Correspondence issued by the Government Accountability Office with an abstract that begins "In fiscal year (FY) 2012, we found that four federal departments--the Department of Health and Human Services (HHS), Department of Veterans Affairs (VA), Department of Defense, and Department of Education--administered 91 programs that supported postsecondary training or education specifically for direct care health professionals. The departments reported obligating about $14.2 billion for these programs in FY 2012 with the majority (78 percent) of funding going to programs that supported graduate medical education--postgraduate internship and residency training for physicians and certain other health professionals. Specifically, two programs administered by HHS's Centers for Medicare & Medicaid Services--Medicare payments to teaching hospitals for Direct Graduate Medical Education and Medicare payments to teaching hospitals for Indirect Medical Education-- accounted for about 66 percent of total reported health care workforce training funding in FY 2012."

A letter report issued by the Government Accountability Office with an abstract that begins "Of the more than two million total participants in the Workforce Investment Act's (WIA) Adult and Dislocated Worker Programs, about 11 percent and 16 percent, respectively, received training in program year 2011, and about two-thirds of the training participants in each program attained a credential. Little is known, however, about how many participants got jobs related to their training. From program year 2006 through program year 2011, the percentages of training participants who earned a credential declined from about 74 percent to 58 percent for the Adult Program and from about 75 percent to 63 percent for the Dislocated Worker Program, according to data from the Department of Labor (DOL). Of those training participants who attained a credential in program year 2011, about 65 percent earned occupational credentials, such as a welding certificate, followed by lower percentages who earned occupational skill licenses and associate's degrees, among others. In contrast, GAO found training-related employment data unreliable primarily because a significant portion of the data was missing."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Emergency Economic Stabilization Act of 2008 (EESA) requires that we annually audit the financial statements of the Troubled Asset Relief Program (TARP) which is implemented by the Office of Financial Stability (OFS). On December 9, 2009, we issued our audit report including (1) an unqualified opinion on OFS's financial statements for TARP as of and for the period ended September 30, 2009, and (2) an opinion that OFS maintained effective internal control over financial reporting as of September 30, 2009. We also reported that our tests of OFS's compliance with selected provisions of laws and regulations for the period ended September 30, 2009, disclosed no instances of noncompliance. Our December 9, 2009, audit report concluded that although certain internal controls could be improved, OFS maintained, in all material respects, effective internal control over financial reporting as of September 30, 2009, that provided reasonable assurance that misstatements, losses, or noncompliance material in relation to the financial statements would be prevented or detected and corrected on a timely basis. Our audit report also identified two significant deficiencies in OFS's internal control over financial reporting. This report presents (1) more …

A letter report issued by the Government Accountability Office with an abstract that begins "Pervasive and sustained computer-based attacks pose a potentially devastating impact to systems and operations and the critical infrastructures they support. Addressing these threats depends on effective partnerships between the government and private sector owners and operators of critical infrastructure. Federal policy, including the Department of Homeland Security's (DHS) National Infrastructure Protection Plan, calls for a partnership model that includes public and private councils to coordinate policy and information sharing and analysis centers to gather and disseminate information on threats to physical and cyber-related infrastructure. GAO was asked to determine (1) private sector stakeholders' expectations for cyber-related, public-private partnerships and to what extent these expectations are being met and (2) public sector stakeholders' expectations for cyber-related, public-private partnerships and to what extent these expectations are being met. To do this, GAO conducted surveys and interviews of public and private sector officials and analyzed relevant policies and other documents."

A letter report issued by the Government Accountability Office with an abstract that begins "Under PPACA, states are responsible for making a number of changes to their Medicaid programs by January 1, 2014, including expanding eligibility levels and streamlining their enrollment processes. Specifically, states must expand Medicaid eligibility to non-elderly individuals with incomes at or below 133 percent of FPL. Under the newly eligible category, states will provide Medicaid coverage to eligible low-income parents and childless adults. States must also begin determining income eligibility for Medicaid beneficiaries, including newly eligible adults, using a uniform methodology—MAGI, which is a tax-based definition of income. To implement these requirements, eligibility categories have been consolidated into four groups—adults, children, parents, and pregnant women. States may choose to expand Medicaid coverage to the newly eligible prior to January 1, 2014 (referred to as the early expansion option), but must cover lower income individuals before higher income individuals. These more uniform eligibility requirements will replace the current system where Medicaid eligibility and income rules may vary from state to state. Further, states must adopt a methodology for identifying the newly eligible in order to obtain the increased federal match. States will receive the enhanced federal match …

A letter report issued by the Government Accountability Office with an abstract that begins "Since 2002, the federal government has offered long-term care insurance to its employees, retirees, and certain others through the Federal Long Term Care Insurance Program (FLTCIP). Enrollees pay the full cost of their premiums. The Office of Personnel Management (OPM) oversees the program. OPM has held two competitive processes to select contractors to insure enrollees and administer FLTCIP, although interest in and competition for these contracts has been limited. In 2009, soon after OPM's award of FLTCIP's second 7-year contract to John Hancock Life Insurance Company (John Hancock), 66 percent of enrollees were notified that their premiums would increase up to 25 percent in order to compensate for how the actuarial assumptions used to set premiums differed from the program's experience. GAO was asked to review FLTCIP. In this report, GAO describes (1) factors affecting carriers' interest in FLTCIP, (2) how the actuarial assumptions used to set FLTCIP premiums have changed since the program's inception, and (3) OPM's oversight of actuarial assumptions and experience and program communications. To do so, GAO interviewed officials from six carriers that in 2009 insured over 60 percent of all long-term …

A letter report issued by the Government Accountability Office with an abstract that begins "Federal agencies occupying facilities owned or leased by the General Services Administration (GSA) are responsible for preparing and maintaining occupant emergency plans (OEP), with assistance or guidance from the Federal Protective Service (FPS) and others, and the majority of selected federal facilities' OEPs GAO reviewed reflect federal guidance. As required by federal regulations, all 20 selected facilities had OEPs and had designated officials, who are responsible for maintaining OEPs and initiating action according to the OEP in the event of an emergency, including the evacuation of facility occupants. Consistent with federal guidance, officials at 19 of the 20 selected facilities reported that they review and update OEPs at least annually, and officials at 1 facility said they were in the process of updating their OEP. When requested, FPS provides OEP guidance, such as templates to facility officials. Officials at 14 facilities reported using FPS guidance or feedback for their OEPs, officials at 1 facility reported not using FPS guidance, and officials at 5 facilities said they used their own agency's guidance. FPS also checks OEPs during periodic facility security assessments--conducted at least every 3 to 5 …

Testimony issued by the Government Accountability Office with an abstract that begins "Information technology (IT) acquisition best practices have been developed by both industry and the federal government. For example, the Software Engineering Institute has developed highly regarded and widely used guidance on best practices, such as requirements development and management, risk management, validation and verification, and project monitoring and control. GAO's own research in IT management best practices led to the development of the Information Technology Investment Management Framework, which describes essential and complementary IT investment management disciplines, such as oversight of system development and acquisition management, and organizes them into a set of critical processes for successful investments."

A letter report issued by the Government Accountability Office with an abstract that begins "The four Department of Defense (DOD) components GAO examined have active processes for referring identified cases of contractor misconduct for appropriate action, including suspension or debarment. The components identify numerous cases of actual or alleged contractor misconduct each year from various internal and external sources. The figure below shows the process for identifying and referring cases to the suspension and debarment official for consideration."

Testimony issued by the Government Accountability Office with an abstract that begins "In summary, based on our work to date, we have found that"

A letter report issued by the Government Accountability Office with an abstract that begins "GAO identified 298 trade and investment commitments made by China in the U.S.-China Joint Commission on Commerce and Trade (JCCT)—184 since 2004—and the U.S.-China Strategic and Economic Dialogue (S&ED) and its predecessor—114 since 2007. The commitments range from affirmations of open trade principles to sector-specific actions. GAO identified 11 issue areas to characterize the content of each commitment. The prominence of issue areas, measured in number of commitments associated with an issue area, differs between the dialogues, reflecting differences in the dialogues' structure and focus. Intellectual property rights commitments are among those most common in the JCCT and investment commitments are among those most common in the S&ED. (For a detailed inventory of commitments and their categorization, see GAO-14-224SP .)"

A letter report issued by the Government Accountability Office with an abstract that begins "DOL and OSC began the USERRA demonstration project on August 9, 2011, meeting the time frame (within 60 days of our report on the project's design) required by the VBA. From August 9, 2011, to May 9, 2012, DOL has received 87 USERRA demonstration project cases and OSC has received 123 cases. The data reported in this study cover only 9 months of the demonstration project and do not represent the overall results of the 36-month project nor are we drawing any conclusions of the relative performance at either agency. As both agencies continue to collect and track data, we will be able to provide an in-depth evaluation of relative performance. We did not report customer satisfaction survey data in this assessment due to the short amount of time the survey has been available to claimants and the low survey response rate. Also, while both agencies track time spent on cases on an ongoing basis, OSC only compiles cost data on those cases that have been closed while DOL compiles cost data on open and closed cases. Therefore, we plan to evaluate and compare the relative …

A letter report issued by the Government Accountability Office with an abstract that begins "While FDA has taken several important steps toward modernizing its IT environment, much remains to be done. FDA reported spending about $400 million for IT investments in fiscal year 2011; however, the agency currently lacks a comprehensive IT inventory that identifies and provides key information about the systems it uses and is developing. Office of Management and Budget (OMB) and GAO guidance call for federal agencies to maintain such an inventory in order to monitor and manage their IT investments. This inventory should include information on each system, such as costs, functionality or purpose, and status. However, FDA does not have such a comprehensive list of its systems. Instead, the agency points to budget documents required by OMB, which included information on 44 IT investments for fiscal year 2011. The agency also provided a partial list of 21 mission-critical systems and modernization initiatives. Nonetheless, agency officials acknowledged that these documents do not identify all FDA’s systems or the complete costs, purpose, or status of each system. Until the agency has a complete and comprehensive inventory, it will lack critical information needed to effectively assess its IT …

A letter report issued by the Government Accountability Office with an abstract that begins "Despite sizeable tax incentives, private pension participation has remained at about 50 percent of the workforce. For those in a pension plan, there is concern that these incentives accrue primarily to higher income employees and do relatively little to help lower income workers save for retirement. The financial crisis and labor-market downturn may have exacerbated these difficulties. Therefore, we examined (1) recent trends in new private pension plan formation, (2) the characteristics of defined contribution plan participants contributing at or above statutory limits, (3) how suggested options to modify an existing credit for low-income workers might affect their retirement income, and (4) the long-term effects of the recent financial crisis on retirement savings. To answer these questions, GAO reviewed reports, federal regulations, and laws, and interviewed academics, agency officials, and other relevant experts. We also analyzed Department of Labor and 2007 Survey of Consumer Finance (SCF) data, and used a microsimulation model to assess effects of modifying tax incentives for low-income workers. We incorporated technical comments from the departments of Labor and Treasury, the Internal Revenue Service, and the Pension Benefit Guaranty Corporation as appropriate."

A letter report issued by the Government Accountability Office with an abstract that begins "Certain indicators suggest that the financial condition of the RRG industry in aggregate generally has remained profitable. In 2003, RRGs wrote about $1.8 billion, or 1.17 percent of commercial liability insurance. In 2010, RRGs continued to comprise a small percentage of the total market, writing about $2.5 billion--or about 3 percent of commercial liability coverage. Other financial indicators, such as ratios of RRG premiums earned compared to claims paid--also suggest profitability. In addition, the number of RRGs has increased since 2004, with the most growth occurring in health care-related lines. In 2010, more than 80 percent of RRGs were domiciled in Vermont, South Carolina, the District of Columbia, Nevada, Hawaii, and Arizona, but RRGs wrote about 95 percent of their premiums outside their state of domicile. Evidence suggests that RRGs may choose to domicile in a particular state, partly due to some financial and regulatory advantages such as lower minimum capitalization requirements. RRG representatives opined that RRGs have expanded the availability of commercial liability insurance--particularly in niche markets--but differed in their opinions of whether RRGs have improved its affordability. Different interpretations of LRRA have led to …

A letter report issued by the Government Accountability Office with an abstract that begins "Nearly all of the Department of Homeland Security (DHS) program managers GAO surveyed reported their programs had experienced significant challenges. Sixty-eight of the 71 respondents reported they experienced funding instability, faced workforce shortfalls, or their planned capabilities changed after initiation, and most survey respondents reported a combination of these challenges. DHS lacks the data needed to accurately measure program performance, but GAO was able to use survey results, information DHS provided to Congress, and an internal DHS review from March 2012 to identify 42 programs that experienced cost growth, schedule slips, or both. GAO gained insight into the magnitude of the cost growth for 16 of the 42 programs, which increased from $19.7 billion in 2008 to $52.2 billion in 2011, an aggregate increase of 166 percent."

A letter report issued by the Government Accountability Office with an abstract that begins "To help combat fraud and abuse in health care programs, including Medicare and Medicaid, Congress enacted the Health Care Fraud and Abuse Control (HCFAC) program as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires that the Departments of Health and Human Services (HHS) and Justice (DOJ) issue a joint annual report to Congress on amounts deposited to and appropriated from the Federal Hospital Insurance (HI) Trust Fund for the HCFAC program. In April 2005, GAO reported on the results of its review of HCFAC program activities for fiscal years 2002 and 2003 and made recommendations to HHS and DOJ. The objectives of this requested review were to assess the extent to which HHS and DOJ (1) took actions to address the recommendations made in the 2005 report and (2) designed effective controls over reporting HCFAC deposits and expenditures for fiscal years 2008 and 2009. GAO reviewed HHS and DOJ documentation; selected nongeneralizable samples; and interviewed agency officials."

A letter report issued by the Government Accountability Office with an abstract that begins "Most agencies have appointed Chief Acquisition Officers (CAO) in accordancewith two of the three key requirements in the Services Acquisition Reform Act of2003 (SARA): that the CAOs be political appointees and have agency SeniorProcurement Executives report directly to them. However, few CAOs haveacquisition management as their primary duty; other areas of responsibilityincluded financial, information, and human capital management."

A letter report issued by the Government Accountability Office with an abstract that begins "The U.S. Agency for International Development (USAID) reduces the average delivery time frame for emergency food aid by prepositioning food domestically—that is, in warehouses in the United States—and overseas. GAO estimates that compared with USAID's standard shipping process, which can take several months, prepositioning food aid shortened delivery time frames by an average of almost a month for shipments to the World Food Program (WFP). GAO also estimates that prepositioning shortened delivery time frames by an average of more than 2 months for other organizations—“cooperating sponsors”—that receive USAID grants. In addition, USAID reduces delivery time frames when it diverts shipments en route to overseas prepositioning warehouses to areas with immediate needs. For all cooperating sponsors, GAO estimates that diversions saved, on average, about 2 months."

A letter report issued by the Government Accountability Office with an abstract that begins "The Coast Guard manages a broad $27 billion major acquisition portfolio intended to modernize its ships, aircraft, command and control systems, and other capabilities. GAO has reported extensively on the Coast Guard's significant acquisition challenges, including project challenges in its Deepwater program. GAO's prior work on the Coast Guard acquisition programs identified problems in costs, management, and oversight, but it also recognized several steps the Coast Guard has taken to improve acquisition management. In response to the Coast Guard Authorization Act of 2010, GAO (1) assessed Coast Guard capabilities to manage its major acquisition programs, and (2) determined the extent to which the Coast Guard leverages Department of Defense (DOD) and other agency contracts or expertise to support its major acquisition programs. GAO reviewed Department of Homeland Security (DHS) and Coast Guard acquisition documents, GAO and DHS Inspector General reports, and selected DOD contracts; and interviewed Coast Guard, DHS, and DOD officials"

Correspondence issued by the Government Accountability Office with an abstract that begins "GPOs are subject to certain federal laws that HHS, DOJ, and FTC are responsible for enforcing. According to HHS Office of Inspector General (HHS-OIG) officials, since 2004, the office has not routinely exercised its authority to request and review disclosures related to GPOs’ contract administrative fees, but it has collected information on GPOs’ contract administrative fees while conducting audits of hospitals’ cost reports. While HHS-OIG is responsible for enforcing the Anti-Kickback statute, the law and regulation do not require routine monitoring of GPO written agreements and disclosures. HHS-OIG officials told us that even if they requested this information from GPOs, it would not necessarily be sufficient to determine whether a GPO violated the Anti-Kickback statute. Officials from HHS-OIG also told us that, since 2004, it participated in two case investigations with DOJ that involved allegations that certain GPOs did not comply with safe harbor requirements and violated the Anti-Kickback statute. Officials told us that HHS-OIG has not imposed administrative penalties on any GPOs since 2004. DOJ and FTC have investigated complaints related to federal antitrust laws, and we identified one lawsuit filed by DOJ against a GPO in …

A letter report issued by the Government Accountability Office with an abstract that begins "Thirty years ago Congress enacted protections to ensure that participants in multiemployer pension plans received their promised benefits. These defined benefit plans are created by collective bargaining agreements covering more than one employer. Today, these plans provide pension coverage to over 10.4 million participants in approximately 1,500 multiemployer plans insured by the Pension Benefit Guaranty Corporation (PBGC). In this report, GAO examines (1) the current status of nation's multiemployer plans; (2) steps PBGC takes to monitor the health of these plans; (3) the structure of multiemployer plans in other countries; and (4) statutory and regulatory changes that could help plans provide participants with the benefits they are due. To address these questions, GAO analyzed government and industry data and interviewed government officials, pension experts and plan practitioners in the United States, the Netherlands, Denmark, United Kingdom, and Canada."

Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision was enacted. The CARE Act, administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. The stop-loss provision that you asked us to address was contained in a draft consolidated appropriations bill for fiscal year 2011."

A letter report issued by the Government Accountability Office with an abstract that begins "The overall number of inmates in the Bureau of Prisons' (BOP) three main types of segregated housing units--Special Housing Units (SHU), Special Management Units (SMU), and Administrative Maximum (ADX)--increased at a faster rate than the general inmate population. Inmates may be placed in SHUs for administrative reasons, such as pending transfer to another prison, and for disciplinary reasons, such as violating prison rules; SMUs, a four-phased program in which inmates can progress from more to less restrictive conditions; or ADX, for inmates that require the highest level of security. From fiscal year 2008 through February 2013, the total inmate population in segregated housing units increased approximately 17 percent--from 10,659 to 12,460 inmates. By comparison, the total inmate population in BOP facilities increased by about 6 percent during this period."