Administration

Social Security Disability: Process Needed to Review Productivity Expectations for Administrative Law Judges

GAO - OIG -

What GAO Found The Social Security Administration's (SSA) administrative law judges review, process, and adjudicate requests for hearings on disability benefits. In 2007, the agency set an expectation—which SSA reported was based on trend data and some regional managers' input—for judges to issue 500-700 dispositions (decisions and dismissals) each year, and the extent to which they have met this expectation has varied over time. SSA did not document the expectation-setting process in 2007, nor has it formally reviewed the expectation since. Judges in discussion groups held by GAO questioned the basis of the expectation and 87 percent of judges GAO surveyed (47 of 54) said the expectation was too high. The extent to which judges met the annual and related expectations has fluctuated over the years (see figure). Without periodic reviews, SSA cannot be assured that its expectations appropriately allow judges to balance productivity with other expectations, such as quality, given changing conditions over time. Administrative Law Judges Who Met or Exceeded SSA's Annual Productivity Expectation, Fiscal Years 2014-2020 Judges in selected hearing offices cited a variety of factors affecting their ability to meet the annual expectation. The top factor cited by judges GAO surveyed was the size of case files, which have increased five-fold on average since the expectation was established, according to SSA data. The COVID-19 pandemic introduced other factors in 2020, resulting in fewer hearings being conducted. SSA monitors judges' productivity and takes various actions when expectations are not met, ranging from informal conversations to formal discipline. In addition, judges in 11 of 13 discussion groups viewed telework restrictions as a consequence for not meeting expectations. Additionally, judges GAO surveyed reported feeling pressured to meet the expectations. For instance, 87 percent of judges surveyed (47 of 54) said that SSA placed too much emphasis on productivity, and some expressed concerns about their work quality and work-life balance. SSA officials said they do not formally seek feedback from judges on the expectations. However, without feedback or other gauges of pressure, SSA lacks information that could help it appropriately balance timely case processing while maintaining high-quality work and employee morale. Why GAO Did This Study SSA's approximately 1,350 judges play a major role in processing and adjudicating requests for hearings to help ensure individuals who do not agree with the determination on their claim for Social Security disability benefits receive due process. SSA receives hundreds of thousands of hearing requests each year and has historically had a large backlog. GAO was asked to review SSA's productivity expectations for its judges. This report examines (1) how SSA set productivity expectations for judges and the extent to which judges have met them over time, (2) reported factors affecting the ability of judges in selected offices to meet the annual productivity expectation, and (3) SSA's management of judges' productivity. GAO obtained and analyzed SSA data on judges' productivity from fiscal years 2005-2020; surveyed and held 13 virtual discussion groups with judges in six hearing offices selected for geographic location, average productivity, and average case size; reviewed relevant federal laws and agency policies and documents; and interviewed officials from SSA and the association representing judges.

Prescription Drugs: Medicare Spending on Drugs with Direct-to-Consumer Advertising

GAO - OIG -

What GAO Found Drug manufacturers spent $17.8 billion on direct-to-consumer advertising (DTCA) for 553 drugs from 2016 through 2018, and spending was relatively stable at about $6 billion each year. Almost half of this spending was for three therapeutic categories of drugs that treat chronic medical conditions, such as arthritis, diabetes, and depression. GAO also found that nearly all DTCA spending was on brand-name drugs, with about two-thirds concentrated on 39 drugs, about half of which entered the market from 2014 through 2017. Medicare Parts B and D and beneficiaries spent $560 billion on drugs from 2016 through 2018, $324 billion of which was spent on advertised drugs. Of the 553 advertised drugs, GAO found Medicare Parts B and D spending for 104 and 463 drugs, respectively. Among the drugs with the highest Medicare spending, some also had the highest DTCA spending. Specifically, among the top 10 drugs with the highest Medicare Parts B or D expenditures, four were also among the top 10 drugs in advertising spending in 2018: Eliquis (blood thinner), Humira (arthritis), Keytruda (cancer), and Lyrica (diabetic pain). Medicare Spending on Advertised Drugs, 2016 - 2018 GAO's review of four advertised drugs found that drug manufacturers changed their DTCA spending during key events, such as increasing spending when a drug was approved to treat additional conditions or decreasing spending following the approval of generic versions. GAO also found that DTCA may have contributed to increases in Medicare beneficiary use and spending among four selected drugs from 2010 through 2018. However, other factors likely contributed to a drug's Medicare beneficiary use and spending, making it difficult to isolate the relationship between drug advertising, use and spending. For example, GAO's review of four selected drugs showed that increases in unit prices were a factor, while stakeholders GAO interviewed cited other contributing factors such as doctors' prescribing decisions and manufacturers' drug promotions directed to doctors. Why GAO Did This Study Drug manufacturers use advertising on television and in other media to promote the use of their drugs to consumers and to encourage them to visit their doctors for more information. From 2016 through 2018, the Medicare program and beneficiaries spent $560 billion on drugs, and spending is projected to increase with the use of newer, more expensive drugs and an increase in beneficiaries. GAO was asked to examine DTCA and Medicare spending on advertised drugs. This report examines (1) drug manufacturer spending on DTCA; (2) Medicare spending on advertised drugs; and (3) changes in DTCA spending and Medicare use and spending for selected drugs. GAO analyzed DTCA spending data from Nielsen Media, and Medicare Parts B and D Drug Spending Dashboard data, from 2016 through 2018 (the most recent available data at the time of GAO's analysis). GAO also analyzed DTCA spending and Medicare data for a non-generalizable selection of four advertised drugs over a longer period—from 2010 through 2018. The four drugs were selected to reflect differences in DTCA and Medicare spending, beneficiary use, and medical conditions treated. GAO also interviewed or obtained information from officials representing 14 stakeholder groups (including research, trade, and physician organizations; and drug manufacturers of the four selected drugs) about DTCA spending and drug use and spending. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.

Navy Readiness: Actions Needed to Evaluate and Improve Surface Warfare Officer Career Path

GAO - OIG -

What GAO Found U.S. Navy Surface Warfare Officers (SWOs) separate from the SWO community earlier and at higher rates compared with officers in similar U.S. Navy communities, and female SWOs separate at higher rates than male SWOs. Retention Rates for U.S. Navy Officers and Surface Warfare Officers by Gender Note: GAO compared the U.S. Navy Surface Warfare Officer community separation rates with those of the other unrestricted line officer communities in the U.S. Navy: Naval Aviation, Submarine, and Explosive Ordinance Disposal and Special Warfare. GAO found that after 10 years of service, around the first major career milestone: 33 percent of SWOs remain in their community, compared with 45 percent of officers from similar U.S. Navy officer communities, and 12 percent of female SWOs remain in their community, compared with 39 percent of male SWOs. By using existing information to develop a plan to improve SWO retention, the Navy will be better positioned to retain a diverse and combat-ready community. The career path for U.S. Navy SWOs differs from those in similar positions in selected foreign navies and other U.S. Navy and U.S. maritime communities. Career Path for U.S. Navy Surface Warfare Officers Compared with Others The U.S. Navy made incremental career path changes for SWOs following the 2017 collisions, but has not regularly evaluated or fundamentally changed its SWO career path for over a century. GAO found that by a factor of four to one, SWOs believe specialized career paths would better prepare them for their duties than the current generalist career path. Without periodic evaluations of current approaches, including alternative career paths, and the use of those evaluations, the U.S. Navy may miss an opportunity to develop and retain proficient SWOs. Why GAO Did This Study SWOs are U.S. Navy officers whose primary duties focus on the safe operation of surface ships at sea. In 2017, the Navy had two collisions at sea that resulted in the death of 17 sailors and hundreds of millions of dollars in damage to Navy ships. Following the collisions, the Navy identified deficiencies in the SWO career path and staffing policies, and took action to improve these areas. The John S. McCain National Defense Authorization Act for Fiscal Year 2019 contained a provision that GAO assess issues related to the U.S. Navy SWO career path. Among other things, this report (1) assesses trends in separation rates of SWOs with those of similar U.S. Navy officer communities, and trends in SWO separation rates by gender; (2) describes how the career path of U.S. Navy SWOs compares to those of selected foreign navies and other U.S. Navy and U.S. maritime communities; and (3) assesses the extent to which the U.S. Navy has used or evaluated alternative career paths. GAO analyzed U.S. Navy officer personnel data; selected foreign navies and U.S. maritime officer communities for comparison; and surveyed a generalizable sample of Navy SWOs.

Management Report: Preliminary Information on Potential Racial and Ethnic Disparities in the Receipt of Unemployment Insurance Benefits during the COVID-19 Pandemic

GAO - OIG -

What GAO Found As part of ongoing work on unemployment insurance (UI) benefits during the COVID-19 pandemic, GAO found potential racial and ethnic disparities in the receipt of UI benefits, including Pandemic Unemployment Assistance (PUA) benefits. Specifically, according to data from the U.S. Census Bureau's COVID-19 Household Pulse Survey, a higher percentage of White, non-Hispanic/Latino applicants received benefits from UI programs during the pandemic than certain other racial and ethnic groups. In addition, our preliminary analysis of data obtained from five selected states in our ongoing review of the PUA program—a temporary program providing benefits to individuals not otherwise eligible for UI—identified some racial and ethnic disparities in the receipt of PUA benefits. In two of the five states, for example, the percentage of White PUA claimants who received benefits in 2020 was considerably higher than the percentage of Black PUA claimants who received benefits that year (both groups consist of non-Hispanic/Latino claimants). This analysis of state-provided data is preliminary and we are continuing to examine these data, including their reliability and potential explanations for disparities. Various factors could explain the disparities we identified in our preliminary analyses, such as differences in UI eligibility that may be correlated with race and ethnicity. However, another potential explanation is that states could be approving or processing UI claims differently for applicants in different racial and ethnic groups. Why GAO Did This Study The UI system provides a vital safety net for individuals who become unemployed through no fault of their own, and this support is essential during widespread economic downturns. During the pandemic, the CARES Act supplemented the regular UI program by creating three federally funded temporary UI programs, including the PUA program, which expanded benefit eligibility and enhanced benefits. As part of our ongoing work on the various UI programs during the pandemic, we analyzed the extent to which there have been differences in the receipt of benefits by race and ethnicity. The purpose of this report is to inform DOL about potential racial and ethnic disparities in the receipt of UI benefits. According to DOL, ensuring equitable access to UI benefits is a top priority for the agency. We recognize that the complexity of these issues may take time to examine in depth. However, given that PUA and the other temporary UI programs are scheduled to expire in September 2021, we are sharing this preliminary information for DOL to consider in determining whether it needs to engage with states at this point to ensure equitable access to the UI system. For more information, contact Thomas M. Costa at (202) 512-7215 orcostat@gao.gov.

Defense Health Care: Actions Needed to Define and Sustain Wartime Medical Skills for Enlisted Personnel

GAO - OIG -

What GAO Found The military departments have not fully defined, tracked, and assessed wartime medical skills for enlisted medical personnel. The departments have defined these skills for 73 of 77 occupations. However, among other issues, the Army and the Air Force have not defined skills for numerous highly-skilled subspecialties that require additional training and expertise, such as Army Critical Care Flight Paramedics. Subspecialty personnel are key to supporting lifesaving medical care during deployed operations. The Army does not consistently track wartime medical skills training for enlisted medical personnel in its official system. The military departments are not able to fully assess the preparedness of enlisted medical personnel because, according to officials, they have not developed performance goals and targets for skills training completion. As a result, the military departments lack reasonable assurance that all enlisted medical personnel are ready to perform during deployed operations. The Department of Defense (DOD) has not fully developed plans and processes to sustain the wartime medical skills of enlisted medical personnel. While the Defense Health Agency (DHA) has initiated planning efforts to assess how the military departments' three primary training approaches sustain readiness (see figure), these efforts will not fully capture needed information. For example, DHA's planned metrics to assess the role of military hospitals and civilian partnerships in sustaining readiness would apply to a limited number of enlisted occupations. As a result, DHA is unable to fully assess how each training approach sustains readiness and determine current and future training investments. Approaches to Train Enlisted Medical Personnel's Wartime Medical Skills DOD officials have identified challenges associated with implementing its training approaches. For example, DOD relies on civilian partnerships to sustain enlisted medical personnel's skills, but DOD officials stated that licensing requirements and other issues present challenges to establishing and operationalizing civilian partnerships. DOD has not analyzed or responded to such risks, and may therefore be limited in its ability to sustain wartime medical skills. Why GAO Did This Study DOD has over 73,000 active-duty enlisted medical personnel who must be ready to provide life-saving care to injured and ill servicemembers during deployed operations, using their wartime medical skills. Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's efforts to maintain enlisted personnel's wartime medical skills. This report examines, among other objectives, the extent to which (1) the military departments have defined, tracked, and assessed enlisted personnel's wartime medical skills, and (2) DOD has developed plans and processes to sustain these skills and assessed risks associated with their implementation. GAO analyzed wartime medical skills checklists and guidance; reviewed plans for skills sustainment; and interviewed officials from DOD and military department medical commands and agencies, and nine inpatient military medical treatment facilities.

Southwest Border: Schedule Considerations Drove Army Corps of Engineers' Approaches to Awarding Construction Contracts through 2020

GAO - OIG -

Why This Matters Following a 2019 Presidential Declaration of National Emergency, billions of dollars were made available for the U.S. Army Corps of Engineers' use on border barrier construction. This report provides information on the Corps' contracting for border barriers during fiscal years 2018–2020. Key Takeaways Some Department of Defense funding was only available for a short time before expiring, giving the Corps a tight schedule for awarding contracts. This—and the emergency declaration—led the Corps to depart from its planned acquisition approach. The Corps focused on starting construction quickly and maximizing the miles of border barrier panels it could build. To do so, it: Awarded $4.3 billion in noncompetitive contracts. Competition helps ensure the government gets a good price. Started work before agreeing to terms. The Corps awarded several contracts before terms, such as barrier specifications and cost, were finalized. By focusing on expediency in contracting, the government risks paying higher costs. Contractors completed most DOD-funded border barrier panels by the end of December 2020 as scheduled. A January 2021 Presidential Proclamation paused border barrier construction to the extent permitted by law, and called for a review. In March 2021, DOD officials said they gave input to the Office of Management and Budget, and OMB will present a plan to the President. The Corps has not developed plans to examine its overall acquisition approach and identify lessons learned. Without doing so, the Corps could miss opportunities to strengthen its contracting strategies in future border support efforts. Border Barrier Obligations, Fiscal Years 2018–2020 How GAO Did This Study We reviewed all of the border barrier construction contracts the Corps awarded for projects from fiscal years 2018 through 2020. We also reviewed relevant federal procurement data and interviewed Corps and Department of Homeland Security officials.

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