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As of May 9, 2024, there are 5116 open recommendations that still need to be addressed. 412 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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4941 - 4960 of 5116 Recommendations, including 412 Priority Recommendations

Computer Matching Act: OMB and Selected Agencies Need to Ensure Consistent Implementation

GAO-14-44
Gregory C. Wilshusen
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3 Open Recommendations
Agency Recommendation Status
Department of Labor To improve the implementation of the act, the Secretary of Labor should develop and implement policies and procedures for cost-benefit analyses related to computer matching agreements to include key elements such as personnel and computer costs, as well as avoidance of future improper payments and recovery of improper payments and debts.
Open

Although department officials have stated that they are taking actions to address this recommendation, as of March 2024, we have not yet received information to validate agency actions. Subsequent to the agency sending documentation, we plan to verify whether implementation has occurred.
Department of Labor To improve the implementation of the act, the Secretary of Labor should ensure the DIB reviews cost-benefit analyses to make certain cost savings information for the computer matching program is included before approving CMAs.
Open

Although department officials have stated that they are taking actions to address this recommendation, as of March 2024, we have not yet received information to validate agency actions. Subsequent to the agency sending documentation, we plan to verify whether implementation has occurred.
Department of Labor To improve the implementation of the act, the Secretary of Labor should ensure the DIB performs annual reviews and submits annual reports on agency computer matching activities, as required by the act.
Open

Although department officials have stated that they are taking actions to address this recommendation, as of March 2024, we have not yet received information to validate agency actions. Subsequent to the agency sending documentation, we plan to verify whether implementation has occurred.

Clinical Data Registries: HHS Could Improve Medicare Quality and Efficiency through Key Requirements and Oversight

GAO-14-75
Linda Kohn
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4 Open Recommendations
Agency Recommendation Status
Department of Health and Human Services To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should direct CMS to establish a requirement for qualified CDRs to demonstrate improvement on key measures of quality and efficiency for their target populations.
Open

As of August 2023, CMS had implemented requirements for qualified CDRs to provide performance feedback to participating clinicians at least 4 times a year. These requirements did not call on qualified CDRs to demonstrate improved performance on their measures of quality and efficiency, as GAO recommended. However, CMS officials expect that the Merit-based Incentive Payment System (MIPS) Value Pathways, once fully implemented, may help to address this recommendation. MIPS Value Pathways are a new quality measurement reporting option for clinicians starting in 2023. CMS officials believe that
Department of Health and Human Services To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should direct CMS to establish a process for monitoring compliance with requirements for qualified CDRs that draws on relevant expert judgment. This process should assess CDR performance on each requirement in a way that takes into account the varying circumstances of CDRs and their available opportunities to promote quality and efficiency improvement for their target populations.
Open – Partially Addressed

As of August 2023, CMS's website documents its process for monitoring qualified CDRs. Based on the available information, this monitoring focuses on ensuring qualified CDR compliance with expectations such as having relevant measure development expertise, incorporating medical knowledge, and not submitting false or inaccurate data. However, this approach differs from our recommendation that CMS draw on expert judgment to take account of the different circumstances and opportunities for improving quality and efficiency across qualified CDRs. Incorporating expert judgment into CMS's oversight of
Department of Health and Human Services To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should determine and implement actions to reduce barriers to the development of qualified CDRs, such as (1) developing guidance that clarifies Health Insurance Portability and Accountability Act requirements to promote participation in qualified CDRs; (2) working with private sector entities to make relevant multipayer cost data available to qualified CDRs; (3) testing one or more models of shared savings between Medicare and qualified CDRs that achieve reduced Medicare expenditures with improved quality of care, and (4) providing technical assistance to qualified CDRs.
Open – Partially Addressed

As of August 2023, CMS officials had provided examples of technical assistance provided to groups seeking to set up qualified CDRs, covering topics such as program requirements, how to construct different types of quality measures, and assistance with measure concepts and feedback on self-nomination to be a qualified CDR. This technical assistance is consistent with GAO's recommendation to reduce barriers in the development of qualified CDRs, but it was not clear if similar technical assistance had continued on an ongoing basis. As of August 2023, CMS's website included links to written
Department of Health and Human Services To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should determine key data elements needed by qualified CDRs--such as those relevant for a required core set of measures--and direct Office of the National Coordinator for Health Information Technology and CMS to include these data elements, if feasible, in the requirements for certification of EHRs under the EHR incentive programs.
Open

As of August 2023, CMS had provided information on its ongoing efforts to promote the development of electronic clinical quality measures in general, along with its broader vision to report quality information through digital means. However, it had not provided information on steps taken to address the two key objectives of the recommendation that are specific to qualified CDRs: 1) identifying a set of clinical data elements that are needed for the particular quality measures used by qualified CDRs, and 2) incorporating these data elements into federal requirements for EHRs, where feasible

Reverse Auctions: Guidance Is Needed to Maximize Competition and Achieve Cost Savings

GAO-14-108
Michele Mackin
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Office of Management and Budget
Priority Rec.
To help mitigate confusion about the use of reverse auctions in federal acquisitions, the Director of the Office of Management and Budget should take steps to amend the FAR to address agencies' use of reverse auctions.
Open – Partially Addressed

In providing comments on this report, OMB generally concurred with this recommendation. In response, in December 2020, FAR Council members published a notice of proposed rulemaking to amend the FAR to provide guidance on reverse auctions. The notice required that comments on the proposed rule be submitted by early February 2021. As of December 2023, OMB had received proposed revisions to FAR guidance for its consideration.

Clean Water Act: Changes Needed If Key EPA Program Is to Help Fulfill the Nation's Water Quality Goals

GAO-14-80
J. Alfredo Gómez
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Environmental Protection Agency
Priority Rec.
To enhance the likelihood that TMDLs support the nation's waters' attainment of water quality standards and to strengthen water quality management, the Administrator of EPA should develop and issue new regulations requiring that TMDLs include additional elements--and consider requiring the elements that are now optional--specifically, elements reflecting key features identified by NRC as necessary for attaining water quality standards, such as comprehensive identification of impairment and plans to monitor water bodies to verify that water quality is improving.
Open

As of April 2024, EPA officials stated that they believe this action has been implemented. Since June 2020, they said the agency has taken several actions that change the focus of the total maximum daily loads (TMDL) program to focus efforts on implementing TMDLs. First, EPA developed a TMDL Vision document to focus on integrating and implementing different efforts to restore and protect the nation's aquatic resources. Second, EPA held regional meetings to discuss different TMDL topics such as monitoring, implementation, and reasonable assurance. Included in these discussions were good

National Mediation Board: Strengthening Planning and Controls Could Better Facilitate Rail and Air Labor Relations

GAO-14-5
Revae Moran
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1 Open Recommendations
Agency Recommendation Status
National Mediation Board In order to improve NMB's planning and make the most effective use of its limited resources, the Chairman of the National Mediation Board should develop and fully implement key components of an information security program in accordance with the Federal Information Security Management Act of 2002.
Open – Partially Addressed

NMB agreed with this recommendation. In April 2022, we reported in GAO-22-105266 that NMB had taken steps to further implement key information security practices but had not fully implemented this recommendation. Specifically, we found that NMB was following five of eight key information security practices laid out in the Federal Information Security Modernization Act of 2014 (FISMA), such as developing and documenting an information technology security policy. As of July 2023, NMB has conducted testing and evaluation of all its major information systems, as required by FISMA. NMB has also

Hurricane Sandy Relief: Improved Guidance on Designing Internal Control Plans Could Enhance Oversight of Disaster Funding

GAO-14-58
Beryl (Berri) H. Davis
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Office of Management and Budget
Priority Rec.
To proactively prepare for oversight of future disaster relief funding, the Director of OMB should develop standard guidance for federal agencies to use in designing internal control plans for disaster relief funding. Such guidance could leverage existing internal control review processes and should include, at a minimum, the following elements: (1) robust criteria for identifying and documenting incremental risks and mitigating controls related to the funding and (2) requirements for documenting the linkage between the incremental risks related to disaster funding and efforts to address known internal control risks.
Open

The Office of Management and Budget (OMB) stated that they generally agreed with our recommendation and requested additional information on the findings to inform future guidance. In July 2016, OMB issued the revised Circular A-123, Management's Responsibility for Enterprise Risk Management and Internal Control. The Circular requires agencies to implement enterprise risk management, which includes the development of a risk profile that analyzes the risks faced in achieving strategic objectives and identifies options for addressing them. In April 2017, OMB staff stated that they believe that

Minority AIDS Initiative: Consolidation of Fragmented HIV/AIDS Funding Could Reduce Administrative Challenges

GAO-14-84
Marcia Crosse
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2 Open Recommendations
Agency Recommendation Status
Department of Health and Human Services In order to reduce the administrative costs associated with a fragmented MAI grant structure that diminishes the effective use of HHS's limited HIV/AIDS funding, and to enhance services to minority populations, HHS should consolidate disparate MAI funding streams into core HIV/AIDS funding during its budget request and allocation process.
Open

HHS stated that it does not support the consolidation of Minority AIDS Initiative (MAI) funds into core funding. As of January 2024, HHS had not changed its position. We will update the status of this recommendation when we receive additional information.
Department of Health and Human Services In order to reduce the administrative costs associated with a fragmented MAI grant structure that diminishes the effective use of HHS's limited HIV/AIDS funding, and to enhance services to minority populations, HHS should seek legislation to amend the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 or other provisions of law, as necessary, to achieve a consolidated approach.
Open

HHS stated that it does not support the consolidation of Minority AIDS Initiative (MAI) funds into core funding. As of January 2024, HHS had not changed its position. We will update the status of this recommendation when we receive additional information.

2020 Census: Bureau Needs to Improve Scheduling Practices to Enhance Ability to Meet Address List Development Deadlines

GAO-14-59
Robert N. Goldenkoff
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1 Open Recommendations
Agency Recommendation Status
Department of Commerce To help maintain a more thorough and insightful 2020 Census development schedule in order to better manage risks to a successful 2020 Census, the Secretary of Commerce and Undersecretary of Economic Affairs should direct the U.S. Census Bureau to improve the credibility of schedules, including conducting a quantitative risk assessment.
Open

The Bureau agreed with this recommendation and stated that it had already begun maturing project schedules to ensure that the logical relationships between discrete schedules were put into place. Schedule integration sessions across projects and programs were held in late January 2014 and into February 2014 and periodically since then, where work was deconstructed into detailed schedules. The Bureau released its operational plan and other documentation in November 2015 and announced in June 2016 that it would finalize and release its 2020 Census schedule in July 2016. In 2015, the Bureau

Human Capital: Opportunities Exist to Further Improve DOD's Methodology for Estimating the Costs of Its Workforces

GAO-13-792
Brenda S. Farrell
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4 Open Recommendations
Agency Recommendation Status
Department of Defense To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation to further develop guidance for cost elements that users have identified as challenging to calculate, such as general and administrative, overhead, advertising and recruiting, and training.
Open

DOD concurred with our recommendation to further develop guidance for personnel cost elements that users identified as challenging to calculate. In a December 2020 memo, the Deputy Secretary of Defense stated that DOD will take timely and significant steps to achieve comprehensive fully burdened personnel cost estimates and directed the Cost Assessment and Program Evaluation (CAPE) office to update DOD Instruction 7041.04, Estimating and Comparing the Full Costs of Civilian and Active Duty Military Manpower and Contract Support. As of August 2021, CAPE was in the process of revising the
Department of Defense To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation to develop business rules for estimating the full cost of National Guard and Reserve personnel.
Open

DOD partially concurred with our recommendation to develop business rules for estimating the full cost of National Guard and Reserve personnel. In a December 2020 memo, the Deputy Secretary of Defense stated that DOD will take timely and significant steps to achieve comprehensive fully burdened personnel cost estimates and directed the Cost Assessment and Program Evaluation (CAPE) office to update DOD Instruction 7041.04, Estimating and Comparing the Full Costs of Civilian and Active Duty Military Manpower and Contract Support. As of August 2021, CAPE was in the process of revising the
Department of Defense To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation, in coordination with the department's Office of the Actuary and appropriate federal actuarial offices, to reevaluate the inclusion and quantification of pension, retiree health care costs, and other relevant costs of an actuarial nature and make revisions as appropriate.
Open

DOD concurred with our recommendation to coordinate with the department's Office of the Actuary and other appropriate federal actuarial offices to reevaluate the inclusion of pension, retiree health care, and other relevant actuarial costs in its methodology for estimating and comparing the full cost of its workforces. In a December 2020 memo, the Deputy Secretary of Defense stated that DOD will take timely and significant steps to achieve comprehensive fully burdened personnel cost estimates and directed the Cost Assessment and Program Evaluation (CAPE) office to update DOD Instruction 7041
Department of Defense To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's ability to estimate contractor support costs, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation, consistent with established practices for developing credible cost estimates, to research the data sources it is currently using and reassess its contractor support data sources for use when determining contractor support costs.
Open

DOD concurred with our recommendation to research the data sources currently used for determining contractor support costs. In a December 2020 memo, the Deputy Secretary of Defense stated that DOD will take timely and significant steps to achieve comprehensive fully burdened personnel cost estimates and directed the Cost Assessment and Program Evaluation (CAPE) office to update DOD Instruction 7041.04, Estimating and Comparing the Full Costs of Civilian and Active Duty Military Manpower and Contract Support. As of August 2021, CAPE was in the process of reviewing and updating all data sources

Information Resellers: Consumer Privacy Framework Needs to Reflect Changes in Technology and the Marketplace

GAO-13-663
Alicia Puente Cackley
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1 Open Recommendations
Agency Recommendation Status
Congress Congress should consider strengthening the current consumer privacy framework to reflect the effects of changes in technology and the marketplace--particularly in relation to consumer data used for marketing purposes--while also ensuring that any limitations on data collection and sharing do not unduly inhibit the economic and other benefits to industry and consumers that data sharing can accord. Among the issues that should be considered are: (1) the adequacy of consumers' ability to access, correct, and control their personal information in circumstances beyond those currently accorded under FCRA; (2) whether there should be additional controls on the types of personal or sensitive information that may or may not be collected and shared; (3) changes needed, if any, in the permitted sources and methods for data collection; and (4) privacy controls related to new technologies, such as web tracking and mobile devices.
Open

As of March 2024, Congress has not enacted comprehensive privacy legislation that would address this matter.

FHA Mortgage Insurance: Applicability of Industry Requirements Is Limited, but Certain Features Could Enhance Oversight

GAO-13-722
Matthew Scirè
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1 Open Recommendations
Agency Recommendation Status
Congress To strengthen FHA accountability for complying with the Fund's statutory capital requirement, Congress should consider requiring that FHA submit a capital restoration plan and regular updates on plan implementation whenever the capital ratio falls below 2 percent as calculated in the annual actuarial review of the Fund, or the Fund's financial condition does not meet other congressionally-defined requirements.
Open

As of March 2024, Congress had not yet acted on this matter for consideration.
Note: the list of open recommendations for the last report may continue on the next page.

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