Reports & Testimonies

GAO’s reports and testimonies give Congress, federal agencies, and the public timely, fact-based, non-partisan information that can improve government operations and save taxpayers billions of dollars.

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Medicare: CMS Needs to Address Risks Posed by Provider Enrollment Waivers and Flexibilities

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To respond to COVID-19, the Centers for Medicare & Medicaid Services waived Medicare requirements to help health care providers treat patients. We identified 47 waivers and flexibilities, such as waiving about 7,300 fingerprint-based background checks for types of providers posing a high risk of fraud, waste, and abuse. Medicare took some steps to oversee providers who enrolled under waivers and flexibilities, such as investigating potential...

Military Correctional Facilities: Consistent Application of Standards and Improved Oversight Could Enhance Health and Safety

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The U.S. military services operate a combined 36 military correctional facilities around the world. As of 2021, these facilities held 1,131 service members who were awaiting trial or had been sentenced by court-martial. Each service branch is responsible for ensuring the health and safety of the staff and incarcerated service members at their respective facilities. We found: Most of the branches routinely assess whether their...

Drug Control: Office of National Drug Control Policy Met Some Strategy Requirements but Needs a Performance Evaluation Plan

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CDC data estimates that a record 107,000 Americans died from drug overdoses in 2021. National efforts to prevent, respond to, and recover from drug misuse are on our High Risk List. The Office of National Drug Control Policy's National Drug Control Strategy aims to reduce illegal drug use and promote prevention, treatment, and recovery. The 2022 Strategy fully met some legal requirements, including setting long-range...

Cancer Clinical Trials: Federal Actions and Selected Non-Federal Practices to Facilitate Diversity of Patients

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Despite more than 3 decades of government policies to improve diversity in clinical cancer trials, certain groups remain underrepresented, including some racial and ethnic groups, women, and low-income individuals. Diversity in clinical trials aims to ensure safe and effective treatments for any patient likely to use them. To increase diversity in federally-funded clinical cancer trials, agencies broadened eligibility requirements, reimbursed patient out-of-pocket costs to reduce...

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2022 Tax Filing: Backlogs and Ongoing Hiring Challenges Led to Poor Customer Service and Refund Delays

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For three years, IRS has struggled with a backlog of work. During the 2022 filing season, IRS focused on reducing its correspondence backlog, which left most phone calls from taxpayers unanswered. IRS also prioritized processing its backlog of returns from 2021, but then had more than 12 million returns from 2022 to process as of late September. IRS hired the staff it needed with the...

Information Technology and Cybersecurity: Evolving the Scorecard Remains Important for Monitoring Agencies' Progress

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The federal government annually spends more than $100 billion on IT and cyber investments—many of which have been ineffectively managed. Congress passed laws to address these issues, including provisions such as the Federal Information Technology Acquisition Reform Act (FITARA). We testified that, since 2015, Congress has issued scorecards to monitor agencies' implementation of FITARA and key IT topics. The scorecards have evolved and served as...

Veterans Health Care: Staffing Challenges Persist for Fully Integrating Mental Health and Primary Care Services

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With the growing demand for mental health services, Veterans Health Administration facilities must make providers—like psychologists and psychiatrists—available within primary care settings to assess and treat veterans with mild-to-moderate symptoms and conditions, like anxiety or depression. But persistent staffing issues at some VHA facilities have negatively affected efforts to integrate these services into primary care settings. To address this, some facilities have offered flexible work...

Recreational Boating: How Vessel Users Contribute to and Benefit from a Federal Trust Fund

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The Sport Fish Restoration and Boating Trust Fund, managed by the Fish and Wildlife Service, provides federal grants that support recreational boating activities such as safety programs and boat ramp installation. About half of the funding for the Trust Fund comes from taxes on motorboat fuel. Import duties and other taxes, such as taxes on sport fishing equipment, also support it. The taxes are imposed...

Telecommunications Workforce: Additional Workers Will Be Needed to Deploy Broadband, but Concerns Exist About Availability

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Recent legislation included big increases in federal funding for the deployment of broadband, which is increasingly critical to daily life, but unavailable in some areas. Our analysis found that thousands more skilled workers will be needed to deploy broadband and 5G funded by recent federal programs. If this work is spread over 10 years, at its peak, the funding would support about 23,000 additional workers...

Federal Research and Development: Funding Has Grown since 2012 and Is Concentrated within a Few Agencies

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Innovation is critical to U.S. competitiveness, prosperity, and security. In the last 10 years, the federal government has increased funding for research and development (R&D)—investing $179.5 billion in FY 2021. DOD and the Department of Health and Human Services received 77% of the FY 2021 funding. COVID-19 stimulus funding led to large R&D increases for HHS. For example, an HHS agency that helps develop vaccines...

Women in Special Operations: Improvements to Policy, Data, and Assessments Needed to Better Understand and Address Career Barriers

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Can gender discrimination, sexual harassment, and other barriers explain why women make up less than 10% of special operations forces? U.S. Special Operations Command may not have the information needed to fully assess barriers affecting women's careers in the command. For example, the command doesn't have full access to timely, complete data on its assigned personnel, including incidents of discrimination, harassment, and sexual assault. Collaborating...

Disaster Recovery: Better Information Is Needed on the Progress of Block Grant Funds

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Hurricanes and wildfires affected millions of people in the U.S. and its territories in 2017 and 2018—and the U.S. government provided billions of dollars in grants to help with recovery efforts. But funding for housing activities—such as home repairs—has been slow to reach affected communities. As of July 2022, states and territories that received the vast majority of the grants had disbursed only 28% of...

COVID-19 in Nursing Homes: Outbreak Duration Averaged 4 Weeks and Was Strongly Associated with Community Spread

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From June 2020 through December 2021, nursing homes faced many separate COVID-19 outbreaks, with the average outbreak lasting 4 weeks. We found that certain factors increased the likelihood that a nursing home would have a longer outbreak. Specifically, transmission of COVID-19 in the community surrounding a nursing home had the strongest association, with nursing homes located in areas with high transmission more likely to have...

VA IT Contracting: Observations on Trends, Competition, and Past Performance Information

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From FYs 2017-2021, Veterans Affairs spent over $25 billion on IT products and services, including efforts to update its electronic health records system. Long-standing problems with IT acquisitions is one reason VA is on our High Risk list. Over the same period, VA awarded more dollars in IT contracts annually to fewer contractors. The growth in IT contract dollars was due in part to VA's...

Chief Data Officer Council: Progress in Strengthening Federal Evidence-Based Policymaking

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In 2019, the government created the position of Chief Data Officer at each federal agency, along with a government-wide council made up of these and other officials. Since that time, the Chief Data Officer Council has worked to improve how the federal government collects and uses data, and agencies have built on these efforts. For example, the Council released a training development guide in June...

GPS Disruptions: DOT Could Improve Efforts to Identify Interference Incidents and Strengthen Resilience

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GPS improves transportation safety, but is vulnerable to interference from radio signal jamming or other sources. The Department of Transportation is responsible for identifying GPS interference incidents and improving the transportation sector's ability to withstand and recover from them. We found that DOT's process for identifying incidents doesn't produce accurate or complete information and isn't documented. Also, DOT has efforts underway to improve the sector's...

Women in the Workforce: The Gender Pay Gap Is Greater for Certain Racial and Ethnic Groups and Varies by Education Level

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In recent years, women were underrepresented in management positions and the gender pay gap was greater for certain groups. Published Census Bureau data showed that in 2021: Women made up about 44% of the total workforce but only 41% of managers Overall, women earned about $.82 for every dollar men earned; Hispanic or Latina women earned about $.58 and Black women earned about $.63 for...

Federal Protective Service: More Collaboration on Hiring and Additional Performance Information Needed

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The Federal Protective Service (FPS) protects about 9,000 federal facilities and their occupants. For the third time in almost 20 years, FPS has moved into a new agency within the Department of Homeland Security. This agency, the Management Directorate, is responsible for providing human capital and other services. FPS has experienced several benefits from the move, including more support from leadership. But FPS continues to...

Private Health Insurance: State and Federal Oversight of Provider Networks Varies

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A majority of Americans are covered by private health insurance plans. Health plans set up provider networks—contracted doctors, other providers, and facilities—to provide medical care to enrollees. A provider network is considered "inadequate" if it doesn't have enough providers for enrollees to receive timely care nearby. Inadequate networks may lead enrollees to seek higher-cost care from out-of-network providers. Most states said they review plans for...

Federal Energy and Water Management: Agencies Report Mixed Success in Meeting Efficiency Requirements, and Additional Data Are Needed

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For decades the federal government has worked to improve energy and water efficiency at federal facilities. It remains the U.S.'s single largest energy consumer, and occupants of its about 350,000 buildings used 119 billion gallons of water in FY 2021. We looked at data for 27 agencies that report their energy and water use to the Department of Energy and their compliance with 6 energy...