Testimony issued by the Government Accountability Office with an abstract that begins "To reduce spending on durable medical equipment (DME) and related items, under federal law the Centers for Medicare & Medicaid Services (CMS) is phasing in, with several rounds of bidding, a competitive bidding program (CBP) for certain DME and other items. Because of numerous concerns, the Medicare Improvements for Patient and Providers Act of 2008 (MIPPA) terminated the CBP round 1 supplier contracts and required CMS to repeat the CBP round 1, the rebid that began in 2009. In November 2009, GAO issued the report Medicare: CMS Working to Address Problems from Round 1 of the Durable Medical Equipment Competitive Bidding Program (GAO-10-27) that documented problems in CMS's implementation of CBP round 1. This statement discusses some of the problems GAO identified and how CMS has or plans to address them in the ongoing CBP rebid bidding process, particularly (1) the bid submission information provided to suppliers, (2) the electronic bid submission system, and (3) the bid disqualification notification process. For the 2009 report, GAO reviewed data provided by CMS and relevant laws and regulations, and interviewed CMS officials. For this statement, GAO also obtained select information on …

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses the U.S. Government Accountability Office's (GAO) budget request for fiscal year 2011. In fiscal year 2009, GAO supported congressional decision making and oversight on a range of critical issues, including the government's efforts to help stabilize financial markets and address the most severe recession since World War II. In addition to providing oversight for the 2008 Economic Stabilization Act and the American Recovery and Reinvestment Act of 2009 (Recovery Act), we continued to provide the Congress updates on programs that are at high risk for waste, fraud, abuse, and mismanagement or are in need of broad reform, and delivered advice and analyses on a broad array of pressing domestic and international issues that demand urgent attention and continuing oversight. These include modernizing the regulatory structure for financial institutions and markets to meet 21st century demands; controlling escalating health care costs and providing more effective oversight of medical products; restructuring the U.S. Postal Service to ensure its financial stability; and improving the Department of Defense's management approaches to issues ranging from weapons system acquisitions to accounting for weapons provided to Afghan security forces. Overall, we responded …

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses the Department of Defense's (DOD) separation requirements for enlisted servicemembers diagnosed with personality disorders and the military services' compliance with these requirements. DOD requires that all enlisted servicemembers, including those serving in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), be physically and psychologically suitable for military service. Enlisted servicemembers who fail to meet this standard may be involuntarily separated from the military. One psychological condition that can render an enlisted servicemember unsuitable for military service is a personality disorder, which is defined as a long-standing, inflexible pattern of behavior that deviates markedly from expected behavior, has an onset in adolescence or early adulthood, and leads to distress or impairment. Although a personality disorder by itself does not make enlisted servicemembers unsuitable for military service, DOD policy allows for involuntary separation from the military if a servicemember's disorder is severe enough that it interferes with his or her ability to function in the military. DOD data show that from November 1, 2001, through June 30, 2007, about 26,000 enlisted servicemembers were separated from the military because of a personality disorder. Of these …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Joint Strike Fighter (JSF) program began in 1996 with an acquisition strategy that called for a competitive engine acquisition program. The program planned to first develop and procure the F135 primary engine and, with a few years lag time, develop the F136 second (or alternate) engine to compete with the F135 engine for future procurements and life-cycle support activities. The Department of Defense (DOD) requested funding for both engines annually as the JSF program progressed until the fiscal year 2007 budget submission, at which point the DOD stopped requesting funding for the F136 alternate engine. Defense officials believe that the operational risks of relying on a single engine supplier are low and do not justify the extra costs to maintain a second engine source. DOD further states that there is no guarantee that having an engine competition will create enough long-term savings to outweigh the up-front costs and now intends to acquire only the F135 primary engine. However, Congress has continued to fund the alternate engine development program annually through fiscal year 2010. According to the Secretary of Defense, DOD would need an additional $2.9 billion in …

Correspondence issued by the Government Accountability Office with an abstract that begins "Since October 1994, the Export-Import Bank of the United States (Ex-Im) has had statutory authority to provide loans, guarantees, and insurance to help finance U.S. exports of defense articles and services, provided that it determines these items are nonlethal and meant primarily for civilian use (dual-use). These exports, referred to as "dual-use" exports, include such items as vehicles that are used by the military primarily for civilian or humanitarian purposes. Legislation providing this authority requires us to report annually on the end uses of the dual-use exports financed by Ex-Im during the second preceding fiscal year. This report covers Ex-Im financing for dual-use exports in fiscal years 2007 through 2009."

Correspondence issued by the Government Accountability Office with an abstract that begins "On September 6, 2008, the Federal Housing Finance Agency (FHFA) placed the Federal National Mortgage Association (Fannie Mae) and the Federal Home Loan Mortgage Corporation (Freddie Mac) into conservatorships. FHFA took this step after concern developed that the deteriorating financial condition of the two government-sponsored enterprises (GSE), which had about $5.4 trillion in combined financial obligations, threatened the stability of financial markets. Since then, the Department of the Treasury (Treasury) has provided financial support to Fannie Mae and Freddie Mac (the enterprises) to help stabilize their financial condition and help ensure their ability to continue to support housing finance. As of September 2010, Treasury had provided about $150 billion in capital contributions to support the enterprises, and the Congressional Budget Office has estimated that the total cost to taxpayers could be nearly $400 billion over a 10-year period. In recent months, Congress and the administration have been considering a variety of proposals to reform the enterprises in order to help ensure their safety and soundness and the effectiveness of the U.S. housing finance system. We issued a report under the Comptroller General's authority on structural reform options for …

Correspondence issued by the Government Accountability Office with an abstract that begins "Spending on prescription drugs in Medicaid--the joint federal-state program that finances medical services for certain low-income adults and children--totaled $15.2 billion in fiscal year 2008. State Medicaid programs do not directly purchase prescription drugs; instead, they reimburse retail pharmacies for covered prescription drugs dispensed to Medicaid beneficiaries. The federal government provides matching funds to state Medicaid programs to help cover a portion of the cost of these reimbursements. For certain outpatient prescription drugs for which there are three or more therapeutically equivalent versions, state Medicaid programs may only receive federal matching funds for reimbursements up to a maximum amount, which is known as a federal upper limit (FUL). FULs were designed as a cost-containment strategy and have historically been calculated as 150 percent of the lowest published price for the therapeutically equivalent versions of a given drug from among the prices published nationally in three drug pricing compendia. The prices from these compendia are list prices suggested by drug manufacturers and do not reflect actual transaction prices. State Medicaid programs have the authority to determine their own reimbursement amounts to retail pharmacies for covered prescription drugs. However, for …

Correspondence issued by the Government Accountability Office with an abstract that begins "This report formally transmits the briefing in response to the Senate Appropriations Committee Report accompanying the Department of Defense Appropriations Bill for fiscal year 2010 (S. Rep. No. 111-74, pp. 155-156). The Committee Report requires the Government Accountability Office to provide information on the differences between Department of Defense and Military Service requirements for corrosion prevention and control projects for fiscal year 2011 and provide the results to the Senate Appropriations Committee within 60 days after submission of the Department of Defense budget."

Correspondence issued by the Government Accountability Office with an abstract that begins "The United States and its international partners from over 40 nations have been engaged in efforts to secure, stabilize, and rebuild Afghanistan since 2001. In an effort to establish clear and specific U.S. strategic goals, the President of the United States, in March 2009, outlined the U.S. Strategy for Afghanistan and Pakistan. This strategy emphasizes a strategic goal to disrupt, dismantle, and defeat Al-Qaeda in Afghanistan and Pakistan and prevent their return. The strategy was followed by the completion, in August 2009, of a Civilian-Military Campaign Plan for Afghanistan. In December 2009, the President reaffirmed the U.S. strategic goal and underscored the importance of U.S. efforts to secure and stabilize Afghanistan to help ensure the safety of the United States and the American people. To assist the Congress in its oversight of U.S. efforts in Afghanistan, this publication (1) identifes and describe key U.S. and international strategies and plans that collectively guide U.S. efforts in Afghanistan; (2) provides examples and information about key efforts to assist Afghanistan; and (3) identifies oversight issues that Congress may wish to consider in its work."

Other written product 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 levels under both "Baseline Extended" and an "Alternative" set of assumptions. GAO has regularly updated these twice a year. 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 a broad context for consideration of policy options by illustrating both the importance of taking action and the magnitude of the steps necessary to change the path. They are not intended to suggest particular policy choices that are the prerogative of elected officials but rather to help facilitate a dialog on this important issue. As in the past, GAO shows two simulations: "Baseline Extended" and an "Alternative." Each is run using two different projections for Social Security and the major health entitlements--CBO's baseline and alternative assumptions and the Social Security and Medicare Trustees' (Trustees) intermediate assumptions and projections based on the Centers for Medicare & Medicaid Services Office of the Actuary (CMS Actuary) alternative assumptions. "Baseline Extended" follows the Congressional Budget Office's (CBO) August 2010 baseline estimates for …

Testimony issued by the Government Accountability Office with an abstract that begins "U.S. insular areas face serious economic and fiscal challenges and rely on federal funding to support their governments and deliver critical services. The Department of the Interior, through its Office of Insular Affairs (OIA), provides about $70 million in grants annually, including technical assistance grants, to increase insular area self-sufficiency. In the past, GAO and others have raised concerns regarding insular areas' internal control weaknesses, which increase the risk of grant fund mismanagement, fraud, and abuse. In March 2010, GAO reported on insular area grants (GAO-10-347); this testimony summarizes that report and focuses on (1) whether previously reported internal control weaknesses have been addressed and, if not, to what extent they are prevalent among OIA grant projects, including technical assistance grant projects, as of March 2010; and (2) the extent to which OIA has taken action to improve the implementation and management grant projects, as of March 2010. For the March 2010 report, GAO reviewed a random sample of 173 OIA grant project files and interviewed OIA and insular area officials. For this testimony, GAO conducted additional analysis for the 49 technical assistance grant projects included in the …

Testimony issued by the Government Accountability Office with an abstract that begins "Since 2003, the Future Combat System (FCS) program has been the centerpiece of the Army's efforts to transition to a lighter, more agile, and more capable combat force. In 2009, however, concerns over the program's performance led to the Secretary of Defense's decision to significantly restructure and ultimately cancel the acquisition program. As a result, the Army is outlining a new approach to ground force modernization. This statement outlines the Army's preliminary post-FCS actions and identifies the challenges the Department of Defense (DOD) and the Army must address as they proceed. This testimony is based on GAO's report on the Army's Ground Force Modernization effort released on March 15, 2010. It emphasizes the December 2009 decision to begin low-rate initial production for Increment 1 of the Brigade Combat Team Modernization."

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses oversight of U.S. assistance programs in Afghanistan. Strengthening the Afghan economy through development assistance efforts is critical to the counterinsurgency strategy and a key part of the U.S Integrated Civilian-Military Campaign Plan for Afghanistan. Since fiscal year 2002, the U.S. Agency for International Development (USAID) has awarded over $11.5 billion in support of development assistance programs in Afghanistan. Since 2003, GAO has issued several reports and testimonies related to U.S. security, governance, and development efforts in Afghanistan. In addition to reviewing program planning and implementation, we have focused on efforts to ensure proper management and oversight of the U.S. investment, which are essential to reducing waste, fraud, and abuse. Over the course of this work, we have identified improvements that were needed, as well as many obstacles that have affected success and should be considered in program management and oversight. While drawing on past work relating to U.S. development efforts in Afghanistan, this testimony focuses on findings in our most recent report released yesterday on the USAID's management and oversight of its agricultural programs in Afghanistan. It will address (1) the challenges the United States …

Testimony issued by the Government Accountability Office with an abstract that begins "The Department of Homeland Security's (DHS) Domestic Nuclear Detection Office (DNDO) is charged with developing and acquiring equipment to detect nuclear and radiological materials to support federal efforts to combat nuclear smuggling. Also within DHS, Customs and Border Protection (CBP) has the lead for operating systems to detect nuclear and radiological materials entering the country at U.S. ports of entry. In 2005, DNDO began working on the cargo advanced automated radiography system (CAARS) intending that it be used by CBP to detect certain nuclear materials in vehicles and containers at U.S. ports of entry. However, in 2007 DNDO decided to cancel the acquisition phase of the program and convert it to a research and development program. GAO was asked to examine events that led to DNDO's decision to cancel the acquisition phase of the program and provide lessons learned from DNDO's experience. This statement is based on prior GAO reports from March 2006 through July 2010 and ongoing work reviewing DHS efforts to develop radiography technology. For ongoing work, GAO reviewed CAARS planning documents and interviewed DHS, DNDO, and CBP officials. GAO provided a draft of the information …

Testimony issued by the Government Accountability Office with an abstract that begins "Millions of people rely on the services of Social Security Administration (SSA) field offices. In fiscal year 2009, SSA's approximately 1,300 field offices provided service to a record 45.1 million customers. People visit field offices to apply for Social Security cards, apply for retirement and disability benefits, request replacement benefit checks, and a host of other services. Over the last several years, growing workloads have challenged field offices' ability to manage work while continuing to deliver quality customer service. The Subcommittee asked GAO to discuss our January 2009 report on SSA field office service delivery challenges. Specifically, this testimony will discuss (1) the state of SSA field office operations, and (2) the status of SSA's efforts to develop a plan to address future service delivery challenges. To respond to the request, GAO relied primarily on the January 2009 report titled Social Security Administration: Service Delivery Plan Needed to Address Baby Boom Retirement Challenges (GAO-09-24, Jan. 2009), and updated it with additional information provided by SSA. In that report, GAO recommended that SSA develop a service delivery plan that explains how it will deliver quality service while managing growing …

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 2010. 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. The financial information and the data measuring GAO's performance contained in this report are complete and reliable."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO has designated Medicare as a high-risk program since 1990, in part because the program's size and complexity make it vulnerable to fraud, waste, and abuse. Fraud represents intentional acts of deception with knowledge that the action or representation could result in an inappropriate gain, while abuse represents actions inconsistent with acceptable business or medical practices. Waste, which includes inaccurate payments for services, also occurs in the Medicare program. Fraud, waste, and abuse all can lead to improper payments, overpayments and underpayments that should not have been made or that were made in an incorrect amount. In 2009, the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--estimated billions of dollars in improper payments in the Medicare program. This statement, will focus on challenges facing CMS and selected key strategies that are particularly important to helping prevent fraud, waste, and abuse, and ultimately to reducing improper payments, including challenges that CMS continues to face. It is based on nine GAO products issued from September 2005 through March 2010 using a variety of methodologies, including analysis of claims, review of relevant policies and procedures, stakeholder interviews, and …

Correspondence issued by the Government Accountability Office with an abstract that begins "This report formally transmits the briefing in response to section 2228(e) of title 10 of the United States Code. The statute requires the Comptroller General to provide an analysis of the Department of Defense's budget submission for corrosion prevention and control, as well as an analysis of the corrosion report accompanying defense budget materials, and provide the results to the congressional defense committees within 60 days after submission of the Department of Defense budget."

Document issued by the Office of the Attorney General of Texas in Austin, Texas, providing an interpretation of Texas law. It provides the opinion of the Texas Attorney General, Greg Abbott, regarding a legal question submitted for clarification: Authority of a magistrate to award ownership or title of a motor vehicle under chapter 47, Code of Criminal Procedure, or other law (RQ-0811-GA)

Document issued by the Office of the Attorney General of Texas in Austin, Texas, providing an interpretation of Texas law. It provides the opinion of the Texas Attorney General, Greg Abbott, regarding a legal question submitted for clarification; Whether a Type A general-law municipality may impose and enforce a nonpoint source pollution ordinance in its extraterritorial jurisdiction pursuant to section 26.177 of the Water Code (RQ-0822-GA)

Broad Funding Opportunity Announcement Project: Foro Energy is developing a unique capability and hardware system to transmit high power lasers over long distances via fiber optic cables. This laser power is integrated with a mechanical drilling bit to enable rapid and sustained penetration of hard rock formations too costly to drill with mechanical drilling bits alone. The laser energy that is directed at the rock basically softens the rock, allowing the mechanical bit to more easily remove it. Foro Energy’s laser-assisted drill bits have the potential to be up to 10 times more economical than conventional hard-rock drilling technologies, making them an effective way to access the U.S. energy resources currently locked under hard rock formations.

Electrofuels Project: MIT is using solar-derived hydrogen and common soil bacteria called Ralstonia eutropha to turn carbon dioxide (CO2) directly into biofuel. This bacteria already has the natural ability to use hydrogen and CO2 for growth. MIT is engineering the bacteria to use hydrogen to convert CO2 directly into liquid transportation fuels. Hydrogen is a flammable gas, so the MIT team is building an innovative reactor system that will safely house the bacteria and gas mixture during the fuel-creation process. The system will pump in precise mixtures of hydrogen, oxygen, and CO2, and the online fuel-recovery system will continuously capture and remove the biofuel product.

Electrofuels Project: MIT is using carbon dioxide (CO2) and hydrogen generated from electricity to produce natural oils that can be upgraded to hydrocarbon fuels. MIT has designed a 2-stage biofuel production system. In the first stage, hydrogen and CO2 are fed to a microorganism capable of converting these feedstocks to a 2-carbon compound called acetate. In the second stage, acetate is delivered to a different microorganism that can use the acetate to grow and produce oil. The oil can be removed from the reactor tank and chemically converted to various hydrocarbons. The electricity for the process could be supplied from novel means currently in development, or more proven methods such as the combustion of municipal waste, which would also generate the required CO2 and enhance the overall efficiency of MIT’s biofuel-production system.

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses preventing and addressing government payment errors in the Medicare program. Medicare, which provides health insurance for those aged 65 and older and certain disabled persons, is susceptible to improper payments due to its size and complexity. Because the Medicare program has paid billions of dollars in error each year, the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--conducts a number of activities to reduce improper payments. CMS administers the Medicare program with the help of Medicare claims administration contractors, which are not only responsible for processing and paying approximately 4.5 million claims per day, but for also conducting pre-payment reviews of claims to prevent improper payments before claims are paid, as well as post-payment reviews of claims potentially paid in error. To supplement these and other program integrity efforts, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed CMS to conduct a 3-year demonstration project on the use of a new type of contractors---recovery audit contractors (RAC)---in identifying underpayments and overpayments, and recouping overpayments in the Medicare program. The RAC demonstration program began in 2005. Subsequently, the Tax Relief and …