Recommendation: To help the Department of Health and Human Services better control spending and encourage efficient delivery of care, Congress should consider requiring Medicare to pay PCHs as it pays PPS teaching hospitals, or provide the Secretary with the authority to otherwise modify how Medicare pays PCHs. To generate cost savings from any reduction in outpatient payments to PCHs, Congress should also provide that all forgone outpatient payment adjustment amounts be returned to the Supplementary Medical Insurance Trust Fund.

Agency: Congress
Status: Open

Comments: As of March 2020, no legislative action had been identified that changes how PCHs are paid for inpatient services, as GAO suggested in February 2015. The 21st Century Cures Act-Pub. L. No. 114-255, ?16002, 130 Stat. 1033, 1325 (2016), enacted in December 2016-slightly reduces the additional payments to PCHs for outpatient services furnished on or after January 1, 2018, and returns savings to the Supplementary Medical Insurance Trust Fund. However, the law does not substantively change how PCHs are paid for outpatient services, which differs from how Medicare pays PPS teaching hospitals. Until Medicare pays these cancer hospitals in a way that encourages greater efficiency, Medicare remains at risk for overspending.

Recommendation: To eliminate unnecessary program duplication and to achieve increased efficiencies and potential savings within the integrated MHS, Congress should terminate the Secretary of Defense's authority to contract with the USFHP designated providers in a manner consistent with a reasonable transition of affected USFHP enrollees into TRICARE's regional managed care program or other health care programs, as appropriate.

Agency: Congress
Status: Open

Comments: As of April 2017, no actions have been taken.

Recommendation: To enable the department to meet its Africa-related missions at the least cost, the Secretary of Defense should conduct a more comprehensive and well-documented analysis of options for the permanent placement of the headquarters for AFRICOM, including documentation as to whether the operational benefits of each option outweigh the costs. These options should include placing some AFRICOM headquarters personnel in forward locations, while moving others to the United States. In conducting this assessment, the Secretary should follow key principles GAO has derived for such studies, as well as principles found in DOD Instruction 7041.3, to help ensure that the results are comprehensive, well-documented, accurate, and credible. Should DOD determine that maintaining a location in Stuttgart is the best course of action, the Secretary of Defense should provide a detailed description of why the operational or other benefits outweigh the costs and benefits of relocating the command.

Agency: Department of Defense
Status: Open

Comments: DOD partially agreed with GAO's recommendation. In its comments on GAO's September 2013 report DOD noted that to meet the requirements of the Budget Control Act of 2011 it would consider a wide range of options, and if any of these options required additional analysis of the location of AFRICOM headquarters, DOD would conduct a more comprehensive and well-documented analysis. However, in June 2019, DOD officials stated that the department had not conducted any additional analysis on the permanent placement of AFRICOM headquarters. Furthermore, DOD officials stated that AFRICOM would remain in Stuttgart, Germany, for the foreseeable future and no additional analysis was being planned. As of January 2020, DOD had not provided additional information to indicate progress on this recommendation. GAO maintains that such an analysis is needed and until the costs and benefits of maintaining AFRICOM headquarters in Germany are specified and weighed against the costs and economic benefits of moving the command, the department may be missing an opportunity to accomplish its missions successfully at a significantly lower cost.

Recommendation: To ensure that IRS is meeting the stated goals of CAP, the Principal Deputy Commissioner of Internal Revenue and Deputy Commissioner for Services and Enforcement should track savings from Compliance Maintenance and CAP overall and develop a plan for reinvesting any savings.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: As of December 2019, IRS had taken some steps to implement this August 2013 recommendation, but had not developed a plan to track and reinvest any savings. IRS provided documents from October 2019 which discussed how portfolio management is used as a tool to prioritize and allocate time to eight compliance program areas, including CAP. IRS officials explained that any hours saved in a compliance program area are reallocated to the same or another compliance program area based on the division's strategic priorities rather than a plan focusing on CAP. Furthermore, CAP has not yet achieved the desired outcome of saving resources, according to IRS. If IRS finds any savings from CAP, it will need to develop a plan for reinvesting it to expand audit coverage. Without a plan for tracking savings and using them to increase audit coverage, IRS cannot be assured that the savings are effectively invested in either CAP or non-CAP taxpayers with a high compliance risk.