A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Health and Human Services (HHS) has established timelines and milestones for the 72 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) priorities--33 activities, 25 threat-based approaches, and 14 capabilities--that HHS selected as key to fulfilling PHEMCE strategic goals. However, HHS has not made spending estimates for its medical countermeasure development or procurement priorities (priority countermeasures) publicly available. In the PHEMCE implementation plan, HHS has grouped the 72 PHEMCE priorities into three time frames for completion--near-term (fiscal years 2012 through 2014), midterm (fiscal years 2015 through 2017), and long-term (fiscal year 2018 and beyond). For 21 priority activities, 10 priority threat-based approaches, and 8 priority capabilities, HHS and PHEMCE have identified specific deliverables, each tied to a milestone or set of milestones that delineate the steps necessary to complete deliverables, and established more specific timelines for completion of deliverables and milestones. For example, HHS's Office of the Assistant Secretary for Preparedness and Response (ASPR) is to lead the development of medical countermeasure requirements, which outline countermeasure quantity, type, and desired characteristics. Deliverables are the threat-specific requirements, such as for antidotes for mustard gas and other …

A letter report issued by the Government Accountability Office with an abstract that begins "The majority of the U.S. Army Corps of Engineers' (Corps) flood control projects budgeted for construction from fiscal years 2004 to 2012 experienced cost increases, including inflation. Specifically, 59 of 87 flood control projects during this period experienced increases from their original authorized cost to their current estimated project cost or their total expenditures at closeout, according to information provided by Corps officials. However, according to a Corps official, as of September 2013, no projects had cost increases that exceeded their maximum allowable cost as defined by law. Various factors other than inflation contributed to cost increases among the 8 projects GAO selected for further review. Factors included design changes, less than optimal federal funding, underestimated costs, and contract cost changes. For example, 6 of the 8 projects had design changes due to unforeseen site conditions and changes in design criteria following Hurricane Katrina. According to Corps officials, receiving less than optimal federal funding increased the costs of 3 of the 8 projects GAO reviewed. Corps officials also said that receiving less than optimal federal funding meant that 2 projects had to break up their work …

A letter report issued by the Government Accountability Office with an abstract that begins "The cruise industry and federal agencies have implemented 11 of 15 Cruise Vessel Security and Safety Act (CVSSA) provisions, but implementation of 4 provisions requires the development of regulations and policy, and is underway. Officials from all five cruise lines GAO met with said most required measures were in place when the CVSSA was enacted. According to U.S. Coast Guard officials, a notice of proposed rulemaking is in development to address 3 of the 4 remaining provisions. The 3 provisions relate to technologies to (1) detect a person going overboard, (2) maintain a video surveillance system to assist in documenting crimes on the vessel, and (3) transmit communications and warnings from the ship to anyone in surrounding waters. A policy linked to the fourth provision on the certification of trainers who provide the CVSSA course on crime scene preservation to cruise line personnel, is, as of December 2013, undergoing review at the Department of Transportation. With respect to CVSSA crime-reporting requirements, the Federal Bureau of Investigation (FBI) and the Coast Guard have implemented these provisions as required. Accordingly, the agencies publish on a website information on …

A letter report issued by the Government Accountability Office with an abstract that begins "The Small Business Innovation Research (SBIR) programs within the military departments use a variety of practices and tools to facilitate technology transition--the act of passing technologies developed in the science and technology environment on to users such as weapon system acquisition programs or warfighters in the field. GAO identified some common transition practices and tools across SBIR programs. For example, specific initiatives, such as the Commercialization Readiness Program, are used by each SBIR program and focus resources on enhancing technology transition opportunities. Transition facilitators are also used by each program to provide a network of personnel who manage SBIR activities that support technology transition. GAO also found some different practices and tools used to support technology transition efforts, such as the Navy Transition Assistance Program, which provides consulting services and helps showcase SBIR projects in an effort to improve small businesses' abilities to transition their projects. Transition facilitation efforts are supported by administrative funds provided through each program's SBIR budget and from other funds received from their respective military department. A recent increase in the amount of administrative funding that can come from SBIR budgets is …

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

A letter report issued by the Government Accountability Office with an abstract that begins "To develop a national benchmark for retail pharmacy acquisition costs of Medicaid covered outpatient prescription drugs--known as the National Average Drug Acquisition Cost (NADAC)--the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) surveys each month randomly selected retail community pharmacies for invoice data on their actual drug acquisition costs. CMS then calculates an average acquisition cost for each drug based on invoice data received from about 500 to 600 pharmacies. CMS officials expressed confidence in their current process, but noted that some limitations may exist. For example, CMS officials stated the extent to which NADACs reflect rebates and discounts is limited because most occur off-invoice or are not tied to a specific drug purchase. CMS has developed and published more than 5,000 NADACs, which CMS has estimated apply to more than 90 percent of the drug claims reimbursed by Medicaid."

A letter report issued by the Government Accountability Office with an abstract that begins "Medicare Advantage (MA) organizations' actual medical expenses, nonmedical expenses (such as marketing, sales, and administration) and profits as a percentage of total revenue were, on average, similar to projected values for plans available to all beneficiaries in 2011, the most recent year for which data were available at the time of the request for this work. MA organizations' actual medical expenses, nonmedical expenses, and profits were 86.3 percent, 9.1 percent, and 4.5 percent of total revenue, respectively. As a percentage of revenue, all three categories were within 0.3 percentage points of what MA organizations had projected. In addition, MA organizations received, on average, $9,893 in total revenue per beneficiary, slightly higher than the projected amount of $9,635."

Correspondence issued by the Government Accountability Office with an abstract that begins "Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-level median profit margin compared to MA plans available to all beneficiaries--7.1 percent vs. 3.2 percent. All three types of SNPs--dual-eligible SNPs, chronic condition SNPs, and institutional SNPs--spent, on average, a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries. SNPs also spent a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries after accounting for whether a plan had a high or low enrollment-weighted average benchmark--the maximum amount Medicare will pay plans to serve an average beneficiary in a given area. Similarly, SNPs spent a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to …

A letter report issued by the Government Accountability Office with an abstract that begins "Despite efficiency gains from processing more tax returns electronically, adding website services, and shifting resources from enforcement, the Internal Revenue Service (IRS) was unable to keep up with demand for telephone and correspondence services. Access to IRS's telephone assistors remained at 68 percent from 2012. The percentage of overage paper correspondence (over 45 days old) increased to 47 percent from 40 percent in 2012. In the face of similar trends, last year GAO reported that a dramatic revision in IRS's taxpayer service strategy was needed and recommended IRS take steps to better balance demand for services with available resources. GAO acknowledged this may require IRS to consider difficult tradeoffs, such as limiting some services. In response, IRS has proposed eliminating or reducing some services for 2014 such as answering basic tax law questions only during the filing season. However, IRS officials told GAO the proposed cuts may not be sufficient to stop the deterioration in services. Until IRS develops a strategy, it risks not communicating expectations about the level of services it can provide based on the resources available. IRS could use the strategy to facilitate …

A letter report issued by the Government Accountability Office with an abstract that begins "Since January 1990, the Bureau of Land Management (BLM) has leased 107 coal tracts, and associated coal production and revenues have grown. Most lease sales have had a single bidder and were leased the first time offered. The amount of coal produced from federal leases and associated revenues have increased since 1990, although production has leveled off since 2002. Revenues from federal coal leases have generated about $1 billion annually in recent years. Royalties paid when coal is sold and bonus bids paid for the right to mine a federal coal tract account for nearly all of these revenues."

A letter report issued by the Government Accountability Office with an abstract that begins "Substantial increases occurred over the last decade in the number of civil lawsuits filed in federal district court alleging violations of the Fair Labor Standards Act of 1938, as amended (FLSA). Federal courts in most states experienced increases in the number of FLSA lawsuits filed and the percentage of total civil lawsuits filed that were FLSA cases, but large increases were concentrated in a few states, including Florida and New York. The number of workers involved in FLSA lawsuits is unknown because the courts do not collect data on the number of workers represented. Many factors may contribute to this general trend; however, the factor cited most often by stakeholders, including attorneys and judges, was attorneys' increased willingness to take on such cases. In fiscal year 2012, an estimated 97 percent of FLSA lawsuits were filed against private sector employers, often from the accommodations and food services industry, and 95 percent of the lawsuits filed included allegations of overtime violations."

A statement of record issued by the Government Accountability Office with an abstract that begins "No overarching federal privacy law governs the collection and sale of personal information among private-sector companies, including information resellers. Instead, laws tailored to specific purposes, situations, or entities govern the use, sharing, and protection of personal information. For example, the Fair Credit Reporting Act limits the use and distribution of personal information collected or used to help determine eligibility for such things as credit or employment, but does not apply to information used for marketing. Other laws apply specifically to health care providers, financial institutions, or to the online collection of information about children."

A letter report issued by the Government Accountability Office with an abstract that begins "As of June 30, 2013, State Small Business Credit Initiative (SSBCI) participants--states, territories, and municipalities--had used $549 million of the $1.5 billion the Department of the Treasury (Treasury) allocated to them, nearly four times the amount used as of June 30, 2012. However, the rates at which participants have used funds continue to vary, as shown below. While initial challenges generally have been addressed, others remain. Participants' challenges with using funds at the start of the program resulted from some program policies not being finalized and low demand for some program types, among other things. Treasury and participants have since addressed many of these issues, but according to agency officials and others, participants will likely continue to face some challenges in using SSBCI funds. For example, some large lenders have been reluctant to partner with SSBCI participants because the variation in participants' programs makes it difficult for lenders to implement the program on a national basis, which has limited the program's reach into the small business lending market."

A letter report issued by the Government Accountability Office with an abstract that begins "Some investments have been made to improve Guam's public infrastructure in recent years, but many deficiencies and regulatory compliance issues continue to exist. The reliability, capacity, and age of much of the public infrastructure--especially the island's utilities--indicate a need for additional upgrades to be able to meet current and future demands related to the realignment. Further, some infrastructure sectors, such as water and wastewater, face issues complying with federal regulations. Other sectors, such as the fire and police departments, are experiencing staffing and other shortages that affect their ability to serve Guam's current population."

Testimony issued by the Government Accountability Office with an abstract that begins "FPS faces challenges ensuring that contract guards have been properly trained and certified before being deployed to federal facilities around the country. In its September 2013 report, GAO found that providing active shooter response and screener training is a challenge for FPS. For example, according to officials at five guard companies, their contract guards have not received training on how to respond during incidents involving an active shooter. Without ensuring that all guards receive training on how to respond to incidents at federal facilities involving an active-shooter, FPS has limited assurance that its guards are prepared for this threat. Similarly, an official from one of FPS's contract guard companies stated that 133 (about 38 percent) of its approximately 350 guards have never received screener training. As a result, guards deployed to federal facilities may be using x-ray and magnetometer equipment that they are not qualified to use which raises questions about their ability to screen access control points at federal facilities--one of their primary responsibilities. GAO was unable to determine the extent to which FPS's guards have received active-shooter response and screener training, in part, because FPS lacks …

A letter report issued by the Government Accountability Office with an abstract that begins "Beneficiaries with continuous health insurance coverage for approximately 6 years before enrolling in Medicare were more likely than those without prior continuous insurance to report being in good health or better during the first 6 years in Medicare. In particular, having prior continuous insurance raised the predicted probability that a beneficiary reported being in good health or better by nearly 6 percentage points during the first 6 years in Medicare."

A letter report issued by the Government Accountability Office with an abstract that begins "Clinical data registries (CDR) have demonstrated a particular strength in assessing physician performance through their capacity to track and interpret trends in health care quality over time. Studies examining results reported by several long-established CDRs demonstrate the utility of CDR data sets for analyzing trends in both outcomes and treatments. CDR efforts to improve outcomes typically involve a combination of performance improvement activities including feedback reports to participating physicians, benchmarking physician performance relative to that of their peers, and related educational activities designed to stimulate changes in clinical practice. Studies GAO reviewed provided less insight on ways to improve the efficiency of care."

Correspondence issued by the Government Accountability Office with an abstract that begins ""

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO found (1) the Federal Housing Finance Agency's (FHFA) financial statements as of and for the fiscal years ended September 30, 2013, and 2012, are presented fairly, in all material respects, in accordance with U.S. generally accepted accounting principles; (2) FHFA maintained, in all material respects, effective internal control over financial reporting as of September 30, 2013; and (3) no reportable noncompliance for fiscal year 2013 with provisions of applicable laws, regulations, contracts, and grant agreements GAO tested. In commenting on a draft of this report, the acting Director of FHFA stated that he accepted the audit conclusions and commented that the agency would continue to work to enhance its internal control and ensure the reliability of its financial reporting, its soundness of operations, and public confidence in its mission."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO found (1) the United States Securities and Exchange Commission's (SEC) and its Investor Protection Fund's (IPF) financial statements are presented fairly, in all material respects, in accordance with U.S. generally accepted accounting principles; (2) SEC maintained, in all material respects, effective internal control over financial reporting as of September 30, 2013, although internal control deficiencies exist that merit attention by those charged with governance; and (3) no reportable noncompliance in fiscal year 2013 with provisions of applicable laws, regulations, contracts, and grant agreements GAO tested. In commenting on a draft of this report, SEC's Chair expressed her pleasure that GAO found that SEC had successfully remediated the two significant deficiencies identified in 2012. The Chair added that SEC will focus on the significant deficiency GAO reported in 2013 in the area of information security."

Testimony issued by the Government Accountability Office with an abstract that begins "In September 2012, GAO reported that Department of Homeland Security (DHS) employees identified having lower average morale than the average for the rest of the federal government, but morale varied across components. Specifically, GAO found that, according to the Office of Personnel Management's 2011 Federal Employee Viewpoint Survey (FEVS), DHS employees had 4.5 percentage points lower job satisfaction and 7.0 percentage point lower engagement--the extent to which employees are immersed in their work and spending extra effort on job performance. Several components with lower morale, such as the Transportation Security Administration, made up a substantial share of FEVS respondents at DHS and accounted for a significant portion of the overall difference between the department and other agencies. In September 2012, GAO recommended that DHS take action to better determine the root cause of low employee morale, and where absent, add benchmarking against similar organizations, among other things. Since September 2012, DHS has taken a number of actions intended to improve employee morale, such as directing component human capital officials to reevaluate their action plans to ensure that metrics of success are clear and measurable. In December 2013, GAO …

A letter report issued by the Government Accountability Office with an abstract that begins "In GAO's opinion, the Bureau of the Fiscal Service's (Fiscal Service) Schedules of Federal Debt for fiscal years 2013 and 2012 were fairly presented in all material respects, and although information systems controls could be improved, Fiscal Service maintained, in all material respects, effective internal control over financial reporting relevant to the Schedule of Federal Debt as of September 30, 2013. GAO's tests disclosed no instances of reportable noncompliance for fiscal year 2013 with selected provisions of applicable laws, regulations, contracts, and grant agreements related to the Schedule of Federal Debt."

A letter report issued by the Government Accountability Office with an abstract that begins "In GAO’s opinion, the Internal Revenue Service’s (IRS) fiscal years 2013 and 2012 financial statements are fairly presented in all material respects. However, in GAO’s opinion, IRS did not maintain effective internal control over financial reporting as of September 30, 2013, because of a continuing material weakness in internal control over unpaid tax assessments. GAO’s tests of IRS’s compliance with selected provisions of applicable laws, regulations, contracts, and grant agreements detected no reportable instances of noncompliance in fiscal year 2013."

A letter report issued by the Government Accountability Office with an abstract that begins "As of August 2013, the Chief Information Officers (CIO) at the eight selected agencies rated 198 of their 244 major information technology (IT) investments listed on the Federal IT Dashboard (Dashboard) as low risk or moderately low risk, 41 as medium risk, and 5 as high risk or moderately high risk. However, the total number of investments reported by these agencies has varied over time, which impacts the number of investments receiving CIO ratings. For example, Energy reclassified several of its supercomputer investments from IT to facilities and Commerce decided to reclassify its satellite ground system investments. Both decisions resulted in the removal of the investments from the Dashboard, even though the investments were clearly IT. In addition, the Office of Management and Budget (OMB) does not update the public version of the Dashboard as the President's budget request is being created. As a result, the public version of the Dashboard was not updated for 15 of the past 24 months, and so was not available as a tool for investment oversight and decision making."