This goal was met in only two of the 14 metropolitan areas in which authorization was given. GSA charges customer agencies two types of fees to recover the costs of their contract management and administration activities. Although GSA does not yet allow MAA contractors to offer FTS2001 services, it is taking steps to allow crossover between the two programs."
Date:
June 13, 2001
Creator:
United States. General Accounting Office.
Object Type:
Text
System:
The UNT Digital Library