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As of May 19, 2024, there are 5119 open recommendations that still need to be addressed. 413 of these are priority recommendations, those that we believe warrant priority attention. Learn more about our priority designation on our Recommendations page.

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4841 - 4860 of 5119 Recommendations, including 413 Priority Recommendations

Electricity Generation Projects: Additional Data Could Improve Understanding of the Effectiveness of Tax Expenditures

GAO-15-302
Frank Rusco
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1 Open Recommendations
Agency Recommendation Status
Congress If Congress wishes to evaluate the effectiveness of the ITC and the PTC as incentives for the development of renewable utility-scale electricity generation projects as it considers proposals to extend the ITC or reauthorize the PTC, it should consider directing the Commissioner of Internal Revenue to take steps to collect project-level data from taxpayers claiming the PTC--such as the number of projects for which they are claiming the credit, the technology of the projects taking the credit, and the total generating capacity--and make these data available for analysis.
Open

Congress has not taken action on this matter as of March 2024.

Defense Inventory: Services Generally Have Reduced Excess Inventory, but Additional Actions Are Needed

GAO-15-350
Zina Merritt
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1 Open Recommendations
Agency Recommendation Status
Department of the Navy To help ensure that the Navy has adequate oversight of on-order excess inventory termination decisions and necessary performance measures consistent with DOD guidance, the Secretary of the Navy should direct the Commander, Naval Supply Systems Command, to incorporate the graduated management reviews and the ability to track and review the reasons for not canceling and modifying on-order excess items into its automated termination module that is under development.
Open

DOD concurred with our recommendation. As of August 2019, Naval Supply Systems Command has taken some steps, such as defining the requirement and piloting some aspects of the effort, to incorporate graduated management reviews and the ability to track and review the reason for not canceling and modifying on-order excess items into its automated termination module. However, this capability is not implemented into the automated termination module, according to Naval Supply Systems Command officials. Navy Supply Systems Command provided information on its plans to implement this capability in

Medicaid Demonstrations: Approval Criteria and Documentation Need to Show How Spending Furthers Medicaid Objectives

GAO-15-239
Katherine Iritani
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2 Open Recommendations
Agency Recommendation Status
Department of Health and Human Services To improve the transparency and accountability of HHS's section 1115 Medicaid demonstration approval process, and to ensure that federal Medicaid funds for the demonstrations do not duplicate other federal funds, the Secretary of Health and Human Services should issue criteria for assessing whether section 1115 expenditure authorities are likely to promote Medicaid objectives.
Open – Partially Addressed

The Department of Health and Human Services (HHS) partially concurred with this recommendation and has taken some steps to address the problems GAO identified. Initially, in August 2015, HHS posted on its website general criteria for assessing whether Medicaid section 1115 demonstration expenditure authorities are likely to promote Medicaid objectives, but GAO found the general criteria were not sufficiently specific. HHS later removed these criteria from its website and replaced them with six broad areas of reform that HHS encouraged states to consider. In 2021, HHS removed these broad areas
Department of Health and Human Services To improve the transparency and accountability of HHS's section 1115 Medicaid demonstration approval process, and to ensure that federal Medicaid funds for the demonstrations do not duplicate other federal funds, the Secretary of Health and Human Services should ensure the application of these criteria is documented in all HHS's approvals of section 1115 demonstrations, including those approving new or extending or modifying existing expenditure authorities, to inform internal and external stakeholders, including states, the public, and Congress, of the basis for the agency's determinations that approved expenditure authorities are likely to promote Medicaid objectives.
Open – Partially Addressed

HHS agreed with this recommendation and, as of May 2021, had taken some steps to ensure that the bases for its approval decisions are documented in all approvals of section 1115 demonstrations. In December 2017, CMS issued a letter to state Medicaid officials, stating that the agency had begun requesting additional documentation of the demonstration purposes being served by certain types of previously approved funding in demonstration proposals. Additionally, the agency noted it was taking certain steps to ensure that only allowable costs were matched by federal Medicaid funds. In April 2018

Medicaid: CMS Oversight of Provider Payments Is Hampered by Limited Data and Unclear Policy

GAO-15-322
Katherine Iritani
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3 Open Recommendations
Agency Recommendation Status
Centers for Medicare & Medicaid Services To improve CMS's oversight of Medicaid payments, the Administrator of CMS should take steps to ensure that states report accurate provider-specific payment data that include accurate unique national provider identifiers (NPI).
Open – Partially Addressed

As of February 2024, this recommendation remains partially addressed. In May 2021, CMS officials reported on a recent effort to validate the NPI--a unique 10-digit identification number assigned to health care providers--for each provider a state reports. At that time, officials said that they had recently implemented checks to validate the accuracy of provider-specific payment data, including the unique national provider identifiers states submit. According to CMS officials, some of these checks had identified data quality issues that had subsequently been resolved, while the results of other
Centers for Medicare & Medicaid Services To improve CMS's oversight of Medicaid payments, the Administrator of CMS should develop a policy establishing criteria for when such payments at the provider level are economical and efficient.
Open

As of February 2024, this recommendation remains not addressed. CMS confirmed it is not currently engaged in any efforts to address payment at the individual provider level. In December 2020, Congress passed and the President signed into law legislation requiring additional state reporting on Medicaid supplemental payments, including requiring states to describe how these payments are consistent with economy and efficiency. In December 2021, CMS issued guidance on these new supplemental payment reporting requirements beginning with information about payments made on or after October 1, 2021
Centers for Medicare & Medicaid Services To improve CMS's oversight of Medicaid payments, the Administrator of CMS should, once criteria are developed, develop a process for identifying and reviewing payments to individual providers in order to determine whether they are economical and efficient.
Open

As of February 2024, this recommendation remains not addressed. CMS confirmed it is not currently engaged in any efforts to address payment at the individual provider level. In December 2021, CMS issued guidance on new supplemental payment reporting requirements beginning with information about payments made on or after October 1, 2021. However, in January 2022, CMS officials said that neither the law nor the guidance establish criteria for economy and efficiency for Medicaid supplemental payments at the provider level. GAO maintains that developing a process, once criteria are developed, for

Library of Congress: Strong Leadership Needed to Address Serious Information Technology Management Weaknesses

GAO-15-315
Joel C. Willemssen
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2 Open Recommendations
Agency Recommendation Status
Library of Congress To effectively plan and manage its acquisitions of IT systems and increase the likelihood of delivering promised system capabilities on time and within budget, the Librarian should establish and implement an organization-wide policy for developing cost estimates that includes key practices as discussed in this report.
Open

The Library of Congress generally agreed with, and has begun to take steps to implement, this recommendation. Specifically, in January 2017 the Library established a centralized Library-wide Project Management Office, located within the Office of the Chief Information Officer (OCIO). Additionally, in June 2017 the Library updated its regulations to give the Project Management Office the authority to establish organization-wide policy for developing cost estimates for IT projects. However, in February 2021, the Library's Office of the Inspector General (OIG) reported that the Library did not
Library of Congress To effectively plan and manage its acquisitions of IT systems and increase the likelihood of delivering promised system capabilities on time and within budget, the Librarian should establish a time frame for finalizing and implementing an organization-wide policy for developing and maintaining project schedules that includes key practices as discussed in this report, and finalize and implement the policy within the established time frame.
Open

The Library of Congress generally agreed with, and has begun to take steps to implement, this recommendation. Specifically, in January 2017 the Library established a Project Management Office within the Office of the Chief Information Officer (OCIO) and tasked the office with communicating and enforcing Library requirements for IT project management and systems development. Additionally, in June 2017 the Library updated its regulations to give the Project Management Office the authority to establish organization-wide policy for developing and maintaining IT project schedules. However, in

Military Personnel: Actions Needed to Address Sexual Assaults of Male Servicemembers

GAO-15-284
Brenda S. Farrell
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3 Open Recommendations
Agency Recommendation Status
Office of the Assistant Secretary of Defense (Health Affairs) To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help ensure that all of DOD's medical and mental health providers are generally aware of any gender-specific needs of sexual assault victims, and that victims are provided the care that most effectively meets those needs, the Assistant Secretary of Defense for Health Affairs should, in collaboration with the services' Surgeons General, develop and issue guidance for the department's medical and mental health providers--and other personnel, as appropriate--based on the results of this evaluation that delineates these gender-specific distinctions and the care regimen that is recommended to most effectively meet those needs.
Open

DOD concurred with this recommendation in written comments on our report. In August 2018, the Office of the Assistant Secretary of Defense for Health Affairs stated that DOD is writing an Instruction and two accompanying Defense Health Agency Procedural Instructions that will delineate gender-specific distinctions and care regimens where appropriate. The guidance will incorporate the findings of a report by the Psychological Health Center of Excellence of the Defense Health Agency resulting from a planned study of the patterns of health care utilization of servicemembers reporting a sexual
Department of Defense To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help DOD's sexual assault prevention and response program realize the full benefit of the data it collects on sexual assault incidents, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to develop a plan for data-driven decision making to prioritize program efforts.
Open

DOD concurred with this recommendation in written comments on our report. In October 2016, DOD published its plan for preventing and responding to sexual assaults of military men. In that plan, DOD generally outlined its intent to develop metrics to assess prevention and response efforts pertaining to males who experience sexual assault. In July 2022, DOD officials stated that the department has built a foundation of data sources on sexual assaults experienced by men, and that completion of the plan's objectives, including metrics to measure implementation, is estimated to occur by December 30
Department of Defense To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to develop clear goals with associated metrics to drive the changes needed to address sexual assaults of males and articulate these goals, for example in the department's next sexual assault prevention strategy.
Open

DOD concurred with this recommendation in written comments on our report. In October 2016, DOD issued a plan to prevent and respond to sexual assault of military men. In August 2018, DOD's Sexual Assault Prevention and Response Office (SAPRO) stated that objectives 1-4 of this plan constitute DOD's goals to address sexual assaults of military men. However, the plan does not contain metrics; one of the plan's objectives is to develop metrics to assess prevention and response efforts pertaining to men who experience sexual assault. In July 2019, SAPRO officials stated that they were waiting to

Crop Insurance: Reducing Subsidies for Highest Income Participants Could Save Federal Dollars with Minimal Effect on the Program

GAO-15-356
Anne-Marie Fennell
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1 Open Recommendations
Agency Recommendation Status
Congress To reduce the cost of the crop insurance program and achieve budgetary savings for deficit reduction or other purposes, Congress should consider reducing premium subsidies for the highest income participants.
Open

As of February 2024, Congress has not acted on this matter.

Operational Contract Support: Actions Needed to Enhance the Collection, Integration, and Sharing of Lessons Learned

GAO-15-243
Cary Russell
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1 Open Recommendations
Agency Recommendation Status
Department of Defense To help improve awareness of OCS roles and responsibilities and to collect OCS issues at the military services and the service component commands, the Secretary of Defense should direct the Secretaries of the military departments, in coordination with the Chairman of the Joint Chiefs of Staff, to establish an OCS training requirement for commanders and senior leaders.
Open

DOD concurred with our recommendation. As of November 2023, DOD has taken steps to focus OCS training to all planners, including those outside the logistics directorate. In December 2015, the Joint Staff J7 certified the Joint OCS Planning and Execution (JOPEC) course of instruction for Joint training. The Joint Staff, per this training certification, is working with the Joint Deployment Training Center and the Joint Force Staff College to provide student administrative and course catalog support for future JOPEC training. In August 2020, OSD officials stated that they have secured funding for

Defense Acquisitions: Better Approach Needed to Account for Number, Cost, and Performance of Non-Major Programs

GAO-15-188
Michael J. Sullivan
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1 Open Recommendations
Agency Recommendation Status
Department of Defense To improve DOD's ability to collect and maintain reliable data on its acquisitions, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology, and Logistics, in consultation with DOD components, to establish guidelines on what constitutes a "current" ACAT II or III program for reporting purposes; the types of programs, if any, that do not require ACAT designations; and whether the rules for identifying current MDAPs would be appropriate for ACAT II and III programs.
Open

DOD partially concurred with our recommendation and stated that it planned to review existing policy to see if revisions were needed. As of August 2023, DOD has yet to establish department-wide guidelines as we recommended. Starting in September 2018, DOD began providing the military departments with a capability to identify ACAT II and III programs using the Defense Acquisition Visibility Environment (DAVE) system. The DAVE system is now considered to be a trusted source for ACAT II and III program data. DOD, in consultation with the military departments, established standard data elements

Defense Logistics: Improvements Needed to Accurately Assess the Performance of DOD's Materiel Distribution Pipeline

GAO-15-226
Cary Russell
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1 Open Recommendations
Agency Recommendation Status
Department of Defense To address the limitations of existing distribution performance metrics, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics, in conjunction with TRANSCOM, to revise guidance to ensure that a customer wait time standard is established and used for the Marine Corps.
Open

DOD concurred with this recommendation. In September 2016, the Marine Corps established a Customer Wait Time (CWT) standard and developed CWT metrics that are in alignment with DOD policy. These changes were to be incorporated into Marine Corps policy through their normal Service procedures. In August 2020, the Marine Corps incorporated the CWT standard in its new policy document and began the internal coordination process. According to Marine Corps officials, in March 2021, due to the volume of comments they received during the coordination period, they sent the policy out for another round

Medicare: Payment Methods for Certain Cancer Hospitals Should Be Revised to Promote Efficiency

GAO-15-199
James Cosgrove
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1 Open Recommendations
Agency Recommendation Status
Congress To help the Department of Health and Human Services better control spending and encourage efficient delivery of care, Congress should consider requiring Medicare to pay PCHs as it pays PPS teaching hospitals, or provide the Secretary with the authority to otherwise modify how Medicare pays PCHs. To generate cost savings from any reduction in outpatient payments to PCHs, Congress should also provide that all forgone outpatient payment adjustment amounts be returned to the Supplementary Medical Insurance Trust Fund.
Open

As of March 2024, no legislative action had been identified that changes how PCHs are paid for inpatient services, as GAO suggested in February 2015. The 21st Century Cures Act--enacted in December 2016--slightly reduces the additional payments to PCHs for outpatient services furnished on or after January 1, 2018, and returns savings to the Supplementary Medical Insurance Trust Fund. However, the law does not substantively change how PCHs are paid for outpatient services, which differs from how Medicare pays PPS teaching hospitals (Pub. L. No. 114-255, § 16002, 130 Stat. 1033, 1325 (2016))

Improper Payments: TRICARE Measurement and Reduction Efforts Could Benefit from Adopting Medical Record Reviews

GAO-15-269
Vijay A. D'Souza
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2 Open Recommendations
2 Priority
Agency Recommendation Status
Department of Defense
Priority Rec.
To better assess and address the full extent of improper payments in the TRICARE program, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to implement a more comprehensive TRICARE improper payment measurement methodology that includes medical record reviews, as done in other parts of its existing postpayment claims review programs.
Open

The Department of Defense (DOD) concurred with our recommendation. The Defense Health Agency (DHA) had taken some actions, as of March 2024, to incorporate medical record reviews in its improper payment estimate. For example, DHA reported that it had completed 2 years of medical record reviews. However, it did not incorporate the reviews into its fiscal year 2020 or 2021 improper payment rate estimates due to challenges, according to the agency. For example, DHA reported a low response rate on its requests for medical records from TRICARE providers. DHA told GAO that it ultimately found that
Department of Defense
Priority Rec.
To better assess and address the full extent of improper payments in the TRICARE program, and once a more comprehensive improper payment methodology is implemented, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to develop more robust corrective action plans that address underlying causes of improper payments, as determined by the medical record reviews.
Open

The Department of Defense concurred with our recommendation. The Defense Health Agency (DHA) reported in 2022 that the medical record reviews did not uncover identifiable root causes or trends to warrant corrective action plans. However, the reviews had significant documentation problems that could be addressed. Of the TRICARE claims that DHA sampled for medical record review in fiscal year 2021, 28 percent in the east TRICARE region and 67 percent in the west region had no or insufficient documentation returned for review. In 2024, GAO continues to believe a corrective action related to these

Contingency Contracting: Contractor Personnel Tracking System Needs Better Plans and Guidance

GAO-15-250
Cary Russell
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1 Open Recommendations
Agency Recommendation Status
Department of Defense To help improve DOD, State, and USAID's ability to track contracts and contractor personnel in contingency operations and to help ensure that DOD possesses the capability to collect and report statutorily required information and to clarify responsibilities and procedures, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics to update SPOT provisions during the process of updating operational contract support guidance.
Open

DOD concurred with our recommendation. In August 2018, the office of the Assistant Secretary of Defense for Logistics and Materiel Readiness reported that an update of DOD Instruction 3020.41 is in progress, and will include updated SPOT provisions. However, as of September 2023, the updated instruction had not been issued and DOD officials stated that they are working to complete its publication and expect final issuance in the near future. We will continue to monitor the department's progress in this area and the recommendation will remain open at this time.
Note: the list of open recommendations for the last report may continue on the next page.

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