The FY 2017 National Defense Authorization Act required DOD to develop and use value-based initiatives in its TRICARE health care program. Value-based healthcare pays providers based on improved health outcomes, enhanced care for patients, and reduced health care costs over time (instead of the volume of services provided). DOD identified 20 potential initiatives and: Has implemented 5, including...

Physicians, nurses, and other providers can volunteer in their communities to help people affected by public health emergencies. These volunteers, known as the Medical Reserve Corps, provide first aid and shelter support during a variety of events—like wildfires, hurricanes, and pandemics—and provided medical aid to migrants at the southern border. They have also assisted with drive-thru testi...

Preventing veteran suicide is the Department of Veterans Affairs' highest clinical priority. The VA started tracking suicide deaths on VA campuses—medical facilities, parking areas, and cemeteries—in October 2017 and identified 55 on-campus veteran suicides through September 2019. We reviewed the VA's data and found errors: 4 missing cases that should've been counted and 10 cases that shouldnÃ...

The Centers for Medicare & Medicaid Services (CMS) reimburses states for most Medicaid costs—health care costs and administrative costs, such as IT. CMS reimbursed states $34.3 billion for Medicaid IT systems in FY 2008-18. The documentation of CMS's reviews for most IT funding requests 2016-2018 lacked information, indicating that reviews may not have been complete. CMS is supposed to oversee s...

In 2017, the Food and Drug Administration created a new office within the agency to oversee its lab safety program. But, 3 years later, there are still disagreements within the FDA about the office's roles and responsibilities. Moreover, FDA's lab safety program does not include key elements of effective oversight. For example, lab safety office staff cannot inspect labs unannounced. Unannounced i...

Normally, if federal contractors can't work, agencies don't pay them. But section 3610 of the CARES Act allows agencies, at their discretion, to reimburse contractors for the cost of paid leave during the COVID-19 pandemic. The Act was passed in March 2020. Between then and early July, all the agencies we reviewed issued some form of guidance to implement section 3610. In July, the Office of Manag...

This report updates our oversight of some aspects of the federal response to the COVID-19 pandemic. Findings include: Spending. Federal obligations totaled $1.5 trillion and expenditures totaled $1.3 trillion, as of June 30. Public health. Between January 1 and June 30, about 125,000 more deaths occurred from all causes than would normally be expected—an indicator of the pandemic's effect on hea...

Our undercover agents conducted 31 tests on health insurance sales representatives to gauge their use of deceptive practices, such as making false statements about coverage. Agents said they had pre-existing conditions, such as diabetes, and sought coverage. In 8 tests, sales representatives engaged in potentially deceptive practices, such as claiming the pre-existing condition was covered when pl...

We looked at how the Department of Defense screens and provides treatment for eating disorders. These disorders have severe health effects and can significantly raise the risk of death. Many people with eating disorders may also have other mental health conditions such as anxiety. While DOD screens new recruits for eating disorders, medical personnel may also detect these conditions during a servi...

Substance use disorders affected 19.3 million adults in the U.S. in 2018. One treatment option for such disorders is services delivered by peer providers—individuals who use their own personal experiences recovering from substance use disorder to support others in their recovery. State Medicaid programs can choose to cover services offered by peer providers, but it is an optional benefit. We fou...