Reports & Testimonies

Private equity firms have drawn attention in recent years by buying nursing homes, changing their operations to increase profit, and selling them for more money. We estimated that 5% of about 14,800 nursing homes enrolled in Medicare had private equity owners in 2022. Medicare collects information about nursing home owners as part of its enrollment and oversight processes. But we had to supplement Medicare's data...

Protecting critical infrastructure—like water and electricity—from cyberattacks is a national priority. Federal agencies and critical infrastructure owners and operators must share information to tackle increasingly complex cyber threats. Long-standing challenges, such as security concerns and timeliness, make this harder. For example, representatives from a nonfederal partner said the FBI briefed them on a cyber threat about 5 months after it was identified. We recommended monitoring...

Manufactured housing—prefabricated, factory built homes—can be an affordable option for lower-income homebuyers. But some borrowers may not qualify for mortgages and might have to turn to other kinds of financing with less favorable rates and terms. Several federal agencies, Fannie Mae, and Freddie Mac have created new or modified existing loan programs to help manufactured home borrowers. But while the Department of Housing and Urban...

About a quarter of people released by the court before their federal trials are required to use location monitoring devices. These devices often use GPS and radio frequency to transmit their location data to court officers. Officers investigate immediately when devices send them "key alerts," which can indicate noncompliance. Key alerts often come in after hours and can be caused by GPS or cellular connection...

This Q&A report looks at how the Navajo Nation is using its authority to lease its lands. In 2018, Congress expanded the Navajo Nation's authority to lease its lands for certain uses like mining. Previously, these leases required Department of the Interior approval. To use the expanded authority, the Navajo Nation must develop tribal leasing regulations. As of Sept. 2023 it hadn't done so. Tribal...

In the coming decades, the Department of Defense plans to spend an estimated $1.7 trillion on nearly 2,500 F-35s. Most of the funds will go to operating, maintaining, and repairing the aircraft. DOD faces costly maintenance issues for the F-35, such as: Delays setting up military service depots—facilities to complete the most complex repairs Inadequate equipment to keep aircraft operational Maintenance and supply delays affecting...

States and the federal government work together to fund Medicaid and protect it from payment errors and fraud. State auditors provide independent reviews of their state's compliance with federal funding requirements and other program rules. Their findings reveal problems such as ineligible beneficiaries and errors in state spending. Federal Medicaid officials started using these findings and collaborating with state auditors to improve the program, but...

The Provider Relief Fund spent $135 billion to help health care providers with COVID -related expenses and lost revenue during the pandemic. Most of the relief payments—about $85 billion—went to hospital-based health systems and hospital-affiliated providers. To confirm that payments were accurate, the Health Resources and Services Administration took steps to review provider eligibility and if funds were used appropriately. In doing so, it found...

This testimony discusses the key role of Medicare Part D drug coverage in giving beneficiaries access to innovative drug treatments. Coverage is provided by private insurance plans that vary in their costs and lists of covered drugs—known as "formularies." Drug makers may give plans rebates in exchange for preferred placement over competitors on formularies. The rebates may lower premiums, but they don't reduce beneficiaries' payments...

The U.S. Postal Service has been on our High Risk List since 2009 due to ongoing financial woes. To help address its financial condition, and improve service, USPS developed a 10-year strategic plan that touches on all parts of its operations. USPS is implementing its ambitious plan through more than 100 ongoing projects. We reviewed USPS implementation policies to see how well they incorporated GAO...

U.S. territories—American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the U.S. Virgin Islands—received more than $32 billion in COVID-19 relief funds through over 100 programs. Territory government officials said they funded key priorities, but some programs were easier to use than others because: Territory governments already knew how to administer and report on pre-existing programs Some agencies provided more support...

Hundreds of thousands of service members live in military barracks. Concerns about poor living conditions and how DOD is managing the barracks go back decades. We observed barracks in poor condition, including some with safety risks like sewage overflow and inoperable fire systems. And some barracks don't meet DOD requirements for privacy or amenities. DOD doesn't have reliable information about barracks conditions, or how these...

The Federal Motor Carrier Safety Administration aims to reduce crashes, injuries, and deaths involving large trucks and buses. To that end, FMCSA collects complaints against companies that operate these vehicles. The complaints can be related to safety—e.g., speeding or reckless driving—or to problems like unfair business practices. FMCSA reviews these complaints, but its guidance is not clear. Specifically, FMCSA guidance doesn't define key terms or...

In 2010, the Dodd-Frank Act established the Financial Stability Oversight Council to help identify and respond to emerging threats to the U.S. financial system. Recent bank failures demonstrate the importance of responding to risks before they harm the system. The council issues an annual report with recommendations—which staff say could address most risks. But we've previously noted that the council's authority—in part, the nonbinding nature...

To see the version of this page in English, see GAO-23-103795 . Desde 2008, los Estados Unidos ha brindado más de $3 mil millones en asistencia a México para abordar el crimen organizado transnacional y la violencia, aumentar el estado de derecho y reducir el narcotráfico. A pesar de la asistencia de los EE. UU., la situación de seguridad en México ha empeorado significativamente, con...

Four Health and Human Services agencies had key roles in the federal COVID-19 response. Our prior reports noted shortcomings to that response, including possible political interference. Our panel of government, academic, and non-profit experts identified steps agencies can take to protect against such interference: Set agency policies to prohibit interference and allow transparency in addressing allegations Train agency staff on how to implement policies Use...

The President and Vice President of the United States are legally allowed to spend funds for certain specified purposes—e.g., official travel, residential maintenance, entertainment—and account for them solely with "official certificates." Spending that's authorized this way is known as certificated expenditures. We examined these certificated expenditures for fiscal year 2022 and determined that they were spent for the purposes authorized under the relevant law.

This Science & Tech Spotlight report explores drone swarm technologies, which use algorithms and local sensors to coordinate drones with minimal human intervention. Swarms could range from a few drones to possibly thousands. Advances in artificial intelligence and drone components have made swarms possible—even if they're limited to simpler missions like aerial light shows for now. As the technology improves, it could be used to...

Linking the financial transactions of domestic violent extremists to suspicious or violent activity can be difficult for financial institutions and federal agencies. The transactions often don't raise red flags because these extremists frequently use their own funds and might not need large amounts to carry out attacks. In addition, the Financial Crimes Enforcement Network shares financial information related to ongoing terrorism investigations with law enforcement...