Recommendation: The acting Bank president and Board chairman should ensure that the Bank evaluates and implements methods to further promote and sustain an antifraud tone that permeates the Bank's organizational culture, as described in GAO's Fraud Risk Framework. This should include consideration of requiring training on fraud risks relevant to Bank programs, for new employees and all employees on an ongoing basis, with the training to include identifying roles and responsibilities in fraud risk management activities across the Bank. (Recommendation 1)

Agency: Export-Import Bank of the United States
Status: Open

Comments: In November 2019, EXIM told us it continues work in this area and will provide us information on this work as it is completed. We will continue to monitor EXIM's progress in this area.

Recommendation: The acting Bank president and Board chairman should ensure that the Bank develops and implements an antifraud strategy with specific control activities, based upon the results of fraud risk assessments and a corresponding fraud risk profile, as provided in GAO's Fraud Risk Framework. (Recommendation 4)

Agency: Export-Import Bank of the United States
Status: Open

Comments: In November 2019, EXIM told us it was in the final stages of its process for completing its antifraud strategy. We will continue to monitor EXIM's efforts in this area.

Recommendation: The acting Bank president and Board chairman should ensure that the Bank identifies, and then implements, the best options for sharing more fraud-related information--including details of fraud case referrals and outcomes--among Bank staff, to help build fraud awareness, as described in GAO's Fraud Risk Framework. (Recommendation 5)

Agency: Export-Import Bank of the United States
Status: Open

Comments: In November 2019, EXIM stated that it is continuing to work with its Inspector General to implement this recommendation. We will continue to monitor EXIM's progress in this area.

Recommendation: The acting Bank president and Board chairman should lead efforts to collaborate with the Bank's OIG to identify a feasible, cost-effective means to systematically track outcomes of fraud referrals from the Bank to the OIG, including creating a means to link the OIG's proven cases of fraud to the specific Bank transactions from which the OIG actions arose. If any such means are found to be feasible and cost-effective, the acting Bank president and Board chairman should direct appropriate staff to implement them, with such information to be used for purposes consistent with GAO's Fraud Risk Framework, such as data analytics. (Recommendation 6)

Agency: Export-Import Bank of the United States
Status: Open

Comments: In November 2019, EXIM stated that it is continuing to work with its Inspector General to implement this recommendation. We will continue to monitor EXIM's progress in this area.

Recommendation: The acting Bank president and Board chairman should ensure that the Bank monitors and evaluates outcomes of fraud risk management activities, using a risk-based approach and outcome-oriented metrics, and that it subsequently adapts antifraud activities or implements new ones, as determined to be appropriate and consistent with GAO's Fraud Risk Framework. (Recommendation 7)

Agency: Export-Import Bank of the United States
Status: Open

Comments: In November 2019, EXIM stated that it is continuing work to implement this recommendation. We will continue to monitor EXIM's progress in this area.

Recommendation: The Administrator of CMS should issue written criteria for when CMS will allow limited evaluation of a demonstration or a portion of a demonstration, including defining conditions, such as what it means for a demonstration to be longstanding or noncomplex, as applicable. (Recommendation 2)

Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
Status: Open

Comments: HHS agreed with this recommendation. In November 2019, HHS reported that it was applying limited evaluation requirements to certain demonstration types, including routine family planning demonstrations. In July 2020, CMS stated that it continues to work with states as they apply for new or extensions of approved demonstrations to determine whether the demonstrations as a whole or certain components would qualify for limited evaluation. The agency, however, reiterated that it needs more experience before developing generalized guidance and that was not a priority for 2020. We will continue to monitor CMS's progress and will review whether to close the recommendation when these criteria are issued.

Recommendation: To improve the accessibility and reliability of SNF expenditure data, the Acting Administrator of CMS should take steps to improve the accessibility of SNF expenditure data, making it easier for public stakeholders to locate and use the data.

Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
Status: Open

Comments: In September 2016, GAO recommended that CMS improve the accessibility and reliability of SNF expenditure data, thereby making it easier for public stakeholders to locate and use the data. The agency concurred with this recommendation in 2016 and stated that it would review the feasibility of increasing the accessibility of this data. However, in August 2017, HHS told GAO that it now believes that the cost of implementing this recommendation would outweigh its benefits. HHS confirmed in July 2019 that its position on this recommendation has not changed. GAO continues to hold that data on SNFs' relative expenditures should be readily accessible to the public to ensure transparency in SNF expenditures.

Recommendation: To improve the accessibility and reliability of SNF expenditure data, the Acting Administrator of CMS should take steps to ensure the accuracy and completeness of SNF expenditure data.

Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
Status: Open

Comments: In September 2016, GAO recommended that CMS take steps to ensure the accuracy and completeness of SNF expenditure data. However, the agency did not concur with this recommendation. HHS reported in 2016 that the amount of time and resources to verify the accuracy and completeness of SNF expenditure data could be substantial, without assurance of benefit to the agency and the public. However, during the course of our work, GAO found that CMS uses this expenditure data to update overall SNF payment rates, in addition to more general purposes. GAO continues to believe that CMS should take steps to ensure reliable expenditure data are accurate and complete. As of July 2019, the agency continues to non-concur with this recommendation.

Recommendation: To improve DOD's management of initiatives directed at increasing the recruitment and accessions of women into the officer corps, the Secretary of Defense should direct the Under Secretary of Defense, Personnel and Readiness, in collaboration with the service Secretaries, to develop an oversight framework that includes or incorporates (consistent with applicable law): (1) Service-wide program goals for initiatives directed at female officers' recruitment, such as goals related to the composition of the applicant pool; (2) Performance measures linked to program goals; and (3) Resource allocations linked to program goals.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. In January 2020, we received a memorandum from DOD requesting closure of this recommendation. It outlined several steps the department was taking to implement our recommendations and attached some Power Point slides as documentation. However, these slides do not provide sufficient documentation that would enable us to close the recommendations. Once we receive the documentation we are requesting, we will re-assess closure.

Recommendation: To improve DOD's management of initiatives directed at increasing the recruitment and accessions of women into the officer corps, the Secretary of Defense should direct the Under Secretary of Defense, Personnel and Readiness, in collaboration with the service Secretaries, to conduct evaluations for key recruitment initiatives to help ensure these initiatives are achieving their intended purpose.

Agency: Department of Defense
Status: Open

Comments: DOD did not state whether it concurred with this recommendation. In January 2020, we received a memorandum from DOD requesting closure of this recommendation. It outlined several steps the department was taking to implement our recommendations and attached some Power Point slides as documentation. However, these slides do not provide sufficient documentation that would enable us to close the recommendations. Once we receive the documentation we are requesting, we will re-assess closure.

Recommendation: To improve EPA's management of the conditional registration process, the Administrator of EPA should direct the Director of the Office of Pesticide Programs to complete plans to automate data related to conditional registrations to more readily track the status of these registrations and related registrant and agency actions and identify potential problems requiring management attention.

Agency: Environmental Protection Agency
Status: Open

Comments: As of August 2020, EPA's Office of Pesticide Programs is providing status information on conditional registrations issued from 2000 through 2020 on the web at https://www.epa.gov/pesticide-registration/conditional-pesticide-registration. However, because plans are not yet complete for automating data related to conditional registrations to more readily track their status and related information, this recommendation remains open. According to EPA, due to the government shutdown and delays in the award of its mission support IT contract, IT modernization efforts enabling the Office of Pesticide Programs to track conditionally registered products electronically are now targeted for completion in 2021 rather than 2020.

Recommendation: To ensure that the geographic combatant commands are properly sized to meet their assigned missions and to improve the transparency of the commands' authorized manpower, assigned personnel, and mission and headquarters-support costs, the Secretary of Defense should direct the Chairman of the Joint Chiefs of Staff to revise Chairman of the Joint Chiefs of Staff Instruction 1001.01A to require a comprehensive, periodic evaluation of whether the size and structure of the combatant commands meet assigned missions.

Agency: Department of Defense
Status: Open
Priority recommendation

Comments: The Department of Defense (DOD) did not concur with our recommendation, stating that the combatant commands had already been reduced during previous budget and efficiency reviews. The department also noted that any periodic review of the combatant commands' size and structure must include a review of assigned missions, and that a requirement for a mission review was not appropriate for inclusion in the commands' guiding instruction on personnel requirements. However, DOD has taken some actions to better manage the combatant command headquarters activities and personnel as GAO recommended in May 2013. First, DOD has taken actions to control management headquarters authorized positions and funding levels across the department, including those at the combatant commands, through the budget process. For example, in a May 2017 memorandum entitled: Lifting the Hiring Freeze for Civilian Employees, the Deputy Secretary of Defense stated that components must operate within the full-time equivalent authorization and funding limits established in the fiscal year 2017 President's budget, including the Future Years Defense Program. Notably, current baselines, divestiture requirements, and hiring limitations applicable to major headquarters activities remain in effect. Major headquarters activities billet adjustments or growth was not authorized unless approved through the program review and budget process. Additionally, in the conference report accompanying the National Defense Authorization Act for Fiscal Year 2020, Congress directed the Secretary of Defense to provide a report to the defense committees by January 1, 2020 that provides a description of the headquarters staff of each geographic combatant command, as well as each sub-unified command and service component command under the geographic combatant command. According to DOD officials, as of March 2020, the Department has not completed the report and they could not provide an estimated timeframe for its completion. As part of this effort, the Secretary of Defense was also directed to submit a report by January 1, 2021 recommending the number of military and civilian personnel required in the headquarters element to execute the missions and functions of each geographic combatant command. Further, in a January 6, 2020 memorandum entitled: Department of Defense Reform Focus in 2020, the Secretary of Defense announced plans to lead a series of reviews with the combatant commands in 2020, to focus on strategic priorities, harvest opportunities to reduce costs, and realign forces and manpower in order to support National Defense Strategy priorities and rebuild readiness. This effort includes establishing a common baseline understanding of all tasks, missions, and overall resources and costs within the commands. According to the memorandum, the goal is to review all the commands in time to inform the fiscal year 2022-2026 program budget review. GAO will continue to monitor DOD's efforts to better manage the combatant command headquarters activities and personnel. Although the department has taken some positive steps, GAO continues to believe that institutionalizing a comprehensive, periodic evaluation of the combatant commands would help to ensure efficient use of resources.