GOVERNMENT 

EFFICIENCY AND 

EFFECTIVENESS

Opportunities to Reduce 

Fragmentation, Overlap, 

and Duplication and 

Achieve Other Financial 

Benefits

Statement of Gene L. Dodaro 

Comptroller General of the United States

Testimony 

Before the Committee on the Budget, 

U.S. Senate

For Release on Delivery 

Expected at 10:30 a.m. ET

Wednesday, May 23, 2018

GAO-18-571T

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-18-571T, a testimony 

before the Committee on the Budget, U.S. 

Senate

May 2018

GOVERNMENT EFFICIENCY AND

EFFECTIVENESS

Opportunities to Reduce Fragmentation, Overlap, and 

Duplication and Achieve Other Financial Benefits

What GAO Found

GAO’s 2018 annual report identifies 68 new actions that Congress or executive 

branch agencies can take to improve the efficiency and effectiveness of 

government in 23 new program areas. For example:

• The Department of Defense (DOD) could potentially save approximately

$527 million over 5 years by minimizing unnecessary overlap and 

duplication in its U.S. distribution centers for troop support goods.

• The Department of Energy may be able to reduce certain risks and save 

tens of billions of dollars by adopting alternative approaches to treat a 

portion of its low-activity radioactive waste at its Hanford Site.

• The Department of Veterans Affairs could potentially save tens of millions 

of dollars when acquiring medical and surgical supplies by better adhering 

to supply chain practices of leading hospitals.

• The Coast Guard should close its boat stations that provide unnecessarily 

duplicative search and rescue coverage to improve operations and 

potentially save millions of dollars.

Significant progress has been made in addressing many of the 724 actions that 

GAO identified from 2011 to 2017. As of March 2018, Congress and executive 

branch agencies have fully or partially addressed 551 (76 percent) of these 

actions. This has resulted in about $178 billion in financial benefits, of which

$125 billion has been realized and at least an additional $53 billion is estimated 

to accrue. These estimates are based on a variety of sources that considered 

different time periods, assumptions, and methodologies. GAO estimates that 

tens of billions of additional dollars could be saved should Congress and 

executive branch agencies fully address the remaining 365 open actions, 

including the 68 new ones identified in 2018.

Further steps are needed to fully address these remaining actions. For example:

• Congress and the Internal Revenue Service could realize hundreds of 

millions of dollars in savings and increased revenues by enhancing online 

services and improving efforts to prevent identity theft refund fraud.

• Medicare could save $1 to 2 billion annually if Congress equalized the 

rates paid for certain health care services, which often vary depending on 

where the service is performed.

• DOD could achieve billions of dollars in savings over the next several years 

by continuing to employ best management practices on its weapon systems 

acquisition programs.

• Congress could consider modifying how Medicare pays certain cancer 

hospitals to achieve almost $500 million annually in program savings.

• The Social Security Administration could help prevent the loss of billions of 

dollars by preventing overpayments to beneficiaries of the Disability 

Insurance program and improper waivers of beneficiaries’ overpayment debt.

• Congress could consider modifying tobacco tax rates to eliminate significant 

tax differentials between similar products to address future revenue losses 

caused by manufacturers and consumers substituting tobacco products. 

Federal losses ranged from $2.6 to 3.7 billion between April 2009 and 

February 2014.

View GAO-18-571T. For more information, 

contact Jessica Lucas-Judy at (202) 512-9110 

or lucasjudyj@gao.gov or J. Christopher Mihm 

at (202) 512-6806 or mihmj@gao.gov.

Why GAO Did This Study

The federal government faces a longterm, unsustainable fiscal path based 

on an imbalance between federal 

revenues and spending. While 

addressing this imbalance will require 

fiscal policy changes, in the near term 

opportunities exist in a number of 

areas to improve this situation, 

including where federal programs or 

activities are fragmented, overlapping, 

or duplicative.

To call attention to these opportunities, 

Congress included a provision in 

statute for GAO to identify and report 

on federal programs, agencies, offices, 

and initiatives—either within 

departments or government-wide—that 

have duplicative goals or activities.

GAO also identifies areas that are 

fragmented or overlapping and 

additional opportunities to achieve cost 

savings or enhance revenue collection. 

GAO’s 2018 annual report is its eighth 

in this series (GAO-18-371SP).

This statement discusses

• new areas identified in GAO's 

2018 annual report;

• the progress made in addressing 

actions GAO identified in its 2011 

to 2017 reports; and

• examples of open actions directed 

to Congress or executive branch 

agencies.

To identify what actions exist to 

address these issues, GAO reviewed 

and updated prior work, including 

recommendations for executive action 

and matters for congressional 

consideration.
Letter

Page 1 GAO-18-571T 

Chairman Enzi, Ranking Member Sanders, and Members of the 

Committee:

The federal government faces an unsustainable long-term fiscal path 

based on an imbalance between federal revenue and spending, primarily 

driven by health care spending and net interest on the debt.1 Addressing 

this imbalance will require long-term changes to both spending and 

revenue and difficult fiscal policy decisions. In the near term, however, 

opportunities exist to take action in a number of areas to better manage 

fragmented, overlapping, or duplicative federal agencies or programs; 

achieve cost savings; or enhance revenues. 

To call attention to these opportunities, Congress included a provision in 

statute for us to identify and report to Congress on federal programs, 

agencies, offices, and initiatives—either within departments or 

government-wide—that have duplicative goals or activities.2 These 

reports are issued annually to the House and Senate.3

In our first seven annual reports issued from 2011 to 2017, we presented 

724 actions in 278 areas for Congress or executive branch agencies to 

reduce, eliminate, or better manage fragmentation, overlap, or 

duplication; achieve cost savings; or enhance revenue.4 To date, 

Congress and executive branch agencies have partially or fully addressed 

551 (76 percent) of the actions we identified from 2011 to 2017, resulting 

 1GAO, Financial Audit: Fiscal Years 2017 and 2016 Consolidated Financial Statements of 

the U.S. Government, GAO-18-316R (Washington, D.C.: Feb. 15, 2018); and The Nation’s 

Fiscal Health: Action Is Needed to Address the Federal Government’s Fiscal Future, 

GAO-17-237SP (Washington, D.C.: Jan. 17, 2017). GAO’s analysis of the federal fiscal 

outlook can be found at http://www.gao.gov/fiscal_outlook/federal_fiscal_outlook/overview. 

2Pub. L. No. 111-139, § 21, 124 Stat. 8, 29 (2010), codified at 31 U.S.C. § 712 note. 

3Specifically, these reports are issued to the Senate Committees on Appropriations, 

Budget, and Homeland Security and Governmental Affairs and the House Committees on 

Appropriations, Budget, and Oversight and Government Reform.

4See GAO’s Duplication and Cost Savings webpage for links to the 2011 to 2017 annual 

reports: http://www.gao.gov/duplication/overview.

Letter
Page 2 GAO-18-571T 

in about $178 billion in financial benefits. We estimate that tens of billions 

more dollars could be saved by fully implementing our open actions.5

Our 2018 report, which we released on April 26, 2018, presents 68 new 

actions across 23 new program areas for Congress or executive branch 

agencies to reduce, eliminate, or better manage fragmentation, overlap, 

and duplication and achieve other financial benefits.6 My testimony today 

describes (1) new issues identified in our 2018 annual report; (2) the 

progress made in addressing actions identified in our past reports; and (3) 

examples of open actions directed to Congress or executive branch 

agencies. 

My comments are based upon our 2018 annual report, as well as our 

update on the progress made in implementing actions that we have 

suggested in our previous annual reports. These efforts are based on 

work we previously conducted in accordance with generally accepted 

government auditing standards. More details on our scope and 

methodology can be found in the full report.

Figure 1 outlines the definitions we use for fragmentation, overlap, and 

duplication for this work.

 5In calculating our total estimated realized and potential financial benefits, we relied on 

individual estimates from a variety of sources, which considered different time periods and 

utilized different data sources, assumptions, and methodologies. Realized benefits have 

been rounded down to the nearest $1 billion. Estimated potential benefits are subject to 

increased uncertainty, depending on whether, how, and when they are addressed, and 

are presented using a notional statement of magnitude. These totals represent a rough 

estimate of financial benefits.

6Of the 68 new actions, 7 were added to six existing areas. We also added 1 action to the 

Action Tracker that was inadvertently not included in the 2017 report to the Agencies' Use 

of Strategic Sourcing area (see 2013, Area 23). See GAO, 2018 Annual Report: Additional 

Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Other 

Financial Benefits, GAO-18-371SP (Washington, D.C.: Apr. 26, 2018). 
Page 3 GAO-18-571T 

Figure 1: Definitions of Fragmentation, Overlap, and Duplication
Page 4 GAO-18-571T 

On April 26, 2018 we released the latest updates to our Action Tracker

(see sidebar). Our tracker includes a downloadable spreadsheet 

(available in XLSX or CSV formats) that users can sort and filter based on 

their specific needs or interests. For example, areas and actions can be 

sorted by the year identified, mission area name, implementation status, 

and implementing entities (Congress or specific agencies).

Over 25 of the 68 new actions we identified in our annual report concern 

fragmentation, overlap, or duplication in government missions and 

functions (see table 1).7

 7The 68 new actions do not include 6 actions in four areas that agencies addressed 

before we issued our annual report. Specifically, the Department of State addressed 3 

actions related to Iraqi and Syrian Cultural Property Protection (see 2018, Area 24), the 

Department of Transportation (DOT) addressed 1 action related to DOT Operational 

Improvements (see 2018, Area 25), the Department of Veterans Affairs addressed 1 

action related to VA Human Capital Challenges (see 2018, Area 6), and the U.S. Agency 

for International Development addressed one action related to Combating Wildlife 

Trafficking (see 2018, Area 11). We added these actions to the Action Tracker with a 

status of “addressed.”

GAO’s online Action Tracker

GAO’s Action Tracker, a publicly accessible 

w ebsite, allows Congress, executive branch 

agencies, and the public to track the 

government’s progress in addressing the 

issues w e have identified. GAO updates the 

Action Tracker twice a year, in the spring and 

fall.

Click here to access GAO’s online Action

Tracker and downloadablespreadsheet

(available in XLSX or CSV formats).

Source: GAO. | GAO-18-571T

New Opportunities 

Exist to Improve 

Efficiency and 

Effectiveness across 

the Federal 

Government
Page 5 GAO-18-571T 

Table 1: New Fragmentation, Overlap, and Duplication Areas Identified 

Mission Area

Agriculture 1. Imported Seafood Oversight: Improved coordination between the Food and Drug Administration and 

the Food Safety and Inspection Service on the oversight of imported seafood would help the agencies 

better manage fragmentation and more consistently protect consumers from unsafe drug residues.

Defense 2. Defense Distribution Centers: By minimizing unnecessary overlap and duplication and more efficiently 

using its U.S. distribution centers to store and process goods for troop support, such as clothing and 

weapon systems repair parts, the Department of Defense could potentially save approximately $527 

million over 5 years. 

3. GPS Modernization: To reduce the risk of unnecessary duplication, the Department of Defense should 

assign a single organization responsibility for ensuring that common solutions for Global Positioning 

System receiver card modernization efforts are collected and shared among hundreds of programs. 

Receiver card modernization for a small portion of weapon systems is estimated to cost $2.5 billion 

through fiscal year 2021.

General 

government

4. Federal Use of Identity Theft Services: The Office of Management and Budget should explore options 

to address the risk that federal agencies may offer duplicative identity theft services in response to data 

breaches, potentially saving millions of dollars annually in unnecessary expenditures.

Health 5. Graduate Medical Education Funding: The Department of Health and Human Services should 

coordinate with federal agencies, including the Department of Veterans Affairs, to improve the 

effectiveness and oversight of fragmented federal funding for physician graduate medical education, 

which cost the federal government $14.5 billion in 2015.

6. VA Human Capital Challenges: The Veterans Health Administration should strengthen its human 

resources internal control practices and its employee performance management processes to address 

fragmentation across the agency and improve its ability to serve veterans.

Homeland 

security/law 

enforcement

7. Coast Guard Boat Stations: The Coast Guard should close its boat stations that provide unnecessarily 

duplicative search and rescue coverage to improve operations and potentially save millions of dollars.

8. National Institute of Standards and Technology Security Program Management: By addressing 

fragmentation in their physical security management structure, the Department of Commerce and the 

National Institute of Standards and Technology could improve their physical security program.

Income security 9. Reviews of SSA Disability Appeals: The Social Security Administration should evaluate its quality 

assurance reviews of decisions on appealed disability claims, which cost at least $11 million in fiscal 

year 2016, to reduce or better manage overlap between the types of reviews. 

10. Supplemental Security Income: To better manage fragmentation in service delivery, the Social 

Security Administration should explore options for better connecting transition-age youth receiving 

Supplemental Security Income to vocational rehabilitation services.

International 

affairs

11. Combating Wildlife Trafficking: Federal agencies that combat wildlife trafficking should clarify roles 

and responsibilities in Southeast Asia to better manage fragmentation and have more reasonable 

assurance that they can effectively marshal the contributions of all agencies.

Science and the 

environment

12. High-Containment Laboratories: The Federal Select Agent Program needs to better coordinate 

workforce planning across its two agencies to help address fragmentation in oversight of highcontainment laboratories.

Training, 

employment, and 

education

13. STEM Education Programs: Meeting requirements to assess the 163 federal science, technology, 

engineering, and mathematics education programs could create opportunities to better manage 

fragmentation and overlap and enhance the effectiveness of the portfolio. 

Source: GAO. | GAO-18-571T
Page 6 GAO-18-571T 

In addition, our 2018 report presents over 30 new opportunities for 

Congress or executive branch agencies to reduce the cost of government 

operations or enhance revenue collections for the U.S. Treasury across 

10 areas of government (see table 2). 

Table 2: New Cost Savings and Revenue Enhancement Opportunities Identified

Mission Area 

Defense 14. Foreign Currency Fluctuation: The Department of Defense needs to more efficiently and effectively manage 

foreign currency funds to potentially save millions of dollars. 

15. Supply Operations at Military Depots: The Department of Defense could improve the efficiency and 

effectiveness of supply operations at Army and Marine Corps depots and Navy shipyards and save tens of 

millions of dollars.

Economic 

development

16. Fiscal Management of the Universal Service Fund: By addressing weaknesses in the management and 

oversight of the Universal Service Fund, the Federal Communications Commission could eliminate at least $1 

million annually in fees paid to a private bank to manage investments. 

Energy 17. DOE’s Treatment of Hanford’s Low-Activity Waste: The Department of Energy may be able to reduce 

certain risks and save tens of billions of dollars by adopting alternative approaches to treat a portion of its 

low-activity radioactive waste.

General 

government 

18. Employment Taxes: Analyzing and using results from the Internal Revenue Service’s National Research 

Program employment tax study could help the agency identify and pursue millions of dollars annually in 

additional revenue owed.

19. Tax Fraud and Noncompliance: The Internal Revenue Service should fully assess the benefits and costs of 

using its existing authority to hold additional taxpayer refunds as well as extending the date for releasing 

those refunds until it can verify wage information on most returns later in the filing season, which could protect 

millions of dollars annually. 

Health 20. Premium Tax Credit Improper Payments: The Centers for Medicare & Medicaid Services and the Internal 

Revenue Service could save money by strengthening controls over the Premium Tax Credit for health 

insurance, which cost about $35 billion for fiscal year 2017. 

21. VA Medical Supplies Procurement: The Department of Veterans Affairs could potentially save tens of 

millions of dollars when acquiring medical and surgical supplies by better adhering to supply chain practices 

of leading hospitals.

Homeland 

security/law 

enforcement

22. Bureau of Prisons Health Care Costs: The Federal Bureau of Prisons could improve the oversight and 

management of its health care costs to more efficiently and effectively acquire health care goods and services 

and potentially save millions of dollars annually.

Income security 23. Railroad Retirement Board Continuing Disability Reviews: The Railroad Retirement Board could reduce 

overpayments by millions of dollars and better target resources by using more timely earnings data and 

reallocating resources used for high-risk continuing disability reviews to more effective efforts.

Source: GAO. | GAO-18-571T
Page 7 GAO-18-571T 

In addition to these new areas, we identified seven new actions that relate 

to six existing areas presented in our 2011 to 2017 annual reports (see 

table 3).8

Table 3: New Actions Added to Existing Areas in 2018

Mission New action (area name links to Action Tracker) Year introduced

(year links to report)

Agriculture Crop Insurance: In July 2017, GAO identified a new action that Congress can take 

to reduce the cost of delivering the federal crop insurance program by hundreds of 

millions of dollars annually. 

2013

Defense Defense Virtual Training: In September 2017, GAO identified a new action to help 

the Marine Corps better manage fragmentation in its virtual training program. 

2016

Navy Shipbuilding: In March 2017, GAO identified a new action to help the Navy 

improve its use of incentives in shipbuilding. 

2017

General 

government

Federal Vehicles: In April 2017, GAO identified two new actions to help the federal 

government better manage its fleet of retained vehicles. 

2016

Homeland 

security/law 

enforcement

Security of Federal Facilities: In February 2017, GAO identified a new action to 

better manage fragmentation among federal agencies to address risks to federal 

courthouse security.

2016

Information 

technology

Information Technology Investment Portfolio Management: In September 2016, 

GAO identified a new action to improve federal agencies’ efforts to complete 

software application inventories, which could further contribute to the billions of 

dollars of potential savings previously identified. 

2014

Source: GAO. | GAO-18-571T

Since our 2018 report was issued, we reported in April 2018 that four of 

the Centers for Medicare & Medicaid Services’ (CMS) Medicare prior 

authorization programs potentially reduced spending by as much as $1.9 

billion from September 2012 through March 2017.9 However, most of 

these programs, which ensure that Medicare coverage and payment rules 

have been met before the agency pays for selected items and services, 

such as certain wheelchairs, are either paused or will end in 2018. CMS 

does not have plans to extend these programs or expand the use of prior 

authorization to additional items and services. 

We recommended that CMS should take steps, based on results from 

evaluations, to continue prior authorization. The Department of Health 

and Human Services (HHS) neither agreed nor disagreed with the 

recommendation but said it would continue to evaluate prior authorization 

 8See appendix IV of GAO-18-371SP for more information.

9 GAO, Medicare: CMS Should Take Actions to Continue Prior Authorization Efforts to 

Reduce Spending, GAO-18-341 (Washington, D.C.: Apr. 20, 2018). 
Page 8 GAO-18-571T 

programs and take our findings and recommendations into consideration 

in determining next steps. We believe continued use of prior authorization 

for certain items and services—determined by lessons learned from 

existing prior authorization programs—could significantly reduce 

unnecessary Medicare spending.

We monitor the progress that Congress and executive branch agencies 

have made in addressing the issues we identified in each of our last 

seven annual reports. As shown in table 4, Congress and executive 

branch agencies have made consistent progress in addressing many of 

the actions we identified from 2011 to 2017. As of March 2018, 376 (52 

percent) of the actions we identified from 2011 to 2017 have been fully 

addressed. See our online Action Tracker for the status of all actions.

Congress and 

Executive Branch 

Agencies Continue to 

Address Actions That 

Span the Federal 

Government
Page 9 GAO-18-571T 

Table 4: Status of 2011 to 2017 Actions Directed to Congress and the Executive Branch, as of March 2018

Status

Number of

congressional actions

(percentage)a

Number of

executive branch actions

(percentage)b

Total

(percentage)

Addressed 30

(31%)

346

(55%)

376

(52%)

Partially addressed 11

(11%)

164

(26%)

175

(24%)

Not addressed 44

(45%)

78

(12%)

122

(17%)

Otherc 12

(12%)

39

(6%)

51

(7%)

Total

97

(100%)

627

(100%)

724

(100%)

Source: GAO. | GAO-18-571T

Note: Due to rounding, the total percentages do not add up to exactly 100 percent.

a

In assessing actions suggested for Congress, GAOapplied the following criteria: “addressed” means 

relevant legislation has been enacted and addressesall aspectsof the action needed; “partially 

addressed” means a relevant bill has passed a committee, the House of Representatives, or the Senate

during the current congressional session, or relevant legislation has been enacted but only addressed

part of the action needed; and “not addressed” means a bill may have been introduced but did not pass

out of a committee, or no relevant legislation has been introduced. At the beginning of a new

congressional session, GAOreapplies the criteria. Asa result, the status of an action may move from 

partially addressed to not addressed if relevantlegislation is not reintroduced fromthe prior 

congressional session.

b

In assessing actions suggested for the executive branch, GAOapplied the follow ing criteria: 

“addressed” means implementation of the action needed has been completed; “partially addressed” 

means the action needed is in development, or started but not yet completed; and “not addressed” 

means the administration, the agencies, or both have made minimal or no progress toward

implementing the action needed.

c

Of the 51 “other” actions, 34 are categorized as “consolidated or other” and 17 as “closed-not 

addressed.” Actions categorized as “consolidated or other” and “closed-not addressed” are no longer 

assessed. In most cases, “consolidated or other” actions were replaced or subsumed by new actions 

based on additional audit w ork or other relevant information. Actions are generally “closed-not 

addressed” when the action is no longer relevant due to changing circumstances. 
Page 10 GAO-18-571T 

The progress Congress and executive branch agencies have made in 

addressing our open actions has resulted in $178 billion in financial 

benefits, including roughly $125 billion in financial benefits from 2010 

through 2017, with at least an additional $53 billion in estimated benefits 

projected to accrue in 2018 or later.10 Table 5 highlights examples of 

these results. 

Table 5: Examples of Addressed or Partially Addressed Actions with Associated Cost Savings and Revenue Enhancements 

Area name (links to Action 

Tracker) Actions taken Financial benefit

Farm Program Payments 

(2011/Area 35)

Congress passed and the President signed the 

Agricultural Act of 2014, which eliminated direct 

payments to farmers.a

Savings of approximately$44.5 billion from 

fiscal year 2015 through fiscal year 2023, of 

which $14.8 billion has accrued and $29.7 

billion is expected to accrue in fiscal year 

2018 or later, according to the Congressional 

Budget Office (CBO). 

Weapon Systems Acquisition 

Programs (2011/Area 38)

Congress passed and the President signed the 

Weapon Systems Acquisition Reform Act of 

2009, which implemented a number of GAO’s 

recommendations for how the Department of 

Defense (DOD) develops and acquires weapon 

systems. GAO highlighted the need for 

additional action in this area in its 2011 report. 

Since then, DOD has followed more best 

practices for these acquisitions.b

Savings of approximately $36 billion from 

2011 through 2015, according to GAO 

analysis.

Domestic Ethanol Production 

(2011/Area 13)

Congress allowed the Volumetric Ethanol Excise 

Tax Credit to expire at the end of 2011, which 

eliminated duplicative federal efforts directed at 

increasing domestic ethanol production and 

reduced revenue losses.c

Reduced revenue losses by $29 billion in 

fiscal years 2012 through 2016, according to 

GAO analysis.

Passenger Aviation Security Fees 

(2012/Area 48)

Congress passed the Bipartisan Budget Act of 

2013 which modified the passenger security fee 

from its current per enplanement structure 

($2.50 per enplanement with a maximum oneway-trip fee of $5.00) to a structure that 

increases the passenger security fee to a flat 

$5.60 per one-way-trip.d

Increased revenue of about $12.9 billion in 

fee collections over a 10-year period 

beginning in fiscal year 2014 and continuing 

through fiscal year 2023.

Tax Policies and Enforcement 

(2015/Area 17)

Congress amended the audit procedures 

applicable to certain large partnerships to 

require that they pay audit adjustments at the 

partnership level.e

Increase revenue by $9.3 billion from fiscal 

years 2019 to 2025, according to the Joint 

Committee on Taxation.

 10In calculating these totals, we relied on individual estimates from a variety of sources, 

which considered different periods and utilized different data sources, assumptions, and 

methodologies. These totals represent a rough estimate of financial benefits and have 

been rounded down to the nearest $1 billion.

Billions in Financial 

Benefits Due to Actions 

Taken by Congress and 

Executive Branch 

Agencies
Page 11 GAO-18-571T 

Area name (links to Action 

Tracker) Actions taken Financial benefit

Real Estate-Owned Properties 

(2014/Area 18)

The Department of Housing and Urban 

Development made improvements to increase 

the recoveries from disposing of properties it 

receives when loans default, such as by selling 

these loans and increasing property inspections 

and oversight of contractors disposing of these 

properties.

Savings of up to $4.7 billion from July 2013 

through June 2017, according to GAO 

analysis. 

Combat Uniforms (2013/Area 2) The Army chose not to introduce a new family of 

camouflage uniforms into its inventory.

Cost avoidance of about $4.2 billion over 5 

years, of which $3.4 billion has accrued since 

fiscal year 2014 and $0.8 billion is expected 

to accrue in fiscal year 2018, according to 

agency estimates.

Federal Data Centers (2011/Area 

15)

The 24 federal agencies participating in the 

Office of Management and Budget’s (OMB) data 

center consolidation and optimization efforts 

have taken steps to consolidate over 5,800 data 

centers as of August 2017.

Cost savings and avoidances of $3.9 billion

from fiscal years 2011 through 2018, based 

on GAO analysis of agency reported data. 

This includes about $345.4 million expected 

to accrue in fiscal year 2018, according to 

agencies’ plans.

Agencies’ Use of Strategic 

Sourcing (2013/Area 23)

The Department of Veterans Affairs evaluated 

strategic sourcing opportunities and set goals 

and metrics such as increasing managed 

spending for information technology (IT) 

products and services.

Cost avoidance of about $3.6 billion from 

fiscal years 2013 through 2015, according to 

agency estimates.

Overseas Defense Posture 

(2012/Area 37)

United States Forces Korea conducted a series 

of consultations with the military services to 

evaluate the costs and benefits associated with 

tour normalization, and DOD decided not to 

move forward with the full tour normalization 

initiative because it was not affordable.

Savings of an estimated $3.1 billion from 

fiscal years 2012 through 2016, according to 

agency estimates.

Homeland Security Grants 

(2012/Area 17)

Congress limited preparedness grant funding 

until the Federal Emergency Management 

Agency completes a national preparedness 

assessment of capability gaps.f

Savings of $2.6 billion from fiscal years 2011 

through 2013, according to GAO analysis.

Treasury’s Foreclosure Prevention 

Efforts (2016/Area 17)

The Department of the Treasury (Treasury) 

updated its analysis of estimated future 

expenditures for the Making Home Affordable 

program, reducing the estimated lifetime cost of 

the program.

Savings of $2 billion as a result of 

deobligating funds in February 2016, 

according to agency estimates.

Information Technology Investment 

Portfolio Management (2014/Area 

24)

Eight agencies completed efforts to migrate 

commodity IT areas to shared services in 

response to OMB’s 2012 guidance to review 

their portfolios and identify duplicative, lowvalue, and wasteful investments, contributing to 

savings.

Savings of about $1.8 billion from fiscal years 

2012 through 2016, according to agency 

estimates.

DOD’s Business Systems 

(2011/Area 8)

DOD canceled the Air Force’s Expeditionary 

Combat Support System because of significant 

cost and schedule overages.

Savings of about $1.6 billion from fiscal years 

2013 through 2025, according to GAO 

analysis of agency estimates.This includes 

about $985 million expected to accrue in 

fiscal year 2018 or later.
Page 12 GAO-18-571T 

Area name (links to Action 

Tracker) Actions taken Financial benefit

Strategic Petroleum Reserve 

(2015/Area 15) 

The Department of Energy (DOE) completed a 

long-term strategic review of the Strategic 

Petroleum Reserve in August 2016, as 

Congress required in 2015.

DOE reported savings of $1.2 billion from 

selling crude oil from the reserve in fiscal year 

2017 and 2018, with potential for over $8.4 

billion in total sales through 2025 according 

to CBO.

Federal Payments for Hospital 

Uncompensated Care (2017/Area 

25)

The Department of Health and Human Services 

began to align Medicare Uncompensated Care 

payments with hospitals’ actual uncompensated 

care costs starting in fiscal year 2018 instead of 

basing these payments on hospitals’ Medicaid 

workload.

Financial benefits of about $752 million in 

fiscal year 2018 from better use of Medicare 

funds, according to GAO analysis. 

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, CBO, and the Joint Committee on Taxation. Some estimates have been updated since 

GAO’s 2017 report to reflect more recent analysis.

a

Pub. L. No. 113-79, § 1101, 128 Stat. 649, 658 (2014). 

b

Pub. L. No. 111-23, 123 Stat. 1704 (2009). 

c

26 U.S.C. § 6426(b)(6). 

d

Pub. L. No. 113-67, § 601(b), 127 Stat. 1165, 1187 (2013)

e

Bipartisan Budget Act of 2015, Pub. L. No. 114-74, § 1101, 129 Stat. 584, 625–638 (2015). 

f

Pub. L. No. 112-10, § 1632, 125 Stat. 38, 143 (2011); Pub. L. No. 112-74, 125 Stat. 786, 960-62 

(2011); Pub. L. No. 113-6, 127 Stat. 198, 358-60 (2013); Pub. L. No. 113-76, 118 Stat. 5, 261-62 

(2014).

These financial benefits continue to grow as we identify and document 

additional agency actions that respond to our recommendations. For 

example, in recent months CMS has formalized changes to its oversight 

of spending allowed for large Medicaid demonstrations, which allow 

states to test new ways to deliver or pay for care. These demonstrations, 

by HHS policy, should not raise federal costs over what the program 

would have cost without the demonstration—that is, they should be 

budget neutral. But our past work has shown that the spending HHS had 

authorized for these demonstrations was much higher than what was 

justified, as HHS had allowed states to use questionable methods when 

proposing spending for their demonstrations. 

CMS’s new policy partially responds to a longstanding recommendation 

we have made to better ensure that valid methods are used to 

demonstrate budget neutrality. We anticipate that CMS’s recent actions 

could potentially reduce the federal government’s liability for Medicaid by 

billions, or tens of billions, annually. 

While not all actions result in financial benefits to taxpayers, all of our 

suggested actions, when implemented, can result in other benefits—for 
Page 13 GAO-18-571T 

instance, they make government more efficient or eliminate, reduce, or 

improve management of fragmented, overlapping, or duplicative 

programs. For example, such benefits can be seen in the results of our 

work on the government’s acquisition of space programs. For over two 

decades, we and others have reported on problems caused by 

fragmented leadership and a lack of a single authority in oversight of 

these multibillion dollar programs.

In 2012, we made a recommendation aimed at strengthening leadership 

and authority of space systems acquisitions. In response, in 2017 the 

President revived the National Space Council to provide a coordinated 

process for developing and monitoring the implementation of national 

space policy and strategy. Separately, in the National Defense 

Authorization Act for Fiscal Year 2018, Congress made changes to 

certain DOD space leadership positions and required the department to 

conduct a review and identify a recommended organizational and 

management structure for its national security space components, and 

submit related reports. The act also required DOD to contract with a 

federally funded research and development center not closely affiliated 

with the Air Force to develop a plan to establish a separate military 

department responsible for DOD national security space activities.11

These actions could reduce fragmentation and speed decision making in 

the development of a substantial investment in space systems.

While Congress and executive branch agencies have made progress 

toward addressing the 798 total actions we have identified since 2011, 

further steps are needed to fully address the 365 actions that are partially 

addressed or not addressed.12 We estimate that tens of billions of dollars 

in additional financial benefits could be realized should Congress and 

executive branch agencies fully address open actions.13 In addition to 

producing financial benefits, these actions make government more 

efficient; improve major government programs or agencies; reduce the 

 11Pub. L. No. 115-91, § 1601(c), (d), 131 Stat. 1283, ___ (2017).

12The 798 total actions include the 68 new actions identified in this report and six new 

actions that were addressed before this report was issued.

13In calculating this estimate, we relied on individual estimates from a variety of sources, 

which considered different time periods and utilized different data sources, assumptions, 

and methodologies. These estimates are subject to increased uncertainty, depending on 

whether, how, and when they are addressed. This amount represents a rough estimate of 

financial benefits.

Action on Remaining 

and New Areas Could 

Yield Significant 

Additional Benefits
Page 14 GAO-18-571T 

risk of mismanagement, fraud, waste, and abuse; and increase 

assurance that programs comply with laws and funds are legally spent.

Congress has used our work to identify legislative solutions to achieve 

cost savings, address emerging problems, and find efficiencies in federal 

agencies and programs. Our work has contributed to a number of key 

authorizations and appropriations. In addition, congressional oversight of 

agencies’ efforts has been critical in realizing the full benefits of our 

suggested actions addressed to the executive branch, and it will continue 

to be critical in the future.

In our 2011 to 2018 annual reports, we directed 100 actions to Congress, 

including the 3 new congressional actions we identified in 2018. Of the 

100 actions, 58 remain open (11 of which were partially addressed and 

47 were not addressed or new) as of March 2018. Table 6 highlights 

areas with significant open actions directed to Congress. Appendix I has 

a full list of all open congressional actions.

Table 6: Examples of Areas with Open Actions Directed to Congress 

Annual report

(year links

to report) Area description (area number links to Action Tracker)

2018 DOE’s Treatment of Hanford’s Low-Activity Waste (Area 17): Congress should consider granting the 

Department of Energy (DOE) authority to manage certain portions of Hanford’s tank waste as a waste type other 

than high-level waste, which would allow DOE to use alternative waste treatment approaches and could reduce 

certain risks and save tens of billions of dollars.

2017 Use of the Do Not Pay Working System (Area 11): The Office of Management and Budget (OMB) needs to

develop a strategy and additional guidance on the use of the Do Not Pay working system, and Congress should

consider amending the Social Security Act to explicitly allow the Social Security Administration (SSA) to share its full

death file through the system to reduce improper payments and mitigate the risks associated with potential 

duplication.

2016 Treasury's Foreclosure Prevention Efforts (Area 17): Congress could rescind and direct $4.8 billion to other 

priorities upon the Department of Treasury’s review of potential unexpended balances and deobligation of excess 

funds for the Making Home Affordable Program.

2016 Medicare Payments by Place of Service (Area 30): Medicare could save $1 to 2 billion annually if Congress 

were to equalize the rates Medicare pays for certain health care services, which often vary depending on where the

service is performed.a

2015 DOD US Family Health Plan (Area 6): To potentiallysave millions of dollars and eliminate duplication within the 

Department of Defense’s (DOD) health care system, Congress should terminate the statutorilyrequired US Family

Health Plan because it offers military beneficiaries the same health care benefit offered by other DOD health care

contractors within many of the same geographic service areas.

2015 Medicare Payments to Certain Cancer Hospitals (Area 19): To achieve almost $500 million annually in program 

savings, Congress should consider modifying how Medicare pays certain cancer hospitals.

Significant Open Actions 

Directed to Congress
Page 15 GAO-18-571T 

Annual report

(year links

to report) Area description (area number links to Action Tracker)

2014 Disability and Unemployment Benefits (Area 8): Congress should consider passing legislation to prevent 

individuals from collecting both full DisabilityInsurance benefits and Unemployment Insurance benefits that cover 

the same period, which could save almost $2.5 billion over 10 years in the Social Security Disability Insurance

program, according to OMB.

2014 Advanced Technology Vehicles Manufacturing Loan Program (Area 13): Unless DOEcan demonstrate

demand for new Advanced TechnologyVehicles Manufacturing loans and viable applications, Congress may wish

to consider rescinding all or part of the remaining $4.3 billion in credit subsidyappropriations.

2013 Crop Insurance (Area 19): To achieve up to $1.4 billion annually in cost savings in the crop insurance program,

Congress could consider limiting the subsidy for premiums that are provided on behalf of individual farmers—as it 

limits the amount of payments to individual farmers in manyfarm programs—or reducing the subsidyor some 

combination of limiting and reducing these subsidies.

2013 Tobacco Taxes (Area 31): Federal revenue losses ranged from as much as $2.6 to $3.7 billion between April 2009

and February 2014 because manufacturers and consumers substituted higher-taxed smoking tobacco products with

similar lower-taxed products. To address future revenue losses, Congress should consider modifying tobacco tax 

rates to eliminate significant tax differentials between similar products.

2011 Social Security Offsets (Area 80): SSA needs data on pensions from noncovered earnings to better enforce

offsets and ensure benefit fairness, which could result in estimatedsavings of $2.4 to $7.9 billion over 10 years if 

enforced both retrospectively and prospectively, according to the CongressionalBudgetOffice and SSA. Congress 

could consider giving the Internal Revenue Service the authority to collect the necessary information. Estimated

savings would be less if SSA only enforced the offsets prospectivelyas it would not reduce benefits already

received.

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive-branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

a

In 2015, Congress took some steps to address this by excluding services furnished by off-campus 

hospital outpatient departments from this higher payment, effective January 1, 2017. How ever, this 

exclusion w ill not apply to services furnished by providers billing as hospital outpatient departments 

prior to enactment of the legislation—that is, all providers billing as hospital outpatients during GAO’s 

study—who would continue to be paid under higher rate or to services provided by on-campus 

hospital outpatient departments. Congress later added providers meeting a mid-build requirement to 

the list of providers to w hich the exclusion would not apply.
Page 16 GAO-18-571T 

In our 2011 to 2018 annual reports, we directed 698 actions to executive 

branch agencies, including 65 new actions identified in 2018. Of the 698 

actions, 307 remained open as of March 2018. Of these open actions, 

164 were partially addressed and 143 were not addressed or new. While 

these open actions span the government, a substantial number of them 

are directed to seven agencies that made up 83 percent—$3.7 trillion—of 

federal outlays in fiscal year 2017 and have the largest number of open 

actions (see figures 2 and 3).

Figure 2: Fiscal Year 2017 Outlays and Number of Open Actions since 2011, by 

Agency 

Notes: Number of open actions includes actions that are partially addressed and not addressed.

a

Treasury’s percentage of fiscal year2017 outlays includes interest payments on the national debt as 

w ell as costs associated with administering Bureaus including the Internal Revenue Service.

b

Other agencies include all federal agencies with fiscal year 2017 outlays not listed above.

Significant Open Actions 

Directed to Executive 

Branch Agencies
Page 17 GAO-18-571T 

As shown in figure 3, seven agencies have at least 25 open actions.

Figure 3: Number of Not Addressed and Partially Addressed Actions since 2011, by Agency 

Notes: Action status is as of March 2018. Individual actions are counted multiple times w hen they

are directed to more than one federal department or agency. Asa result, the number of open
Page 18 GAO-18-571T 

actions shown in this figure totals 514 instead of 307, the latter of which is the total number of open

actions directed to the executive branch as of March 2018.

The number of actions “partially addressed”means the action needed is in development or started but

not yet completed. The number of actions “not addressed”means the administration, the agencies, or

both have made minimal or no progress toward implementing the action needed. Actions that w ere

introduced in this 2018 annualreport are counted as “not addressed.”

a

”Other entities” reflectsopen actionsdirectedto the following federal entities: The Executive Office

of the President, National Security Council, Office of the Director of National Intelligence, Office of 

National Drug ControlPolicy, Office of Science and TechnologyPolicy, Homeland Security Council, 

Consumer Financial Protection Bureau, FederalReserve, U.S. Commission on International

Religious Freedom, National Telecommunications and Information Administration, Railroad 

Retirement Board, the Committee on Science, Technology, Engineering, and Mathematics 

Education and the FederalCommunications Commission.

The following sections highlight examples of open actions across those 

seven major agencies. 

In our 2011 to 2018 reports, we directed 176 actions to DOD in areas that 

center on DOD’s effectiveness in providing the military forces needed to 

deter war and to protect the security of the United States. As of March 

2018, 74 of these 176 actions remained open. DOD represented about 14 

percent of federal spending in fiscal year 2017, with outlays totaling about 

$635.5 billion. Our work suggests that effectively implementing these 

open actions, including those related to areas listed in table 7, could yield 

substantial financial benefits and improve DOD’s effectiveness.

More Efficiently Targeting 

Defense Resources
Page 19 GAO-18-571T 

Table 7: Examples of Areas with Open Actions Directed to the Department of Defense 

Annual report 

(year links

to report) Area description (area number links to Action Tracker)

2018 Defense Distribution Centers (Area 2): By minimizing unnecessary overlap and duplication and more efficiently 

using its U.S. distribution centers to store and process goods for troop support, such as clothing and weapon 

systems repair parts, the Department of Defense (DOD) could potentially save approximately $527 million over 5 

years. 

2017 DOD Commissaries (Area 16): By managing its commissaries more efficiently, DOD could position itself to better 

achieve its cost savings target of $2 billion.

2013 Agencies’ Use of Strategic Sourcing (Area 23): Selected agencies—including DOD—could better leverage their

buying power and achieve additional savings by directing more procurement spending to existing strategically

sourced contracts and further expanding strategic sourcing practices to their highest spending procurement 

categories. GAO originally estimates that savings of 1 percent from selected agencies’ procurement spending alone 

would equate to over $4 billion. Resulting action from one of these agencies (the Department of Veterans Affairs) 

has already resulted in $3.6 billion in savings.

2012, 2015 DOD Headquarters Reductions and Workforce Requirements (Areas 34, 14): DOD could potentially save $9.4

billion by identifying further opportunities for consolidating or reducing the size of headquarters organizations to 

meet their assigned missions through periodic reassessments of its workforce requirements. 

2011 Weapon Systems Acquisition Programs (Area 38): Continuing to employbest management practices could help

DOD save money on its weapon systems acquisition programs. Given the trillion-dollar size of the portfolio, GAO

estimates potential savings from addressing the remaining actions could be in the billions of dollars over the next 

several years.

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

In our 2011 to 2018 reports, we directed 111 actions to HHS in areas that 

contribute to HHS’s mission to enhance the health and well-being of 

Americans. HHS provides health coverage for over 145 million Americans 

through three principal programs—Medicare, Medicaid, and the 

Children’s Health Insurance Program—as well as the health-insurance 

marketplaces. HHS also operates other public health-related agencies 

such as the Food and Drug Administration, the Centers for Disease 

Control and Prevention, and the National Institutes of Health. 

HHS represented about 27 percent of the fiscal year 2017 federal budget, 

with outlays totaling about $1.2 trillion. As of March 2018, 56 of HHS’s 

111 actions remained open. Our work suggests that effectively 

implementing these actions, including those related to areas listed in table 

8, could reduce costs, provide services more efficiently, and yield 

substantial financial benefits.

Improving the Efficiency of 

Health Care Programs 
Page 20 GAO-18-571T 

Table 8: Examples of Areas with Open Actions Directed to the Department of Health and Human Services

Annual report 

(year links

to report) Area description (area number links to Action Tracker)

Medicare

2015 Medicare Postpayment Claims Reviews (Area 7): To prevent inappropriate duplicative postpayment claims 

reviews by contractors, the Centers for Medicare & Medicaid Services (CMS) should monitor the Recovery Audit 

Data Warehouse—the database developed in part to prevent duplicative reviews.

2012 Medicare Advantage Payments (Area 45): To help ensure appropriate payments to Medicare Advantage plans,

CMS should take steps to improve the accuracy of the adjustment made for differences in diagnostic coding 

practices between Medicare Advantage plans and traditional Medicare providers, which could result in savings of 

billions of dollars.

Medicaid

2017 Medicaid Personal Care Services Data (Area 26): CMS needs timely, complete, and consistent data on Medicaid 

personal care services so it can effectively monitor these services, which could lead to savings of tens of millions 

of dollars annually.

2016 Medicaid Payments to Institutional Providers (Area 29): CMS should take steps to improve the oversight of state

Medicaid payments to institutional providers and better ensure that the federal government does not provide funds

for excessive state payments made to certain providers,which could result in savings of hundreds of millions of

dollars annually.

2014,

2016

Demonstration Spending (Areas 21, 27): Federal spending on Medicaid demonstrations could be reduced by

billions of dollars if the Department of Health and Human Services improved the process for reviewing, approving, 

and making transparent the basis for spending limits approved for Medicaid demonstrations, including better 

ensuring that valid methods are used to demonstrate budget neutrality and implemented other actions and 

recommendations, such as establishing specific criteria for assessing whether demonstration spending furthers 

Medicaid objectives.

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

In our 2011 to 2018 reports, we directed 91 actions to the Internal 

Revenue Service (IRS) in areas that contribute to effectively and 

efficiently providing high-quality service to taxpayers and enforcing the 

law with integrity and fairness to all. As of March 2018, 38 of these 91 

actions remained open. The funding of the federal government depends 

largely upon IRS’s ability to collect taxes legally owed. Our work suggests 

that effective implementation of our open actions, including those related 

to areas listed in table 9, could increase revenues through better 

compliance or reduce costs.

Enhancing Federal 

Revenues
Page 21 GAO-18-571T 

Table 9: Examples of Areas with Open Actions Directed to the Internal Revenue Service

Annual report 

(year links

to report) Area description (area number links to Action Tracker)

2018 Employment Taxes (Area 18): Analyzing and using results from the Internal Revenue Service’s (IRS) National 

Research Program employment tax study could help the agency identify and pursue millions of dollars annually 

in additional revenue owed. 

2018 Tax Fraud and Noncompliance (Area 19): IRS should fully assess the benefits and costs of using its existing 

authority to hold additional taxpayer refunds as well as extending the date for releasing those refunds until it can 

verify wage information on most returns later in the filing season, which could protectmillions of dollars annually.

2017 Refundable Tax Credits (Area 24): IRS could potentially realize hundreds of millions of dollars in cost savings

by improving the administration of three large refundable tax credits (the Earned Income Tax Credit; the Additional

Child Tax Credit, which is sometimes combined with its nonrefundable counterpart, the Child Tax Credit; and the

America Opportunity Tax Credit).

2016 Identity Theft Refund Fraud (Area 22): IRS and Congress could potentiallysave billions of dollars in fraudulent 

refunds by improving the agency’s efforts to prevent refund fraud associated with identitytheft.

2014 Online Taxpayer Services (Area 17): IRS could potentiallyrealize hundreds of millions of dollars in cost savings 

and increased revenues by enhancing its online services,which would improve service to taxpayers and encourage 

greater tax-law compliance.

2013,

2015

Tax Policy and Enforcement (Areas 22, 17): By using more-rigorous analyses to allocate enforcement resources 

and using data to improve management of enforcement programs such as large partnership and correspondence 

audits, among other things, the IRS can increase revenue collections byhundreds of millions of dollars.

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

In our 2011 to 2018 reports, we directed 79 actions to the Department of 

Homeland Security (DHS) in areas that contribute to the effective 

implementation of its mission. In fiscal year 2017, DHS spent about $63.6 

billion, about 1.4 percent of federal outlays. As of March 2018, 31 of the 

79 actions to DHS remained open. Fully implementing these actions, 

including those related to areas listed in table 10, could result in financial 

benefits and substantial improvements in agency operations.

Improving the Efficiency 

and Effectiveness of 

Homeland Security 

Operations
Page 22 GAO-18-571T 

Table 10: Examples of Areas with Open Actions Directed to the Department of Homeland Security

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

Many of the results the federal government seeks to achieve require the 

coordinated effort of more than one federal agency, level of government, 

or sector. OMB manages and coordinates many government-wide efforts. 

In our 2011 to 2018 reports, we directed 66 actions to OMB in areas to 

improve the efficiency and effectiveness of government-wide programs 

and activities. As of March 2018, 30 of the 66 actions to OMB remained 

open. Fully implementing these actions, including those related to areas 

listed in table 11, could yield significant financial benefits and substantial 

program improvements across government.

Annual report 

(year links

to report) Area description (area number links to Action Tracker)

2018 Coast Guard Boat Stations (Area 7): The Coast Guard should close its boat stations that provide unnecessarily 

duplicative search and rescue coverage to improve operations and potentially save millions of dollars.

2012 Border Security (Area 47): The Department of Homeland Security’s (DHS) future acquisitions of border 

surveillance technology could be better informed by using performance metrics to assess the contributions of 

existing surveillance technologies.

2012 Domestic Disaster Assistance (Area 51): The Federal EmergencyManagement Agency could reduce the costs to

the federal government related to major disasters declared by the President by updating the principal indicator on

which disaster funding decisions are based and better measuring a state’s capacityto respond without federal

assistance.

2012 Homeland Security Grants (Area 17): DHS needs better project information and coordination among four

overlapping grant programs and needs to establish a framework for assessing preparedness capabilities to identify

gaps and prioritize investments.

Advancing the 

Implementation of 

Government-Wide Policies 

and Performance
Page 23 GAO-18-571T 

Table 11: Examples of Areas with Open Actions Directed to the Office of Management and Budget

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

In our 2011 to 2018 reports, we directed 32 actions to the Social Security 

Administration (SSA) in areas that contribute to SSA providing financial 

assistance to eligible individuals through Social Security retirement and 

disability benefits and Supplemental Security Income (SSI) payments. As 

of March 2018, 27 of these 32 actions remained open. 

In fiscal year 2017, SSA spent about $1 trillion, roughly 22 percent of 

federal outlays. While most of SSA’s funding is used to pay Social 

Security retirement, survivors, and disability benefits from the Old-Age 

and Survivors Insurance Trust Fund and the Disability Insurance Trust 

Fund, our work suggests that effective implementation of these actions, 

including the examples listed in table 12, could result in significant 

benefits. 

Annual report 

(year links

to report) Area description (area number links to Action Tracker)

2018 Federal Use of Identity Theft Services (Area 4): The Office of Management and Budget (OMB) should explore 

options to address the risk that federal agencies may offer duplicative identity theft services in response to data 

breaches, potentially saving millions of dollars annually in unnecessary expenditures. 

2014 Information Technology Investment Portfolio Management (Area 24): OMB and multiple agencies could help the 

federal government realize billions of dollars in savings by taking steps to better implementPortfolioStat, a process 

to help agencies manage their information technologyinvestments.

2013 Geospatial Investments (Area 11): Better coordination among federal agencies that collect, maintain, and use

geospatial information could help reduce duplication in geospatial investments and provide the opportunity for 

potential savings ofmillions of dollars.

2012 Federal User Fees (Area 43): Regularly reviewing federal user fees and charges can help Congress and federal

agencies identifyopportunities to address inconsistent federal funding approaches and enhance user financing, 

thereby reducing reliance on general fund appropriations.

2011 Tax Expenditures (Area 17): Periodic reviews could help identifyineffective tax expenditures and redundancies in 

related tax and spending programs, potentiallyreducing revenue losses by billions of dollars.

2011 Government-Wide Improper Payments (Area 46): Efforts to address the reported estimate of about $141 billion in 

government-wide improper payments for fiscal year 2017 could result in significant cost savings.

More Efficiently 

Administering Services to 

Retirees and Citizens with 

Disabilities
Page 24 GAO-18-571T 

Table 12: Examples of Areas with Open Actions Directed to the Social Security Administration

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

In our 2011 to 2018 reports, we directed 54 actions to the Department of 

Veterans Affairs (VA) in areas that contribute to VA effectively and 

efficiently achieving its mission to promote the health, welfare, and dignity 

of all veterans by ensuring that they receive medical care, benefits, and 

social support. As of March 2018, 25 of these 54 actions remained open. 

In fiscal year 2017, VA spent about $183.0 billion—about 4 percent of 

federal outlays—for veterans’ benefits and services. Our work suggests 

that effective implementation of these actions, including those related to 

areas listed in table 13, could yield cost savings and efficiencies that 

would improve the delivery of services to the nation’s veterans and their 

families. 

Annual report 

(year links to 

report) Area description (area number links to Action Tracker)

2018 Supplemental Security Income (Area 10): To better manage fragmentation in service delivery, the Social Security 

Administration (SSA) should explore options for better connecting transition-age youth receiving Supplemental 

Security Income to vocational rehabilitation services. 

2016 Disability Insurance Overpayments (Area 32): To help prevent the loss of billions ofdollars,SSA should take

steps to prevent overpayments to beneficiaries of the DisabilityInsurance program and improper waivers of 

beneficiaries’ overpayment debt.

2016 Disability Reviews (Area 33): SSA mayincrease federal savings realized as a result of disabilityreviews by further 

considering factors that affect individuals’ expected lifetime benefits when prioritizing its reviews of Disability

Insurance and Supplemental SecurityIncome cases.

2012 Social Security Benefit Coordination (Area 27): Benefit offsets for related programs help reduce the potential for 

overlapping payments but pose administrative challenges.

Improving Support and 

Services for Veterans
Page 25 GAO-18-571T 

Table 13: Examples of Areas with Open Actions Directed to the Department of Veterans Affairs

Source: GAO. | GAO-18-571T

Note: The estimates in this report are from a range of sources, including GAO, executive branch 

agencies, the Congressional Budget Office, and the Joint Committee on Taxation. Some estimates 

have been updated since GAO’s 2017 report to reflect more recent analysis.

We will continue to look for additional or emerging instances of 

fragmentation, overlap, and duplication and opportunities for cost savings 

or revenue enhancement. Likewise, we will continue to monitor 

developments in the areas we have already identified. We stand ready to 

assist this and other committees in further analyzing the issues we have 

identified and evaluating potential solutions.

Thank you, Chairman Enzi, Ranking Member Sanders, and Members of 

the Committee; this concludes my prepared statement. I would be 

pleased to answer questions.

For further information on this testimony or our April 26, 2018 report, 

please contact J. Christopher Mihm, Managing Director, Strategic Issues, 

at (202) 512-6806 or mihmj@gao.gov, and Jessica Lucas-Judy, Director, 

Strategic Issues, at (202) 512-9110 or lucasjudyj@gao.gov. Contact 

points for the individual areas listed in our 2018 annual report can be 

found at the end of each area in GAO-18-371SP. Contact points for our 

Congressional Relations and Public Affairs offices may be found on the 

last page of this statement.

Annual report 

(year links

to report) Area description (area number links to Action Tracker)

2018 VA Human Capital Challenges (Area 6): The Veterans Health Administration should strengthen its human 

resources internal control practices and its employee performance management processes to address fragmentation 

across the agency and improve its ability to serve veterans. 

2018 VA Medical Supplies Procurement (Area 21): The Department of Veterans Affairs (VA) could potentially save

tens of millions of dollars when acquiring medical and surgical supplies by better adhering to supply chain 

practices of leading hospitals. 

2017 Department of Veterans Affairs Medical Facility Construction (Area 20): VA could better avoid cost increases

and schedule delays on its medical facilityconstruction projects byimproving management of facility construction.

2013 Information Technology Operations and Maintenance (Area 30): Strengthening oversight offederal agencies’—

including VA’s—major information technologyinvestments in operations and maintenance provides opportunityfor 

savings ofbillions of dollars across the federal government.

2012 Military and Veterans Health Care (Area 15): The Departments of Defense (DOD) and Veterans Affairs (VA) need

to improve integration across care coordination and case-management programs to reduce duplication and better 

assist service members, veterans, and their families.

GAO Contacts
Appendix I: Open Congressional Actions, by 

Mission

Page 26 GAO-18-571T 

In our 2011 to 2018 annual reports, we directed 100 actions to Congress, 

of which 58 remain open. Of the 58 open congressional actions, 11 are 

partially addressed and 47 are not addressed or new, as of March 2018. 

See table 14.

Table 14: Open Congressional Actions Related to Fragmentation, Overlap, Duplication, Cost Savings, or Revenue 

Enhancement, 2011-2018 

Mission 

Annual 

report Area Action summary

Agriculture 2013 Agricultural 

Quarantine 

Inspection Fees

(Area 18) 

Congress should consider taking steps to allow the Secretary of Agriculture to set 

fee rates to recover the full costs of the Agricultural Quarantine Inspection program. 

Crop Insurance

(Area 19) 

Congress may wish to consider either limiting the amount of premium subsidies that 

an individual farmer can receive each year as it limits the amount of payments to 

individual farmers in many farm programs or reducing premium subsidy rates, or 

both limiting premium subsidies and reducing premium subsidy rates. Implementing 

this action could result in $1.4 billion annually in cost savings, according to GAO 

analysis.

Congress should consider repealing the 2014 farm bill requirement that any revision 

to the standard reinsurance agreement not reduce insurance companies’ expected 

underwriting gains, and directing the Risk Management Agency to, during the next 

renegotiation of the agreement, (1) adjust the participating insurance companies’ 

target rate of return to reflect market conditions and (2) assess the portion of 

premiums that participating insurance companies retain and, if warranted, adjust it. 

Implementing this action could result in hundreds of millions of dollars in savings 

annually, according to GAO analysis.

2011 Food Safety (Area 

1) 

Congress should consider commissioning the National Academy of Sciences or a 

blue ribbon panel to conduct a detailed analysis of alternative food safety 

organizational structures.

Congress should consider formalizing the Food Safety Working Group through 

statute to help ensure sustained leadership across food safety agencies over time.

Defense 2013 Joint Basing (Area 

20) 

Congress should consider directing the Assistant Secretary of Defense for Energy, 

Installations, and Environment, in collaboration with the military services and joint 

bases, to evaluate the purpose of the program and determine whether the current 

goals, as stated in the 2005 Base Realignment and Closure Commission 

recommendation, are still appropriate, or whether goals should be revised; 

communicate these goals to the military services and joint bases, and adjust 

program activities accordingly; provide direction to the joint bases on requirements 

for meeting program goals, including determining reporting requirements and 

milestones; and determine any next steps for joint basing, including whether to 

expand it to other installations. 

2012 Stabilization, 

Reconstruction, 

and Humanitarian 

Assistance Efforts

(Area 6) 

Congress should consider amending the legislation that supports the Overseas 

Humanitarian, Disaster, and Civic Aid-funded humanitarian assistance program—the 

Department of Defense’s (DOD) largest humanitarian assistance program—to more 

specifically define DOD’s role in humanitarian assistance, taking into account the 

roles and similar types of efforts performed by the civilian agencies.

Appendix I: Open Congressional Actions, by 

Mission
Appendix I: Open Congressional Actions, by 

Mission

Page 27 GAO-18-571T 

Mission 

Annual 

report Area Action summary

Economic 

development

2016 Treasury’s 

Foreclosure 

Prevention Efforts 

(Area 17)

Congress should consider rescinding any excess Making Home Affordable (MHA) 

balances that the Department of the Treasury (Treasury) deobligates and does not 

move into the Housing Finance Agency Innovation Fund for the Hardest Hit Housing 

Markets (Hardest Hit Fund). Implementing the actions in this area could result in 

$4.8 billion in savings, according to GAO analysis.

The agency estimated $4.8 billion in potential excess funds, $2 billion of which 

Treasury deobligated in February 2016. As of March 1, 2018, Treasury had not 

deobiligated MHA funds beyond the $2 billion that it transferred to the Troubled 

Asset Relief Program-funded Hardest Hit Fund in February 2016. To the extent that 

Treasury identifies and deobligates any MHA funds that are likely to not be 

expended, these funds may then be available for Congress to rescind and use 

elsewhere for other priorities.

2011 Essential Air 

Service (Area 42) 

Congress may wish to consider revising the program’s operating requirements for 

providing air service to communities to improve efficiency and to better match 

capacity with community use.

This action is partially addressed. Congress has taken some action to address this 

action, such as revising the program’s operating requirements most recently in the 

Consolidated Appropriations Act, 2018. However, opportunities still exist to address 

this action, such as allowing flexibility in the number of flights provided.

Congress may wish to consider assessing multimodal solutions, such as more costeffective bus service to hub airports or air taxi service, to provide communities 

alternatives to Essential Air Service.

Energy 2018 DOE’s Treatment 

of Hanford’s Low 

Activity Waste 

(Area 17) 

Congress should consider clarifying, in a manner that does not impair the regulatory 

authorities of the Environmental Protection Agency and the state of Washington, 

Department of Energy’s (DOE) authority at Hanford to determine, in consultation 

with the Nuclear Regulatory Commission, whether portions of the supplemental lowactivity waste can be managed as a waste type other than high-level waste. 

Implementing this action could result in savings of tens of billions of dollars from 

2018 to 2061, according to GAO analysis.

2015 U.S Enrichment 

Corporation Fund

(Area 16) 

Congress may wish to permanently rescind the entire $1.6 billion balance of the U.S. 

Enrichment Corporation Fund. Implementing this action could result in savings of 

$1.6 billion, according to GAO analysis.

2014 Advanced 

Technology 

Vehicles 

Manufacturing 

Loan Program

(Area 13) 

Congress may wish to consider rescinding all or part of the remaining $4.3 billion in 

credit subsidy appropriations, unless the DOE can demonstrate a demand for new 

Advanced Technology Vehicles Manufacturing loans and viable applications. 

Implementing this action could result in a one-time savings of up to $4.3 billion,

according to a DOE estimate. 

2011 Federal Fleet 

Energy Goals

(Area 12) 

Changes in existing laws could streamline the requirements and provide fleet 

managers with more flexibility in meeting goals.

Oil and Gas 

Resources (Area 

45) 

Congress may need to take action to require the Department of the Interior (Interior) 

to establish an annual production incentive fee or similar fee for nonproducing 

leases.
Appendix I: Open Congressional Actions, by 

Mission

Page 28 GAO-18-571T 

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Congress may wish to provide additional guidance or take additional actions to 

direct Interior to improve its oversight of federal lands and waters and the revenues 

derived from production of oil and gas if Interior chooses not to take any action on its 

study examining how other oil and gas resource owners select fiscal parameters for 

leasing and adjusting oil and gas royalty rates. Implementing the actions in this area 

could result in additional revenue of $1.7 billion, according to Interior estimates.

General 

government

2017 Use of the Do Not 

Pay Working 

System (Area 11)

Congress should consider amending the Social Security Act to explicitly allow the 

Social Security Administration to share its full death file with Treasury for use 

through the Do Not Pay working system.

As of March 2018, members of Congress have introduced the Stopping Improper 

Payments to Deceased People Act (HR.4929 and S.2374) that, if enacted into law, 

would address this issue. Sharing the full death file through the Do Not Pay working 

system would provide agencies with additional information and enhance efforts to 

identify and prevent improper payments to deceased individuals.

Recovery 

Operations Center 

Closure (Area 10)

Congress may wish to consider directing the Council of the Inspectors General for 

Integrity and Efficiency to develop a legislative proposal to reconstitute the essential 

capabilities of the Recovery Operations Center to help ensure federal spending 

accountability. 

2016 Financial 

Regulatory 

Structure (Area 5)

Congress should consider whether additional changes to the financial regulatory 

structure are needed to improve (1) the efficiency and effectiveness of oversight; (2) 

the consistency of consumer and investor protections; and (3) the consistency of 

financial oversight for similar institutions, products, risks, and services.

This action is partially addressed. As of March 2018, at least two bills, the Financial 

CHOICE Act of 2017 (H.R. 10) and the Economic Growth, Regulatory Relief, and 

Consumer Protection Act (S. 2155) have been introduced in the 115th Congress that 

would change the financial regulatory structure, to some degree, to address 

fragmented and overlapping regulatory authorities, as GAO suggested in February 

2016. GAO will continue to monitor the reform efforts to determine the extent to 

which they could help to address fragmentation and overlap between the federal 

financial regulatory agencies and reduce opportunities for inefficiencies in the 

regulatory process and inconsistencies in how regulators conduct oversight activities 

over similar types of institutions, products, and risks. 

Congress should consider whether legislative changes are necessary to align the 

Financial Stability Oversight Council’s authorities with its mission to respond to 

systemic risks.

This action is partially addressed. As of March 2018, two bills were introduced, the 

Financial CHOICE Act of 2017 (H.R. 10) and the Economic Growth, Regulatory 

Relief, and Consumer Protection Act (S. 2155), which may alter the FSOC’s 

authorities, but it is not clear to what extent the legislation would address GAO’s 

February 2016 suggestion. GAO will continue to monitor the reform efforts to 

determine the extent to which they help to align FSOC’s authorities with its mission 

to respond to systemic risks.

Identity Theft 

Refund Fraud 

(Area 22)

Congress should consider providing the Secretary of the Treasury with the 

regulatory authority to lower the threshold for electronic filing of W-2s from 250 

returns annually to between 5 to 10 returns, as appropriate. Implementing the 

actions in this area could result in savings ofbillions of dollars, according to GAO 

analysis. 
Appendix I: Open Congressional Actions, by 

Mission

Page 29 GAO-18-571T 

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report Area Action summary

2015 Consumer Product 

Safety Oversight

(Area 4) 

Congress should consider transferring the oversight of the markings of toy and 

imitation firearms in section 5001 of title 15 of the U.S. Code from the Department of 

Commerce’s National Institute of Standards and Technology to the Consumer 

Product Safety Commission.

Congress should consider establishing a formal comprehensive oversight 

mechanism for consumer product safety agencies to address crosscutting issues as 

well as inefficiencies related to fragmentation and overlap such as communication 

and coordination challenges and jurisdictional questions between agencies. Different 

types of formal mechanisms could include, for example, creating a memorandum of 

understanding to formalize relationships and agreements or establishing a task force 

or interagency work group. As a starting point, Congress may wish to obtain agency 

input on options for establishing more formal coordination.

Tax Policies and 

Enforcement 

(Area 17)

Congress should consider revisiting the use of individual retirement accounts (IRA) 

to accumulate large balances and considering ways to improve the equity of the 

existing tax expenditure on IRAs. Options could include limits on (1) the types of 

assets permitted in IRAs, (2) the minimum valuation for an asset purchased in an 

IRA, or (3) the amount of assets that can be accumulated in IRAs and employersponsored plans that get preferential tax treatment.

Congress should consider expanding the mandate that partnerships and S 

corporations electronically file their tax returns in order to cover a greater share of 

filed returns. Implementing the actions in this area could potentially enable IRS to 

collect hundreds of millions of dollars in additional revenue, according to GAO 

analysis. 

2012 Internal Revenue 

Service 

Enforcement 

Efforts (Area 44) 

To help improve taxpayer compliance, Congress may wish to make owners of rental 

real estate subject to the same payment reporting requirements regardless of 

whether they engaged in a trade or business under current law.

To help improve taxpayer compliance, Congress may wish to require payers to 

report service payments to corporations, thereby reducing payers’ burden to 

determine which payments require reporting. Implementing the actions in this area 

could result in tax revenues of billions of dollars, according to GAO analysis of 

information from the Joint Committee on Taxation.
Appendix I: Open Congressional Actions, by 

Mission

Page 30 GAO-18-571T 

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Annual 

report Area Action summary

2011 Simple Tax Return 

Errors (Area 56) 

Congress may want to consider granting the Internal Revenue Service (IRS) broader 

math error authority, with appropriate safeguards against misuse of that authority, to 

correct errors during tax return processing.

This action is partially addressed. The Consolidated Appropriations Act, 2016 gave 

IRS additional math error authority, but limited to certain circumstances. Giving IRS 

broader math error authority with appropriate controls would enable IRS to correct 

obvious noncompliance, would be less intrusive and burdensome to taxpayers than 

audits, and would potentially help taxpayers who underclaim tax benefits to which 

they are entitled. 

If Congress decides to extend broader math error authority to IRS, controls may be 

needed to ensure that this authority is used properly such as requiring IRS to report 

on its use of math error authority. The administration also requested that Congress 

expand IRS’s math error authority as part of the Service’s Congressional Budget 

Justification and Annual Performance Report and Plan for fiscal year 2019. 

Specifically, the administration requested authority to correct a taxpayer’s return in 

the following circumstances: 1) the information provided by the taxpayer does not 

match the information contained in government databases; 2) the taxpayer has 

exceeded the lifetime limit for claiming a deduction or credit; or 3) the taxpayer has 

failed to include with his or her return certain documentation that is required by 

statute. As of March 2018, the Congress had not provided Treasury with such 

authority.

S Corporations

(Area 63) 

Congress could require S corporations to use information already available to them 

to calculate shareholders’ basis as completely as possible and report it to 

shareholders and the IRS. Implementing this action could result in savings of 

hundreds of millions of dollars, according to GAO analysis.

Research Tax 

Credit(Area 65) 

Congress could eliminate the regular credit and add a minimum base amount (equal 

to 50 percent of a taxpayer’s current spending) to the method for computing the 

alternative simplified credit.

New Markets Tax 

Credit (Area 66)

Congress should consider offering grants in lieu of credits to Community 

Development Entities if it extends the program again. If it does so, Congress should 

require Treasury to gather appropriate data to assess whether and to what extent 

the grant program increases the amount of federal subsidy provided to low-income 

community businesses compared to the New Markets Tax Credit; how costs for 

administering the program incurred by the Community Development Financial 

Institutions Fund, Community Development Entities, and investors would change; 

and whether the grant program otherwise affects the success of efforts to assist lowincome communities. One option would be for Congress to set aside a portion of 

funds to be used as grants and a portion to be used as tax credit allocation authority 

under the current structure of the program to facilitate comparison of the two 

program structures.

Governmental 

Bonds (Area 67) 

Congress should consider whether facilities, including hotels and golf courses, that 

are privately used should be financed with tax-exempt governmental bonds. 

Implementing this action could result in savings of hundreds of millions of dollars, 

according to GAO analysis.

Health 2016 Medicare 

Payments by 

Place of Service 

(Area 30)

Congress should consider directing the Secretary of Health and Human Services to 

equalize payment rates between settings for evaluation and management office 

visits and other services that the Secretary deems appropriate and return the 

associated savings to the Medicare program. Implementing this action could result in 

savings of billions of dollars annually, according to MedPAC and Bipartisan Policy 

Center estimates. 
Appendix I: Open Congressional Actions, by 

Mission

Page 31 GAO-18-571T 

Mission 

Annual 

report Area Action summary

2015 DOD US Family 

Health Plan (Area 

6)

Congress should terminate the Secretary of Defense’s authority to contract with the 

US Family Health Plan (USFHP) designated providers in a manner consistent with a 

reasonable transition of affected USFHP enrollees into TRICARE’s regional 

managed care program or other health care programs, as appropriate. Implementing 

this action could save millions of dollars from fiscal years 2019 to 2022, according 

to GAO analysis. 

Medicare 

Payments to 

Certain Cancer 

Hospitals (Area 

19)

Congress should consider requiring Medicare to pay these prospective payment 

system (PPS)-exempt cancer hospitals (PCH) as it pays PPS teaching hospitals, or 

provide the Secretary of HHS with the authority to otherwise modify how Medicare 

pays PCHs, and provide that all forgone outpatient payment adjustment amounts be 

returned to the Supplementary Medical Insurance Trust Fund. Implementing this 

action could result in savings of almost $500 million annually, according to GAO 

analysis. 

2014 Medicaid 

Demonstration 

Waivers (Area 21)

Congress could consider requiring the Secretary of Health and Human Services to 

improve the Medicaid demonstration review process, through steps such as 

improving the review criteria, better ensuring that valid methods are used to 

demonstrate budget neutrality, and documenting and making clear the basis for the 

approved limits. GAO had previously recommended that the Department of Health 

and Human Services (HHS) take these actions. GAO elevated these actions for 

Congress to consider after HHS disagreed with the need to improve budget 

neutrality criteria, methods, and documentation of the basis for approved spending 

limits. Implementing the actions in this area could result in savings of billions of 

dollars, according to GAO analysis.

2013 Medicaid 

Supplemental 

Payments (Area 

26)

Congress should consider requiring the Administrator of the Centers for Medicare & 

Medicaid Services (CMS) to improve state reporting of non-Disproportionate Share 

Hospital (DSH) supplemental payments, including requiring annual reporting of 

payments made to individual facilities and other information that the agency 

determines is necessary to oversee non-DSH supplemental payments.

This action is partially addressed. In January 2017, a bill, H.R. 541, was introduced 

in the House of Representatives which, if enacted, would require annual state 

reporting of non-DSH supplemental payments made to individual facilities. However, 

as of March 2018, Congress has not enacted legislation to require such reporting. In 

addition, CMS has taken some action, including issuing a State Medicaid Director 

Letter requiring annual reporting of certain Medicaid supplemental payments and 

awarding a contract to review Medicaid supplemental payment information 

submitted by states.

Congress should consider requiring the CMS Administrator to clarify permissible 

methods of calculating non-DSH supplemental payments.

This action is partially addressed. In January 2017, a bill, H.R. 541, was introduced 

in the House of Representatives which, if enacted, would require CMS to issue 

guidance to states that identifies permissible methods for calculating non-DSH 

supplemental payments to providers. However, as of March 2018, Congress has not 

enacted legislation to require CMS to issue such guidance. In addition, CMS has 

taken some action, including issuing a State Medicaid Director Letter requiring 

states to submit non-DSH supplemental payment information and awarding a 

contract to review Medicaid supplemental payment information submitted by states.
Appendix I: Open Congressional Actions, by 

Mission

Page 32 GAO-18-571T 

Mission 

Annual 

report Area Action summary

Congress should consider requiring the CMS Administrator to require states to 

submit an annual independent certified audit verifying state compliance with 

permissible methods for calculating non-DSH supplemental payments. Implementing 

these three actions could result in savings in the hundreds of millions of dollars, 

according to GAO analysis. 

2011 Medicare’s Health 

Care Payment 

(Area 74)

Congress could exempt from the budget neutrality requirement savings attributable 

to policies that reflect efficiencies occurring when services are furnished together.

This action is partially addressed. The Consolidated Appropriations Act of 2016 

revised the payment reduction for the professional component of multiple diagnostic 

imaging services from 25 percent to 5 percent beginning on January 1, 2017, and 

exempted the reduced expenditures attributable to this multiple procedure payment 

reduction (MPPR) from the budget neutrality provision. MPPRs or other policies that 

may result in a reduction to payments for the technical component for diagnostic 

cardiovascular and ophthalmology services continue to be subject to budget 

neutrality for 2016. Unless Congress exempts from the budget neutrality 

requirement savings realized from the implementation of all MPPRs or other policies 

that reflect efficiencies occurring when services are furnished together, these 

savings will not accrue to the Medicare program.

Homeland 

security/law 

enforcement

2012 Homeland 

Security Grants 

(Area 17)

Congress may want to consider requiring the Department of Homeland Security 

(DHS) to report on the results of the Federal Emergency Management Agency’s 

(FEMA) efforts to identify and prevent unnecessary duplication within and across its 

preparedness grant programs, and consider these results when making future 

funding decisions for these programs.

Once FEMA has completed its assessment, Congress may wish to consider limiting 

the use of federal preparedness grant programs to fund only projects to fill identified, 

validated, and documented capability gaps that may (or may not) include 

maintaining existing capabilities developed.

Immigration 

Inspection Fee 

(Area 49)

Congress may wish to require the Secretary of the Department of Homeland 

Security (DHS) to adjust the air passenger immigration inspection fee as needed so 

that collections are aligned with total inspection costs, if it is determined that total 

immigration fee collections do not cover total immigration inspection costs. 

Implementing this action could increase annual fee revenue by tens of millions of 

dollars, according to GAO analysis of fiscal year 2012 data.

This action is partially addressed. As of March 2018, Congress had not enacted 

legislation, as GAO suggested in February 2012, to adjust the air passenger 

immigration fee. However, Immigration and Customs Enforcement (ICE) and 

Customs and Border Protection (CBP) have identified the extent to which collections 

are aligned with total immigration inspection costs. 

Congress may wish to require the Secretary of DHS to direct U.S. Immigration and 

Customs Enforcement and Customs and Border Protection to establish a regular 

schedule to review and coordinate on the costs of their respective air passenger 

immigration inspection activities, and revise the proportion of the fee received by 

each agency accordingly.

Income 

security

2018 Railroad 

Retirement Board 

Continuing 

Disability Reviews 

(Area 23)

Congress should consider granting the Board access to the HHS’s quarterly 

earnings information from the National Directory of New Hires database. 

Implementing this action could result in savings of millions of dollars annually, 

according to GAO analysis.
Appendix I: Open Congressional Actions, by 

Mission

Page 33 GAO-18-571T 

Mission 

Annual 

report Area Action summary

2014 Disability and 

Unemployment 

Benefits (Area 8)

Congress should consider passing legislation to require the SSA to offset Disability 

Insurance benefits for any Unemployment Insurance benefits received in the same 

period. Implementing this action could save about $2.5 billion dollars over 10 

years, according to an OMB estimate. 

Federal 

Employees’ 

Compensation 

and 

Unemployment 

Benefits (Area 9)

Congress should consider granting the Department of Labor (DOL) the additional 

authority to access wage data to help verify claimants’ reported income and help 

ensure the proper payment of benefits.

Veterans’ and 

Survivors’ Benefits 

(Area 23)

Congress should consider passing legislation that would establish a look-back and 

penalty period for claimants who transfer assets for less than fair market value prior 

to applying for pension benefits. Implementing this action could save about $4 

million annually, according to a Congressional Budget Office estimate.

This action is partially addressed. As of March 2018, there has been no legislative 

action taken in the current Congress. In the 113th Congress, the House of 

Representatives passed H.R. 2189, which contained language to establish a 3-year 

look-back and penalty period for the VA pension program. However, the bill was not 

ultimately enacted. Additionally, in January 2015, the Department of Veterans Affairs 

(VA) proposed regulations establishing a look-back and penalty period for the VA 

pension program. In February 2018, VA officials told GAO the regulations were 

undergoing legal review as part of the final concurrence process. 

2011 Social Security 

Offsets (Area 80)

Congress could consider giving the IRS the authority to collect the information that 

the Social Security Administration (SSA) needs on government pension income to 

administer the Government Pension Offset and the Windfall Elimination Provision 

accurately and fairly. Implementing this action could result in savings between $2.4 

billion to $7.9 billion over 10 years, if enforced both retrospectively and 

prospectively, based on estimates from the CBO and SSA. 

Information 

technology

2014 Interoperable 

Radio 

Communications 

Systems (Area 10)

Congress should consider requiring DHS, the Department of Justice (DOJ), and 

Treasury to collaborate on the development and implementation of a joint radio 

communications solution that specifically requires the departments to establish an 

effective governance structure that includes a formal process for making decisions 

and resolving disputes, define and articulate a common outcome for this joint effort, 

and develop a joint strategy for improving radio communications.

This action is partially addressed. Legislation has been enacted to provide funding 

for, among other things, the development of a nationwide, interoperable broadband 

network that is aimed at improving interoperable radio communications among 

public safety officials. However, the use of the broadband network by public safety 

users will be voluntary. In addition, DHS, DOJ, and Treasury officials indicated that 

once mission-critical voice capabilities have been developed for the broadband 

network, they will determine whether they will use the network for that purpose. 

Therefore, until the three departments make a decision to use the nationwide public 

safety broadband network to support mission critical voice capabilities, it is uncertain 

if the legislation will address these agencies’ fragmented approaches to improving 

interoperable radio communications. As of March 2018, there has been no 

legislative action taken in the current Congress. 
Appendix I: Open Congressional Actions, by 

Mission

Page 34 GAO-18-571T 

Mission 

Annual 

report Area Action summary

2013 Dissemination of 

Technical 

Research Reports 

(Area 10)

Congress should consider examining the appropriateness and viability of the feebased model under which the National Technical Information Service (NTIS) 

currently operates for disseminating technical information to determine whether the 

use of this model should be continued.

This action is partially addressed. As of March 2018, there has been no legislative 

action taken in the current Congress. Several bills were introduced during the 115th 

Congress, including H.R. 3354, S.1662, that had the potential to address this action. 

However, these bills were not ultimately enacted. Additionally, the Department of 

Commerce Appropriations Act, 2015, 2016, and 2017, limited instances where NTIS 

could charge customers fees for reports. This limitation continues in effect under the 

Consolidated Appropriations Act, 2018. 

Geospatial 

Investments (Area 

11)

Congress should consider assessing the impact of the disclosure restrictions of 

Section 9 of Title 13 and Section 412 of Title 39 of the U.S. Code in moving toward a 

national geospatial address database. If warranted, Congress should consider 

revising those statutes to authorize the limited release of addresses, without any 

personally identifiable information, specifically for geospatial purposes. Such a 

change, if deemed appropriate, could potentially result in significant savings across 

federal, state, and local governments. Implementing the actions in this area could 

result in savings of millions of dollars, according to GAO analysis.

International 

affairs

2016 Cargo Preference 

for Food Aid (Area 

36) 

While recognizing that cargo preference serves policy goals established by 

Congress with respect to the U.S. merchant marine, including maintenance of a fleet 

capable of serving as a naval and military auxiliary in time of war or national 

emergency, Congress should consider clarifying cargo preference legislation 

regarding the definition of “geographic area” to ensure that agencies can fully utilize 

the flexibility Congress granted to them when it lowered the cargo preference for 

food aid requirement. Implementing this action could potentially result in millions of 

dollars in savings, according to GAO analysis. 

2013 Tobacco Taxes 

(Area 31)

Congress, as it continues oversight of the Children’s Health Insurance Program 

Reauthorization Act (CHIPRA), may wish to consider equalizing tax rates on rollyour-own and pipe tobacco.

Congress, as it continues oversight of CHIPRA, may wish to consider, in 

consultation with Treasury options for reducing tax avoidance due to tax differentials 

between small and large cigars. Federal revenue losses were as much as $2.6 to 

$3.7 billion between April 2009 and February 2014, and Congressional action could 

address future revenue losses.

2012 Overseas 

Administrative 

Services (Area 20)

Congress may wish to consider requiring agencies to participate in International 

Cooperative Administrative Support Services (ICASS) unless they provide a 

business case to show that they can obtain these services outside of ICASS without 

increasing overall costs to the U.S. government or that their mission cannot be 

achieved within ICASS.

2011 Antidumping and 

Countervailing 

Duties (Area 81)

Congress could eliminate the retrospective component of the U.S. antidumping and 

countervailing duty system and, instead, treat the antidumping and countervailing 

duties assessed at the time the product enters the country as final.
Appendix I: Open Congressional Actions, by 

Mission

Page 35 GAO-18-571T 

Mission 

Annual 

report Area Action summary

Social services 2012 Housing 

Assistance (Area 

28)

Congress may wish to consider requiring the Departments of Agriculture (USDA) 

and Housing and Urban Development (HUD) to examine the benefits and costs of 

merging those programs that serve similar markets and provide similar products. As 

a first step, Congress could consider requiring USDA and HUD to explore merging 

their single-family insured lending programs and multifamily portfolio management 

programs, taking advantage of the best practices of each and ensuring that targeted 

populations are not adversely affected.

Source: GAO. | GAO-18-571T

Notes: Unless otherw ise indicated, actions in this table are not addressed, meaning that a bill may 

have been introduced but did not pass out of a committee, or no relevant legislation has been 

introduced. At the beginning of a new congressional session, we reapply the criteria. As a result, the 

status of an action may move from partially addressed to not addressed if relevant legislation is not 

reintroduced from the prior Congressional session.

As of March 2018, eleven actions are partially addressed. Partially addressed means a relevant bill 

has passed a committee, the House of Representatives, or the Senate, or relevant legislation has 

been enacted but only addressed part of the action needed. This table provides information on steps 

Congress took for actions that are considered partially addressed.

This table provides estimates of cost savings or increased revenue where such information w as 

available. The potential cost savings for implementing individual actions are provided w hen known, or 

for implementing multiple actions in an area, w hen the savings are not attributable to a specific action.

(102807)
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