Bøger af U S Government Accountability Office

"The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform five duties related to health care quality measurement and authorized $40 million from the Medicare Trust Funds for the contract. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), under which HHS will reimburse NQF for its costs and pay additional fixed fees. Established in 1999, NQF is a nonprofit member organization that fosters agreement on national standards for measuring and public reporting of health care performance data. This is the first of two reports MIPPA requires GAO to submit on NQF's contract with HHS. In this report, which covers the first contract year-January 14, 2009, to January 13, 2010-GAO describes (1) the status of NQF's work on the five duties under MIPPA; (2) the costs and fixed fees NQF has reported; and (3) what NQF and HHS do in order to help ensure that NQF's reported costs are proper. GAO reviewed relevant MIPPA provisions and reviewed HHS and NQF documents, such as HHS's contract with NQF, monthly progress reports and invoices for the first contract year, and policies..."

The President has announced his intention to improve the acquisition process, particularly given the half a trillion dollars the federal government spent in fiscal year 2009 on acquiring goods and services. The Department of Defense (DOD) spent $384 billion in fiscal year 2009 on goods and servicesdouble what it spent in 2001. A high-quality workforce with the right competencies and skill sets will be critical to improving DOD acquisitions.GAO was mandated to determine the efficacy of DODs certification training for its acquisition workforce. GAO assessed (1) DODs capability to provide certification training, (2) the extent that such training reaches members of the workforce, and (3) the extent that previous training recommendations have been implemented. To conduct this work, GAO compared DODs certification training to GAO guidance for effective training programs and analyzed policies, data, and previous reports on acquisition training.

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agencies using a service level agreement (SLA) in a contract when acquiring information technology (IT) services through a cloud computing services provider. An SLA defines the level of service and performance expected from a provider, how that performance will be measured, and what enforcement mechanisms will be used to ensure the specified performance levels are achieved. GAO identified ten key practices to be included in an SLA, such as identifying the roles and responsibilities of major stakeholders, defining performance objectives, and specifying security metrics. The key practices, if properly implemented, can help agencies ensure services are performed effectively, efficiently, and securely. Under the direction of the Office of Management and Budget (OMB), guidance issued to agencies in February 2012 included seven of the ten key practices described in this report that could help agencies ensure the effectiveness of their cloud services contracts. GAO determined that the five agencies and the 21 cloud service contracts it reviewed had included a majority of the ten key practices. Specifically, of the 21 cloud service contracts reviewed from the Departments of Defense, Health and Human Services, Homeland Security, Treasury, and Veterans Affairs, 7 had fulfilled all 10 of the key practices, as illustrated in the figure. The remaining 13 contracts had incorporated 5 or more of the 10 key practices and 1 had not included any practices.

"To be competitive in the global economy, the United States relies heavily on innovation through research and development (R&D). The Small Business Innovation Development Act of 1982 established the Small Business Innovation Research (SBIR) Program to stimulate technological innovation among small businesses. SBIR offers one avenue for introducing technological innovation in the Department of Defense (DOD) space sector. GAO was asked to assess (1) the extent to which DOD is utilizing the SBIR program to develop and transition space-related technologies; and (2) whether small businesses face challenges to participating in the space industrial base. To do this, GAO analyzed program documentation and DOD data on the SBIR program and interviewed key officials. "

Tax evasion by individuals with unreported offshore financial accounts was estimated by one IRS commissioner to be several tens of billions of dollars, but no precise figure exists. IRS has operated four offshore programs since 2003 that offered incentives for taxpayers to disclose their offshore accounts and pay delinquent taxes, interest, and penalties. GAO was asked to review IRS's second offshore program, the 2009 OVDP. This report (1) describes the nature of the noncompliance of 2009 OVDP participants, (2) determines the extent IRS used the 2009 OVDP to prevent noncompliance, and (3) assesses IRS's efforts to detect taxpayers trying to circumvent taxes, interests, and penalties that would otherwise be owed. To address these objectives, GAO analyzed tax return data for all 2009 OVDP participants and exam files for a random sample of cases with penalties over $1 million; interviewed IRS Offshore officials; and developed and implemented a methodology to detect taxpayers circumventing monies owed. As of December 2012, the Internal Revenue Service's (IRS) four offshore programs have resulted in more than 39,000 disclosures by taxpayers and over $5.5 billion in revenues. The offshore programs attract taxpayers by offering a reduced risk of criminal prosecution and lower penalties than if the unreported income was discovered by one of IRS's other enforcement programs. For the 2009 Offshore Voluntary Disclosure Program (OVDP), nearly all program participants received the standard offshore penalty-20 percent of the highest aggregate value of the accounts-meaning the account value was greater than $75,000 and taxpayers used the accounts (e.g., made deposits or withdrawals) during the period under review. The median account balance of the more than 10,000 cases closed so far from the 2009 OVDP was $570,000. Participant cases with offshore penalties greater than $1 million represented about 6 percent of all 2009 OVDP cases, but accounted for almost half of all offshore penalties. Taxpayers from these cases disclosed a variety of reasons for having offshore accounts, and more than half of them had accounts at Swiss bank UBS. Using 2009 OVDP data, IRS identified bank names and account locations that helped it pursue additional noncompliance. Based on a review of cases, GAO found examples of immigrants who stated in their 2009 OVDP applications that they were unaware of their offshore reporting requirements. IRS officials from the Offshore Compliance Initiative office said they have not targeted outreach efforts to new immigrants. Using information from the 2009 OVDP, such as the characteristics of taxpayers who were not aware of their reporting requirements, to increase education and outreach to those populations could promote voluntary compliance. IRS has detected some taxpayers with previously undisclosed offshore accounts attempting to circumvent paying the taxes, interest, and penalties that would otherwise be owed, but based on GAO reviews of IRS data, IRS may be missing attempts by other taxpayers attempting to do so. GAO analyzed amended returns filed for tax year 2003 through tax year 2008, matched them to other information available to IRS about taxpayers' possible offshore activities, and found many more potential quiet disclosures than IRS detected. Moreover, IRS has not researched whether sharp increases in taxpayers reporting offshore accounts for the first time is due to efforts to circumvent monies owed, thereby missing opportunities to help ensure compliance. From tax year 2007 through tax year 2010, IRS estimates that the number of taxpayers reporting foreign accounts nearly doubled to 516,000. Taxpayer attempts to circumvent taxes, interest, and penalties by not participating in an offshore program, but instead simply amending past returns or reporting on current returns previously unreported offshore accounts, result in lost revenues and undermine the programs' effectiveness. GAO-13-318

"Two years after the Department of the Treasury (Treasury) first made available up to $50 billion for the Making Home Affordable (MHA) program, foreclosure rates remain at historically high levels. Treasury recently introduced several new programs intended to further help homeowners. This report examines (1) the status of three of these new programs, (2) characteristics of homeowners with first-lien modifications from the Home Affordable Modification Program (HAMP), and (3) the outcomes for borrowers who were denied or fell out of first-lien modifications. To address these questions, GAO analyzed data from Treasury and six large MHA servicers. "

" Medicare spent about $10.1 billion in 2011 on dialysis treatments and related items and services for about 365,000 beneficiaries with end-stage renal disease (ESRD). Most individuals with ESRD are eligible for Medicare. As required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS implemented the LVPA to compensate dialysis facilities that provided a low volume of dialysis treatments for the higher costs they incurred. MIPPA required GAO to study the LVPA; GAO examined (1) the extent to which the LVPA targeted low-volume, high-cost facilities that appeared necessary for ensuring access to care and (2) CMS's implementation of the LVPA, including the extent to which CMS paid the 2011 LVPA to facilities eligible to receive it. To do this work, GAO reviewed Medicare claims, facilities' annual reports of their costs, and data on dialysis facilities' location to identify and compare facilities that were eligible for the LVPA with those that received it. "

" PPACA created the Innovation Center within CMS. The purpose of the Innovation Center is to test new approaches to health care delivery and payment-known as models-for use in Medicare or Medicaid. GAO was asked to review the implementation of the Innovation Center. Specifically, GAO: (1) describes the center's activities, funding, organization, and staffing as of March 31, 2012; (2) describes the center's plans for evaluating its models and its own performance; and (3) examines whether efforts of the center overlap with those of other CMS offices and how the center coordinates with other offices. GAO analyzed budget and staffing data; reviewed available documentation, such as Innovation Center policies and procedures and functional statements for CMS offices; and interviewed officials from the Innovation Center and other CMS offices, such as the Center for Medicare. GAO assessed how the Innovation Center coordinates in the context of federal internal control standards and key practices for collaboration from prior GAO work. "

The tax filing season is an enormousundertaking in which the InternalRevenue Service (IRS) processesmillions of tax returns, issues billions ofdollars in refunds to taxpayers, corrects taxpayers errors, andprovides service to millions oftaxpayers through telephones, website, and face-to-face assistance. Amongother things, GAO was asked toassess (1) IRSs performanceprocessing returns and issuingrefunds, and providing telephoneassistance, and (2) IRSs plans toexpand self-service options on itswebsite. To conduct the analyses, GAO obtained and compared datafrom 2007 through 2011, reviewed IRSdocuments, interviewed IRS officials, observed IRS operations, andinterviewed tax-industry experts, including from tax preparation f

"In 2007, following reports of poor case management for outpatients at Walter Reed Army Medical Center, the Departments of Defense (DOD) and Veterans Affairs (VA) jointly developed the Federal Recovery Coordination Program (FRCP) to coordinate the clinical and nonclinical services needed by severely wounded, ill, and injured servicemembers and veterans. The FRCP, which continues to expand, is administered by VA, and the care coordinators, called Federal Recovery Coordinators (FRC), are VA employees. This report examines (1) whether servicemembers and veterans who need FRCP services are being identified and enrolled in the program, (2) staffing challenges confronting the FRCP, and (3) challenges facing the FRCP in its efforts to coordinate care for enrollees. GAO reviewed FRCP policies and procedures and conducted over 170 interviews of FRCP officials, FRCs, headquarters officials and staff of DOD and VA case management programs, and staff at medical facilities where FRCs are located. GAO recommends that VA direct the FRCP Executive Director to establish systematic oversight of enrollment decisions, complete development of a workload assessment tool, document staffing decisions, and develop..."

" In May 2010, the Secretary of Defense announced a department-wide initiative with the goal of achieving efficiencies and reducing excess overhead costs while reinvesting those savings in sustaining DOD's force structure and modernizing its weapons portfolio. The Secretary tasked the military departments and SOCOM to find estimated savings of about $100 billion over the period of fiscal years 2012 to 2016. For fiscal years 2013 and 2014, DOD identified additional efficiency initiatives. The National Defense Authorization Act for Fiscal Year 2012 mandated that GAO assess the extent to which DOD has tracked and realized savings proposed pursuant to the initiative to identify $100 billion in efficiencies. As the second report in response to this mandate, this report addresses 1) DOD's progress in adjusting its approach to tracking and reporting on the implementation of its efficiency initiatives since GAO's December 2012 report, and 2) the extent to which DOD is evaluating the impact of its initiatives. GAO reviewed guidance, and analyzed and discussed information developed after December 2012 with DOD officials. "

" HUD's MTW demonstration program gives participating PHAs the flexibility to create innovative housing strategies through their fiscal year 2018. MTW agencies must create activities linked to three statutory purposes-reducing costs, providing incentives for self-sufficiency, and increasing housing choices-and meet five statutory requirements. Congress is considering expanding MTW and has asked GAO to examine what is known about (1) the program's success in addressing the three purposes, (2) HUD's monitoring efforts, and (3) the potential benefits of and concerns about expansion. GAO analyzed the most current annual reports for 30 MTW agencies; compared HUD's monitoring efforts with internal control standards; and interviewed agency officials, researchers, and industry officials. "

" The federal government collects, maintains, and uses geospatial information-information linked to specific geographic locations-to support many functions, including national security and disaster response. In 2012, the Department of the Interior (Interior) estimated that the federal government invests billions of dollars on geospatial data annually, and that duplication is common. GAO was asked to determine the extent to which the federal government has established and effectively implemented policies and procedures for coordinating its geospatial investments and avoiding duplication. To do so, GAO focused on FGDC coordination activities; efforts within the departments of Commerce, the Interior, and Transportation; and OMB oversight. GAO reviewed FGDC and department documentation, such as policies, procedures, and strategic plans; OMB guidance and an executive order; and reports concerning duplicative investments. "

"The President issued Homeland Security Presidential Directive (HSPD) -9 in 2004 to establish a national policy to defend the food and agriculture systems against terrorist attacks, major disasters, and other emergencies. HSPD-9 assigns various emergency response and recovery responsibilities to the Departments of Agriculture (USDA), Health and Human Services (HHS), Homeland Security (DHS), and others. In addition, Emergency Support Function (ESF) -11 addresses the federal food and agriculture response during emergencies and is coordinated by USDA. GAO was asked to evaluate (1) the extent to which there is oversight of federal agencies' overall progress in implementing HSPD-9; (2) the steps USDA has taken to implement its HSPD-9 responsibilities for response and recovery and challenges, if any; and (3) the circumstances under which USDA has coordinated an ESF-11 response and challenges it faces, if any. GAO reviewed key documents; surveyed states; and interviewed agency, state, and industry officials. "

"Since 1998, the Federal Communications Commission's (FCC) Schools and Libraries Universal Service Support Mechanism-commonly known as the "E-rate" program-has been a significant federal source of technology funding for schools and libraries. FCC designated the Universal Service Administrative Company (USAC) to administer the program. As requested, GAO examined the system of internal controls in place to safeguard E-rate program resources. This report discusses (1) the internal controls FCC and USAC have established and (2) whether the design of E-rate's internal control structure appropriately considers program risks. GAO reviewed the program's key internal controls, risk assessments, and policies and procedures; assessed the design of the internal control structure against federal standards for internal control; and interviewed FCC and USAC officials. "

" About 42 million workers, or about one-third of all private-sector employees, work for employers with fewer than 100 employees, and recent federal data suggest many of these workers lack access to work-based retirement benefits. Despite efforts by the federal government to develop new plan designs and to increase tax incentives, plan sponsorship remains low among small employers. MEPs, a type of arrangement involving more than one employer, have been suggested as a potential way to increase coverage. This testimony describes (1) the challenges small employers face in helping ensure that their workers secure retirement income, and (2) types of MEPs and their potential to address these challenges. GAO drew from its previous reports related to small employer challenges in establishing and maintaining a retirement plan and recent work on MEPs issued from March 2012 through September 2012. "

Wind energy has been the fastest growing source of U.S. electric power generation in recent years. The increase in federal funding for wind technologies and involvement of multiple agencies has raised questions about fragmented, overlapping, or duplicative federal support. In this report, GAO examines federal wind-related initiatives-programs or groups of agency activities that promoted wind energy through a specific emphasis or focus. GAO (1) identifies wind-related initiatives implemented by federal agencies in fiscal year 2011 and their key characteristics; (2) assesses the extent of fragmentation, overlap, and duplication, if any, among these initiatives, and the extent to which they were coordinated; and (3) examines how agencies allocate support to projects through their initiatives and the extent to which they assess applicant need for support. GAO identified 82 federal wind-related initiatives, with a variety of key characteristics, implemented by nine agencies in fiscal year 2011. Five agencies-the Departments of Energy (DOE), the Interior, Agriculture (USDA), Commerce, and the Treasury-collectively implemented 73 of the initiatives. Initiatives supporting deployment of wind facilities, such as those financing their construction or use, constituted the majority of initiatives and accounted for nearly all obligations and estimated tax subsidies related to wind in fiscal year 2011. In particular, a tax expenditure and a grant initiative, both administered by Treasury, accounted for nearly all federal financial support for wind energy. The 82 wind-related initiatives GAO identified were fragmented across agencies, most had overlapping characteristics, and several that financed deployment of wind facilities provided some duplicative financial support. The 82 initiatives were fragmented because they were implemented across nine agencies, and 68 overlapped with at least one other initiative because of shared characteristics. About half of all initiatives reported formal coordination. Such coordination can, in principle, reduce the risk of unnecessary duplication and improve the effectiveness of federal efforts. However, GAO identified 7 initiatives that have provided duplicative support-financial support from multiple initiatives to the same recipient for deployment of a single project. GAO also identified 3 other initiatives that did not fund any wind projects in fiscal year 2011 but that could, based on their eligibility criteria, be combined with 1 or more initiatives to provide duplicative support. Of the 10 initiatives, those at Treasury accounted for over 95 percent of the federal financial support for wind in fiscal year 2011. Agencies implementing the 10 initiatives allocate support to projects on the basis of the initiatives' goals or eligibility criteria, but the extent to which applicant financial need is considered is unclear. DOE and USDA allocate support based on projects' ability to meet initiative goals such as reducing emissions or benefitting rural communities, as well as other criteria. Both agencies also consider applicant need for the support of some initiatives, according to officials. However, GAO found that neither agency documents assessments of applicant need; therefore the extent to which they use such assessments to determine how much support to provide is unclear. Unlike DOE and USDA, Treasury generally supports projects based on the tax code's eligibility criteria and does not have discretion to allocate support to projects based on need. While the support of these initiatives may be necessary in many cases for wind projects to be built, because agencies do not document assessments of need, it is unclear, in some cases, if the entire amount of federal support provided was necessary. Federal support in excess of what is needed to induce projects to be built could instead be used to induce other projects to be built or simply withheld, thereby reducing federal expenditures. GAO-13-136

" The School Improvement Grant (SIG) program funds reforms in low performing schools. Congress provided $3.5 billion for SIG in fiscal year 2009, and a total of about $1.6 billion was appropriated in fiscal years 2010-2012. SIG requirements changed significantly in 2010. Many schools receiving SIG funds must now use the funding for specific interventions, such as turning over certain school operations to an outside organization (contractor). GAO examined (1) what, if any, aspects of SIG pose challenges for successful implementation; (2) how Education and state guidance and procedures for screening potential contractors and reviewing contractor performance compare with leading practices; and (3) to what extent Education's technical assistance and oversight activities are effectively supporting SIG implementation. GAO surveyed SIG directors in all 50 states and the District of Columbia; analyzed Education and state documents; and interviewed officials from 8 states and school districts in those states, SIG contractors, and education experts. "

" Personnel management is important to the mission of federal agencies. Several high-profile enforcement failures have raised concerns about SEC's personnel management. Section 962 of the Dodd-Frank Wall Street Reform and Consumer Protection Act mandates GAO to report on SEC's personnel management. This report examines (1) SEC's organizational culture and (2) its personnel management challenges and efforts to address these challenges. GAO assessed SEC's personnel management systems against OPM guidance and other criteria related to workforce planning and performance management (which includes appraisals and feedback); reviewed relevant reports; surveyed SEC employees and senior management (with 78 and 74 percent response rates, respectively) to gather their views on SEC's organizational culture and personnel management practices; and spoke with former employees, the SEC Inspector General, representatives of the employees' union, financial industry associations, consulting firms, and academics. "

" UAS do not carry a pilot on board, but instead operate on pre-programmed routes and by following commands from pilot-operated ground stations. UAS can be small, generally 55 pounds or less, or large. Current domestic uses include law enforcement, forest fire monitoring, border security, weather research, and scientific data collection. However, current uses are limited. FAA authorizes UAS operations on a case-by-case basis after conducting a safety review. FAA and the other federal agencies that have a role or interest in UAS are working to provide routine access for UAS into the national airspace system. As requested, this report discusses (1) the status of obstacles identified in GAO's 2008 report to integrate UAS into the national airspace system, (2) FAA's progress in meeting its congressional requirements for UAS, and (3) emerging issues. GAO reviewed and analyzed documents and interviewed relevant government, academic, and private-sector entities, as well as UAS users and civil liberties organizations. "

U.S. Customs and Border Protection (CBP) data indicate that arrests of CBP employees for corruption-related activities since fiscal years 2005 account for less than 1 percent of CBP's entire workforce per fiscal year. The majority of arrests of CBP employees were related to misconduct. There were 2,170 reported incidents of arrests for acts of misconduct such as domestic violence or driving under the influence from fiscal year 2005 through fiscal year 2012, and a total of 144 current or former CBP employees were arrested or indicted for corruption-related activities, such as the smuggling of aliens and drugs, of whom 125 have been convicted as of October 2012. Further, the majority of allegations against CBP employees since fiscal year 2006 occurred at locations along the southwest border. CBP officials have stated that they are concerned about the negative impact that these cases have on agency wide integrity. CBP employs screening tools to mitigate the risk of employee corruption and misconduct for both applicants (e.g., background investigations and polygraph examinations) and incumbent CBP officers and Border Patrol agents (e.g., random drug tests and periodic reinvestigations). However, CBP's Office of Internal Affairs (IA) does not have a mechanism to maintain and track data on which of its screening tools (e.g., background investigation or polygraph examination) provided the information used to determine which applicants were not suitable for hire. Maintaining and tracking such data is consistent with internal control standards and could better position CBP IA to gauge the relative effectiveness of its screening tools. CBP IA is also considering requiring periodic polygraphs for incumbent officers and agents; however, it has not yet fully assessed the feasibility of expanding the program. For example, CBP has not yet fully assessed the costs of implementing polygraph examinations on incumbent officers and agents, including costs for additional supervisors and adjudicators, or factors such as the trade-offs associated with testing incumbent officers and agents at various frequencies. A feasibility assessment of program expansion could better position CBP to determine whether and how to best achieve its goal of strengthening integrity-related controls for officers and agents. Further, CBP IA has not consistently conducted monthly quality assurance reviews of its adjudications since 2008, as required by internal policies, to help ensure that adjudicators are following procedures in evaluating the results of the preemployment and periodic background investigations. CBP IA officials stated that they have performed some of the required checks since 2008, but they could not provide data on how many checks were conducted. Without these quality assurance checks, it is difficult for CBP IA to determine the extent to which deficiencies, if any, exist in the adjudication process. CBP does not have an integrity strategy, as called for in its Fiscal Year 2009-2014 Strategic Plan. During the course of our review, CBP IA began drafting a strategy, but CBP IA's Assistant Commissioner stated the agency has not set target timelines for completing and implementing this strategy. Moreover, he stated that there has been significant cultural resistance among some CBP components in acknowledging CBP IA's authority for overseeing all integrity-related activities. Setting target timelines is consistent with program management standards and could help CBP monitor progress made toward the development and implementation of an agency wide strategy.

" MA organizations are entities that contract with the Centers for Medicare & Medicaid Services (CMS) to offer one or more private plans as an alternative to the Medicare fee-for-service (FFS) program. These MA plans are generally available to all Medicare beneficiaries, although certain types of plans, such as employer group plans, have specific eligibility requirements. Payments to MA organizations are based, in part, on the projected expenses and profits that MA organizations submit to CMS. These projections also affect (1) the extent to which MA beneficiaries receive additional benefits not provided under FFS and (2) beneficiary cost-sharing and premium amounts. The Patient Protection and Affordable Care Act (PPACA) required that, starting in 2014, MA organizations have a minimum medical loss ratio of 85 percent-that is, they must spend 85 percent of revenue on medical expenses, quality-improving activities, and reduced premiums. This report examines how MA organizations' actual expenses and profits for 2011 as a percentage of revenue and in dollars compared to projections for the same year, both for plans available to all Medicare beneficiaries and for plans with specific eligibility requirements. GAO analyzed data on MA organizations' projected and actual allocation of revenue to expenses and profits. The percentage of revenue spent on medical expenses reported in GAO's study is not directly comparable to the PPACA medical"

"The Department of Defense (DOD) provides health care and mental health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through TRICARE Prime, an option that includes the use of civilian provider networks and requires enrollment. TRICARE beneficiaries who do not enroll in this option may obtain care from nonnetwork providers through TRICARE Standard, or from network providers through TRICARE Extra. In addition, qualified National Guard and Reserve servicemembers may purchase TRICARE Reserve Select, a plan whose care options are similar to those of TRICARE Standard and TRICARE Extra. We refer to servicemembers who use TRICARE Standard, TRICARE Extra, or TRICARE Reserve Select as nonenrolled beneficiaries. The National Defense Authorization Act for Fiscal Year 2008 directed GAO to analyze the adequacy of DOD's surveys of TRICARE beneficiaries and providers and report what the surveys' results indicate about access to care for nonenrolled beneficiaries. To do so, GAO evaluated the surveys' methodology by interviewing DOD officials and reviewing relevant documentation, including the Office of Management and Budget's (OMB) survey standards. GAO..."

" In 2007, the United States enacted a law incrementally raising the minimum wages in American Samoa and the CNMI until they equal the U.S. minimum wage. American Samoa's minimum wage increased by $.50 per hour three times, and the CNMI's four times before legislation delayed the increases amid concerns that they would have a detrimental effect on the American Samoa and CNMI economies. The most recent increase in American Samoa occurred on May 25, 2009. The next is scheduled for September 30, 2015, with additional increases every 3 years thereafter. Under current law, the minimum wage in American Samoa's tuna canning industry will equal the current U.S. minimum wage of $7.25 in 2027. The CNMI's most recent increase occurred on September 30, 2012. The next increase is scheduled for September 30, 2014, with additional increases in 2016 and annually thereafter until it reaches the U.S. minimum wage. GAO is mandated to report in 2014, and every 3 years thereafter, on the impact of the minimum wage increases. This report updates our previous reports and discusses for each territory (1) changes in employment and earnings and (2) changes in key industries since the most recent federal minimum wage increase and since the increases began. GAO reviewed local and federal earnings information; collected data from employers in key industries through a questionnaire and from employers and workers through discussion groups and interviews"

" There have been various reported incidents of individuals being potentially exposed to environmental hazards while on military installations. Indeed, some incidents, such as contaminated air due to burn pits in Afghanistan and Iraq and contaminated water at Camp Lejeune, North Carolina, have received considerable attention, and in the case of Camp Lejeune have resulted in claims seeking billions of dollars from the government. Public Law 111-383, §314(2011) directed GAO to assess Department of Defense (DOD) policies regarding environmental exposures. GAO's objectives were to determine (1) the extent to which DOD has policies that identify and respond to environmental exposures, (2) what programs exist to provide health care or compensation to individuals for environmental exposures, and (3) which features of other federal programs may provide options in designing future compensation programs. GAO briefed the Armed Services Committees in December 2011, to satisfy the mandate. To address these objectives, GAO reviewed relevant documentation, visited installations, and interviewed relevant officials. "

"assessed DOD's 2014 Strategy and accompanying implementation plans submitted to Congress in response to the mandate, interviewed cognizant officials, and reviewed DOD's October 2015 Strategy. "

Infusion therapydrug treatment generally administered intravenouslywas once provided strictly in hospitals. However, clinical developments and emphasis on cost containment have prompted a shift to other settings, including the home. Home infusion requires coordination among providers of drugs, equipment, and skilled nursing care, as needed. GAO was asked to review home infusion coverage policies and practices to help inform Medicare policy. In this report, GAO describes (1) coverage of home infusion therapy components under Medicare fee-for-service (FFS), (2) coverage and payment for home infusion therapy by other health insurersboth commercial plans and Medicare Advantage (MA) plans, which provide a private alternative to Medicare FFS, and (3) the utilization and quality management practices that health insurers use with home infusion therapy benefits.To do this work, GAO reviewed Medicare program statutes, regulations, policies, and benefits data. GAO also interviewed officials of five large private health insurers that offered commercial and MA plans.

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