GAO Reports
News stories and news briefs of Government Accountability Office audits, news, reports and testimony.
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GAO Issues Report on Medicaid Managed Care
WASHINGTON, Nov. 20 -- The Government Accountability Office has issued a report on Medicaid managed care encounter data reliability. The report (GAO-19-10) is titled "Medicaid Managed Care: Additional CMS Actions Needed to Help Ensure Data Reliability".
The report was sent to Sen. Orrin G. Hatch, R-Utah, chairman of the Senate Finance Committee, Rep. Greg Walden, R-Oregon, chairman of the House Energy and Commerce Committee, Rep. Gregg Harper, R-Mississippi, chairman of the House Energy and Commerce subcommittee on Oversight and Investigations, and Rep. Fred Upton, R-Michigan, on Oct. 19. Here
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WASHINGTON, Nov. 20 -- The Government Accountability Office has issued a report on Medicaid managed care encounter data reliability. The report (GAO-19-10) is titled "Medicaid Managed Care: Additional CMS Actions Needed to Help Ensure Data Reliability".
The report was sent to Sen. Orrin G. Hatch, R-Utah, chairman of the Senate Finance Committee, Rep. Greg Walden, R-Oregon, chairman of the House Energy and Commerce Committee, Rep. Gregg Harper, R-Mississippi, chairman of the House Energy and Commerce subcommittee on Oversight and Investigations, and Rep. Fred Upton, R-Michigan, on Oct. 19. Hereare excerpts of summaries associated with the report.
What GAO Found: "The Centers for Medicare & Medicaid Services (CMS) requires states to collect service utilization data--known as encounter data--from Medicaid managed care organizations (MCO). GAO found that, in 2017, all eight selected states it reviewed checked MCO-submitted encounter data for reasonableness--that is, they checked that the data contained valid values, were submitted in a timely manner, and reflected historical trends. Three of the selected states used an additional oversight practice--comparing encounter data with an external data source--which could involve comparing encounter data with a sample of medical records. Such comparisons are recommended by CMS and other experts, such as actuaries, to help ensure data reliability (i.e., accuracy, completeness, and timeliness). Five of the eight selected states reported using mechanisms--such as penalties--to enforce encounter data reporting requirements in 2017.
GAO found that CMS has provided states with limited information on how to fulfill new regulatory requirements related to encounter data reliability. For example, CMS has provided states with limited information on:
- the required scope and methodology for the required independent audits of state encounter data; and
- the required content of annual assessments of encounter data reporting that states must submit to the agency.
Because of the limited information from CMS, the agency will not have the information it needs to perform effective oversight of encounter data reliability.
States report encounter data to CMS's Transformed Medicaid Statistical Information System (T-MSIS). However, CMS has not provided states with information on the circumstances under which the agency will determine whether to defer or disallow federal matching funds in response to T-MSIS data submissions that do not comply with the agency's standards. In 2016, CMS indicated that it would provide this information before taking such actions. Until CMS provides this information to states, the effectiveness of deferring or disallowing funds as a potential enforcement tool to ensure state compliance is diminished, thus potentially hampering its efforts to ensure the reliability of encounter data."
Why GAO Did This Study: "Questions have been raised about the reliability of states' Medicaid managed care encounter data, which are often used to set rates paid to MCOs. States collect the data from the Medicaid MCOs they contract with and then submit the data to CMS through T-MSIS. With managed care comprising nearly half of the total federal Medicaid expenditures in 2017, the importance of reliable encounter data is paramount to ensuring that rates are appropriate and beneficiaries in Medicaid managed care are receiving covered services.
GAO was asked to examine Medicaid managed care encounter data reliability. In this report, GAO examined (1) states' oversight practices, and (2) CMS's actions for helping to ensure encounter data reliability. GAO reviewed documents on oversight practices, and interviewed Medicaid officials from eight states, selected based on enrollment and geography; and collected information from two MCOs (one with low and one with high enrollment) in each of the eight states. GAO also reviewed relevant federal regulations and guidance; and interviewed CMS officials."
What GAO Recommends: "The Administrator of CMS should provide states information on (1) scope and methodology requirements for encounter data audits; (2) required content of the annual assessments; and (3) circumstances for deferring or disallowing matching funds in response to noncompliant T-MSIS data submissions. The Department of Health and Human Services agreed with the first two recommendations and neither agreed nor disagreed with the third recommendation."
The text of the GAO report is available at https://www.gao.gov/products/GAO-19-10?utm_campaign=usgao_email&utm_content=daybook&utm_medium=email&utm_source=govdelivery
GAO Issues Report on Navy Readiness
WASHINGTON, Nov. 20 -- The Government Accountability Office has issued a report on the readiness of the Navy's attack submarine force. The report (GAO-19-229) is titled "Navy Readiness: Actions Needed to Address Costly Maintenance Delays Facing the Attack Submarine Fleet".
The report was sent to Rep. Joe Wilson, R-South Carolina, and Del. Madeleine Z. Bordallo, D-Guam, ranking member of the House Armed Services subcommittee on Readiness, on Nov. 19. Here are excerpts of summaries associated with the report.
What GAO Found: "The Navy has been unable to begin or complete the vast majority of its
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WASHINGTON, Nov. 20 -- The Government Accountability Office has issued a report on the readiness of the Navy's attack submarine force. The report (GAO-19-229) is titled "Navy Readiness: Actions Needed to Address Costly Maintenance Delays Facing the Attack Submarine Fleet".
The report was sent to Rep. Joe Wilson, R-South Carolina, and Del. Madeleine Z. Bordallo, D-Guam, ranking member of the House Armed Services subcommittee on Readiness, on Nov. 19. Here are excerpts of summaries associated with the report.
What GAO Found: "The Navy has been unable to begin or complete the vast majority of itsattack submarine maintenance periods on time resulting in significant maintenance delays and operating and support cost expenditures. GAO's analysis of Navy maintenance data shows that between fiscal year 2008 and 2018, attack submarines have incurred 10,363 days of idle time and maintenance delays as a result of delays in getting into and out of the shipyards. For example, the Navy originally scheduled the USS Boise to enter a shipyard for an extended maintenance period in 2013 but, due to heavy shipyard workload, the Navy delayed the start of the maintenance period. In June 2016, the USS Boise could no longer conduct normal operations and the boat has remained idle, pierside for over two years since then waiting to enter a shipyard (see figure). GAO estimated that since fiscal year 2008 the Navy has spent more than $1.5 billion in fiscal year 2018 constant dollars to support attack submarines that provide no operational capability--those sitting idle while waiting to enter the shipyards, and those delayed in completing their maintenance at the shipyards.
(Figure omitted)
The Navy has started to address challenges related to workforce shortages and facilities needs at the public shipyards. However, it has not effectively allocated maintenance periods among public shipyards and private shipyards that may also be available to help minimize attack submarine idle time. GAO's analysis found that while the public shipyards have operated above capacity for the past several years, attack submarine maintenance delays are getting longer and idle time is increasing. The Navy may have options to mitigate this idle time and maintenance delays by leveraging private shipyard capacity for repair work. But the Navy has not completed a comprehensive business case analysis as recommended by Department of Defense guidelines to inform maintenance workload allocation across public and private shipyards. Navy leadership has acknowledged that they need to be more proactive in leveraging potential private shipyard repair capacity. Without addressing this challenge, the Navy risks continued expenditure of operating and support funding to crew, maintain, and support attack submarines that provide no operational capability because they are delayed in getting into and out of maintenance."
Why GAO Did This Study: "According to the Navy, its 51 attack submarines provide the United States an asymmetric advantage to gather intelligence undetected, attack enemy targets, and insert special forces, among others. These capabilities make attack submarines some of the most-requested assets by the global combatant commanders.
GAO was asked to review the readiness of the Navy's attack submarine force. This report discusses the extent to which the Navy (1) has experienced maintenance delays in its attack submarine fleet and costs associated with any delays; and (2) has addressed any challenges and developed mitigation plans for any maintenance delays. GAO analyzed readiness information from fiscal years 2008-2018, operating and support costs, maintenance performance, and other data; visited attack submarines and squadrons; and interviewed public and private shipyard and fleet officials.
This is a public version of a classified report issued in October 2018. Information the Department of Defense deemed classified or sensitive, such as attack submarine force structure requirements and detailed data on attack submarine maintenance delays, has been omitted."
What GAO Recommends: "GAO recommends that the Navy conduct a business case analysis to inform maintenance workload allocation across public and private shipyards. The Department of Defense concurred with GAO's recommendation."
The text of the GAO report is available at https://www.gao.gov/products/GAO-19-229?utm_campaign=usgao_email&utm_content=daybook&utm_medium=email&utm_source=govdelivery
GAO Issues Report on Federal Personal Property
WASHINGTON, Nov. 17 -- The Government Accountability Office has issued a report on agencies' use of the exchange/sale authority. The report (GAO-19-33) is titled "Federal Personal Property: GSA and VA Have Opportunities to Improve the Exchange Sale Process".
The report was sent to Sen. Ron Johnson, R-Wisconsin, chairman, and Sen. Claire McCaskill, D-Missouri, ranking member of the Senate Homeland Security and Governmental Affairs Committee, on Nov. 16. Here are excerpts of summaries associated with the report.
What GAO Found: "According to data compiled by the General Services Administration's
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WASHINGTON, Nov. 17 -- The Government Accountability Office has issued a report on agencies' use of the exchange/sale authority. The report (GAO-19-33) is titled "Federal Personal Property: GSA and VA Have Opportunities to Improve the Exchange Sale Process".
The report was sent to Sen. Ron Johnson, R-Wisconsin, chairman, and Sen. Claire McCaskill, D-Missouri, ranking member of the Senate Homeland Security and Governmental Affairs Committee, on Nov. 16. Here are excerpts of summaries associated with the report.
What GAO Found: "According to data compiled by the General Services Administration'sOffice of Government-wide Policy (GSA OGP), 27 agencies executed exchange/sale transactions, governed by statute and GSA regulations, to exchange (trade-in) or sell personal property from fiscal year 2013 through fiscal year 2017. The 27 agencies reported transactions totaling about $3.1 billion. Vehicle sales accounted for $2.6 billion (about 84 percent) of that total.
GAO found that GSA officials who procure vehicles for federal agencies and Army officials who purchase helicopters appeared to understand the exchange/sale process and used it frequently. However, Department of Veterans Affairs (VA) officials expressed confusion about key aspects of the authority. For example, officials were unclear about how to sell property; this lack of clarity led to missed opportunities to use sale proceeds for replacing property. GSA OGP officials who guide agencies on the use of the authority acknowledged that the exchange/sale regulations can be confusing but GSA's plan to amend them is at least 2 years away. Because GSA does not plan to address this confusion in the near term through other means such as bulletins or outreach, agencies' misunderstanding of the authority could lead to additional missed opportunities to be effective stewards of government funds.
Regarding monitoring of exchange and sale activities, GAO found that the Army monitored activities consistent with its policy. However, GSA and VA performed limited monitoring because:
- GSA had not clarified its responsibilities or defined the scope of its authority for monitoring internal GSA exchanges and sales, and
- VA did not have a detailed policy for monitoring and had not communicated information about monitoring to pertinent employees.
Until GSA clarifies its responsibilities and the scope of its authority and VA revises its policy with pertinent details and communicates this information to staff members, neither agency will be positioned to sufficiently monitor exchange/sale activities."
Why GAO Did This Study: "According to the U.S. Treasury, the government owns about $1.3 trillion in "personal property" such as computers, furniture, and vehicles. Federal law authorizes agencies to exchange or sell personal property and retain the allowances or proceeds for replacing similar needed property. These are called "exchange/sale" transactions. GSA is responsible for issuing exchange/sale regulations and guiding agencies on the use of the authority.
GAO was asked to review agencies' use of the exchange/sale authority. This report (1) describes what is known about personal property exchange/sale transactions from fiscal year 2013 through fiscal year 2017 and (2) examines selected agencies' experiences using the exchange/sale authority and monitoring such activities. GAO analyzed multi-year data compiled by GSA OGP and found the data to be sufficiently reliable. GAO selected three agencies--GSA, the Army, and VA--based on the type, quantity, and value of personal property exchanged and sold; reviewed agencies' personal property policies; examined agencies' monitoring of exchange/sale activities; and interviewed their officials about personal property management."
What GAO Recommends: "GAO is recommending that GSA OGP address agency confusion about the exchange/sale authority and that GSA clarify its responsibilities and the scope of its authority. GAO is also recommending VA revise its policy to address monitoring and communicate the revision to staff. Both agencies agreed with the recommendations."
The text of the GAO report is available at https://www.gao.gov/products/GAO-19-33?utm_campaign=usgao_email&utm_content=daybook&utm_medium=email&utm_source=govdelivery
GAO Issues Report on Agent Orange
WASHINGTON, Nov. 16 -- The Government Accountability Office has issued a report on the the government's handling of Agent Orange on Guam. The report (GAO-19-24) is titled "Agent Orange: Actions Needed to Improve Accuracy and Communication of Information on Testing and Storage Locations".
The report was sent to Rep. Mac Thornberry, R-Texas, chairman, Rep. Adam Smith, D-Washington, ranking member of the House Armed Services Committee, Del. Madeleine Z. Bordallo, D-Guam, ranking member of the House Armed Services subcommittee on Readiness, and Del. Gregorio Kilili Camacho Sablan, D-Northern Mariana
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WASHINGTON, Nov. 16 -- The Government Accountability Office has issued a report on the the government's handling of Agent Orange on Guam. The report (GAO-19-24) is titled "Agent Orange: Actions Needed to Improve Accuracy and Communication of Information on Testing and Storage Locations".
The report was sent to Rep. Mac Thornberry, R-Texas, chairman, Rep. Adam Smith, D-Washington, ranking member of the House Armed Services Committee, Del. Madeleine Z. Bordallo, D-Guam, ranking member of the House Armed Services subcommittee on Readiness, and Del. Gregorio Kilili Camacho Sablan, D-Northern MarianaIslands, on Nov. 15. Here are excerpts of summaries associated with the report.
What GAO Found: "Available shipment documentation indicates that nearly all of the Agent Orange procured was either used in U.S. military operations in Southeast Asia, used for testing, damaged, or destroyed. However, some records are incomplete, such as shipment documentation and logbooks that identify ports where vessels stopped on the way to Southeast Asia. GAO obtained and reviewed shipment documentation for over 12.1 million of the 13.9 million gallons of Agent Orange procured by the Department of Defense (DOD). GAO reviewed logbooks for 96 percent (152 of 158) of those shipments and identified that vessels stopped at various ports on the way to Southeast Asia, including at least one vessel carrying Agent Orange that stopped at Guam. While the logbooks GAO reviewed identify when vessels left various ports as they traveled to and from Vietnam, they do not show whether and how much cargo was loaded or unloaded at those ports.
DOD's official list of herbicide testing and storage locations outside of Vietnam that is posted on the Department of Veterans Affairs' (VA) website is inaccurate and incomplete. For example, the list lacks clarity in descriptive information and omits both testing and storage locations and additional time periods covered by testing events. Also, the list has not been updated in over a decade, though DOD and VA have obtained reports on its shortcomings since 2006. Both DOD and VA communicate with veterans in response to inquiries about Agent Orange, but some veterans GAO met with expressed confusion regarding how to obtain information on potential exposure. DOD officials acknowledged this confusion and stated that veterans are contacting multiple agencies to obtain such information. However, DOD and VA have not established a formal process for coordinating on how best to communicate information to veterans and the public regarding the presence of Agent Orange outside of Vietnam. Without a reliable list with complete and accurate information and a formal process for DOD and VA to coordinate on communicating this information, veterans and the public do not have quality information about the full extent of locations where Agent Orange was present and where exposure could potentially have occurred.
Challenges exist with testing for Agent Orange today due to degradation of the herbicide's two chemical components and a potential for sources of contamination other than the herbicide. According to scientific research, the half-life (average time for components to decrease by half of the original amount) of Agent Orange's two chemical components--n-butyl 2,4-D and n-butyl 2,4,5-T-- in soil can range from several days to many months, depending on conditions. The suggested half-life of the dioxin 2,3,7,8-TCDD--a by-product of the 2,4,5-T manufacturing process--is much longer, but there are multiple sources of dioxins, including the burning of wood and waste. DOD and the U.S. and Guam Environmental Protection Agencies are testing for the acid form of the components of Agent Orange at Andersen Air Force Base on Guam. While acknowledging the low probability of conclusively identifying the components of Agent Orange on Guam, DOD has made a decision to move forward with testing to address veterans' and the public's concerns, and it expects to complete the updates for the sampling and analysis plan, field sampling, analysis, and reporting in early 2019."
Why GAO Did This Study: "The tactical herbicide Agent Orange was first produced in 1964, and some 12 million gallons were shipped from U.S. ports to Southeast Asia from 1965 to 1970. DOD suspended its use in 1970 and incinerated remaining stockpiles at sea in 1977. Congress has expressed long-standing interest in the effects of Agent Orange exposure.
The House report accompanying a bill for the National Defense Authorization Act for Fiscal Year 2018 included a provision that GAO review the government's handling of Agent Orange on Guam. This report examines (1) information the federal government has about the procurement, distribution, use, and disposition of Agent Orange; (2) DOD and VA efforts to make information about where Agent Orange and its components were tested and stored available; and (3) challenges associated with Agent Orange testing. GAO reviewed agency policies, documents, and available archival records that GAO identified; interviewed DOD, VA, and other agency officials; and met with a non-generalizable sample of 38 veterans and a veterans service organization."
What GAO Recommends: "GAO is making six recommendations, including that DOD develop a process for updating its list of Agent Orange testing and storage locations, and that DOD and VA develop a process for coordinating the communication of information on where Agent Orange was known to have been present. DOD concurred with four recommendations. VA concurred with one recommendation and non-concurred with one recommendation."
The text of the GAO report is available at https://www.gao.gov/products/GAO-19-24?utm_campaign=usgao_email&utm_content=daybook&utm_medium=email&utm_source=govdelivery
