Recommendation: The Secretary of Homeland Security should direct Homeland Security's members of the interagency working group for protection of Native American cultural property to implement selected leading collaboration practices, such as taking steps to agree on outcomes and objectives, clarify roles and responsibilities, and document these decisions. (Recommendation 1)

Agency: Department of Homeland Security
Status: Open

Comments: As of August 2019, we have reached out to the Department of Homeland Security and are awaiting a response on actions they may have taken in response to this recommendation.

Recommendation: The Secretary of the Interior should direct Interior's members of the interagency working group for protection of Native American cultural property to implement selected leading collaboration practices, such as taking steps to agree on outcomes and objectives, clarify roles and responsibilities, and document these decisions. (Recommendation 2)

Agency: Department of the Interior
Status: Open

Comments: Since August 2018, Interior's Office of International Affairs has updated its contact list for international repatriation assistance with information on the Department's roles and responsibilities in support of international repatriation. In addition, Interior's interagency working group members have developed a description of the interagency working group. However, the statement does not include outcomes and objectives for the group's work. GAO made the same recommendation to each of the four agencies covered in the review because implementing leading collaboration practices will require the collective participation of group members. GAO will keep the recommendation open until further collaborative actions are taken.

Recommendation: The Attorney General should direct Justice's members of the interagency working group for protection of Native American cultural property to implement selected leading collaboration practices, such as taking steps to agree on outcomes and objectives, clarify roles and responsibilities, and document these decisions. (Recommendation 3)

Agency: Department of Justice
Status: Open

Comments: As of August 2019, we have reached out to the Department of Justice and are awaiting a response on actions they may have taken in response to this recommendation.

Recommendation: The Secretary of State should direct State's members of the interagency working group for protection of Native American cultural property to implement selected leading collaboration practices, such as taking steps to agree on outcomes and objectives, clarify roles and responsibilities, and document these decisions. (Recommendation 4)

Agency: Department of State
Status: Open

Comments: Since August 2018, the Department of State shared a statement of its roles and responsibilities with other working group members. However, the statement does not include outcomes and objectives for the group's work. GAO made the same recommendation to each of the four agencies covered in the review because implementing leading collaboration practices will require the collective participation of group members. GAO will keep the recommendation open until further collaborative actions are taken.

Recommendation: The Secretary of Homeland Security should direct Homeland Security's members of the interagency working group for protection of Native American cultural property to identify and externally communicate to tribes points of contact within the agency that are responsible for responding to tribes' requests for assistance with repatriating cultural items from overseas auctions. (Recommendation 5)

Agency: Department of Homeland Security
Status: Open

Comments: As of August 2019, we have reached out to the Department of Homeland Security and are awaiting a response on actions they may have taken in response to this recommendation.

Recommendation: The Attorney General should direct Justice's members of the interagency working group for protection of Native American cultural property to identify and externally communicate to tribes points of contact within the agency that are responsible for responding to tribes' requests for assistance with repatriating cultural items from overseas auctions. (Recommendation 7)

Agency: Department of Justice
Status: Open

Comments: As of August 2019, we have reached out to the Department of Justice and are awaiting a response on actions they may have taken in response to this recommendation.

Recommendation: The Secretary of Homeland Security should direct Homeland Security's members of the interagency working group for protection of Native American cultural property to collaborate with the interagency working group members from other agencies to assess, in consultation with Indian tribes, whether and how amending the U.S. legal framework governing the export, theft, and trafficking of Native American cultural items would facilitate the repatriation of these items from auctions overseas and report its findings to Congress. (Recommendation 9)

Agency: Department of Homeland Security
Status: Open

Comments: As of August 2019, we have reached out to the Department of Homeland Security and are awaiting a response on actions they may have taken in response to this recommendation.

Recommendation: The Secretary of the Interior should direct Interior's members of the interagency working group for protection of Native American cultural property to collaborate with the interagency working group members from other agencies to assess, in consultation with Indian tribes, whether and how amending the U.S. legal framework governing the export, theft, and trafficking of Native American cultural items would facilitate the repatriation of these items from auctions overseas and report its findings to Congress. (Recommendation 10)

Agency: Department of the Interior
Status: Open

Comments: As of September 2019, Interior is working to develop an assessment of legislative options for discussion with the interagency working group, and plans to meet with tribes later this fall to discuss the assessment. Interior anticipates a September 30, 2020, completion date for the assessment of these legislative options. Interior has also reviewed legislative proposals related to the export, theft, and trafficking of Native American cultural items and has prepared for Congressional hearings on this topic.

Recommendation: The Attorney General should direct Justice's members of the interagency working group for protection of Native American cultural property to collaborate with the interagency working group members from other agencies to assess, in consultation with Indian tribes, whether and how amending the U.S. legal framework governing the export, theft, and trafficking of Native American cultural items would facilitate the repatriation of these items from auctions overseas and report its findings to Congress. (Recommendation 11)

Agency: Department of Justice
Status: Open

Comments: As of August 2019, we have reached out to the Department of Justice and are awaiting a response on actions they may have taken in response to this recommendation.

Recommendation: The Secretary of State should direct State's members of the interagency working group for protection of Native American cultural property to collaborate with the interagency working group members from other agencies to assess, in consultation with Indian tribes, whether and how amending the U.S. legal framework governing the export, theft, and trafficking of Native American cultural items would facilitate the repatriation of these items from auctions overseas and report its findings to Congress. (Recommendation 12)

Agency: Department of State
Status: Open

Comments: In November 2019, the Department of State, in conjunction with other interagency working group members, circulated a draft legal assessment and draft legislative options. The interagency working group members conducted a listening session with tribal members in November 2019, and conducted a tribal consultation in January 2020. GAO will continue monitoring the agencies' efforts toward implementing this recommendation.

Recommendation: To improve operational efficiencies and reduce costs related to product management and services that support commissary operations, the Secretary of Defense should direct the Chief Executive Officer of DeCA to conduct comprehensive cost-benefit analyses to guide decisions on implementing the most cost-effective option as stocking and custodial services contracts are renewed, and on choosing product distribution options.

Agency: Department of Defense
Status: Open

Comments: The Defense Commissary Agency (DeCA) agreed with GAO's March 2017 recommendation that it conduct comprehensive cost-benefit analyses to guide decisions on implementing the most cost-effective option as stocking and custodial services contracts are renewed, and on choosing product distribution options. For example, according to Department of Defense (DOD) officials, DeCA conducted a cost-benefit analysis as part of renewing an agreement with one of the Navy Exchanges in May 2018 and will provide service on a reimbursable basis instead of using the commercial vendor. DeCA officials stated that they will also review product distribution options during commercial negotiations, including taking into account product sales and shipment requirements, among other things. As of January 2020, DOD has not provided documentation to confirm completed actions to implement our recommendations. When we confirm what actions DOD has taken, we will provide updated information.

Recommendation: To help the Department of Health and Human Services ensure accuracy in Part B drug payment rates, Congress should consider requiring all manufacturers of Part B drugs paid at ASP, not only those with Medicaid drug rebate agreements, to submit sales price data to CMS, and ensure that CMS has authority to request source documentation to periodically validate all such data.

Agency: Congress
Status: Open

Comments: As of June 2020, no action has been taken on this Matter for Congressional Consideration.

Recommendation: CMS should periodically verify the sales price data submitted by a sample of drug manufacturers by requesting source documentation from manufacturers to corroborate the reported data, either directly or by working with the HHS Office of Inspector General as necessary.

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

Comments: In September 2018, HHS officials reiterated that they believe the agency has addressed our recommendation because CMS works with HHS's Office of Inspector General (OIG) as appropriate to collect source documentation from drug manufacturers and takes action as warranted. HHS stated that CMS has continued to provide information regarding problematic ASP submissions to OIG for evaluation of misreporting and continues to use AMP and other benchmarks as comparisons for pricing determinations. They further stated that they do not believe that additional collection of detailed sales information about ASP, such as invoices, is authorized under Part B drug payment provisions in section 1847A or under section 1927(b). As of June 2020, CMS did not provide any additional updates. While we recognize that CMS conducts routine checks to assess the completeness of ASP data submitted by drug manufacturers, we do not believe these activities are enough to close the recommendation. Specifically, CMS only collects source documentation from manufacturers under very limited circumstances (e.g., when there are obvious inconsistencies in the data submitted by manufacturers). CMS does not periodically verify the accuracy of ASP data for a sample of manufacturers by tracing the data to and from drug manufacturers' source documents, such as sales invoices. Because CMS does not routinely verify the accuracy of the underlying data used to determine Medicare payment rates, the resulting payment rates may be inaccurate if drug manufacturers do not report accurate data. With regards to CMS's authority to collect additional information, such as invoices, we believe the agency could work through OIG to collect such information.

Recommendation: In light of the agency's declining revenue associated with its basic statutory function and the charging for information that is often freely available elsewhere, Congress should consider examining the appropriateness and viability of the fee-based model under which NTIS currently operates for disseminating technical information to determine whether the use of this model should be continued.

Agency: Congress
Status: Open

Comments: Congress had taken a number of actions that affect the NTIS fee-based model for disseminating technical information. Specifically, for the past 5 fiscal years and in the current Consolidated Appropriations Act, 2020, NTIS is prohibited from charging customers for reports generated by legislative branch offices unless the agency tells the customer how an electronic copy of the report can be accessed or downloaded for free online. The act further states that, if a customer still requires such a report from NTIS, the agency should not charge more than what is needed to recover the cost of processing, reproducing, and delivering the document requested. It remains to be seen whether these requirements will be continued under the yet to be introduced House and Senate bills making appropriations for the Department of Commerce (Commerce) for fiscal year 2021. Congress again has the opportunity to consider legislation that would ensure the assessment of the appropriateness or viability of NTIS functions.