GAO provided a supplement evaluating the Department of Veterans Affairs' (VA) responses to a previous GAO report and recommendations concerning senior VA medical center managers' dual employment at medical schools and the possibility for conflict-of-interest.

GAO found that: (1) the Secretary of Veterans Affairs has acknowledged that conflict-of-interest situations may have occurred and that enforcement of existing ethics rules involving dual employment may have been inadequate; (2) although VA believes medical centers' affiliations with medical schools were unique and beneficial, increased controls are needed to avoid conflict-of-interest situations; (3) recent VA efforts to strengthen ethics enforcement have included the establishment of a task force to deal with dual employment conflict-of-interest, an office for medical specialist contract oversight, and guidelines and revised federal ethics rules for contract-related activities; (4) VA needs to ensure that the new federal ethics guidelines and procedures monitor part-time VA managers' dual employment and contractor activities; (5) VA disagreed that ethics requirements prohibit VA managers' supervision of contractor activities; and (6) VA has not provided adequate guidance and needs to improve its overall oversight of medical center managers' dual employment and establish clear guidelines on what activities are permissible.