Recommendation: The Administrator of FNS should present the uncertainty around its retailer trafficking estimates in future reports by, for example, including the full range of the estimates in the report body and executive summary. (Recommendation 1)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: FNS generally agreed with this recommendation, and stated that it will present the uncertainty around the retailer trafficking estimates in the executive summary and main body of all future trafficking reports, instead of presenting the information in appendices, as it did in past reports. In August 2020, FNS stated that it has made this change to the next trafficking report, which is in clearance at USDA. GAO will consider this recommendation implemented when FNS issues its this report.

Recommendation: The Administrator of FNS should continue efforts to improve the agency's retailer trafficking estimates by evaluating (1) whether the factors used to identify stores for possible investigation could help address the bias in its sample, and (2) the accuracy of its assumption of the percentage of SNAP benefits that are trafficked by different types of stores. (Recommendation 2)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: FNS generally agreed with this recommendation. FNS stated that it will evaluate whether incorporating additional factors, such as the Watch List score used to identify stores for possible investigation, could improve its estimation methodology. FNS also stated that it will work with the USDA OIG to better understand the methodology the OIG uses to estimate the share of benefits that are trafficked by a retailer who is prosecuted for trafficking, and determine whether it is feasible to apply a similar methodology to the transaction data maintained by FNS in order to improve the accuracy of its assumptions about the percentage of SNAP benefits that are trafficked. In August 2020, FNS noted that it will evaluate the feasibility of this revised methodology for the trafficking estimates covering years 2018 through 2020. GAO will consider this recommendation implemented when FNS provides information on the results of this evaluation.

Recommendation: The Administrator of FNS should assess the benefits and costs of reauthorizing a sample of high-risk stores more frequently than other stores, use the assessment to determine the appropriate scope and time frames for reauthorizing high-risk stores moving forward, and document this decision in policy and on its website. (Recommendation 3)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: FNS generally agreed with this recommendation. In August 2020, FNS stated that it included a sample of 471 high-risk stores that had not yet reached their 5-year reauthorization cycle in its fiscal year 2020 reauthorization pool. Once fiscal year 2020 reauthorizations are complete, FNS will analyze the outcomes of these reauthorizations to determine the benefits and costs of reauthorizing some high-risk stores more frequently. At that point, FNS will determine the appropriate scope and time frames for reauthorizing high-risk stores moving forward. GAO will consider this recommendation implemented when FNS completes this work.

Recommendation: The Administrator of FNS should move forward with plans to increase penalties for retailer trafficking. (Recommendation 4)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: FNS generally agreed with this recommendation. In August 2020, FNS reported that it has developed a proposed rule to accomplish this change. The agency expects the proposed rule to be published in December 2020.

Recommendation: The Administrator of FNS should establish performance measures for its trafficking prevention activities. (Recommendation 5)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: FNS generally agreed with this recommendation. In August 2020, FNS reported that the agency has assessed existing data to develop strategies for trafficking prevention, and is taking a two-pronged approach. First, the agency stated that it has updated training materials and guidance to make them more accessible for staff. Second, the agency stated that it is continuing to assess store applications and reauthorizations for business integrity, including prior fraud and other criminal offenses by store owners or managers, as described in regulations and policy. However, FNS did not indicate whether the agency currently has plans to establish performance measures for its trafficking prevention activities.

Recommendation: To help ensure that DOD is implementing the fraud, waste, and abuse prevention requirements to the OIGs, the Inspectors General of the Army, Navy, and Air Force should implement the requirements themselves or delegate the implementation of the requirements to the investigative services.

Agency: Department of Defense: Department of the Navy: Naval Inspector General
Status: Open

Comments: DOD concurred with the recommendation in its comments on the draft report. In June 2020, we requested information on the status of the recommendation. When we confirm the actions the Navy has taken, we will provide updated information.

Recommendation: To help ensure that DOD is implementing the fraud, waste, and abuse prevention requirements to the OIGs, the Inspectors General of the Army, Navy, and Air Force should implement the requirements themselves or delegate the implementation of the requirements to the investigative services.

Agency: Department of Defense: Department of the Army: Office of the Inspector General
Status: Open

Comments: DOD concurred with the recommendation in its comments on the draft report. As of July 2020, the Army had drafted a memorandum that would delegate the requirements to the investigative services or program office. We will update the status of this recommendation after the Army issues the final memorandum.

Recommendation: In order to better ensure proper Medicare payments and protect Medicare funds, CMS should seek legislative authority to allow the RAs to conduct prepayment claim reviews.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In April 2016, we recommended that the Centers for Medicare and Medicaid Services (CMS) should seek legislative authority to allow the Recovery Auditors (RAs) to conduct prepayment claim reviews. The Department of Health and Human Services did not concur with this recommendation, and the President's fiscal year 2021 budget did not include a proposal for such authority. We continue to believe CMS should seek legislative authority to allow RAs to conduct these reviews. Until CMS seeks and implements this authority, it will be missing an opportunity to help identify improper payments before they are made.

Recommendation: To ensure states have appropriate and current guidance to assist them in designing and administering Medicaid NEMT, the Secretary of HHS should direct CMS to assess current Medicaid NEMT guidance and update that guidance as needed.

Agency: Department of Health and Human Services
Status: Open

Comments: As of July 2019, HHS officials reported that they are waiting for a policy decision from leadership concerning non-emergency medical transportation. GAO will continue to monitor and update the status of this recommendation.

Recommendation: To enhance State's efforts to protect SWT participants from abuse and the SWT program from misuse, the Secretary of State should direct the Bureau of Education and Cultural Affairs to establish a mechanism to ensure that sponsors provide complete and consistent lists of fees that participants must pay.

Agency: Department of State
Status: Open

Comments: In response to our recommendation that the State Department (State) establish a mechanism to ensure that sponsor provide complete and consistent lists of fees that exchange visitors on the Summer Work Travel program must pay, State acknowledged it collected such fee information in 2016. As July 18, 2018, we are awaiting State's review and analysis of this information to ensure the price lists are consistent and comprehensive, as well as published guidance it is sending to sponsors on how fee and cost information must be listed on their websites so that there will be consistency among sponsors. State indicated its fee study will take place in 2019 to cover the period of 2018. As of August 2020, State indicated that it planned to complete the fee study following final Summer Work Travel rule, pending OMB approval.

Recommendation: To enhance State's efforts to protect SWT participants from abuse and the SWT program from misuse, the Secretary of State should direct the Bureau of Education and Cultural Affairs to establish a mechanism to ensure that information about these participant fees is made publicly available.

Agency: Department of State
Status: Open

Comments: In response to our recommendation that the State Department (State) establish a mechanism to ensure that information about Summer Work Travel participant fees is made publicly available, State noted that it had published a notice for proposed rulemaking on January 12, 2017. When finalized, this would require each sponsor to include in its recruiting material, and post on its main Web site (e.g., with a visible link to such a page on the sponsors homepage), examples of the typical monthly budgets of exchange visitors placed in various regions of the United States to illustrate wages (based on the required weekly minimum of 32-hours of work at a typical host placement) balanced against itemized fees and estimated costs. Until State finalizes this rule, they cannot enforce this requirement. State anticipated releasing the final rule in the middle of 2019, pending OMB approval. As of August 2020 State has not issued a final rule; and OMB approval is still pending.

Recommendation: To enhance State's efforts to protect SWT participants from abuse and the SWT program from misuse, the Secretary of State should direct the Bureau of Education and Cultural Affairs to establish detailed criteria that will allow State to assess the sufficiency and appropriateness of opportunities for cultural activities outside the workplace that sponsors provide to SWT participants.

Agency: Department of State
Status: Open

Comments: In response to our recommendation that the State Department (State) establish detailed criteria that will allow it to assess the sufficiency and appropriateness of opportunities for cultural activities outside the workplace that sponsors provide to Summer Work Travel participants, State published a notice for proposed rulemaking on January 12, 2017. When finalized, this would require sponsors and their host entities to create cultural opportunities at least once per month. The proposed rule also notes that State will issue guidance outlining best practices for cross-cultural programming. As of August 2020 this is not finalized.

Recommendation: To address the current information gap in Regulation SHO for prime brokerage arrangements and mitigate the impact of any unintended consequences caused by SEC rules, as well as ensure consistent implementation of SEC rules by the industry, the Chairman of the Securities and Exchange Commission should finalize, in an expedited manner upon finalization of the temporary rule, the revised 1994 Prime Broker Letter.

Agency: United States Securities and Exchange Commission
Status: Open

Comments: As of June 4, 2019, the revised Prime Broker letter has not been finalized. Staff from the Reg SHO team in SEC's Trading and Markets division stated that they have regularly and continuously asked the industry for comments on the Prime Broker Letter without receiving any real progress. Their most recent request for comments was emailed to industry counsel on May 22, 2019. Industry counsel acknowledged the request but have yet to provide comments.