In 2018, Medicare paid over $2 billion for anesthesia services such as those needed for surgery. In 2007, we reported that private insurance was paying about 3 times more for certain anesthesia services than Medicare was. Recent studies indicate that has increased to about 3.5 times more than what Medicare pays. Anesthesia providers can negotiate higher payments from private insurance for a number...

The Ground-Based Midcourse Defense system aims to defend the U.S. against ballistic missile attacks from rogue states like North Korea. Since the 1990s, the Department of Defense has largely relied on a prime contractor to manage development of this complex system. It is considering a new approach where multiple prime contractors would develop system components, and DOD, potentially, would integra...

The Department of Homeland Security's Chief Acquisition Officer designates Component Acquisition Executives to oversee each component's acquisition programs and policies, the acquisition workforce, and program data collection and reporting. But DHS can't be sure all of these executives are qualified or that they're consistently fulfilling all of their acquisition-related responsibilities. For exam...

Jobs in home care are expected to grow by 40 percent in the next decade to meet demand from older adults and people with disabilities. Despite being part of one of the fastest growing industries, many home care workers did not have federal minimum wage and overtime protections until 2015. The Department of Labor extended these protections through a regulation known as the Home Care Rule. We compar...

Veterans Affairs researchers have found that LGBT veterans may experience higher rates of depression and more frequent thoughts of suicide. Yet the VA can't systematically analyze the health of these veterans because it doesn't consistently collect data on sexual orientation or self-identified gender identity. For example, according to the VA, 89% of veterans' records lack gender identity data. Wi...

To maintain and modernize the U.S. nuclear weapons stockpile, the National Nuclear Security Administration needs a supply of depleted uranium metal (a by-product of enriching uranium to make nuclear fuel) to manufacture nuclear weapon components. But, its supply is dwindling, and critical manufacturing capabilities have been dormant. NNSA plans to: upgrade existing Department of Energy facilities...

Since 2017, more than 260 major disasters were declared—many of which disrupted K-12 schools and students' lives. Now, these challenges are compounded by the COVID-19 pandemic. Local education officials in disaster-affected areas said the pandemic exacerbated mental health issues, delayed recovery projects, and more. Officials said student mental health was a top priority but services needed to...

Consumer advocates, airlines, and others raised concerns about how the Department of Transportation enforces aviation consumer protection laws and regulations. This includes protection from unfair and deceptive practices, discrimination on the basis of disability, and other harms. We found that Transportation's enforcement of these protections lacked transparency on how investigations were conduct...

Since 1995, the Department of Defense's financial management has been on our High Risk List. Thousands of audit findings from DOD's department-wide financial statement audits in 2018 show the extent of improvements needed. Our 2017 recommendation prompted DOD to develop a centralized database that uses real-time data to track audit findings and its progress in addressing them. However, some of the...

The Office of Personnel Management maintains USAJOBS—a website for posting federal job opportunities from across the government. USAJOBS connects federal agencies with job seekers and facilitates the transfer and merit-based promotions of current federal employees. Since the redesign of USAJOBS in 2016, OPM has assessed and enhanced the user experience with the website. For example, OPM added in...