Firefighting Foam Chemicals: DOD Is Investigating PFAS and Responding to Contamination, but Should Report More Cost Information

What GAO Found The Department of Defense (DOD) is early in the environmental restoration process at or near the 687 installations with a known or suspected release of certain per- and polyfluoroalkyl substances (PFAS)—heat-resistant chemicals found in certain firefighting foams that can contaminate drinking water (see fig.). DOD Installations in the Environmental Restoration Process with a Known or Suspected PFAS Release, as of Fiscal Year 2020 aAccording to DOD officials, in fiscal year 2021 the Air Force changed its definition for when this phase is considered complete, resulting in a lower number of DOD installations (129 installations) that had completed this phase as of March 2021. DOD has taken actions (e.g., providing bottled water, installing water treatment systems) to address PFAS in drinking water at or near its installations when PFAS amounts exceeded federal health advisory levels. DOD generally has not taken actions to address PFAS in drinking water where PFAS amounts were below the federal advisory levels, but above state PFAS standards. DOD estimates that its future PFAS investigation and cleanup costs will total more than $2.1 billion beginning in fiscal year 2021, which is in addition to $1.1 billion in actual PFAS costs incurred through fiscal year 2020. These costs will likely increase significantly, because DOD is still in the early phases of its PFAS investigation. DOD officials also cited regulatory uncertainty at the federal and state levels as a significant challenge in estimating PFAS environmental restoration costs. However, DOD has not reported future PFAS cost estimates, or the scope and limitations of those estimates, in its annual environmental reports to Congress. By reporting this information to Congress, DOD would ensure that Congress has increased visibility into the significant costs and efforts associated with PFAS investigation and cleanup at or near military installations. As of March 2021, DOD had identified six potential PFAS-free foam candidates; however, PFAS-free foams have been unable to fully meet DOD's current performance requirements. By law, DOD must ensure that a PFAS-free firefighting alternative is available for use at its installations by October 2023. DOD is funding research to address challenges associated with identifying PFAS-free alternatives. DOD plans to continue using PFAS-containing foam aboard ships at sea—as allowed for by the National Defense Authorization Act for Fiscal Year 2020—until a PFAS-free alternative can meet existing requirements. Why GAO Did This Study DOD has long used PFAS-containing firefighting foam to extinguish fires quickly and keep them from reigniting. PFAS can migrate into the environment (e.g., drinking water) and may have adverse effects on human health. The federal government has issued two nonenforceable advisories but has not yet regulated PFAS in drinking water; some states have adopted PFAS regulations. Conference Report 116-333, accompanying the National Defense Authorization Act for Fiscal Year 2020, included a provision for GAO to review DOD's response to PFAS contamination. This report (1) describes DOD's progress in the investigation and cleanup of PFAS at its installations, and DOD's actions to address PFAS in drinking water; (2) describes DOD's actual and estimated costs for PFAS investigation and cleanup, and evaluates the extent to which DOD has reported those figures to Congress; and (3) describes DOD's progress in identifying PFAS-free firefighting alternatives. GAO analyzed DOD data on PFAS cleanup, costs (actual and estimated obligations), and foam alternatives; evaluated DOD's PFAS cost reporting against policy; and interviewed officials from DOD and selected installations and state environmental agencies.

Pipeline Safety: Performance Measures Needed to Assess Recent Changes to Hazardous Liquid Pipeline Safety Regulations

What GAO Found In 2019, the Pipeline and Hazardous Materials Safety Administration (PHMSA) issued a final rule amending its hazardous liquid pipeline safety regulations. Selected pipeline operators and officials from PHMSA and selected states' pipeline safety offices said that these changes would enhance pipeline safety and present no significant challenges. They said the most beneficial changes expanded the scope of inspections. For example, in addition to existing requirements for operators to use specialized tools to inspect pipelines in “high consequence areas”—defined by population and environmental factors—the 2019 Rule requires such inspections outside of those areas. While operators noted the rule's potential to improve safety, all 11 operators GAO interviewed identified specific amendments that could increase their costs. For example, several operators said they would need to modify or replace some of their pipeline to allow for certain inspection tools required by the changes. PHMSA and state pipeline safety officials said they did not anticipate oversight challenges or additional costs because the changes did not alter their inspection process. Specialized In-Line Inspection Tool Being Placed in a Launch Point on a Pipeline PHMSA held meetings with and provided guidance to operators and inspectors on the changes but has not developed measures to assess if the changes improve safety. Leading performance management practices call for agencies to track progress toward goals using measures that include targets for expected levels of performance and timeframes. While PHMSA has desired outcomes for the 2019 Rule, including safety improvements, PHMSA officials said they have not established performance measures for those outcomes because some of the changes have long-term compliance deadlines, and so data are not yet available to assess effectiveness. However, other changes have shorter-term deadlines for compliance and PHMSA could use data it already collects from operators for its assessment. Without performance measures, PHMSA cannot determine whether the changes made by the 2019 Rule are achieving their intended outcomes and contributing to PHMSA's safety goals. Why GAO Did This Study The U.S. hazardous liquid pipeline network runs for over 220,000 miles and is a critical component of the nation's economy. Pipelines are considered to be a relatively safe mode of transporting crude oil, refined petroleum products, and other hazardous liquids, but accidents can occur that result in loss of life and environmental damage. PHMSA, within the Department of Transportation (DOT), sets the federal minimum pipeline safety standards and generally ensures operator compliance. In 2016, a pipeline safety statute included a provision for GAO to report on hazardous liquid pipeline safety after PHMSA issued a specific final rule amending its safety regulations, which it did in 2019. This report examines: (1) perspectives of selected pipeline stakeholders on the benefits and challenges of the amendments made by the 2019 Rule and (2) steps PHMSA has taken to inform stakeholders of these amendments and to measure their effects on pipeline safety. GAO reviewed relevant statutes and regulations; analyzed PHMSA accident data from calendar years 2011-2020; interviewed 11 pipeline operators—selected by pipeline type, miles, and product type—as well as pipeline industry and safety stakeholders, and PHMSA and pipeline safety officials from six states.

Priority Open Recommendations: Department of Commerce

What GAO Found In April 2020, GAO identified 20 priority recommendations for the Department of Commerce. Since then, Commerce has implemented nine of those recommendations by, among other things, improving the risk management of the decennial census by ensuring identified risks had the required mitigation and contingency plans, and by establishing a process for conducting an organization-wide cybersecurity risk assessment. Commerce also had one priority recommendation related to the decennial census that we closed as not implemented. Additionally, Commerce had two priority recommendations that will remain open for the 2030 Census, but are no longer a priority in 2021 because action on these recommendations does not need to occur until later in the 10-year decennial cycle. In June 2021, GAO identified three additional priority recommendations for Commerce, bringing the total number to 11. These recommendations involve the following areas: Managing climate change risks International trade  Information technology management and workforce planning Ensuring the cybersecurity of the nation  Decennial Census  Conflict minerals rule Full implementations of these open recommendations could significantly improve Commerce’s operations. Why GAO Did This Study Priority open recommendations are the GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional and/or executive branch decision-making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015 GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, contact Michelle Sager at (202) 512-6806 or

GAO Comments on AICPA Proposed SAS – Inquiries of the Predecessor Auditor Regarding Fraud and Noncompliance With Laws and Regulations

This letter provides GAO's response to the American Institute of Certified Public Accountants' (AICPA) Auditing Standards Board's (ASB) exposure draft, Proposed Statement on Auditing Standards – Inquiries of the Predecessor Auditor Regarding Fraud and Noncompliance With Laws and Regulations. GAO provides standards for performing high-quality audits of governmental organizations, programs, activities, and functions and of government assistance received by contractors, nonprofit organizations, and other nongovernmental organizations with competence, integrity, objectivity, and independence. These standards, often referred to as generally accepted government auditing standards (GAGAS), are to be followed when required by law, regulation, agreement, contract, or policy. For financial audits, GAGAS incorporates by reference the AICPA's Statements on Auditing Standards (SAS).

Independence Day Celebrations: Estimated Costs and COVID-19 Protective Measures for 2020 Fourth of July Events

What GAO Found Federal agencies and state and local jurisdictions combined spent millions of dollars for the estimated costs of 2020 Fourth of July events in Washington, D.C., and at Mount Rushmore. The various federal agencies involved in the events included the United States Capitol Police; the Executive Office of the President; and the Departments of the Interior, Defense, Homeland Security, and Health and Human Services. Beyond the federal effort, the District of Columbia Government (DC Government), the state of South Dakota, and local law enforcement played a role in the events. Fourth of July Estimated Costs for Events in 2020 Event Estimated costs (dollars) General event costs a 2,610,164 A Capitol Fourth Concert 3,888,607 Independence Day fireworks 2,546,737 Salute to America 1,610,811 Mount Rushmore National Memorial Events 3,917,289 Total 14,573,608 Source: GAO analysis of estimated cost data provided by federal agencies and state and local jurisdictions. | GAO-21-458 aGeneral event costs are those that cannot be attributed to a specific event. Costs incurred were associated with contracts, equipment, and federal personnel, such as costs for overtime pay. Officials GAO interviewed from federal agencies and state and local jurisdictions said they did not incur COVID-19 mitigation costs for the events because personal protective equipment (PPE) and other related supplies used were from existing stockpiles. Federal agencies and the DC Government primarily used annual appropriations to fund the events. The National Park Service also used the Centennial Challenge and Federal Lands Recreation Enhancement Act appropriation accounts to fund portions of the Salute to America and Mount Rushmore events and to cover costs incurred as part of the fireworks display. The DC Government used funds from other available appropriations to cover the cost of events occurring after the obligation of its $18 million appropriation for fiscal year 2020 security costs, including the $1.4 million estimated cost of the 2020 Fourth of July events. The United States Park Police reimbursed state and local jurisdictions outside of Washington, D.C., $35,057 for their costs associated with the events in the District. During the 2020 Fourth of July events, Centers for Disease Control and Prevention–issued federal guidelines as well as state and local guidelines that South Dakota and Washington, D.C., issued were in effect. These guidelines encouraged event organizers and the public to take a variety of steps to help prevent the spread of COVID-19. Events held on federal property in Washington, D.C., were to follow federal guidelines that included recommendations for social distancing of 6 feet, use of cloth face coverings, and frequent handwashing. South Dakota state guidance was in effect for the events at the Mount Rushmore National Memorial. Federal agencies and state and local jurisdictions instructed their employees to follow relevant COVID-19 guidance and provided employees with PPE. In addition, federal and state agencies made PPE, such as masks, available to the public. Why GAO Did This Study Since July 4, 1776, Americans have celebrated Independence Day through events held in towns and cities across the nation. In the nation's capital, Washington, D.C., visitors have celebrated on the National Mall with federally sponsored parades, concerts, fireworks, and in 2019 the Salute to America. In 2020, additional federally sponsored activities were held at the Mount Rushmore National Memorial in South Dakota. Because of the COVID-19 pandemic, federal Fourth of July celebrations in 2020 required adjustments and precautions in order to mitigate the spread of COVID-19. GAO was asked to review the estimated costs associated with the 2020 Fourth of July events and describe protective measures taken because of COVID-19. This report describes (1) the total estimated costs that federal agencies and state and local jurisdictions incurred for federal 2020 Fourth of July events, the appropriations used to pay the federal costs, and the extent to which the federal government reimbursed costs incurred by state and local jurisdictions and (2) the protective measures that federal agencies and state jurisdictions took to help ensure the health and safety of the public, federal employees, and other essential workers at the events. To perform this work, GAO reviewed documentation and interviewed personnel from federal agencies and state and local jurisdictions about their estimated costs and actions at the events in response to the COVID-19 pandemic. For more information, contact Kristen Kociolek at (202) 512-2989 or

Defense Cybersecurity: Defense Logistics Agency Needs to Address Risk Management Deficiencies in Inventory Systems

What GAO Found For six selected inventory management systems that support processes for procuring, cataloging, distributing, and disposing of materiel, the Defense Logistics Agency (DLA) fully addressed two of the Department of Defense's (DOD) six cybersecurity risk management steps and partially addressed the other four. Specifically, the agency categorized the systems based on risk and established an implementation approach for security controls. However, it only partially addressed the four risk management steps of selecting, assessing, authorizing, and monitoring security controls (see figure). Extent to Which the Defense Logistics Agency Addressed the Department of Defense's Risk Management Steps for Six Selected Inventory Management Systems • Select security controls : DLA selected specific security controls, but it did not develop system-level monitoring strategies to assess the effectiveness of selected security controls for three of the six systems GAO assessed. DOD's risk management framework requires components to develop a system-specific monitoring strategy during the security control selection step. • Assess security controls : DLA assessed the security controls for the six selected inventory management systems, but its assessment procedures lacked approvals, as required. As a result, GAO found that DLA's assessment plans lacked essential details and missed opportunities for risk-based decisions. • Authorize the system : DLA authorized the selected systems, but it did not report complete and consistent security and risk assessment information to support decisions. GAO found that DLA had not established a process for program offices to review authorization documentation prior to submitting packages to the authorizing official. • Monitor security controls : DLA did not consistently monitor the remediation of identified security weaknesses across its six inventory management systems. As a result, GAO found that 1,115 of the 1,627 corrective action plans (69 percent) for the six systems did not complete intended remediation within DLA's required time frame of 365 days or less--they were ongoing for an average of 485 days. Until DLA addresses the identified deficiencies, the agency's management of cyber risks for critical systems will be impeded and potentially pose risks to other DOD systems that could be accessed if DLA's systems are compromised. Why GAO Did This Study In November 2018 DOD's Survivable Logistics Task Force examined current and emerging threats to DOD logistics, including cybersecurity threats. The task force concluded that DOD's inventory management systems were potentially vulnerable to cyberattacks, and that DOD did not have corrective action plans to mitigate the potential risks posed by associated vulnerabilities. House Report 116-120, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, included a provision for GAO to evaluate DOD's efforts to manage cybersecurity risks to the DOD supply chain. GAO's report determines the extent to which DLA has implemented risk management steps to address cybersecurity risks to its inventory management systems. GAO selected six systems that DLA officials deemed critical to inventory management operations. GAO reviewed documents, analyzed data, and interviewed officials to determine whether DLA fully addressed, partially addressed, or did not address DOD steps for cybersecurity risk management.

Sex Trafficking: Online Platforms and Federal Prosecutions

What GAO Found Two events in April 2018 disrupted the landscape of the online commercial sex market. First, federal authorities seized the largest online platform for buying and selling commercial sex, Second, the Allow States and Victims to Fight Online Sex Trafficking Act of 2017 (FOSTA) was enacted. These events led many who controlled platforms in this market to relocate their platforms overseas. Additionally, with no longer in the market, buyers and sellers moved to other online platforms, and the market became fragmented. From 2014 through 2020, the Department of Justice (DOJ) brought at least 11 criminal cases against those who control platforms in this market, including three cases against those who control, as shown below. Federal Criminal Cases Brought against Those Who Control Platforms in the Online Commercial Sex Market Under Various Laws Including FOSTA (from 2014 through 2020) Note: Funds targeted by DOJ represents funds in accounts that have been seized, are subject to potential forfeiture, or have been ordered to be forfeited. GAO uses the term “at least” because there is an unknown amount of funds in many accounts. Funds in cryptocurrency are expressed in the equivalent of U.S. Dollars. The current landscape of the online commercial sex market heightens already-existing challenges law enforcement face in gathering tips and evidence. Specifically, gathering tips and evidence to investigate and prosecute those who control or use online platforms has become more difficult due to the relocation of platforms overseas, platforms' use of complex payment systems, and the increased use of social media platforms. Criminal restitution has not been sought and civil damages have not been awarded under section 3 of FOSTA. In June 2020, DOJ brought one case under the criminal provision established by section 3 of FOSTA for aggravated violations involving the promotion of prostitution of five or more people or acting in reckless disregard of sex trafficking. As of March 2021, restitution had not been sought or awarded. According to DOJ officials, prosecutors have not brought more cases with charges under section 3 of FOSTA because the law is relatively new and prosecutors have had success using other criminal statutes. Finally, in November 2020 one individual sought civil damages under a number of constitutional and statutory provisions, including section 3 of FOSTA. However, in March 2021, the court dismissed the case without awarding damages after it had granted defendants' motions to dismiss. Why GAO Did This Study Online marketing and communication platforms can enable sex trafficking—the commercial sexual exploitation of adults through force, fraud or coercion, or children under the age of 18 (with or without force, fraud, or coercion)—by making it easier for traffickers to exploit victims and connect with buyers. Section 3 of FOSTA established criminal penalties for those who promote or facilitate prostitution and sex trafficking through their control of online platforms. It also allows for those injured by an aggravated violation involving the promotion of prostitution of five or more people or reckless disregard of sex trafficking to recover damages in a federal civil action. It also makes federal criminal restitution mandatory for aggravated offenses contributing to sex trafficking. FOSTA includes a provision for GAO to provide detailed information on restitution and civil damages. This report examines: (1) DOJ enforcement efforts against online platforms that promote prostitution and sex trafficking, from 2014 through 2020; and (2) the extent to which criminal restitution and civil damages have been sought and awarded for aggravated violations under section 3 of FOSTA. GAO reviewed federal criminal cases brought against those who controlled platforms in the online commercial sex market from 2014 through 2020; visited a selection of online platforms in this market; and conducted a legal search to identify criminal and civil cases brought pursuant to section 3 of FOSTA. GAO also interviewed DOJ officials and representatives from third parties. For more information, contact Gretta L. Goodwin at (202) 512-8777 or

Physician Workforce: Caps on Medicare-Funded Graduate Medical Education at Teaching Hospitals

What GAO Found Medicare sets caps on both of its types of physician graduate medical education (GME) payments (direct and indirect) to teaching hospitals. Caps on these payments determine the number of physician trainees—known as residents—that each payment type supports. Hospitals can use other sources of funds to train more residents than these caps. Medicare data show that in 2018, 70 percent of hospitals were over one or both caps on Medicare-funded residents, and 20 percent of hospitals were under one or both caps. For both payment types, hospitals funded significantly more slots over the cap than they left unfilled, but Medicare still funded the large majority of resident slots. Graduate Medical Education (GME) Residents and Slots by Medicare Payment Type and Funding, 2018 Notes: Medicare's payments for GME are based, in part, on the number of full-time equivalent residents that a hospital trains. Caps reflect the number of residents eligible for the two GME payment types. Direct Graduate Medical Education payments offset direct costs of GME training, such as resident salaries, and Indirect Medical Education payments offset indirect costs of GME training, such as the additional cost of resident supervision. Medicare gives hospitals starting their first new GME programs 5 years to establish and grow their GME programs before their caps are set. Once set, hospitals' resident caps are generally permanent. GAO asked GME stakeholders about recent proposals to extend this window beyond 5 years. Stakeholders said that extending this time window could result in larger caps and more residents training at some hospitals because the hospitals would have more time to, for example, recruit more faculty and residents or start programs in more complex specialties before caps are set. Some stakeholders representing providers and a researcher suggested targeting the extension to under-resourced hospitals—such as those located in rural areas or areas with health care provider shortages—which often face challenges in quickly recruiting faculty and ensuring a variety of educational experiences for residents. However, they noted that extending the cap-establishment window would not address all challenges that under-resourced hospitals face when starting new GME programs. Why GAO Did This Study Studies have shown the United States faces a shortage of physicians, making it increasingly difficult for people to access needed health care. Physicians need GME training before they can practice medicine independently and often practice in the same geographic area as their training. The vast majority of federal funding for this training—about $15 billion in 2018—supports physician training through the Department of Health and Human Services' Medicare GME payments. Medicare offers payments to teaching hospitals to offset costs of training full-time equivalent residents, up to a capped number of resident slots for each hospital. For most hospitals, caps reflect the number of residents that Medicare funded in 1996; for hospitals starting their first new GME program in 1997 or later, caps were based on the number of Medicare-funded residents trained at the end of a specific time window. GAO was asked to review Medicare GME funding. This report, among other issues, describes the extent to which hospitals were over or under their Medicare GME caps and stakeholders' views on extending the time window before new caps are established. GAO analyzed 2018 Medicare data (the most recent available at the time of GAO's analysis), reviewed agency documentation, and interviewed eight selected stakeholder groups—including a GME accreditor and groups representing health care providers—identified through past GAO work. 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 Michelle Rosenberg at (202) 512-7114 or

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

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

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

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

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

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

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

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

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.

Commercial Space Transportation: FAA Continues to Update Regulations and Faces Challenges to Overseeing an Evolving Industry

What GAO Found The Federal Aviation Administration (FAA) recently updated and streamlined its launch and reentry licensing regulations but has made less progress on other key commercial space transportation regulations. The new licensing regulations, issued in December 2020, replaced prescriptive requirements—in which a certain technology or action was required—with a performance-based regulatory framework, which provides applicants flexibility in how they achieve required outcomes, such as a specific level of safety. Given its focus on the licensing regulations, FAA placed on hold revisions to other regulations governing commercial space transportation—revisions which, according to FAA officials, are warranted given the industry's evolution. For example, FAA has not yet begun to revise its financial responsibility regulations, which require launch companies conducting FAA-licensed launches to purchase insurance to cover damage to third parties in case of a launch mishap. According to FAA officials, revising these regulations is their next planned rulemaking and when finalized, will respond to GAO's recommendations to improve FAA's methodologies for evaluating and calculating potential third-party losses from launch and reentry mishaps and help ensure the federal government is not exposed to greater liability than expected. FAA also faces ongoing challenges regulating an evolving industry. In particular, as GAO previously reported, FAA continues to face the challenge of whether and when to regulate the safety of crew and spaceflight participants. While some companies have announced plans to take tourists to space within the next several years, FAA is prohibited by statute from regulating crew and passenger safety before 2023, except in response to events that caused or posed a risk of serious or fatal injury. However, FAA has taken some steps in anticipation of the expiration of the statutory moratorium, such as working with its industry advisory committee to develop and disseminate human spaceflight best practices. FAA also has taken some steps to help the agency keep pace with changes in the industry. For example, in response to recommendations GAO made in 2019, FAA recently assessed its workforce to identify skills and competencies that are needed among its workforce and is working to improve its workload projections to better account for the full range of its regulatory activities and the timeline of its licensing process. Such efforts are critical for ensuring FAA can better anticipate and respond to the growing and evolving commercial space industry and FAA's emerging workforce needs. Why GAO Did This Study The commercial space transportation industry provides launch services for government and private customers that carry objects, such as satellites and vehicles with scientific research, or passengers to or from space. Continued growth and evolution in the industry is expected as reliance on space-based applications increases. Within FAA, the Office of Commercial Space Transportation (AST) is charged both with overseeing the industry, including licensing and monitoring launch vehicle operations, and promoting the industry. This statement describes FAA's efforts to update regulations governing commercial space transportation; challenges FAA faces regulating an evolving industry; and steps FAA has taken to help ensure it is positioned to meet the needs of the evolving industry. This statement is based largely on GAO's body of work on commercial space transportation, including GAO-19-437 issued in May 2019. To update this information, GAO interviewed FAA officials and reviewed applicable statutes, regulations and selected industry documents.

Taxpayer Advocate Service: Opportunities Exist to Improve Reports to Congress

What GAO Found The budget for the Internal Revenue Service's (IRS) Taxpayer Advocate Service (TAS) declined by about 14 percent from fiscal years 2011 to 2020, when adjusted for inflation. For fiscal year 2020, TAS used most of its resources to assist individual taxpayers, known as case advocacy. TAS allocated about 76 percent of its $222 million budget and 86 percent of its almost 1,700 full-time equivalents to this purpose. The percentage of resources for case advocacy has decreased during the past decade—in fiscal year 2011 about 85 percent of the budget was devoted to it. For the same period, resources to address broader issues affecting groups of taxpayers, known as systemic advocacy, increased from 9 percent to 14 percent of the total budget. This shift is due in part to the reallocation of staff to better integrate systemic advocacy work and TAS's overall attrition rate more than doubling to 15.9 percent between fiscal years 2011 and 2019. Since 2011, TAS has received more than 2 million taxpayer cases, of which almost half were referrals from other IRS offices. TAS closed more cases than it received each year from 2012 to 2017, but its inventory has grown since fiscal year 2018, due in part to attrition in case advocacy staff and an increase in taxpayers seeking assistance (see figure below). Number of Taxpayer Cases Received and Closed, Fiscal Years 2011 to 2020 TAS has recently modified its two mandated reports to Congress by reducing their length and separately compiling legislative recommendations. It shortened its annual reports in part because the Taxpayer First Act reduced the required number of most serious taxpayer problems from “at least 20” to “the 10” most serious problems. GAO identified the following additional actions that could further improve TAS reporting. Report outcome-oriented objectives and progress. The objectives for the upcoming fiscal year that TAS included in its most recent report are not always clearly identified and do not link to the various planned activities that are described. Further, the objectives TAS does identify do not include measurable outcomes. In addition, TAS's reports do not include the actual results achieved against objectives so it is not possible to assess related performance and progress. Improved performance reporting could help both TAS and Congress better understand which activities are contributing toward achieving TAS's objectives and where actions may be needed to address any unmet goals. Consult with Congress and other stakeholders. TAS briefs congressional committees each year after publishing its annual report and solicits perspectives from stakeholders. TAS officials said they incorporate the perspectives into its objectives. However, TAS does not follow leading practices to consult congressional committees about its goals and objectives prior to publication at least once every 2 years. Thus, it misses opportunities to obtain congressional input on its objectives and performance reporting. Consultations would provide TAS opportunities to confirm if its goals incorporate congressional and other stakeholder perspectives and whether its reports meet their information needs. Publish updates on recommendation implementation status. By law, TAS's annual report must include an inventory of actions IRS has fully, partially, and not yet taken on TAS's recommendations to address the most serious problems facing taxpayers. If those recommendations take multiple years to implement, which some have as shown in the table below, updating the inventory would be required. In its objectives reports, TAS provides only a one-time inventory of IRS responses to TAS's recommendations made during the preceding year, including plans and preliminary actions taken for those IRS accepts for implementation. TAS does not publicly update the inventory in subsequent annual reports to reflect actions IRS takes or does not take to address TAS's recommendations. This reporting approach does not provide complete information on the status of actions IRS has taken to address serious problems facing taxpayers and also does not provide the information in the annual report, as required. Publishing such updated status information would support congressional oversight. Taxpayer Advocate Service's (TAS) Recommendation Reporting and Status as of the Fourth Quarter of Fiscal Year 2020 GAO also identified options for TAS to consider to improve its reporting. These options include explaining changes to the list of the most serious taxpayer problems from year to year and streamlining report sections congressional staff use less frequently. Why GAO Did This Study TAS, an independent office within IRS, helps taxpayers resolve problems with IRS and addresses broader, systemic issues that affect groups of taxpayers by recommending administrative and legislative changes to mitigate such problems. Congress mandated that TAS issue two reports every year—one known as the annual report which includes sections on, among other things, the 10 most serious problems encountered by taxpayers, and the other known as the objectives report that discusses organizational objectives. GAO was asked to review how TAS carries out its mission, focusing on resources and reporting. This report (1) describes TAS's resources and workload, and (2) assesses TAS's reporting to Congress and identifies opportunities for improvement. GAO reviewed documents from TAS, IRS, and other sources, including TAS's annual and objectives reports and internal guidance; analyzed TAS's budget, staffing, and workload data for fiscal years 2011 through 2020; and interviewed knowledgeable TAS and IRS officials. GAO assessed TAS's reporting of its objectives and performance against statutory requirements, relevant internal control standards, and selected key practices for performance reporting developed by GAO. In addition, GAO reviewed relevant TAS web pages, analyzed the length and composition of TAS's reports, and interviewed key congressional committee staff to identify additional options to improve TAS's reporting.

Contractor Oversight: Information on the National Nuclear Security Administration's Report on Burdensome Regulatory Requirements

What GAO Found In 2019, the Department of Energy's (DOE)'s National Nuclear Security Administration (NNSA) provided a report to Congress on its findings from its survey of the seven contractors that manage and operate its nuclear security enterprise sites to identify requirements the contractors viewed as burdensome. This survey was congressionally mandated after reports by external groups found that the environment in which NNSA carried out its oversight of such management and operating (M&O) contractors was strained. GAO reviewed information on the following three areas related to NNSA's report: Comparison of NNSA's findings with related reports. GAO found that during the past 10 years, three external groups carried out studies and assessments of the nuclear security enterprise and issued reports citing ways NNSA's oversight has contributed to burden for M&O contractors. These groups were all directed by Congress to complete their studies, which were published between 2014 and 2020. Their reports also cite ways in which NNSA's oversight may have contributed to increased costs or reduced mission capabilities. NNSA's Burdensome Regulatory Requirements report explicitly identifies 91 requirements that M&O contractors found burdensome; these include requirements found in sources such as DOE and NNSA directives, federal regulations, and statutes. NNSA's approach to collecting and reporting information on requirements that M&O contractors identified as burdensome. NNSA first collected information on the requirements the contractors viewed as burdensome, and second, asked the contractors to rate these requirements based on the likelihood that the requirement could be changed and the effects such a change would have on cost savings, morale, recruitment and retention, and mission capability. While NNSA did not provide a definition to its contractors of what constituted a "burdensome" requirement, some contractors created their own definitions, while others told us the definition was understood based on the previously published related reports. GAO interviewed M&O contractor representatives and found that their definitions of what constituted a "burdensome requirement" varied. Also, the seven M&O contractors used different approaches to identify and rate requirements they considered burdensome. However, multiple M&O contractors identified the same requirements, or sources of those requirements, as burdensome. For example, one contractor identified the entire DOE Order for Program and Project Management of the Acquisition of Capital Assets (DOE Order 413.3B) as burdensome, while another contractor identified specific requirements within the same order as burdensome. NNSA actions to address matters that M&O contractors identified as burdensome. In its report, NNSA included a list of 16 matters that it committed to reviewing based on the rating data it collected from M&O contractors and input from members of the Operations and Efficiencies Board, an internal body established to improve coordination and collaboration across NNSA's sites. According to NNSA officials, 10 matters are under revision or have been changed; two matters were reviewed, but no changes were made; and four matters were reviewed, and M&O contractor input will be considered should the regulation undergo a revision in the future. NNSA's list of matters included DOE directives, federal requirements, and an M&O contract change. According to agency officials, NNSA chose to prioritize its review of certain matters because the agency did not have the resources to review all 91 requirements that M&O contractors identified as burdensome. NNSA provided technical comments on a draft of this report, which were incorporated as appropriate. Why GAO Did This Study NNSA is responsible for maintaining a safe, secure, and reliable nuclear stockpile and relies on and oversees contractors who manage and operate its laboratory and production sites. NNSA's M&O contracts include requirements for contractors to adhere to laws, regulations, and DOE and NNSA directives. NNSA also has processes to hold contractors accountable for meeting these requirements. Senate Report 115-262, accompanying the John S. McCain National Defense Authorization Act for Fiscal Year 2019, directed NNSA to collect information from its M&O contractors on specific requirements they deemed particularly burdensome and to publish this information in a report. Senate Report 115-262 also included a provision for GAO to review NNSA's report. GAO's report provides information on (1) a comparison of NNSA's findings with findings reported by external groups, (2) NNSA's approach to collecting and reporting information on requirements the M&O contractors identified as burdensome, and (3) NNSA's actions to address the requirements that the M&O contractors identified. GAO reviewed NNSA's 2019 report and supplemental documents and interviewed NNSA officials and M&O contractor representatives. For more information, contact Allison Bawden at (202) 512-3841 or

Financial Services Industry: Factors Affecting Careers for Women with STEM Degrees

What GAO Found Several factors affect women's participation in Science, Technology, Engineering, and Math (STEM) degree programs and subsequent careers in the financial services industry, according to research and stakeholders GAO interviewed. These factors include young girls' early exposure to STEM topics, access to resources such as computers and high-speed internet, and a sense of whether they belong in STEM degree programs. Women's interest in a financial services career also may be affected by the presence of role models and awareness of job opportunities. In recent years, women have represented roughly 30 percent of financial services industry workers with STEM degrees (see figure). Financial Services Industry Workers with Degrees in Science, Technology, Engineering, and Math (STEM) by Gender, Fiscal Years 2014-2019 To encourage elementary and high school girls to learn about STEM, selected financial services firms provide funding and other support to nonprofit organizations that focus on increasing girls' participation in STEM. With this support, nonprofit organizations introduce girls to coding, basic programming, and other activities that may inspire interest in STEM education. Similarly, to encourage college women to pursue STEM degrees, selected firms sponsor conferences for women in STEM, offer scholarships to women studying STEM, and work with nonprofit organizations to help increase students' awareness of careers in the financial services industry. Selected financial services firms recruit women with STEM degrees by collaborating with organizations that work with women STEM majors and sponsoring conferences for women in technology, among other efforts. Some firms have employee retention practices that are tailored to women with STEM expertise. For example, selected firms offer leadership training or employee resource groups for women in technology. Why GAO Did This Study The financial services industry is highly dependent on technology and more than one-fifth of industry employees have STEM degrees. Women continue to be underrepresented in management positions in the financial services industry and in STEM degree programs. As a result, some financial services firms have made efforts to promote interest among women in both STEM and financial services. GAO was asked to review factors affecting financial services careers for women with STEM degrees. This report examines (1) factors that affect the participation of women in STEM degree programs and subsequent participation in financial services careers, (2) how selected financial services firms encourage girls and women to participate in STEM education programs, and (3) how selected financial services firms recruit and retain women with STEM backgrounds. GAO analyzed Equal Employment Opportunity Commission (EEOC) and Department of Education data from 2014 through 2018 and Census Bureau data from 2014 through 2019. At the time of analysis, these were the most recent data available. GAO also reviewed studies on financial services and STEM education. GAO interviewed representatives of financial services firms, industry associations, and nonprofit organizations. GAO selected organizations and representatives based on their participation in previous work and a literature review. EEOC and the Board of Governors of the Federal Reserve System provided technical comments on a draft that GAO incorporated as appropriate. For more information, contact Alicia Puente Cackley at (202) 512-8678 or

VA COVID-19 Procurements: Pandemic Underscores Urgent Need to Modernize Supply Chain

What GAO Found Like most medical institutions nationwide, the Department of Veterans Affairs (VA) faced difficulties obtaining medical supplies, including personal protective equipment for its medical workforce, particularly in the early stages of the COVID-19 pandemic. Long-standing problems with its antiquated inventory management system exacerbated VA's challenges. GAO found VA obligated over $4 billion for COVID-19-related products, such as ventilators, and services, such as information technology to support VA's telework environment, as of May 2021. GAO also found that some vendors were unable to deliver personal protective equipment, which resulted in VA terminating some contracts, particularly early in the pandemic. VA also took additional steps to screen vendors. VA has several initiatives underway to modernize its supply chain and prepare for future public health emergencies, but each faces delays and is in early stages (see figure). For example: Inventory management. VA intended to replace its system with the Defense Medical Logistics Standard Support (DMLSS), with initial implementation in October 2019, and enterprise-wide implementation by 2027. Prior to the pandemic, however, this schedule was at significant risk. VA hopes to accelerate full implementation to 2025, and has received COVID-19 supplemental funds to help, but it is too soon to tell if this will occur. Regional Readiness Centers. VA planned to establish four centers—as central sources of critical medical supplies—by December 2020. As of March 2021, VA has not completed a concept of operations or implementation plan for the project. VA faces an additional year delay in achieving full operational capability, which is now expected in 2023. According to VA officials, the pandemic, among other things, contributed to delays. Warstopper program. VA seeks participation in this Defense Logistics Agency program, which would allow VA emergency access to critical supplies. Legislation recently was introduced to require VA participation. However, as GAO reported in March 2021, several questions remain, such as the range of products the program will cover, the amount of funding needed, and the way the program links to Regional Readiness Centers. Department of Veterans Affairs' Selected Ongoing and New Supply Chain Initiatives, Fiscal Years 2021 through 2028 Why GAO Did This Study In March 2020 and March 2021, Congress appropriated $19.6 billion and $17 billion in supplemental funds, respectively, for VA's COVID-19 response effort. VA also authorized use of emergency flexibilities and automated aspects of its inventory system. In accordance with Congress's direction in the CARES Act to monitor the exercise of authorities and use of funds provided to prepare for, respond to, and recover from the pandemic, relevant committees requested our sustained focus on VA. GAO was asked to assess VA's acquisition management during its COVID-19 pandemic response. This report examines VA's efforts to obtain and track COVID-19-related products and services amid its ongoing struggle to improve its inventory and supply chain management. GAO reviewed federal procurement data, analyzed selected VA contract documents, reviewed selected interagency agreements, assessed VA documents on modernization and other initiatives, and interviewed VA officials and staff.

Capitol Police: Applying Effective Practices to Address Recommendations Will Improve Oversight and Management

What GAO Found The U.S. Capitol Police (Capitol Police) may benefit from applying practices to help implement recommendations from auditing entities, such as those from GAO and the Capitol Police Office of the Inspector General (OIG). These effective practices include the following: Provide management oversight over the prompt remediation of deficiencies and delegate authority. Federal internal control standards state that management should oversee the prompt remediation of deficiencies. This should be done by communicating the corrective actions to the appropriate personnel and delegating authority for completing these actions. Communicate regularly with auditing entities on the status of recommendations. Engagement between Capitol Police and auditing agency leaders could provide important leadership attention to help ensure actions are taken to implement recommendations. Work with Congress to address recommendations. Congress plays a key role in providing oversight and maintaining focus on recommendations from audit entities. For example, federal agencies, including the Capitol Police, are required to report on the implementation status of public recommendations. Further, agencies can also assess the need for legislation to address recommendations and report their findings to Congress. Follow key organizational transformation practices . As the Capitol Police takes steps to implement recommendations from auditing entities, the agency may benefit from following key organizational transformation practices, such as (1) setting implementation goals and a timeline, (2) dedicating an implementation team to manage the transformation process, and (3) involving employees to obtain their ideas and gain their ownership for the transformation. Coordination between the Capitol Police and its Board is critical to addressing its recommendations. The Capitol Police Board (the Board) is charged with oversight of the Capitol Police. Given the oversight role of the Board, the Capitol Police may need approval from the Board in order to take actions to address recommendations from auditing entities. GAO's 2017 work on the Board assessed whether the Board, in fulfilling its role in overseeing the Capitol Police, had developed and implemented policies that incorporate leading practices to facilitate accountability, transparency, and effective external communication. In that effort, GAO examined the Board's main governing document, its Manual of Procedures, and determined that it fully incorporated one leading practice and partially incorporated five others. Specifically, the Board's manual did develop processes for the internal functions of the Board but did not address any Board responsibilities in ensuring that any audit findings and recommendations to the Capitol Police were promptly resolved. By incorporating leading practices into its manual, the Board can ensure it is facilitating accountability, transparency, and effective external communication as it fulfills its oversight role of the Capitol Police. Why GAO Did This Study The attack on the U.S. Capitol on January 6, 2021, highlighted the critical need to identify and address deficiencies in the management and security functions of the Capitol Police. Various auditing entities have work ongoing related to the attack on the U.S. Capitol, including GAO and the Capitol Police OIG. It is important that the Capitol Police is well positioned to respond to existing and future recommendations from auditing entities. To do so, Capitol Police will also need to work closely with the Capitol Police Board, which has varied and wide-ranging oversight roles and responsibilities per statute. This statement discusses (1) effective practices for addressing recommendations from auditing agencies and (2) GAO's open recommendation to the Capitol Police Board from February 2017. To identify effective practices for addressing recommendations, GAO reviewed reports and testimonies issued from July 2003 through March 2021 that discussed the implementation of GAO recommendations, federal internal control standards, and organizational transformation. GAO also reviewed its February 2017 report on the Capitol Police Board, and used information gathered from its recommendation follow up efforts with the Capitol Police Board in 2020 and 2021.