A letter report issued by the Government Accountability Office with an abstract that begins "The nation is at risk for a catastrophic biological event. The Implementing Recommendations of the 9/11 Commission Act directed GAO to report on biosurveillance--to help detect and respond to such events--at multiple jurisdictional levels. In June 2010, GAO recommended that the National Security Staff lead the development of a national biosurveillance strategy, which is now under development. This report focuses on nonfederal jurisdictions, which own many of the resources that support a national capability. It discusses (1) federal support for state and local biosurveillance; (2) state and local challenges; (3) federal support and challenges for tribal and insular areas and (4) federal assessments of nonfederal capabilities. To conduct this work, GAO interviewed select federal-agency, jurisdiction, and association officials and reviewed relevant documents. To collect information on federal efforts and challenges, we also sent standardized questionnaires to seven states and two cities."

A letter report issued by the Government Accountability Office with an abstract that begins "Once comprised of local, sole-proprietor ownership, the nation's for-profit institutions now range from small, privately owned schools to publicly traded corporations. Enrollment in such colleges has grown far faster than in traditional higher-education institutions. Moreover, during the 2009-2010 school year, for-profit colleges received almost $32 billion in grants and loans provided to students under federal student aid programs, as authorized under Title IV of the Higher Education Act of 1965, as amended. Because of interest in the student experience at for-profit colleges, GAO was asked to conduct undercover testing by enrolling in online classes under degree-granting programs. To conduct this testing, GAO selected 15 for-profit colleges using a selection process that included the 5 largest colleges and a random sample and attempted to enroll using fictitious identities. Once enrolled, each fictitious student engaged in behaviors consistent with substandard academic performance. Each fictitious identity enrolled for approximately one term, as defined by the college. The experience of each of GAO's undercover students is unique and cannot be generalized to other students taking courses offered by the for-profit colleges we tested or to other for-profit or nonprofit colleges. …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) has emphasized the importance of developing language skills and knowledge of foreign cultures to meet current and future needs and is investing millions of dollars to provide language and culture predeployment training to its general purpose forces. DOD has also noted that such training should be viewed as a long-term investment and that training and personnel systems should better account for the knowledge and skills of service members acquired through training to help manage its forces. The committee report accompanying a proposed bill for the National Defense Authorization Act for Fiscal Year 2011 (H.R. 5136) directed GAO to review language and culture training for Army and Marine Corps general purpose forces. For this report, GAO evaluated the extent to which these services (1) captured information in training and personnel systems on the completion of language and culture predeployment training and proficiency gained from training and (2) developed plans to sustain language skills acquired through predeployment training. GAO analyzed service documents and interviewed cognizant officials."

A letter report issued by the Government Accountability Office with an abstract that begins "Enrollment and spending in Medicare Advantage (MA) plans--the private plan alternative to the Medicare fee-for- service (FFS) program--have more than doubled since 2004. MA plans generally receive larger payments from Medicare than what these plans would require to provide the original Medicare FFS benefit package. Plans must use this additional money to reduce cost sharing, reduce premiums, and offer additional benefits. The Patient Protection and Affordable Care Act, enacted in 2010, required that the Centers for Medicare & Medicaid Services (CMS)--the agency within the Department of Health and Human Services (HHS) that administers Medicare--make changes in how Medicare pays MA plans. These changes, once fully implemented, are expected to reduce MA enrollment and payments, and lead to less generous benefit packages. GAO was asked to examine trends in MA from 2010 to 2011. This study assesses the extent to which the following changed from 2010 to 2011: (1) MA enrollment, (2) MA premiums and cost-sharing requirements, and (3) the additional benefits offered by MA plans. GAO analyzed data for the most common types of MA plans, accounting for about 71 percent of both the 11.1 million …

Correspondence issued by the Government Accountability Office with an abstract that begins "To help ensure that millions of Americans who rely on private insurance for health care coverage receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of insurance premium revenues health insurers spent on their enrollees' medical claims. The MLR definition specified in the PPACA provision-- referred to as the PPACA MLR in this report--differs from the traditional MLR definition. Key differences are that the PPACA MLR allows insurers to include in their expenses spending on activities to improve health care quality and to deduct from their revenues certain tax payments and fees, and these differences will generally increase insurers' MLRs. Beginning in 2011, PPACA required insurers to meet minimum PPACA MLR standards of 85 percent in the large group market and 80 percent in the small group and individual markets or pay rebates to their enrollees. In implementing these MLR requirements, the Department of Health and Human Services (HHS) includes an adjustment for certain insurers to help address the disproportionate impact of …

A letter report issued by the Government Accountability Office with an abstract that begins "The Tennessee Valley Authority (TVA), the nation's largest public power provider, is a self-financing, federal electric utility with annual revenues of about $11 billion. TVA has financed large capital investments mostly by issuing debt and is subject to a $30 billion debt ceiling imposed by the TVA Act. TVA is governed by a 9-member Board. Within an affirmation requirement for the TVA Board, the TVA Act recognizes that TVA's broad missions and objectives include being a national leader in technological innovation, low-cost power, and environmental stewardship. GAO was asked to examine (1) how TVA plans to meet future demand for electricity and how TVA's resource planning and forecasts compare to those from other sources, (2) TVA's efforts to use energy efficiency to meet demand for electricity, and (3) TVA's financial condition and how it affects TVA's ability to meet its operational and financial goals. GAO analyzed data from TVA and third parties, reviewed agency documents, and interviewed federal and state officials and industry stakeholders."

A letter report issued by the Government Accountability Office with an abstract that begins "Congressional interest in the security of offshore energy infrastructure has increased because of the lives lost and the substantial damages that resulted from the Deepwater Horizon incident in April 2010. The U.S. Coast Guard--a component of the Department of Homeland Security (DHS)--is the lead federal agency for maritime security, including the security of offshore energy infrastructure. The Coast Guard oversees two main types of offshore energy infrastructure--facilities on the Outer Continental Shelf (OCS) and deepwater ports. GAO was asked to examine (1) Coast Guard actions to ensure the security of OCS facilities and what additional actions, if any, are needed; (2) Coast Guard actions to ensure the security of deepwater ports and what additional actions, if any, are needed; and (3) what limitations in oversight authority, if any, the Coast Guard faces in ensuring the security of offshore energy infrastructure. GAO reviewed Coast Guard documents, such as inspection records, and relevant laws and regulations and interviewed Coast Guard inspectors and officials, including those at Coast Guard headquarters and the two Coast Guard districts that oversee all OCS facilities and deepwater ports that are subject to security …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates one of the largest health care delivery systems in the nation--providing health care services to more than 5 million veterans each year in over 1,000 facilities. These health care services are delivered by physicians, nurses, and other types of practitioners and range from routine examinations to complex surgical procedures. As in any health care setting, veterans receiving health care services at VA facilities may be at risk of incurring medical injury as a result of substandard care. Recent incidents have heightened concern about the quality of care provided to veterans by VA facilities. For example, in 2010 we reported that one VA facility discovered in 2009 that medical equipment had been improperly cleaned, thus posing safety risks to 2,526 veterans. In the event that an injury occurs as a result of care rendered by a VA practitioner, a veteran alleging medical malpractice may seek compensation by filing a tort claim with one of VA's 22 regional counsel offices. The offices, which operate under VA's Office of General Counsel (OGC), are responsible for initially investigating and, to the extent possible, resolving the …

A publication issued by the Government Accountability Office with an abstract that begins "As one of the largest and most complex organizations in the world, the Department of Defense (DOD) faces many challenges in resolving its long-standing financial and related business operations and system problems. DOD is in the process of implementing modern multifunction enterprise resource planning (ERP) systems to replace many of its outdated legacy systems. The ERPs are intended to perform business-related tasks such as general ledger accounting and supply chain management. Modernizing DOD's business systems is a critical part of transforming the department's business operations, addressing high-risk areas, and providing more-accurate and reliable financial information to Congress on DOD's operations. The Panel requested that GAO provide its perspective on DOD's ERP implementation efforts and the impact implementation problems could have on DOD's efforts to improve financial management and be audit ready by fiscal year 2017. This statement is based on GAO's prior work, reports issued by the Department of Defense Inspector General (DOD IG), and GAO's ongoing oversight of selected DOD ERP efforts. Over the years, GAO has made numerous recommendations to improve the department's financial management operations."

A letter report issued by the Government Accountability Office with an abstract that begins "Since 1976, the International Military Education and Training (IMET) program has provided education and training to foreign military personnel. The program's objectives include professionalizing military forces and increasing respect for democratic values and human rights. In 2010, Congress appropriated $108 million in IMET funding for more than 120 countries. The Department of State (State) and the Department of Defense (DOD) share responsibility for IMET. In response to a mandate in the conference report accompanying the Consolidated Appropriations Act of 2010, this report assesses (1) changes in the program from fiscal years 2000 to 2010, by funding levels, students trained, and recipient countries; (2) the program's provision of and emphasis on human rights training for its students; and (3) the extent to which State and DOD monitor IMET graduates and evaluate program effectiveness. GAO reviewed and analyzed agency funding, planning, and performance management documents, and interviewed U.S. officials in Washington, D.C., and overseas."

Testimony issued by the Government Accountability Office with an abstract that begins "The Social Security Administration's (SSA) Supplemental Security Income (SSI) program provides cash benefits to eligible low-income disabled individuals, including children, as well as certain others. Children may generally qualify for SSI benefits if they meet certain financial requirements and are deemed to have a qualifying medically determinable physical or mental impairment of a specified duration or severity that results in a functional limitation. In 2010, SSA paid more than $9 billion to about 1.2 million disabled children. Over the past decade, the overall number of children receiving SSI benefits has continued to rise. In this statement, GAO discusses initial observations from its ongoing review and examines (1) the trends in the rate of children receiving SSI benefits due to mental impairments over the past decade; (2) the role that medical and nonmedical information, such as medication and school records, play in the initial determination of a child's medical eligibility; and (3) the steps SSA has taken to monitor the continued medical eligibility of these children. To examine these issues, GAO analyzed program data, interviewed SSA officials, conducted site visits to SSA field offices and state disability determination services …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates a regional office in the Republic of the Philippines--the only one of its 57 regional offices that is located in a foreign country. Over the last two decades, Congress has periodically reauthorized the office for an average of 3 years each time. The Philippines was a U.S. territory prior to World War II and was granted independence in 1946. Congress authorized limited benefits for Filipino veterans who served under the command of the United States during the war, and authorized VA to operate a regional office to administer these benefits. In 1958, the office expanded to include an outpatient health clinic. VA estimates that about 18,000 Filipino WWII veterans were alive as of 2010, down from an estimated 452,000 in 1977. In light of this declining population eligible for benefits, maintaining the office may no longer be warranted at some point. Public Law 111-275 extended the authority for VA to operate this office until December 31, 2011, and directed GAO to submit this report. Our objectives are to (1) describe the primary activities undertaken by the VA regional office in the …

A publication issued by the Government Accountability Office with an abstract that begins "After the Army canceled the Future Combat System in June of 2009, it began developing modernization plans, including developing a new Ground Combat Vehicle (GCV) and additional network capability. At the same time, the Army was considering options on how to improve its light tactical vehicles. This statement addresses potential issues related to developing (1) the new GCV, (2) a common information network, and (3) the Joint Light Tactical Vehicle (JLTV) in a constrained budget environment. The statement is based largely on previous GAO work conducted over the last year in response to congressional requests and results of other reviews of Army modernization. To conduct this work, GAO analyzed program documentation, strategies, and test results; interviewed independent experts and Army and Department of Defense (DOD) officials; and witnessed demonstrations of current and emerging network technologies. DOD reviewed the facts contained in this statement and provided technical comments, which were incorporated as appropriate."

A publication issued by the Government Accountability Office with an abstract that begins "The Justice Department has reported that Indians are at least twice as likely to be raped or sexually assaulted as all other races in the United States. Indians living in remote areas may be days away from health care facilities providing medical forensic exams, which collect evidence related to an assault for use in criminal prosecution. The principal health care provider for Indians, which operates or funds tribes to operate 45 hospitals, is the Department of Health and Human Services' Indian Health Service (IHS). In response to a Tribal Law and Order Act of 2010 mandate, GAO examined (1) the ability of IHS and tribally operated hospitals to collect and preserve medical forensic evidence involving cases of sexual assault and domestic violence, as needed for criminal prosecution; (2) what challenges, if any, these hospitals face in collecting and preserving such evidence; and (3) what factors besides medical forensic evidence contribute to a decision to prosecute such cases. GAO surveyed all 45 IHS and tribally operated hospitals and interviewed IHS and law enforcement officials and prosecutors.."

A letter report issued by the Government Accountability Office with an abstract that begins "What GAO Found"

Correspondence issued by the Government Accountability Office with an abstract that begins "This report is in response to a request from congressional subcommittees to evaluate the design of the Department of Veterans Affairs (VA) fraud prevention controls within the Service-Disabled Veteran-Owned Small Business (SDVOSB) verification program instituted in response to Public Law 111-275. This work is part of our ongoing audit of the SDVOSB program governmentwide, which, in part, assesses the design of the three areas of a fraud prevention framework including preventive controls, detection and monitoring controls, and investigations and prosecutions. We will report the results of the larger audit at a later date.."

A letter report issued by the Government Accountability Office with an abstract that begins "On April 20, 2010, an explosion of the Deepwater Horizon oil rig leased by BP America Production Company (BP) resulted in a significant oil spill. GAO was requested to (1) identify the financial risks to the federal government resulting from oil spills, particularly Deepwater Horizon, (2) assess the Coast Guard's internal controls for ensuring that processes and payments for spill-related cost reimbursements and claims related to the spill are appropriate, and (3) describe the extent to which the federal government oversees the BP and Gulf Coast Claims Facility cost reimbursement and claims processes. We issued status reports in November 2010 and April 2011. This is the third and final report related to these objectives. We obtained and analyzed data on costs incurred from April 2010 through May 2011 and claims submitted and processed from September 2010 through May 2011. We reviewed relevant policies and procedures, interviewed officials and staff at key federal departments and agencies, and tested a sample of claims processed and cost reimbursements paid for compliance with internal controls.."

A publication issued by the Government Accountability Office with an abstract that begins "Traumatic brain injury (TBI) has emerged as a serious concern among U.S. forces serving in military operations in Afghanistan and Iraq. The widespread use of improvised explosive devices in these conflicts increases the likelihood that servicemembers will sustain a TBI, which the Department of Defense (DOD) defines as a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force. TBI cases within DOD are generally classified as mild, moderate, severe, or penetrating. From 2000 to March 2011 there were a total of 212,742 TBI cases reported by the Defense and Veterans Brain Injury Center within DOD. A majority of these cases, 163,181, were classified as mild traumatic brain injuries (mTBI)--commonly referred to as concussions. Early detection of injury is critical in TBI patient management. Diagnosis of moderate and severe TBI usually occurs in a timely manner due to the obvious and visible nature of the head injury. Identification of mTBI presents a challenge due to its less obvious nature. With mTBI, there may be no observable head injury. In addition, in the combat theater, an mTBI may not be identified …

A publication issued by the Government Accountability Office with an abstract that begins "Since 1992, GAO has published long-term fiscal simulations showing federal deficits and debt under different sets of assumptions. GAO developed its long-term model in response to a bipartisan request from members of Congress concerned about the long-term effects of fiscal policy. GAO's simulations provide context for consideration of policy options. They are not intended to suggest particular policy choices but rather to help facilitate a dialogue on this important issue. GAO regularly updates its simulations as new data become available from the Congressional Budget Office (CBO) and the Social Security and Medicare Trustees (Trustees). This update incorporates provisions of the Budget Control Act. As in the past, GAO shows two simulations: The Baseline Extended simulation follows CBO's August 2011 baseline for the first 10 years and then holds revenue and spending other than interest on the debt and large entitlement programs (Social Security, Medicare, and Medicaid) constant as a share of gross domestic product (GDP). Revenue as a share of GDP over the entire period is higher than the historical averages; discretionary spending is below average. In the Alternative simulation, expiring tax provisions other than the temporary …

A letter report issued by the Government Accountability Office with an abstract that begins "In recent years, the United States experienced public health crises suspected to have been caused by the deliberate substitution or addition of harmful ingredients in food and drugs--specifically melamine in pet food and oversulfated chondroitin sulfate in the blood thinner heparin. These ingredients were evidently added to increase the apparent value of these products or reduce their production costs, an activity GAO refers to as economic adulteration. The Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), has responsibility for protecting public health by ensuring the safety of a wide range of products that are vulnerable to economic adulteration. This report examines (1) the approaches that FDA uses to detect and prevent economic adulteration of food and medical products and (2) the challenges FDA faces in detecting and preventing economic adulteration and views of stakeholders on options for FDA to enhance its efforts to address economic adulteration. GAO reviewed FDA documents and interviewed FDA officials and stakeholders from academia and industry, among others.."

A letter report issued by the Government Accountability Office with an abstract that begins "International flights bound for the United States continue to be targets of terrorist activity, as demonstrated by the October 2010 discovery of explosive devices in air cargo packages bound for the United States from Yemen. The Transportation Security Administration (TSA) is responsible for securing the nation's civil aviation system, which includes ensuring the security of U.S.-bound flights. As requested, GAO evaluated (1) the steps TSA has taken to enhance its foreign airport assessment program since 2007, and any remaining program challenges; (2) TSA's assessment results, including how TSA uses the results to guide future efforts; and (3) what opportunities, if any, exist to enhance the program. To conduct this work, GAO reviewed foreign airport assessment procedures and results, interviewed TSA and foreign aviation security officials, and observed TSA conduct a foreign airport assessment. While these interviews and observations are not generalizable, they provided insights on TSA's program. This is the public version of a sensitive report GAO issued in September, 2011. Information that TSA deemed sensitive has been omitted."

A letter report issued by the Government Accountability Office with an abstract that begins "Planned federal information technology (IT) spending has now risen to at least $81 billion for fiscal year 2012. As GAO has previously reported, although a variety of best practices exists to guide their successful acquisition, federal IT projects too frequently incur cost overruns and schedule slippages while contributing little to mission-related outcomes. Recognizing these problems, the Office of Management and Budget (OMB) has launched several initiatives to improve the oversight and management of IT investments. GAO was asked to identify (1) federal IT investments that were or are being successfully acquired and (2) the critical factors that led to the successful acquisition of these investments. To do this, GAO interviewed agency officials from selected federal departments responsible for each investment. In commenting on a draft of GAO's report, three departments generally agreed with the report. OMB and the other departments either provided minor technical comments, or stated that they had no comments at all."

A letter report issued by the Government Accountability Office with an abstract that begins "The federal adoption tax credit, established in 1996, was amended in 2010. These amendments included making the credit refundable (meaning taxpayers could receive payments in excess of their tax liability) and increasing the maximum allowable credit to $13,170 of qualified adoption expenses for tax year 2010. As of August 20, 2011, taxpayers filed just under 100,000 returns, claiming about $1.2 billion in adoption credits. Following these changes, the Internal Revenue Service (IRS) developed a strategy for processing adoption credit claims. GAO was asked to (1) describe IRS's strategy for ensuring compliance with the adoption credit for the 2011 filing season, (2) assess IRS's related communication with taxpayers and stakeholders, and (3) assess its processing and audit of claims. To conduct its analysis, GAO analyzed IRS data and documents, interviewed IRS officials, observed IRS examiners, and interviewed other stakeholders."

A publication issued by the Government Accountability Office with an abstract that begins "The United States Postal Service (USPS) is in a serious financial crisis and has not generated sufficient revenue to cover its expenses and financial obligations as mail volume continues to decline. Congress requested that we examine how much additional revenue could result from the increased use of voting by mail--that is, more registered voters receiving and casting ballots through the mail. Currently, all states use voting by mail to some degree, most commonly in the form of absentee ballots mailed to registered voters who cannot, or choose not to, vote in person on Election Day. However, Oregon and Washington now administer elections solely through mail voting. According to a 2009 U.S. Election Assistance Commission (EAC) study, about 23.7 million ballots, or 17.7 percent of all votes, were cast by mail in the 2008 presidential election. This report documents information on the revenue potential of increased use of voting by mail that we presented to your office on August 17, 2011."