A letter report issued by the Government Accountability Office with an abstract that begins "Medicare pays for surgical procedures performed at ambulatory surgical centers (ASC) and hospital outpatient departments through different payment systems. Although they perform a similar set of procedures, no comparison of ASC and hospital outpatient per-procedure costs has been conducted. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed GAO to compare the relative costs of procedures furnished in ASCs to the relative costs of those procedures furnished in hospital outpatient departments, in particular, how accurately the payment groups used in the hospital outpatient prospective payment system (OPPS) reflect the relative costs of procedures performed in ASCs. To do this, GAO collected data from ASCs through a survey. GAO also obtained hospital outpatient data from the Centers for Medicare & Medicaid Services (CMS)."

A letter report issued by the Government Accountability Office with an abstract that begins "Government agencies and businesses that require significant capacity to meet voice and data needs depend on dedicated access services. This segment of the telecommunications market generated about $16 billion in revenues for the major incumbent telecommunications firms in 2005. The Federal Communications Commission (FCC) has historically regulated dedicated access prices. With the Telecommunications Act of 1996, FCC reformed its rules to rely on competition to bring about cost-based pricing. Starting in 2001, FCC granted pricing flexibility on the basis of a proxy measure of competition. GAO examined (1) the extent that alternatives are available in areas where FCC granted pricing flexibility, (2) how prices have changed since the granting of pricing flexibility, and the effect on government agencies, and (3) how FCC monitors competition. GAO's work included analyzing data on competitive alternatives, list prices, and average revenue, and interviewing FCC officials and industry representatives."

A letter report issued by the Government Accountability Office with an abstract that begins "The National Transportation Safety Board (NTSB) plays a vital role in advancing transportation safety by investigating accidents, determining their causes, and issuing safety recommendations. To support its mission, NTSB's training center, which opened in 2003, provides training to NTSB investigators and others. It is important that NTSB use its resources efficiently to carry out its mission. GAO was asked to examine the extent to which NTSB follows leading management practices, how NTSB carries out its transportation safety function, and the extent to which NTSB's training center is cost-effective, including potential options for improving the center's cost-effectiveness. GAO reviewed NTSB documents and data concerning management practices and accident investigations, interviewed relevant NTSB and other federal officials, and evaluated NTSB's management practices based on leading practices identified in prior work."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) provides mental health services to veterans with conditions such as post-traumatic stress disorder (PTSD) and substance abuse disorders. To address gaps in services needed by veterans, VA approved a mental health strategic plan in 2004. VA planned to increase its fiscal year 2005 allocations for plan initiatives by $100 million above fiscal year 2004 levels and its fiscal year 2006 allocations for plan initiatives by $200 million above fiscal year 2004 levels. GAO was asked to provide information on VA's allocation and use of funding for mental health strategic plan initiatives in fiscal years 2005 and 2006, and to examine the adequacy of how VA tracked spending and the extent of spending for plan initiatives. GAO reviewed VA reports and documents on plan initiatives and conducted interviews with VA officials at headquarters, 4 of 21 health care networks, and seven medical centers. VA networks provide oversight of medical center operations and most medical center resources."

A letter report issued by the Government Accountability Office with an abstract that begins "Begun in 1998, the Job Access and Reverse Commute (JARC) program provides grants to states and localities for improving the mobility of low-income persons seeking work. The Federal Transit Administration (FTA) administers this program. In 2005, the Safe, Accountable, Flexible, Efficient Transportation Equity Act--A Legacy for Users (SAFETEA-LU) authorized $727 million for JARC for fiscal years 2005 through 2009, changed how these funds were to be awarded after fiscal year 2005, and required FTA to evaluate the program by August 2008. GAO examined (1) SAFETEA-LU's changes to JARC, (2) FTA's progress in implementing these changes, (3) states' and localities' efforts to respond and challenges they have encountered, and (4) FTA's proposed strategy for evaluation and oversight. GAO's work included analyzing program guidance as well as interviewing officials from FTA, industry groups, and more than 30 state and local agencies."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Head Start program, administered by the U. S. Department of Health and Human Services (HHS), provides grants to local organizations to offer comprehensive early childhood services to approximately 900,000 poor children, ages 5 years or younger. While transportation is not a required service, in order to make Head Start more widely available to very poor children, over 70 percent of Head Start grantees and delegates provide transportation to at least some of the children they enroll. To address concerns about transporting children safely, the 1992 Head Start Improvement Act directed the Office of Head Start (OHS) to develop transportation regulations to ensure the safety and effectiveness of transportation services made available to children by Head Start grantees and delegates. In 2001, citing safety concerns related to vehicles as well as the variation in states' standards for pupil transport, Head Start issued regulations governing transportation services. Among other things, the regulations mandated that grantees and delegates use school buses or similar alternative vehicles and that children be placed in restraints and attended by bus monitors. In commenting on the 2001 regulations, grantees and delegates expressed concerns about potential …

A letter report issued by the Government Accountability Office with an abstract that begins "Drug development is complex and costly, requiring the testing of numerous chemical compounds for their potential to treat disease. Before a new drug can be marketed in the United States, a new drug application (NDA), which includes scientific and clinical data, must be approved by the Food and Drug Administration (FDA). Recent scientific advances have raised expectations that an increasing number of new and innovative drugs would soon be developed to more effectively prevent, treat, and cure serious illnesses. However, industry analysts and the FDA have reported that new drug development, and in particular, development of new molecular entities (NMEs)--potentially innovative drugs containing ingredients that have never been marketed in the United States--has become stagnant. GAO was asked to provide information on (1) trends in the pharmaceutical industry's reported research and development expenses as well as trends in the number of NDAs submitted to, and approved by, FDA; and (2) experts' views on factors accounting for these trends and their suggestions for expediting and enhancing drug development. GAO analyzed data from FDA on all 1,264 NDAs submitted to the agency from 1993 through 2004. GAO also …

Correspondence issued by the Government Accountability Office with an abstract that begins "Beginning January 1, 2007, the premiums for the Medicare Part B Supplementary Medical Insurance program will be based on income, which will raise the premiums for approximately 1.65 million higher-income beneficiaries to as much as 80 percent of the full cost over the 3-year phase-in period. This change, which may be unknown to some beneficiaries, will affect single individuals with incomes over $80,000 and married couples who file jointly with incomes over $160,000. Medicare Part B is a voluntary program administered by the Centers for Medicare & Medicaid Services (CMS) that covers doctors' services, certain outpatient services, and other care. Currently, Medicare Part B beneficiaries generally pay a flat premium of 25 percent (the standard monthly premium) of the cost of the program, with the remaining 75 percent subsidized by the federal government. While CMS administers the program, the Social Security Administration (SSA) is responsible for determining and assessing Medicare Part B income-based premiums once CMS has set the standard premium amount for the year. To better understand how SSA is implementing such premiums, the Senate Committee on Finance requested that we review the process that SSA has …

A letter report issued by the Government Accountability Office with an abstract that begins "Estimated costs for the Department of Defense's (DOD) major space acquisition programs have increased by about $12.2 billion from initial estimates for fiscal years 2006 through 2011. Cost growth for ongoing Air Force programs above initial estimates accounts for a substantial portion of this 44 percent increase. In light of the role that optimistic estimating is believed to have played in exacerbating space acquisition cost growth, you requested that we examine (1) in what areas space system acquisition cost estimates have been unrealistic and (2) what incentives and pressures have contributed to the quality and usefulness of cost estimates for space system acquisitions."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO is pleased to offer three sets of recommendations for consideration of the agenda of the 110th Congress. The first suggests targets for near-term oversight; the second proposes policies and programs that are in need of fundamental reform and re-engineering; and the third lists governance issues that should be addressed to help ensure an economical, efficient, effective, ethical, and equitable federal government capable of responding to the various challenges and capitalizing on related opportunities in the 21st century. Details on each of these recommendations can be found in the enclosure. GAO has three key roles to play in making a difference for the Congress and the American people: oversight, insight, and foresight. The attached lists reflect those missions and represent an effort to synthesize GAO's institutional knowledge and special expertise for the benefit of you and your colleagues in your planning efforts. In this regard, GAO believes that to be effective, congressional oversight needs to be constructive. For example, related hearings and other activities should offer opportunities for leading federal agencies to share best practices and facilitate governmentwide transformation. They should also hold people accountable for delivering positive …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Architect of the Capitol (AOC), through the Capitol Power Plant (CPP), operates five walkable utility tunnels containing steam and chilled water pipes associated with serving the heating and cooling requirements of the U.S. Capitol and 23 surrounding facilities. The tunnels also carry other utilities, such as fiber optic and telephone lines. The Office of Compliance (OOC), which is responsible for advancing safety, health, and workplace rights in the legislative branch, and the tunnel workers have raised concerns about health and safety issues in the tunnels. Specifically, in March 2006, the utility tunnel workers sent a letter to Congress complaining of unsafe working conditions in the tunnels, including falling concrete, asbestos, and extreme heat. In February 2006, OOC filed a complaint against AOC concerning hazards in the tunnels, including falling concrete, an inadequate communication system for these confined spaces, and inadequate escape exits. According to OOC officials, these conditions had been previously brought to the attention of AOC by OOC inspectors as early as 1999. Following a reinspection in mid-2005, OOC determined that AOC had not made sufficient progress in addressing them and that conditions in the tunnels …

Testimony issued by the Government Accountability Office with an abstract that begins "Of the 26 areas on GAO's high-risk list of federal programs or activities that are at risk for waste, fraud, abuse, or mismanagement, 8 are Department of Defense (DOD) programs or operations and another 6 are governmentwide high-risk areas that also apply to DOD. These high-risk areas relate to most of DOD's major business operations. DOD's failure to effectively resolve these high-risk areas has resulted in billions of dollars of waste each year, ineffective performance, and inadequate accountability. At a time when DOD is competing for resources in an increasingly fiscally constrained environment, it is critically important that DOD get the most from every defense dollar. DOD has taken several positive steps and devoted substantial resources toward establishing key management structures and processes to successfully transform its business operations and address its high-risk areas, but overall progress by area varies widely and huge challenges remain. This testimony addresses DOD's efforts to (1) develop a comprehensive, integrated, enterprisewide business transformation plan and its related leadership approach and (2) comply with legislation that addresses business systems modernization and improving financial management accountability. The testimony also addresses two sections included in …

Testimony issued by the Government Accountability Office with an abstract that begins "In 1995, the Department of Defense (DOD) began an effort to implement a standard departmentwide travel system. The Defense Travel System (DTS) is envisioned as DOD's standard end-to-end travel system. This testimony is based on GAO's September 2006 related report. Today's testimony highlights GAO's key findings with regard to the following objectives: (1) Were the two key assumptions made in the September 2003 economic analysis reasonable? (2) Was DOD taking action to ensure full utilization of DTS and gathering the data needed to monitor DTS utilization? and (3) Has DOD resolved several functional problems associated with weak system requirements and testing? To address these objectives, GAO (1) reviewed the September 2003 DTS economic analysis, (2) analyzed DTS utilization data, and (3) analyzed DTS flight information."

A letter report issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) is responsible for overseeing direct-to-consumer (DTC) advertising of prescription drugs. If FDA identifies a violation of laws or regulations in a DTC advertising material, the agency may issue a regulatory letter asking the drug company to take specific actions. GAO was asked to discuss (1) trends in drug company spending on DTC advertising and other activities; (2) what is known about the relationship between DTC advertising and drug spending and utilization; (3) the DTC advertising materials FDA reviews; (4) the number of regulatory letters that cited DTC materials and FDA's process for issuing those letters; and (5) the effectiveness of these letters at limiting the dissemination of violative DTC advertising. GAO reviewed research literature, analyzed FDA's processes, and examined FDA documentation."

A letter report issued by the Government Accountability Office with an abstract that begins "The President's Management Agenda (PMA) focuses attention on ensuring resources entrusted to the federal government are well managed and used wisely. The Office of Management and Budget (OMB) developed standards to measure success and a PMA scorecard that gives a "green", "yellow" or "red score" by agency. Green indicates success, yellow indicates mixed results, and red indicates unsatisfactory results. For the Improved Financial Performance Initiative, GAO was asked to (1) study and evaluate OMB's process and criteria for awarding a green score for current status and progress and (2) provide examples of how agency managers use financial data to better manage on a day-to-day basis. To fulfill these objectives, GAO interviewed OMB and agency officials and examined OMB and agency documentation relevant to OMB's scoring process."

A letter report issued by the Government Accountability Office with an abstract that begins "American workers are increasingly relying on 401(k) plans, which allow pre-tax contributions to individual accounts, for their retirement income. As workers accrue earnings on their investments, they also pay a number of fees that may significantly decrease their retirement savings. Because of concerns about the effects of fees on participants' retirement savings, GAO examined (1) the types of fees associated with 401(k) plans and who pays these fees, (2) how information on fees is disclosed to plan participants, and (3) how the Department of Labor (Labor) oversees plan fees and certain business arrangements. GAO reviewed industry surveys on fees and interviewed Labor officials and pension professionals about disclosure and reporting practices."

A letter report issued by the Government Accountability Office with an abstract that begins "The United Nations (UN) estimated in 2005 that renovating its headquarters will cost up to $1.75 billion. As the UN's host country and largest contributor, the United States has a substantial interest in the project's success. In this report, we (1) determine whether the development of the Capital Master Plan (CMP) has been consistent with leading industry practices, (2) examine factors that led to changes in the cost estimate and determine whether the 2005 estimate was updated using industry practices, (3) review the status of financing of the renovation, (4) identify decisions needed for the renovation to proceed, and (5) review UN oversight and State monitoring efforts. To address these objectives, we reviewed UN design and planning documents, including the latest cost estimate, to compare them with industry standards. To assess oversight, we reviewed Office of Internal Oversight Services (OIOS) and UN Board of Auditors reports and met with UN officials."

A letter report issued by the Government Accountability Office with an abstract that begins "The prevalence of opium poppy cultivation and drug trafficking in Afghanistan imperils the stability of its government and threatens to turn the conflict-ridden nation once again into a safe haven for traffickers and terrorists. To combat the drug trade, the U.S. government developed a counternarcotics strategy consisting of five pillars--alternative livelihoods, elimination and eradication, interdiction, law enforcement and justice, and public information. The Emergency Supplemental Appropriations Act of 2005 directed GAO to examine the use of all fiscal year 2005 funds administered by the U.S. Agency for International Development (USAID) and Department of State (State) for Afghan counternarcotics programs. To comply with this mandate, we examined progress under each counternarcotics pillar, challenges faced, and efforts to ensure that funds were used for intended purposes. To address these objectives, GAO reviewed pertinent USAID and State documents and met with cognizant U.S. and international officials in Washington, D.C., and Afghanistan. GAO makes no recommendations in this report. USAID, State, Department of Defense, and Department of Justice were provided a draft of this report, but did not provide formal comments."

Testimony issued by the Government Accountability Office with an abstract that begins "We are pleased to assist the Senate Committee on Appropriations, Subcommittee on the Legislative Branch in monitoring progress on the Capitol Visitor Center (CVC) project. Our remarks will focus on (1) the Architect of the Capitol's (AOC) construction progress and problems since the Subcommittee's September 21, 2006, hearing and their impact on the project's schedule; and (2) the project's expected cost at completion and funding situation. As part of this discussion, we will address a number of key challenges and risks that continue to face the project as well as actions AOC has recently taken, and plans or needs to take, to meet its currently scheduled completion date."

A letter report issued by the Government Accountability Office with an abstract that begins "Federal statistical information is used to make appropriate decisions about budgets, employment, and investments. GAO was asked to (1) describe selected characteristics of federally funded statistical or research surveys, (2) describe agencies' and Office of Management and Budget's (OMB) roles in identifying and preventing unnecessary duplication, (3) examine selected surveys to assess whether unnecessary duplication exists in areas with similar subject matter, and (4) describe selected agencies' efforts to improve the efficiency and relevance of surveys. GAO reviewed agency documents and interviewed officials. Using this information and prior GAO work, GAO identified surveys with potential unnecessary duplication."

A letter report issued by the Government Accountability Office with an abstract that begins "Established in 1934 to enforce the securities laws and protect investors, the Securities and Exchange Commission (SEC) plays an important role in maintaining the integrity of the U.S. securities markets. Pursuant to the Accountability of Tax Dollars Act of 2002, the SEC is required to prepare and submit to Congress and the Office of Management and Budget audited financial statements. GAO agreed, under its audit authority, to perform the audit of SEC's financial statements. GAO's audit was done to determine whether, in all material respects, (1) SEC's fiscal year 2006 financial statements were reliable and (2) SEC's management maintained effective internal control over financial reporting and compliance with laws and regulations. GAO also tested SEC's compliance with certain laws and regulations."

Other written product issued by the Government Accountability Office with an abstract that begins "Presented is GAO's performance and accountability report for fiscal year 2006. In the spirit of the Government Performance and Results Act, this annual report informs the Congress and the American people about what we have achieved on their behalf. Importantly, GAO received a clean opinion from independent auditors on our financial statements for the 20th consecutive year. The financial information and the data measuring GAO's performance contained in this report are complete and reliable."

A letter report issued by the Government Accountability Office with an abstract that begins "U.S. law authorizes aid for nonviolent democratic change in Cuba. From 1996-2005, the Department of State (State) and the U.S. Agency for International Development (USAID) awarded grants totaling $74 million to support such change. A presidential commission recently recommended increasing funding for these efforts. This report examines (1) agency roles in implementing this aid and selection of grantees; (2) types of aid, recipients, and methods of delivery reported in 2005; (3) oversight of grantees; and (4) data about the impact of this aid. To address these objectives, we analyzed the activities and internal controls, and USAID's oversight and management of, 10 grantees with about 76 percent (in dollars) of total active awards for Cuba democracy aid. Our review focused on USAID because State's first awards were not made until mid-2005."

A letter report issued by the Government Accountability Office with an abstract that begins "GAO previously testified that federal contractors abused the tax system with little consequence. While performing those audits, GAO noted that the Internal Revenue Service (IRS) records sometimes contained inaccurate or outdated tax information that prevented IRS from taking appropriate collection actions against those contractors, including submitting their tax debt to the Federal Payment Levy Program (FPLP) for collection. As a result, GAO was asked to review IRS's coding of tax debt excluded from the FPLP to determine whether (1) IRS tax records contain inaccurate status or transaction codes that exclude tax debt from the FPLP, (2) IRS's monitoring could be strengthened to ensure the accuracy of its status and transaction codes, and (3) other opportunities exist to increase the amount of tax debt included in the FPLP."