# Reports News from the GAO

Reports News from the GAO.

- Counternarcotics: DOD Should Improve Coordination and Assessment of Its Activities What GAO FoundThe amount of funding available for Department of Defense (DOD) counternarcotics and counter–transnational organized crime activities changed from about $750 million in fiscal year (FY) 2018 to about $580 million in FY 2022. In FY 2022, DOD allocated most of the funding to support detection and monitoring activities and allocated the remainder to support intelligence activities and efforts, such as constructing training facilities, in partner nations.DOD's six geographic combatant commands—DOD components responsible for efforts in designated geographic areas—coordinate on activities. However, three reported varying understandings of their roles in an overlapping joint operation area, including confusion over the management of air and naval operations. Although DOD required the three commands to develop agreements defining their responsibilities, the three commands have not fully documented their roles in the overlapping joint operation area. Without such agreements, confusion about the commands' responsibilities in the area may continue, reducing DOD's ability to disrupt the transport of illicit drugs to the U.S.Map Showing Overlap of Joint Operation AreaDOD has not assessed the agency-wide effectiveness of its counternarcotics and counter–transnational organized crime activities and does not have a plan for future assessments. DOD has defined its strategic objectives, strategies, and performance goals. But contrary to key practices, it has not identified measurable outcomes for each strategic objective. As a result, DOD cannot measure progress toward these objectives. Officials also said they intend to assess agency-wide progress but have not developed a plan to do so. Assessing agency-wide progress toward its strategic objectives would better position DOD to make decisions about priorities, resource allocations, and strategies for improvements.Why GAO Did This StudyThe U.S. government has identified illicit drugs, as well as the criminal organizations that produce and traffic them, as significant threats to both the U.S. and partner nations. DOD is the lead department responsible for detecting and monitoring the aerial and maritime transport of illicit drugs to the U.S.Senate report 117-130 accompanying the FY 2023 National Defense Authorization Act contains a provision for GAO to examine issues related to counternarcotics and counter–transnational organized crime activities. This report examines (1) funding available for DOD's activities and funding allocation in FYs 2018 through 2022; (2) the extent to which DOD components coordinate activities; and (3) how DOD assessed the effectiveness of these activities, and the extent to which its future assessments align with key practices.GAO reviewed DOD documents and data about its authorities, funding, and activities, including coordination and performance management. GAO also interviewed DOD officials, including officials at headquarters and combatant commands.
- Restrictive Housing: Actions Needed to Enhance BOP and ICE Management and Oversight What GAO FoundFederal correctional and immigration detention facilities can place individuals in restrictive housing settings in certain circumstances. Restrictive housing generally consists of one- or two-person cells that isolate individuals from the general population. U.S. Immigration and Customs Enforcement (ICE) and the Bureau of Prisons (BOP) have policies and processes that govern their use of restrictive housing. Two prior studies examined restrictive housing at BOP, both of which identified ways for BOP to improve oversight. The first was a 2014 contracted assessment and the second was a 2016 Department of Justice report.In February 2024, GAO reported that BOP had not fully implemented 54 of 87 recommendations from these two studies. BOP had fully implemented 33, partially addressed 42, and had not taken any steps to address the remaining 12 recommendations. This was due in part to BOP not assigning responsibility for recommendation implementation to appropriate officials and not establishing a time frame for completion. GAO recommended that BOP develop and execute an approach to fully implement recommendations from these prior studies. This would include assigning implementation responsibility, establishing a time frame for completion, and monitoring progress. BOP concurred and described its planned steps.BOP and ICE have not consistently collected or used information needed for restrictive housing oversight. In reports from 2020–2024, GAO recommended actions to improve both BOP's processes for monitoring restrictive housing operations and BOP and ICE's analysis of complaints data. For example:In February 2024, GAO found that BOP was not monitoring key aspects of restrictive housing operations. Specifically, it did not examine the cause behind substantial racial disparity in a restrictive housing unit designed for individuals with heightened security concerns. GAO recommended that BOP conduct an evaluation to determine and address the cause of the racial disparity. BOP concurred and as of February 2024, said it would take steps to implement it.	In August 2020 and February 2024, GAO found that neither ICE nor BOP was analyzing complaint data from those in its custody to identify areas for improvement, such as concerns over restrictive housing conditions. GAO made recommendations to ICE and BOP to analyze complaint data, which could help each agency identify trends and ultimately enhance oversight. As of December 2023, ICE has taken some steps, including integrating several data systems that store detention-related information into a new system to provide enhanced analysis capabilities. As of February 2024, BOP agreed to take steps toward implementation.Why GAO Did This StudyICE recorded 14,581 restrictive housing placements of detained noncitizens from fiscal years 2017 through 2021. Those placements increased by 18 percent from fiscal year 2017 to 2020 before declining in 2021. As of October 2023, BOP housed about 8 percent of all incarcerated individuals (approximately 11,600) in restrictive housing. Studies have shown some potentially harmful mental and physical impacts of such placements.This statement discusses the extent to which (1) BOP has addressed recommendations from two prior restrictive housing studies and (2) BOP and ICE have information needed to manage and oversee use of restrictive housing.This statement is based on three prior GAO reports published from August 2020 through February 2024, along with selected updates on ICE efforts to address previous GAO recommendations. To produce those reports, GAO reviewed ICE and BOP documentation, analyzed data, and interviewed agency officials. For selected recommendation updates, GAO reviewed documents and interviewed ICE officials.
- Medicare and Medicaid: Additional Actions Needed to Enhance Program Integrity and Save Billions What GAO FoundThe Department of Health and Human Services (HHS) estimated a combined total of over $100 billion in improper payments in the Medicare and Medicaid programs in fiscal year 2023. This represents 43 percent of the government-wide total of estimated improper payments that agencies reported for that year.Improper Payments Estimates for Fiscal Year 2023Note: Estimates also include payments whose propriety cannot be determined due to lacking or insufficient documentation.The Centers for Medicare &amp; Medicaid Services (CMS), within HHS, has taken several steps in response to GAO recommendations to help reduce improper payments in Medicare and Medicaid. These actions have resulted in billions of dollars in federal savings. For example:Improved fraud prevention in Medicare.   CMS implemented capabilities that automatically stopped payments of certain improper and non-payable claims. These improvements generated an estimated almost $2 billion in savings over a 5-year period.	Improved Medicaid managed care oversight.  CMS worked with states and audit contractors to improve oversight. This included an exponential increase in investigations of managed care providers, from 16 in 2016 through 2018 to 893 in 2019 through 2021. Preliminary results indicate that the audits are identifying overpayments.In the current fiscal environment, addressing improper payments and providing sufficient oversight of program spending, more generally, is particularly important. Federal spending for Medicare and Medicaid has grown by almost 80 percent over the past decade and growth in these and other health programs is projected to continue.Health Care and Other Government Program Spending, Actual and ProjectedCMS and congressional action on GAO recommendations related to Medicare and Medicaid has resulted in over $200 billion in financial benefits since 2006. Action on recommendations that remain unimplemented would further enhance program integrity and save billions of dollars in Medicare and Medicaid spending.Provider screening and enrollment.  GAO recommended CMS expand its review of states' implementation of provider screening and enrollment requirements in Medicaid, and monitor progress when states are not fully compliant. For Medicare, GAO recommended that CMS implement a risk-based plan for revalidating enrollment for Medicare providers after pauses during the COVID-19 pandemic.	Prepayment claim reviews in Medicare.  GAO recommended that CMS seek legislative authority to allow Recovery Auditors to conduct prepayment claim reviews, which are generally more cost effective than postpayment reviews in preventing improper payments.	Equalizing certain Medicare payments.  GAO recommended that Congress take action to address that Medicare pays more for certain services based on where they are provided. Congress has taken some actions. For example, this committee proposed and the House passed legislation to equalize payments for certain drug administration services. Taking additional steps to equalize payments has been estimated to save Medicare $141 billion over 10 years.	Telehealth.  In response to the COVID-19 pandemic, HHS temporarily waived certain Medicare restrictions on telehealth and use increased dramatically. We recommended CMS comprehensively assess the quality of telehealth services in Medicare, which is needed to ensure those services are medically necessary, among other things.	Medicaid demonstrations.  In response to GAO recommendations, CMS has made changes to its policies for ensuring that demonstrations do not increase federal spending, reducing federal liabilities by over $120 billion. Additional action by CMS and Congress could result in further savings.	State auditors.  State auditors play an important role in Medicaid oversight and have identified improper payments and other deficiencies through their reviews. GAO recommended that CMS use trends in state auditor findings to inform its Medicaid oversight and share information on the status of actions to address findings with state auditors.Why GAO Did This StudyIn 2023, the Medicare program spent an estimated $1.0 trillion to provide health care services for approximately 66 million elderly and disabled individuals. This involved processing over a billion transactions. Medicaid is a joint federal-state program that finances health care for low-income and medically needy individuals. It is the second largest health care program by expenditures, with an estimated $849 billion in federal and state spending for services provided to about 90 million individuals in 2023.Medicare and Medicaid are complex and large programs. They represented 26 percent of federal program spending in fiscal year 2023. The programs are susceptible to improper payments, as well as potential mismanagement and fraud, waste, and abuse. As a result, GAO added Medicare to its High-Risk list in 1990 and Medicaid in 2003.This testimony focuses on examples of steps taken by CMS to reduce improper payments in Medicare and Medicaid, as well as actions still needed by CMS and Congress. It draws on GAO's reports issued and recommendations made from 2008 through 2024 on the Medicare and Medicaid programs and known steps CMS has taken to address these recommendations as of March 2024.
- Fraud Risk Management: 2018-2022 Data Show Federal Government Loses an Estimated $233 Billion to $521 Billion Annually to Fraud, Based on Various Risk Environments What GAO FoundGAO estimated total direct annual financial losses to the government from fraud to be between $233 billion and $521 billion, based on data from fiscal years 2018 through 2022. The range reflects the different risk environments during this period. Ninety percent of the estimated fraud losses fell in this range.GAO collected data from three key sources to develop the estimate: investigative data, such as the number of cases sent for prosecution and the dollar value of closed cases; Office of Inspector General (OIG) semiannual report information; and confirmed fraud data reported to the Office of Management and Budget (OMB) by agencies. GAO organized these data around three fraud categories—adjudicated, detected potential, and undetected potential. Model design and validation were also informed by 46 fraud studies. OIG and other knowledgeable officials agreed with these categories and subcategories.Categories of Fraud-Related Data Used in GAO's EstimateGAO's approach is sensitive to the assumptions made about fraud and accounts for data uncertainty and limitations. GAO used a well-established probabilistic method for estimating a range of outcomes under different assumptions and scenarios where there is uncertainty. The estimate does not include fraud loss associated with federal revenue or fraud against federal programs that occurs at the state, local, or tribal level unless federal authorities investigated and reported it. GAO's estimate is in line with other estimates of fraud losses from the United Kingdom and Association of Certified Fraud Examiners, among others.As a first of its kind government-wide estimate of federal dollars lost to fraud, there are known uncertainties associated with the model and underlying data important to interpreting the results. These include caveats related toapplying the estimate to agencies or programs.  GAO's model was developed to estimate government-wide federal fraud. The fraud estimate's range represents 3 to 7 percent of average federal obligations. These percentages should not be applied at the agency or program level. While every federal program and operation is at risk of fraud, the level of risk can vary substantially. Controls, growth or shrinkage of budget, and the emergence of new fraud schemes are some reasons the risk level can vary;	drawing conclusions about pandemic fraud.  GAO's estimate is based on data from fiscal years 2018 through 2022. The data include time periods and programs with and without pandemic-related spending. Therefore, the estimate includes, but is not limited to, pandemic-related spending fraud. While the upper range of the estimate is associated with higher-risk environments, it is not possible to break out a subset of our government-wide estimate to describe pandemic program fraud;	comparing with improper payment estimates.  GAO's estimate is not comparable to improper payment estimates. Improper payment estimates are based on a subset of federal programs, using a methodology not designed to identify fraud. GAO has also consistently reported that the federal government does not know the full extent of improper payments and has long recommended that agencies improve their improper payment reporting. In contrast, GAO's fraud estimate includes all federal programs and operations and is based on fraud-related data. With these differences in scope and data, the upper end of GAO's estimated fraud range exceeded annual improper payment estimates; and	assuming the estimate is predictive.  GAO's estimate is not based on a predictive model. Factors such as the amount of emergency spending, the effectiveness of federal fraud risk management, and the nature of new fraud threats could substantially impact the scale of future fraud. GAO has previously issued Matters for Congressional Consideration and recommendations to improve agencies' program integrity, including fraud risk management. Fraud estimation provides opportunities to improve fraud risk management, according to OIG and agency officials. For example, estimates can demonstrate the scope of the problem, improve oversight prioritization, and help determine the return on investment from fraud risk management activities. While it is not possible to eliminate fraud, with a better understanding of the costs, agencies will be better positioned to manage the risk.How Fraud Estimates Can Improve Fraud Risk ManagementOIG and agency officials noted challenges in producing fraud estimates, such as limited available fraud-related data and use of varying terms and definitions of fraud for recording data. These data gaps and variability result in information that cannot be readily compared or consolidated to determine the extent of fraud across the federal government. Guidance for collecting and reporting fraud-related data is currently limited to OIG semiannual reports and confirmed fraud reported by agencies to OMB, which are not designed to support fraud estimation. With guidance targeted to the purpose of fraud estimation, agencies and OIGs would be better positioned to collect and report data on potential and adjudicated fraud in support of estimation efforts.OIG and agency officials also noted the utility of agency or program-level estimates compared with government-wide estimates. They further noted the need for expertise and data-analytics capacity to produce estimates. GAO previously reported that agencies identified limitations in expertise, data, and tools as a significant challenge for their fraud risk management efforts. These challenges could also impact agencies' ability to develop effective fraud estimates at a program or agency level. The Department of the Treasury's Office of Payment Integrity (OPI) supports agencies facing such challenges. OPI's resources are dedicated to preventing and detecting improper payments through a variety of data-matching and data-analytics services. Therefore, OPI is well positioned—with the expertise, data, and analytic tools—to evaluate and advance methods that the federal government can take to estimate fraud in support of fraud risk management.Why GAO Did This StudyAll federal programs and operations are at risk of fraud. Therefore, agencies need robust processes in place to prevent, detect, and respond to fraud. While the government obligated almost $40 trillion from fiscal years 2018 through 2022, no reliable estimates of fraud losses affecting the federal government previously existed.As part of GAO's work on managing fraud risks, this report (1) estimates the range of total direct annual financial losses from fraud based on 2018-2022 data and (2) identifies opportunities and challenges in fraud estimation to support fraud risk management.GAO estimated the range of total direct annual financial losses from fraud based on 2018-2022 data using a Monte Carlo simulation model. GAO identified opportunities and challenges through interviews and data collection focused on 12 agencies representing about 90 percent of federal obligations.
- Homeland Security: DHS Internal Entities Facilitate Information Sharing in Key Areas and Collaborate as Needed What GAO FoundGAO identified nine Department of Homeland Security (DHS) groups that are focused on sharing information internally within the department. GAO found the purpose of these groups was generally to facilitate information sharing for one of the following three purposes: (1) leadership decision-making; (2) internal policymaking, or (3) threat identification.&nbsp;Categories of Department of Homeland Security (DHS) Internal Information Sharing Groups and Their PurposeNote: These groups were operational any time from January 1, 2020, through September 30, 2023.aDHS discontinued the Operations Deputies Board in 2022 as part of a departmental reorganization initiative.Although there was no evidence of unnecessary duplication among these nine groups, GAO found that some of the groups' purposes and activities had the potential for overlap. In those instances, GAO also found that agency officials associated with these groups described activities to leverage their respective resources and information—a leading interagency collaboration practice—to mitigate possible duplication. For example, according to DHS officials, the Homeland Security Intelligence Council, which is composed of less senior staff than the Counter Threats Advisory Board, schedules its meetings to occur a month or so before board's meetings. This allows the more detailed information from the council meetings to inform meetings of more senior staff serving on the board.Why GAO Did This StudyGAO was asked to review the number and purpose of groups DHS uses to promote information sharing across its headquarters offices and components. This report (1) describes the various groups DHS uses to promote internal information sharing and their purpose and operating status and (2) identifies the extent to which any similar groups collaborate to avoid duplicating efforts.GAO identified information sharing groups with select characteristics that were operational any time between January 1, 2020, and September 30, 2023, the most recent calendar years at the time GAO distributed its request for information to DHS. GAO reviewed documentation, such as charters, policies, and procedures, and interviewed relevant DHS headquarters and component officials about the history of the information sharing groups it identified.For more information, contact Triana McNeil at: 202-512-8777 or McNeilT@gao.gov.
- F-35 Sustainment: Costs Continue to Rise While Planned Use and Availability Have Decreased What GAO FoundThe F-35 Lightning II aircraft (F-35) is the Department of Defense's (DOD) most ambitious and costly weapon system and its most advanced fighter aircraft. DOD operates and sustains about 630 F-35 aircraft and plans to buy about 2,500 total by the mid-2040s with a projected planned life into the 2080s.However, DOD's projected costs for sustaining the F-35 continue to increase while planned use of the aircraft declines. Specifically:Sustainment cost estimates have increased 44 percent, from $1.1 trillion in 2018 to $1.58 trillion in 2023.	DOD's planned use of the F-35 and its availability have decreased. The Air Force, Navy, and Marine Corps project they will fly the F-35 less than originally estimated on an annual basis. The F-35 fleet's overall availability has trended downward considerably over the past 5 years, and none of the variants of the aircraft (i.e., the F-35A, F-35B, and F-35C) are meeting availability goals.	The Air Force, Navy, and Marine Corps' have made progress in meeting their affordability targets (i.e., the amount of money they project they can afford to spend per aircraft per year for operating the aircraft). This is due in part to the reduction in planned flight hours, and because the Air Force increased the amount of money it projects it can afford to spend. DOD currently estimates the Air Force will pay $6.6 million annually to operate and sustain an individual aircraft. This continues to be well above the $4.1 million original target. In June 2023, the Air Force increased the amount of money it can afford to spend per F-35 aircraft to $6.8 million per year.	DOD has pursued cost savings efforts and continues to look for new ways to reduce costs. However, DOD officials generally agree that these efforts are not likely to fundamentally change the estimated costs to operate the aircraft.Why GAO Did This StudyDOD plans to use the F-35 aircraft through 2088 and plans to spend over $2 trillion on acquisition and sustainment. The National Defense Authorization Act for Fiscal Year 2022 includes a provision for GAO to conduct an annual review of F-35 sustainment efforts, including DOD's ability to reduce sustainment costs, or otherwise maintain the affordability of the F-35 fleet. This report provides information on the F-35's sustainment cost estimates over the life of the program, actions taken by the F-35 Joint Program Office to reduce sustainment costs, and the extent to which the F-35 fleet has met performance goals. GAO analyzed DOD's F-35 sustainment cost estimates and performance data and interviewed cognizant DOD officials about these issues.
- Prescription Drugs: Selected States' Regulation of Pharmacy Benefit Managers What GAO FoundPrivate health plans contract with pharmacy benefit managers (PBM) to administer their prescription drug benefits and help control costs. Each of the five states selected for review—Arkansas, California, Louisiana, Maine, and New York—enacted a variety of laws to regulate PBMs.Fiduciary or other “duty of care” requirements.  Four of the five states (California, Louisiana, Maine, and New York) enacted laws to impose a duty of care on PBMs. The laws varied from imposing a fiduciary duty—that is, a requirement to act in the best interest of the health plan or other entity to which the duty is owed—to what state regulators described as “lesser” standards such as a requirement to act in “good faith and fair dealing.”	Drug pricing and pharmacy reimbursement requirements.  The five states enacted a variety of laws relating to drug pricing and pharmacy payments, such as laws limiting PBMs' use of manufacturer rebates and their ability to pay pharmacies less than they charge health plans—a practice referred to as “spread pricing.”	Transparency, including licensure and reporting requirements.  To increase the transparency of PBM operations, the five states enacted laws that require PBMs to be licensed by or registered with the state, or both, and to report certain information such as drug pricing, fees charged, and the amounts of rebates received and retained.	Pharmacy network and access requirements.  The five states also enacted laws regarding pharmacy networks and patient access. Examples include laws prohibiting discrimination against unaffiliated pharmacies and limiting patient co-pays charged by PBMs.The regulators GAO interviewed from selected states described lessons learned regarding PBM regulation. Examples include the following.Regulators in four states said that providing regulators with broad regulatory authority was more effective than enacting specific statutory provisions. Doing so allowed regulators to address emerging issues without new legislation, according to regulators from one state.	Some regulators also stressed the need for robust enforcement of PBM laws and effective penalties to enforce them. Two pharmacy associations GAO interviewed concurred with these views, while a health plan association said that monitoring is needed to ensure compliance with PBM requirements. Three regulators also said that clear reporting requirements and definitions helped ensure consistent enforcement.The Department of Labor provided technical comments on a draft copy of this report, which GAO incorporated as appropriate.Why GAO Did This StudyPrescription drug spending by private health plans climbed to nearly $152 billion in 2021, an 18 percent increase from 2016. Health plans generally rely on PBMs to process claims, develop pharmacy networks, and negotiate rebates from drug manufacturers. However, some researchers and stakeholders have questioned certain PBM practices, such as PBMs retaining a share of the rebates and use of spread pricing. In response, states have begun to enact legislation addressing PBMs, with all 50 states having enacted at least one PBM-related law between 2017 and 2023.GAO was asked to review states' regulation of PBMs serving private health plans. Among other things, this report describes actions selected states have taken to regulate PBMs, and lessons learned that state regulators identified for PBM regulation.GAO focused on a selection of five states that have enacted a wide range of PBM laws, based on existing inventories maintained by national policy research organizations, such as the National Conference of State Legislatures. GAO reviewed states' laws and interviewed state regulators as well as a variety of other stakeholders. These included state pharmacy associations and state health plan associations in each of the five states, and four national organizations representing interests of PBMs, patients, employers, and drug manufacturers, respectively.For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.
- Persistent Chemicals: Navy Efforts to Address PFAS at Joint Base Pearl Harbor-Hickam What GAO FoundAs of February 2024, DOD testing had not detected any per-and polyfluoroalkyl substances (PFAS) in the active drinking water shaft at Joint Base Pearl Harbor-Hickam. PFAS are a large group of heat and stain resistant chemicals that can persist in the environment—including in water, soil, and air—for decades or longer. In November 2022, during maintenance activities 1,300 gallons of aqueous film-forming foam (AFFF) concentrate was released from a pipe in a tunnel at the Red Hill Bulk Fuel Storage Facility at Joint Base Pearl Harbor-Hickam in Hawaii. Because AFFF—a product used to fight flammable liquid fires—contains PFAS, this incident raised concerns about PFAS in the installation's drinking water and how the Department of Defense (DOD) remediates PFAS contamination at the installation.Following the AFFF release, DOD took immediate action to ensure the AFFF was contained and removed from the affected area. Both DOD and the Environmental Protection Agency (EPA) have since completed investigations of the November 2022 AFFF release and issued final reports. Both investigations recommended that (1) increased government oversight of AFFF-related activities at the Red Hill facility was necessary, (2) all AFFF concentrate should be removed from the Red Hill facility, and (3) the AFFF system at Red Hill should be decommissioned.On April 10, 2024, EPA announced a National Primary Drinking Water Regulation establishing allowable levels of 4 parts per trillion for certain PFAS in drinking water (one part per trillion is equivalent to a single drop of water in 20 Olympic-sized swimming pools). Prior to this, PFAS in drinking water were not regulated at the federal level. However, in 2016, under the authority of the Safe Drinking Water Act, EPA published health advisory levels of 70 parts per trillion for certain PFAS in drinking water. Since 2016, DOD has had policies in place for monitoring PFAS levels in drinking water at its installations at 70 parts per trillion. Joint Base Pearl Harbor-Hickam regularly monitors for PFAS in its active drinking water shaft at frequencies required by DOD policy and requests by EPA and the state of Hawaii. While PFAS have not been detected in the active drinking water shaft at the installation, low amounts of PFAS falling below 70 parts per trillion have been detected in the installation's two inactive drinking water shafts. These two shafts are currently not in use and according to DOD officials, the PFAS detected are not due to the November 2022 AFFF release. According to DOD policy and officials we met with, DOD will implement and comply with the April 2024 EPA regulation.PFAS contamination at Joint Base Pearl Harbor-Hickam is being addressed by DOD's environmental restoration program. Through this program the Navy has identified 32 sites of known or potential PFAS contamination (e.g., soil or groundwater) at Joint Base Pearl Harbor-Hickam and is taking steps to assess these sites and, where appropriate, develop plans for their long-term cleanup. The Navy has finalized its preliminary assessment and site inspection reports for these 32 sites, with recommendations for the areas in 20 of these sites to advance to the in-depth remedial investigation phase of the environmental cleanup program. The remaining 12 sites were found to have no documentation of past use of AFFF or other potentially PFAS-containing products or materials.Why GAO Did This StudyDOD has policies related to monitoring PFAS levels in drinking water at its installations, long term cleanup of PFAS contamination, and use and disposal of products containing PFAS. According to EPA, exposure to certain PFAS may have adverse effects on human health, including effects on fetal development, the immune system, and the thyroid, and may cause liver damage and cancer.GAO was asked to examine DOD efforts to address PFAS contamination at Joint Base Pearl Harbor-Hickam. This report describes DOD's response to the November 2022 AFFF release at the installation; DOD processes for ongoing monitoring and long-term cleanup of PFAS at Joint Base Pearl Harbor-Hickam; and DOD's and EPA's policies addressing PFAS in the environment.To conduct this work, GAO reviewed and summarized information from previous GAO reports and relevant DOD, EPA, and state of Hawaii guidance, policies, and other documentation on regulating release, response, use, and disposal of PFAS-containing substances. GAO interviewed DOD, EPA, and state of Hawaii officials and conducted a site visit to Joint Base Pearl Harbor-Hickam to observe the site of the November 2022 AFFF release. GAO met with Navy and state of Hawaii officials to understand the Navy's response to and cleanup of the release, as well as ongoing efforts to monitor and cleanup PFAS at Joint Base Pearl Harbor-Hickam.For more information, contact Alissa Czyz at (202) 512-3058 or CzyzA@gao.gov.
- Military Health Care: DOD Should Improve Its Process for Clinical Adverse Actions against Providers What GAO FoundThe Defense Health Agency (DHA) uses its clinical adverse action process to investigate concerns about a health care provider's quality of care, and if warranted, to take action to limit or prohibit the care a provider is allowed to deliver. GAO reviewed 55 clinical adverse action cases at four selected military medical treatment facilities and found that they did not always adhere to certain requirements. For example, in more than one-third of the cases, the facilities did not adhere to the DHA requirement to establish a deadline for the investigation of a provider. GAO found that, while DHA monitors facilities' adherence by conducting an audit of each case and by monitoring the process, DHA's monitoring approach does not include information needed to assess adherence to many of the facility-level steps of the clinical adverse action process.GAO also found that DHA did not always report providers within required time frames to the National Practitioner Data Bank. This database is an electronic repository administered by the federal government that is used by hospitals and others across the health care industry to obtain information on providers with histories of substandard care or misconduct. GAO found that while DHA reported all 14 of the providers from the four facilities in GAO's review who received a final clinical adverse action, DHA did not meet the 30-day reporting requirement for four providers.Defense Health Agency Adherence to Requirements for Reporting 14 Final Clinical Adverse Actions to the National Practitioner Data BankDHA's approach to monitoring its clinical adverse action process does not include information needed to assess adherence to certain requirements, such as whether DHA reports providers within required time frames. Further, DHA has not established timeliness requirements for many of the DHA-level steps in the process, such as legal reviews and appeal panel meetings. GAO found it took DHA almost one year on average to complete its steps for 14 cases that resulted in final clinical adverse actions. While DHA's procedures state that the purpose of the clinical adverse action process is to ensure timely resolution of issues and reporting, GAO found that DHA does not sufficiently monitor its timeliness. Such deficiencies could present risks to the quality and safety of care that military service members and their families receive in DOD facilities.Why GAO Did This StudyLike all health care delivery settings, concerns may arise about the quality and safety of care delivered by individual health care providers in the Department of Defense's (DOD) military medical treatment facilities. DHA and its medical facilities share responsibility for investigating concerns and determining whether to take clinical adverse action against providers. DHA is also responsible for reporting any actions taken against providers to regulatory bodies for use among the health care industry.Senate Report 117-39 accompanying the National Defense Authorization Act for Fiscal Year 2022 includes a provision for GAO to review DOD's clinical adverse action process. GAO's review examines adherence to DHA clinical adverse action requirements at four selected facilities and at the DHA-level. GAO reviewed documentation of 55 clinical adverse action cases initiated between October 2019 and September 2022 by four facilities, selected to obtain variation in location and the number of clinical adverse actions conducted. Additionally, GAO reviewed DHA procedures and interviewed DHA officials and facility staff.
- Economic Development: Additional Training Could Help Small Lenders Implement Technology What GAO FoundCommunity development financial institutions (CDFI) are lenders that provide financial products and services to underserved communities, and minority depository institutions (MDI), which can be certified as CDFIs, are generally banks or credit unions primarily owned by minority individuals or serving minority populations. In response to GAO's survey of CDFIs and MDIs, many small CDFIs and MDIs reported they lack the technology needed to provide online services or to underwrite loans, manage operations, and conduct outreach more efficiently. Officials GAO interviewed from some small institutions said their limited technology—such as lack of ability to provide mobile banking—constrains their ability to serve underserved communities. Technology costs and limited staff capacity were the most common reasons CDFIs and MDIs cited for not being able to obtain the technology they need, according to a GAO survey. These institutions reported that additional funding and training related to technology could help them address these challenges.Challenges CDFIs and MDIs Reported Frequently or Always Prevented Them from Acquiring New TechnologyThe CDFI Fund has increased the grant funding CDFIs can use for improving their technology but has not provided technology-related training. CDFI Fund certifies financial institutions (including eligible MDIs) as CDFIs and provides financial and technical assistance. Over the last 10 years, total CDFI Fund technical assistance grants increased from $3.6 million to $25.2 million per year. The CDFI Fund's strategic plan states it will develop training programs targeting key issues affecting CDFIs. However, it has not created any new training or materials since 2020, and none related to technology. Fund officials said they were aware of the impact of technology capacity on small CDFIs' ability to serve their communities and grow. They said they have considered creating training and materials to help CDFIs build technology capacity, but they do not have a time frame for doing so. Such resources could help CDFIs implement the technology they need to increase lending to underserved communities.Why GAO Did This StudyCDFIs and MDIs target loans to traditionally underserved businesses and individuals. Prior GAO work identified challenges some CDFIs and MDIs had accessing emergency lending capital during the COVID-19 pandemic, raising questions about whether they had the technology capacity needed to best serve their communities.GAO was asked to review CDFIs' and MDIs' technology capacities and potential federal solutions to address any technology challenges. This report examines (1) CDFI and MDI officials' views on their technology capacity and challenges, and (2) available federal resources for improving CDFI and MDI technology.GAO surveyed a sample of 711 CDFI and MDI officials in June and July 2023 and generalized results to the population as a whole and to small and large institutions. GAO also reviewed relevant federal laws and regulations and agency funding documents, strategic plans, and other program documentation, including those from Treasury. In addition, GAO interviewed representatives from 23 judgmentally selected CDFIs and MDIs, and officials from Treasury and federal financial regulators.
- Coast Guard Health Care: Information on Telehealth Usage What GAO FoundThe Coast Guard began offering video and telephone telehealth appointments to its personnel in 2021 in response to the COVID-19 pandemic, according to officials. The Coast Guard piloted an updated video telehealth platform in 2022 across behavioral health clinics, with full deployment to primary care settings occurring in September 2023. The service continues to formalize its telehealth program; for example, the Coast Guard formalized its telehealth policy in December 2023, and Coast Guard officials told GAO they are working on establishing standardized scheduling practices for telehealth appointments and improving their monitoring capabilities.According to Coast Guard officials and documents, the benefits of telehealth include increasing access to medical care for personnel located in remote locations and maximizing staff resources at Coast Guard clinics. Challenges the Coast Guard identified include issues with the Coast Guard's IT infrastructure that may, for example, limit the use of telehealth while at sea due to inconsistent internet connectivity aboard Coast Guard vessels.GAO found that the Coast Guard has plans to address these challenges. For example, the service is in the process of improving its internet capabilities aboard its vessels and is developing standardized scheduling practices for telehealth appointments in Coast Guard clinics.Why GAO Did This StudyThe James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 includes a provision for GAO to report on aspects of the Coast Guard's telehealth program. This report describes how the Coast Guard uses telehealth to provide medical care to its active duty personnel, as well as describes telehealth benefits and challenges identified by Coast Guard officials and documents.To conduct this work, GAO reviewed Coast Guard telehealth policy and guidance documentation, interviewed officials, and conducted site visits to three Coast Guard clinics and three afloat sickbays. Additionally, GAO obtained and reviewed data on the Coast Guard's use of video telehealth from the Defense Health Agency, which manages the video platform. GAO analyzed data from October 2022, the earliest data available at the time of the request, through December 2023, the most recent available at the time of GAO's work.For more information, contact Alyssa M. Hundrup at (202) 512-7114 or hundrupa@gao.gov.
- Broadband Deployment: Agencies Should Take Steps to Better Meet Deadline for Processing Permits What GAO FoundThe Bureau of Land Management (BLM) and Forest Service process the most applications from telecommunications providers to install communications use equipment or facilities—including for broadband internet—on federal property. However, GAO found that from fiscal years 2018 through 2022, BLM and Forest Service did not have sufficiently reliable—i.e., accurate and complete data—to determine the processing time for 42 percent and 7 percent, respectively, of their communications use applications. These agencies lacked the necessary controls to ensure staff entered key information, such as start and end dates, in their electronic systems. Without accurate, complete data to determine processing times, the agencies cannot track the extent to which they are complying with the statutory requirement that they grant or deny applications within 270 days.For those communications use applications with sufficient data, BLM and Forest Service reduced their average processing time by 57 percent from fiscal years 2018 through 2022. However, despite this overall improvement, about half of the applications either exceeded the 270-day deadline or did not have sufficiently accurate and complete information to determine if they met the deadline.Selected Agencies' Performance in Processing Communications Use Permit Applications Within the 270-Day Deadline, Fiscal Years 2018—2022Officials from BLM and Forest Service said that applicant non-responsiveness and staffing issues contributed to the delays in processing communications use applications. Forest Service has taken some steps to improve processing, including hiring additional staff, but neither agency has fully analyzed or addressed reasons why many applications processing time exceeded the deadline. Moreover, neither agency has a method to alert staff to applications that are at risk of exceeding the 270-day deadline. Until BLM and Forest Service address issues that contribute to delays and establish methods to flag at-risk applications, the agencies may continue to miss the deadline at similar rates, which could cause delays and increased costs in deploying needed broadband infrastructure.Why GAO Did This StudyMillions of Americans do not have broadband access, which has become essential for online activities like work, school, and health care. With the federal government investing billions of dollars in expanding access in the coming years, new broadband infrastructure will frequently cross federal lands or connect to federal buildings, which requires a federal permit. Legislation requires that executive agencies process applications for communications use permits—including for broadband infrastructure—within 270 days of receipt.GAO was asked to review issues related to processing federal broadband permits. This report examines the extent to which selected agencies (1) used reliable data to track application processing times for communications use permits; and (2) processed communications use applications by the required deadline.GAO analyzed federal permitting data; reviewed laws and reports on the application review process; and interviewed agency officials.
- Justice40: Additional Efforts Needed to Improve Tribal Applicants' Access to Federal Programs   Under Environmental Justice Initiative What GAO FoundThe Justice40 Initiative is the administration's goal for 40 percent of the overall benefits of certain federal investments to flow to disadvantaged communities. GAO reviewed six Justice40 programs in three selected agencies—the Environmental Protection Agency (EPA), Federal Emergency Management Agency (FEMA), and U.S. Department of Agriculture (USDA). GAO found that each agency adjusted program mechanisms to increase access to funding for underserved communities, including Tribes and eligible Indigenous communities (tribal applicants), in response to the Justice40 Initiative as well as other agency initiatives.However, certain program characteristics create barriers to tribal applicants' ability to access selected covered Justice40 programs, including cost shares, administrative burdens, and certain statutory and regulatory requirements. For example, EPA has a mechanism to reduce administrative burdens for recipients by combining funds from multiple grants into a single budget. Agency officials told GAO that grants funded by the Infrastructure Investment and Jobs Act and Inflation Reduction Act are not eligible for this mechanism. Agencies have taken actions to identify statutory and regulatory barriers to access for tribal recipients. Additional actions to document and discuss these barriers with affected stakeholders to determine any additional statutory and regulatory changes needed could help tribal applicants more readily access covered programs, consistent with the Justice40 goal and executive orders.Examples of Historic Barriers to Tribes' Access to Federal ProgramsSelected agencies consulted with Tribes on new programs, funding opportunities, and related topics, such as equity assessments. However, the extent to which these efforts informed agency implementation of Justice40 is unclear because the agencies generally did not make related consultation results publicly available. Consistent with executive orders and presidential memoranda, considering publicly sharing high-level consultation summaries could help ensure Tribes have access to information about prior tribal input on federal programs. In turn, this information could inform Tribes' future input on Justice40 and reduce their administrative burdens. Additionally, GAO's review of the selected agencies' online consultation tracking systems and interviews with agency officials found that the agencies did not consult with Tribes specifically about the Justice40 Initiative. Interim implementation guidance directs agencies to consult with stakeholders, including Tribes, when determining Justice40 covered program benefits. Agencies have additional opportunities to consult with Tribes and conduct outreach on Justice40 implementation to ensure meaningful input.Why GAO Did This StudyUnderserved communities—including federally recognized Tribes and other historically marginalized people—experience a disproportionate share of adverse socioeconomic and environmental conditions, according to GAO's prior work. Executive Order 14008 established the Justice40 Initiative with the goal of delivering to disadvantaged communities 40 percent of the overall benefits of certain federal investments. In determining Justice40 benefits, guidance directed agencies to consult with Tribes and other stakeholders to ensure meaningful involvement.GAO was asked to review agencies' implementation of the Justice40 Initiative with respect to tribal applicants. This report reviews the actions selected agencies took to (1) adjust programs to direct funding to tribal recipients, and (2) consult with Tribes and conduct outreach to Indigenous communities regarding the initiative. GAO examined laws, executive orders, presidential memoranda, guidance, and policies; and interviewed officials from three selected agencies, leadership from six Tribes, and representatives from seven tribal organizations. GAO selected a mix of agencies and programs based on tribal participation, funding mechanisms, and types of programs.
- Fiscal Year 2025 Budget Request: U.S. Government Accountability Office In fiscal year 2023, GAO’s work yielded $70.4 billion in financial benefits, a return of about $84 for every dollar invested in GAO. Our average return on investment for the past 6 years is $133 to $1. In 2023 we also identified 1,220 other benefits that led to improved services to the American people, strengthened public safety, and spurred improvements across the government. GAO’s High Risk Series this past year resulted in $32.9 billion in financial benefits and 468 program and operational improvements. GAO is also helping advance agencies’ efforts and related Congressional oversight to prevent, detect, and respond to fraud, waste, and abuse. For instance, in FY 2023 we estimated that the amount of unemployment insurance fraud during the COVID-19 pandemic was likely between $100 billion and $135 billion.For our fiscal year 2025 budget, GAO is requesting $916.0 million in appropriated funds and $59.8 million in offsets and supplemental appropriations. This will maintain 3,600 full-time equivalents (FTE). These resources will enable GAO to continue to meet the priority needs of the Congress including five key areas of importance to the nation and Congress:National Security Enterprise. GAO evaluates an array of national security efforts in areas such as military readiness, space programs, and the U.S. nuclear complex.	Fraud Prevention. We examine government efforts to safeguard programs from fraud by focusing agencies more on prevention.	Science and Technology. GAO’s growing portfolio of ongoing and future work includes many aspects of artificial intelligence, medical research and applications, critical minerals recovery, and quantum computing.	Cybersecurity. GAO assesses the development and execution of a comprehensive national cybersecurity strategy, the cybersecurity of 16 critical infrastructure sectors across the U.S., and the security of federal information systems.	Health Care Costs. GAO examines the sustainability and integrity of the Medicare and Medicaid programs, Veterans Affairs, DOD, and Indian Health Service health care services.Our fiscal year 2025 budget request also supports GAO’s IT modernization and space optimization efforts. We will transition processes to Cloud Services and enhance cybersecurity. This will allow GAO to grow in agility and better engage IT Modernization strategies. In addition, we will advance space optimization projects to increase leasable space in headquarters and decrease leased space in the field. We will also continue addressing a maintenance backlog at the headquarters building.BackgroundGAO’s mission is to support Congress in meeting its constitutional responsibilities and to help improve the performance and ensure the accountability of the federal government for the benefit of the American people. We provide nonpartisan, objective, professional and reliable information to Congress, federal agencies, and to the public. GAO recommends hundreds of improvements across the full breadth and scope of the federal government’s responsibilities.In fiscal year 2023 alone, GAO issued 671 products, and 1,345 new recommendations. Congress used our work extensively to inform its decisions on key fiscal year 2023 and 2024 legislation.Since fiscal year 2002, GAO’s work has resulted in over:$1.38 trillion dollars in financial benefits; and	Over 28,000 program and operational benefits that helped to change laws, improve public safety, and promote sound management throughout government.As a non-partisan, fact-based service organization, GAO is committed to providing program and technical expertise to support Congress. This includes crafting legislation; overseeing the executive branch; evaluating government programs, operations, and spending priorities; and assessing information from outside parties.For more information, contact A. Nicole Clowers at (202) 512-4400 or clowersa@gao.gov.&nbsp;
- COVID-19 Relief: State and Local Fiscal Recovery Funds Spending as of September 30, 2023 The Coronavirus State and Local Fiscal Recovery Funds, established under the American Rescue Plan Act of 2021, allocated $350 billion to Tribes, states, the District of Columbia, localities, and U.S. territories to help cover a broad range of costs stemming from the health and economic effects of the COVID-19 pandemic. This snapshot updates the status of these funds.The Big PictureMost ($325.5 billion) of the $350 billion in Coronavirus State and Local Fiscal Recovery Funds (SLFRF) were allocated to states, the District of Columbia, and local governments. SLFRF recipients have until December 31, 2024, to obligate their SLFRF awards and generally have until December 31, 2026, to spend their awards.The Department of the Treasury, which administers the SLFRF, requires recipients to submit project and expenditure reports quarterly or annually—depending on the recipient type, population, and award size. The reports detail recipients’ uses of SLFRF funds, including obligations and spending amounts. The most recent quarterly reports reflect this information as of September 30, 2023.This snapshot includes aggregate data on obligation and spending amounts that SLFRF recipients reported to Treasury as of September 30, 2023, the most recent reporting available when this snapshot was issued. The snapshot updates our October 2023 report on states’ and localities’ obligations and spending amounts, as of March 31, 2023 (GAO-24-106753). Our prior report also includes detailed information on Treasury’s reporting requirements for SLFRF recipients.What GAO’s Work ShowsStates’ Reported ObligationsAs of September 30, 2023, states and the District of Columbia reported obligating 73 percent ($142.4 billion) of their $195.8 billion in SLFRF awards. All states reported obligating at least 25 percent of their SLFRF awards and 23 states reported obligating over 75 percent. Minnesota and North Dakota reported obligating the largest share of their awards (over 99 percent and 100 percent, respectively), while New Jersey and West Virginia reported obligating the smallest shares (36 percent and 33 percent, respectively).States’ Reported Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Obligations, as of Sept. 30, 2023States’ Reported SpendingAs of September 30, 2023, states and the District of Columbia reported spending 53 percent ($103.7 billion) of their $195.8 billion in SLFRF awards. All but eight states reported spending at least 25 percent of their awards. Eight states reported spending 75 percent or more of their awards. Minnesota and Alaska each reported spending the largest share of their awards (99 percent and 96 percent, respectively). Oklahoma and South Carolina reported spending the smallest shares (5 percent each).States’ Reported Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Spending, as of Sept. 30, 2023Localities’ Reported Obligations and SpendingAs of September 30, 2023, a total of 26,442 localities reported SLFRF obligations and expenditures, either through an annual report (as of March 31, 2023) or a quarterly report (as of September 30, 2023). Smaller localities—referred to as non-entitlement units of local government (NEU)—comprised the majority of reporting localities (22,361) but received the smallest amount of allocations ($18.9 billion) in the aggregate, compared to counties and metropolitan cities (which we refer to as cities throughout this snapshot).As of September 30, 2023, a total of 26,442 localities reported SLFRF obligations and expenditures, either through an annual report (as of March 31, 2023) or a quarterly report (as of September 30, 2023). Smaller localities—referred to as non-entitlement units of local government (NEU)—comprised the majority of reporting localities (22,361) but received the smallest amount of allocations ($18.9 billion) in the aggregate, compared to counties and metropolitan cities (which we refer to as cities throughout this snapshot).Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Allocations Received, by Locality Type, as of Sept. 30, 2023&nbsp;			Number of localities reporting			Amount of SLFRF allocation (in billions)		Citiesa			1,105			$47.7		Counties			2,976			$59.4		Non-entitlement units of local governmentb			22,361			$18.9		Total			26,442			$126.1		Source: GAO analysis of Department of the Treasury data. &nbsp;I &nbsp;GAO-24-107472aCities refer to metropolitan cities as defined in 42 U.S.C. § 803(g)(4).bNon-entitlement units of local government as defined in 42 U.S.C. § 803(g)(5).In their annual or quarterly reports, these localities reported obligating 64 percent ($80.1 billion) and spending 47 percent ($59.4 billion) of their $126.1 billion in SLFRF allocations.Cities, counties, and NEUs in the aggregate each reported obligating between 61 and 65 percent of their awards. Cities received the second largest amount of allocations ($47.7 billion), but they reported spending the largest amount of their awards (54 percent), compared to counties and NEUs (each reporting spending 43 percent of their awards).Localities’ Reported Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Obligations and Spending, as of Sept. 30, 2023aCities refer to metropolitan cities as defined in 42 U.S.C. § 803(g)(4).bNon-entitlement units of local government as defined in 42 U.S.C. § 803(g)(5).We will continue to review states’ and localities’ reported obligations and spending, as well as their uses of SLFRF awards.&nbsp;For more information, contact Jeff Arkin at (202) 512-6806 or ArkinJ@gao.gov.
- Coast Guard: Aircraft Fleet and Aviation Workforce Assessments Needed What GAO FoundThe U.S. Coast Guard relies on its aircraft to support its many missions, using them most heavily for search and rescue. However, its aircraft generally did not meet the Coast Guard's 71 percent availability target during fiscal years 2018 through 2022. Specifically, the aircraft fleet availability ranged from 66 percent to 68 percent during this timeframe. The Coast Guard set this target to help ensure a high probability that its air stations can deploy at least one aircraft on short notice for search and rescue. Coast Guard officials attributed the aircraft fleet generally not meeting availability targets to maintenance and repair challenges.Coast Guard Aircraft As of January 2024, the Coast Guard had four programs underway to modernize its aircraft and help ensure they are available for operations in the coming decades, at an estimated cost of $105.6 billion. These programs were generally meeting their approved cost and schedule baselines. One of these programs aims to consolidate the fleet from 98 short-range and 48 medium-range helicopters to an all medium-range helicopter fleet. This would reduce the fleet size from 146 to at least 127 total helicopters.However, the Coast Guard has not fully assessed whether this transition will result in the type and quantity of helicopters needed to meet its mission demands. For example, it has not conducted an analysis of alternatives—an analytical study comparing the operational effectiveness, costs, and risks—to determine the best suited aircraft to meet mission needs. Assessing different helicopters using such an analysis would help the Coast Guard determine the best alternative to replace its short-range helicopter. Additionally, a fleet mix analysis would help ensure it identifies the necessary number of helicopters it requires to meet its mission demands.As of July 2023, the Coast Guard had 387 of 4,134 (9 percent) of its authorized military aviation workforce positions vacant. However, the Coast Guard has not fully determined its aviation workforce needs. Coast Guard guidance calls for the Coast Guard to assess and determine necessary staffing levels and skills to meet mission needs. This may be higher or lower than the number of its authorized positions. The Coast Guard has not used this process for a large portion of its aviation workforce, including all 25 of its air stations and its major aircraft repair facility. Until such analysis is completed, the Coast Guard will not fully understand the resources it requires for its aviation units.Why GAO Did This StudyThe Coast Guard, a multi-mission military service within the Department of Homeland Security, is responsible for protecting and defending more than 100,000 miles of U.S. coastline and inland waterways. It relies heavily on its fleet of about 200 aircraft to do so.Several of the Coast Guard's aircraft are approaching the end of their original service lives. The Coast Guard is amid a multibillion-dollar acquisition effort to modernize its aircraft fleet. It has also reported challenges maintaining a sufficient workforce to meet its growing mission demands.The James N. Inhofe National Defense Authorization Act for Fiscal Year 2023 includes a provision for GAO to review issues related to Coast Guard aircraft availability. This report examines, among other things, (1) the extent Coast Guard aircraft met operational availability targets, (2) Coast Guard efforts to modernize its aircraft fleet, and (3) the extent it has determined its aviation-related workforce needs.GAO analyzed Coast Guard documentation and data on aircraft availability, acquisitions, and aviation workforce. GAO also interviewed Coast Guard officials, including those representing eight of 25 air stations with a mix of aircraft and geographic locations.
- Higher Education: Employment Discrimination Case Referrals Between Education and the Equal Employment Opportunity Commission Could Be Improved What GAO FoundThe proportions of Black or African American (Black) and Hispanic or Latino (Hispanic) college faculty increased from fiscal years 2003 through 2021. Yet, there were lower proportions of Black and Hispanic college faculty compared to Black and Hispanic workers with advanced degrees (e.g., master's and doctorate) and professional workers (e.g., lawyers and engineers), according to GAO's analysis of Department of Education and Census Bureau data. Black and Hispanic individuals were also less represented among college faculty than among students, according to GAO's analysis of Education data. For example, in fiscal year 2021, 8 percent of faculty were Black compared to 12 percent of students, and 7 percent of faculty were Hispanic compared to 19 percent of students.College Faculty and Students by Race and Ethnicity, Fiscal Year 2021Notes: Black refers to Black or African American. Hispanic refers to Hispanic or Latino. An individual who self-identifies as Hispanic only, or both Hispanic and any race category, would be classified as Hispanic. The Other category includes individuals such as those that identified as Native American, Pacific Islander, multiple races, or unknown race.GAO's literature search identified strategies used by colleges to recruit and retain a diverse faculty, given the potential benefits to their students. Colleges have enhanced their job search processes, developed mentoring programs, and improved campus climate to recruit and retain a diverse faculty.Education refers certain employment discrimination complaints against colleges to the Equal Employment Opportunity Commission (EEOC) for investigation consideration but has been consistently late in doing so. In fiscal year 2022, Education processed and referred to EEOC 99 complaints alleging employment discrimination at colleges based on race, color, national origin, or sex. GAO found that Education referred the complaints in 71 days on average, although Education policy calls for doing so in 30 days. However, Education does not track the timing of these referrals. Without doing so, Education could miss an opportunity to learn from offices that are more timely than others and apply those lessons agency-wide to reduce delays. Individuals with delayed complaints may experience adverse effects, such as continued discrimination or less pay. In fiscal year 2021, EEOC processed 1,342 complaints alleging employment discrimination at colleges based on race, color, religion, sex, national origin, or disability, some of which were referred by Education. However, EEOC does not have a protocol to consistently track and account for the complaint referrals. Recently, one such referral was not initially received by EEOC until the individual who filed the complaint followed up. Without a protocol to ensure that EEOC receives and processes all Education complaint referrals, some may be missed or resolution may be delayed.Why GAO Did This StudyWhile the U.S. population has become increasingly diverse, college faculty may not reflect those same levels of diversity. Little is known at the national level about the relationship between faculty diversity and student outcomes. Separately, faculty have reported experiencing discrimination at colleges.GAO was asked to review faculty diversity and employment discrimination at colleges. This report examines (1) selected aspects of diversity among faculty, (2) efforts by colleges to recruit and retain a diverse faculty, and (3) how Education and EEOC process employment discrimination complaints at colleges. GAO analyzed Education data on faculty and students from fiscal years 2003–2021, national workforce data from the Census Bureau and Bureau of Labor Statistics ranging from calendar years 2014–2021, Education complaint data from fiscal years 2011–2022, and EEOC complaint data from fiscal years 2011–2021 (each set was the most recent available). GAO also conducted literature reviews; reviewed relevant federal laws, regulations, and policies; and interviewed agency officials and selected higher education experts.
- IRS Direct File: Actions Needed during Pilot to Improve Information on Costs and Benefits What GAO FoundThe Internal Revenue Service (IRS) reported to Congress in May 2023 that it estimated the annual costs of a Direct File tax system could range from $64 million to $249 million depending on the number of taxpayers served and the complexity of tax situations supported. IRS also described assumptions used to estimate costs—a best practice for cost estimation. For example, IRS noted that it assumed a Direct File system would start with a limited tax scope. IRS also included elements of a sensitivity analysis, another best practice for cost estimation, to examine how changes in assumptions may affect cost estimates. IRS described how costs were expected to change depending on the number of taxpayers served and the complexity of tax situations supported.However, IRS's cost estimates did not address other recommended best practices, such as ensuring all costs were included and documented. GAO and the Treasury Inspector General for Tax Administration found that IRS had no documentation to support the underlying data, analysis, or assumptions used for Direct File cost estimates. Further, IRS officials told GAO that the cost estimates did not include start-up costs, such as technology for a novel system, which could be substantial. A best practice for cost estimation is to include development costs as part of a complete cost estimate. Without a comprehensive accounting of costs, IRS's estimates could understate the full amount of resources required to develop and maintain a permanent Direct File program.A Direct File pilot provides opportunities for IRS to improve its cost estimates. IRS officials stated that they will update the cost estimates after the pilot. However, GAO found insufficient documentation to provide reasonable assurance that the pilot will capture the necessary data to inform more complete cost estimates. IRS officials reported that their current focus is to evaluate critical operational aspects of the pilot. However, IRS officials risk missing time-sensitive opportunities to inform cost estimates in such categories as customer service costs, potential costs of integrating a federal Direct File system with additional state-level direct file systems, and incremental costs of expanding the system's capabilities to assist taxpayers with additional tax situations. Complete cost information informs decisions about program design tradeoffs such as what additional tax situations to support.The Direct File pilot also provides opportunities for IRS to estimate potential benefits for taxpayers and for improving tax administration. IRS estimates that the Direct File pilot for the 2024 tax filing season will save taxpayers $21 million in compliance costs. In addition, IRS identified other potential benefits of Direct File, such as making it easier for eligible taxpayers to claim credits and deductions, reducing the volume of paper returns, and reducing errors. However, IRS evaluation documents did not consistently identify relevant metrics for measuring these potential benefits.IRS officials told GAO in February 2024 that senior leadership has not decided on the future of the pilot beyond the 2024 tax filing season. IRS officials reported that the time required to continue Direct File would depend on several factors, such as the size of the team working on the program. They noted that hiring new employees to replace outgoing employees is a lengthy process. Thus, IRS officials will have a short amount of time to analyze cost and benefit information before making decisions about the pilot for the 2025 tax filing season.Why GAO Did This StudyIRS is piloting an online tax filing system to allow certain taxpayers to prepare and file their tax returns on an IRS website for free using a question-and-answer format during the 2024 tax filing season. Once mature, a government-run tax filing system could save taxpayers time and money, make it easier to claim tax benefits, and provide several benefits to IRS. Questions have been raised about how much funding will be required to support such a system, including providing a sufficient level of customer service.The Inflation Reduction Act of 2022 appropriated funds for IRS to study the cost of developing and running a free Direct File tax return system. IRS submitted its report to Congress in May 2023. The act also includes a provision for GAO to oversee the distribution and use of such funds. For this report, GAO evaluated IRS's estimates of the costs and benefits of Direct File and opportunities to use the pilot to collect data to improve those estimates to inform future decisions. GAO compared IRS's initial cost and benefit estimates against best practices for cost estimation and an IRS strategic goal of ensuring a Direct File system is cost effective.
- Aircraft Registrations: Risks Remain from Efforts to Obscure Ownership Information What GAO FoundTo register civil aircraft with the Federal Aviation Administration (FAA), applicants can provide opaque information on beneficial owners—persons who ultimately own and control the aircraft—resulting in criminal and national security risks through aircraft registry fraud and abuse. Additionally, FAA generally relies on self-certification of registrants' eligibility and does not verify key information.In a March 2020 report, GAO identified several ways that beneficial ownership in aircraft registrations could be hidden. Specifically, beneficial ownership could be hidden usinopaque ownership structures, such as shell companies and noncitizen trusts, which are aircraft trusts registered to U.S.-citizen owner trustees with noncitizen trustors;	intermediaries, which are individuals and entities that facilitate aircraft registration for a fee;	addresses of registered agents, which are individuals or entities authorized to accept important legal and tax documents on behalf of a business; and	nominees, which are individuals or entities listed as the owners but in fact acting on behalf of beneficial owners.The following example illustrates the use of such approaches to obscure the beneficial owner of an aircraft involved in a Malaysian money laundering case. The aircraft, among other assets, was ultimately forfeited to the U.S. government.Example of Aircraft Registration Using Opaque Ownership Structures and Multiple Intermediaries and JurisdictionsFAA took steps to mitigate registry fraud and abuse by implementing three GAO recommendations. Specifically, FAA assessed its fraud and abuse risks; determined the impact and likelihood of those risks and established its risk tolerance; and developed an antifraud strategy. However, 12 recommendations remain open, including key recommendations related to collecting data on individuals and entities to verify identity and eligibility. Without further action by FAA, the aircraft registry remains vulnerable to continued fraud and abuse.Why GAO Did This StudyThe U.S. aircraft registry, managed by FAA, maintains information on civil aircraft to facilitate aviation safety, security, and commerce. FAA issues aircraft registrations to individuals and entities that meet eligibility requirements, such as U.S. citizenship or permanent legal residence. Registry fraud and abuse hinders national security and criminal investigations when law-enforcement officials try to identify aircraft and their owners who might be involved in illicit operations.This testimony discusses (1) how beneficial ownership information can be obscured in aircraft registrations and (2) FAA efforts to implement GAO recommendations to mitigate registry fraud and abuse.This testimony is based primarily on GAO's March 2020 report on FAA's efforts to prevent, detect, and respond to fraud and abuse risks in aircraft registrations (GAO-20-164). For that report, GAO reviewed relevant laws, regulations, and FAA policies; reviewed reports, press releases, and court cases that illustrated risks associated with the registry; analyzed aircraft registry data from fiscal years 2010 through 2018 to identify registrations with risk indicators; and interviewed FAA and federal law enforcement officials.
- Federal Research: Key Practices for Scientific Program Managers What GAO FoundTo oversee basic and applied research at federal agencies, scientific program managers are typically responsible for managing award selection, monitoring ongoing awards, and coordinating with awardees and the research community. Program managers GAO interviewed from selected agencies identified key practices they used to carry out these responsibilities. They said these practices helped advance their agencies' goals, further science, and avoid unnecessary duplication. Further, the practices may help program managers, agencies, and others assess and improve management of basic and applied research.As outlined in the figure below, the key practices fall into three areas.Strengthening and building expertise—Practices that help program managers maintain scientific and management expertise.	Developing connections—Practices that help program managers enhance collaboration with the scientific community and the public, as well as within their own agencies and in other agencies.	Building a strong research portfolio—Practices that help program managers advance their agencies' research mission and scientific knowledge in general, while ensuring their own accountability and that of federally funded researchers.Key Practices for Federal Program Managers to Select, Coordinate, and Monitor Scientific ResearchWhy GAO Did This StudyThe federal government invests in basic and applied scientific research to drive innovation, promote economic competitiveness, and enhance national security. The National Science Foundation estimates that 32 federal agencies funded over $85 billion in basic and applied research in fiscal year 2021.Scientific program managers at federal agencies that sponsor basic and applied research play a critical role in guiding and shaping the research funded by their agencies.In this report, GAO describes key practices that federal program managers use to manage their research.GAO held 14 group discussions with 79 program managers from seven selected agencies that funded over 90 percent of basic and applied research obligations in fiscal year 2021. GAO asked the program managers to describe the practices they use when managing projects in their basic and applied research portfolios. GAO conducted qualitative analysis to identify common themes and distilled them into 10 key practices. These key practices were cited by multiple program managers or agencies and could be used by program managers across the federal government when managing projects in their basic and applied research portfolios.GAO also conducted a literature review to help corroborate the key practices. GAO sought and incorporated feedback on these practices from the selected agencies as well as experts identified by the National Academies of Sciences, Engineering, and Medicine.For more information, contact Candice N. Wright at (202) 512-6888 or wrightc@gao.gov.
- Indian Health Service: Opportunities Exist to Improve Clinician Screening Adherence and Oversight What GAO FoundTo provide patients with the highest level of care at its federally operated facilities, the Indian Health Service (IHS) reviews and verifies professional qualifications of clinicians through a process known as credentialing and privileging. GAO found that existing IHS oversight methods did not ensure adherence to all of IHS's credentialing and privileging requirements. GAO's review of a random nongeneralizable sample of 91 clinician files found that IHS generally met some of the requirements reviewed. However, IHS did not meet six of the requirements in 10 percent or more of the applicable files GAO reviewed. (Some of these requirements only apply to clinicians new to IHS.)Indian Health Service (IHS) Adherence to Selected Credentialing and Privileging RequirementsThis lack of adherence was due to IHS not having a single, comprehensive source of its credentialing and privileging requirements and limited monitoring by headquarters. Currently, IHS requirements are spread across multiple, sometimes conflicting, documents, making it challenging for officials to know of and meet them. Further, existing IHS oversight is concentrated at the local level and does not routinely include headquarters' reviews of clinicians' files for adherence with IHS requirements. IHS officials said they plan to improve guidance and oversight, but plans are in initial stages and have not yet been implemented. Until it ensures clinicians are appropriately screened, IHS risks hiring or retaining clinicians with performance, health, or other issues, potentially affecting the quality of care provided to patients and putting them at risk.The 24 IHS clinicians from federally operated facilities who GAO interviewed reported performing a range of tasks they considered to be administrative, including entering data in IHS's electronic health record (EHR) system and communicating about patient care. They varied in the time they estimated spending on administrative tasks; 11 clinicians said they spent 20 percent or less of their time, while 13 said they spent from 21 to 50 percent of their time on such tasks. Clinicians who previously worked in non-IHS facilities generally reported spending less time performing administrative tasks at those facilities than at their IHS facilities. They attributed the difference to non-IHS facilities having a superior EHR, fewer training requirements, or more administrative support.Why GAO Did This StudyIHS provides health care services to 2.8 million American Indians and Alaska Natives, including through a system of federally operated facilities. Clinician competence and excessive time spent on administrative tasks are factors that can affect the quality of care that clinicians provide.GAO was asked to review IHS clinician screening and the performance of administrative tasks. This report examines IHS oversight of credentialing and privileging. It also describes administrative tasks performed by IHS clinicians at federally operated facilities.GAO reviewed IHS policies and other documents, including the most recently available credentialing and privileging file for a random nongeneralizable sample of 91 clinicians. GAO also interviewed officials from IHS headquarters and nine geographic areas, as well as a random nongeneralizable sample of 24 clinicians who were working at an IHS federally operated facility.
- Federal Home Loan Banks: Actions Related to the Spring 2023 Bank Failures What GAO FoundSilicon Valley Bank (SVB), Signature Bank, and First Republic Bank had borrowed substantial secured loans, or advances, from their respective Federal Home Loan Banks (FHLBanks) before their failures in spring 2023. As of year-end 2022, each of the three banks held substantially more FHLBank advances (as a proportion of their total assets) than a group of their peer banks.The three banks increased their outstanding FHLBank advances by 37 to 50 percent in the first 2 weeks of March 2023, when SVB and Signature Bank failed (see table). First Republic Bank’s outstanding advances then largely stabilized until the bank failed on May 1. &nbsp;Percentage Changes in Outstanding Federal Home Loan Bank Advances for Failed Banks, March 1, 2023–Failure Date			Bank 									Date 									Outstanding FHLBank advances (in billions of dollars)									Percentage change								Silicon Valley Bank									March 1									$20.0									50%								March 10									30.0								Signature Bank									March 1									8.2									37								March 12									11.2								First Republic Bank									March 1									19.4									45								May 1									28.1					Source: GAO analysis of Federal Home Loan Bank (FHLBank) advance data. | GAO-24-106957Prior to the three bank failures, the FHLBanks of New York and San Francisco reviewed examination reports for the three failed banks and stated that they met regularly with the Federal Deposit Insurance Corporation (FDIC), the Federal Reserve Banks, and other regulators. The two FHLBanks and FDIC communicated about Signature Bank and First Republic Bank as the banks were declining. In addition, the two FHLBanks relied on established policies, procedures, and agreements with the relevant Federal Reserve Banks to help Signature Bank and First Republic Bank access additional funding. However, officials from the FHLBank of San Francisco said that SVB failed before they&nbsp;could coordinate with the Federal Reserve Bank of San Francisco to request additional supervisory information or facilitate SVB’s access to additional funding.Since the bank failures, the FHLBanks have received full repayment for SVB’s and Signature Bank’s advances. The bank that acquired First Republic Bank’s advances has indicated that it intends to repay the advances according to the advance terms.Why GAO Did This StudyBetween March 10 and May 1, 2023, state banking supervisors closed SVB, Signature Bank, and First Republic Bank and named FDIC as receiver.The three failed banks had borrowed substantial secured loans (known as advances) from their respective FHLBanks before their failures. The FHLBanks are government-sponsored enterprises that support liquidity by making advances to member financial institutions and promote housing and community development. SVB and First Republic Bank were members of the FHLBank of San Francisco, and Signature Bank was a member of the FHLBank of New York.GAO was asked to review the role of the FHLBanks with regard to the recent bank failures. This report provides information on the FHLBanks’ funding to the failed banks, their communication and coordination with FDIC and the Federal Reserve System (the failed banks’ primary federal regulators), and repayment of the failed banks’ outstanding advances. This report is one in a series of reports about the bank failures. GAO plans to follow this report with work on broader issues related to the FHLBanks.GAO reviewed relevant laws and regulations; publications, policies, procedures, and other documentation and data from the FHLBanks and the federal banking regulators; and publicly available regulatory reporting data for the three failed banks. GAO also interviewed officials from the FHLBanks, federal banking regulators, and others.For more information, contact Jill Naamane at (202) 512-8678 or NaamaneJ@gao.gov.
- Health Centers: Revenue, Grant Funding, and Methods for Meeting Certain Access-To-Care Requirements What GAO FoundIn 2022, nearly 1,400 health centers provided primary and preventive health services to more than 30 million people, regardless of their ability to pay. Health centers' total revenue rose from about $28.7 billion in 2018 to $42.9 billion in 2022—an increase of more than $14 billion. The largest single source of revenue was Medicaid, accounting for over one-third of total revenue each year. The second largest revenue source each year was grants, including those provided by the Health Resources and Services Administration (HRSA).Health Center Revenue Sources and Amounts, 2018 and 2022Note: For more details, see figure 2 in GAO-24-106815.HRSA awarded about $34 billion in grant funding to health centers through its Health Center Program in fiscal years 2018 through 2022. About two-thirds of that funding—$23.5 billion—was awarded for service area funding, which supports ongoing operations and services, including existing and recently expanded services, at health centers. The second largest category of funding was provided for the purpose of assisting health centers with preventing, mitigating, and responding to COVID-19. The remaining grant funding supported special initiatives, such as cancer screening; increasing services at existing health centers; and increasing the number of health centers and sites.Health centers used various methods to meet requirements that they provide care at accessible locations and hours, and coverage for medical emergencies after regularly scheduled hours. According to officials from five primary care associations—organizations that provide technical assistance to health centers —most health centers in their states have at least one site that regularly offers extended hours, such as evenings or weekends, to accommodate patient needs. Officials said health centers have varied arrangements to ensure patients are evaluated after hours by a clinician and referred to emergency care or local urgent care as appropriate. GAO's analysis of HRSA's site visit findings from 2018 through 2022 found that over 93 percent of the 1,391 health centers that had a site visit complied with both of these access-to-care requirements. Health centers not in compliance took corrective actions, such as expanding clinic hours to include weekend hours and contracting with nurse triage services to clinically evaluate patients who called with symptoms after regular hours.Why GAO Did This StudyHealth centers rely on revenue from a variety of public and private sources, including grants awarded by HRSA through its Health Center Program. Among other things, HRSA requires health centers to have locations and hours that are responsive to patient needs, and to have procedures to handle medical emergencies that arise after hours.GAO was asked to review health centers' revenue, grant funding, and efforts to meet certain access-to-care requirements. This report describes (1) amounts and sources of health centers' revenue from 2018 through 2022; (2) purposes of HRSA grants awarded from fiscal year 2018 through 2022; and (3) methods used to meet requirements for accessible locations and hours, and coverage of medical emergencies after hours.GAO analyzed health center revenue data from HRSA and the Department of Health and Human Services for 2018 through 2022, the most recent data available. GAO also reviewed documentation for HRSA grants awarded from fiscal years 2018 through 2022 to determine grant amounts and purposes.Additionally, GAO reviewed results of health center site visits HRSA conducted from 2018 through 2022 that assessed compliance with certain access-to-care requirements. GAO also interviewed officials from five primary care associations, selected to achieve variation in geographic distribution and number of health centers in their states.For more information, contact Michelle B. Rosenberg at (202) 512-7114 or rosenbergm@gao.gov.
- Vehicle Repair: Information on Evolving Vehicle Technologies and Consumer Choice [Reissued with revisions on Apr. 5, 2024] What GAO FoundRight-to-repair is the ability of consumers to decide who repairs their products. For vehicles, this means consumers deciding whether to make their own repairs or take their vehicle to repair facilities at independent repair shops or dealerships franchised with automakers. Most automakers have been operating under a 2014 voluntary nationwide right-to-repair agreement. This agreement has generally resulted in independent repair shops not associated with vehicle manufacturers having access to the information, data, and tools needed for vehicle repairs. However, stakeholders GAO interviewed and a nongeneralizable review of complaints suggest that independent repair shops may face some limitations in that access.Advanced vehicle technologies, such as electric vehicles, may make repairs more expensive and complex because they require additional knowledge, equipment, and other investments. Such issues could particularly affect some independent repair shops, that are unable to make such commitments. In addition, according to some independent repair stakeholders GAO interviewed, the use of telematics systems to wirelessly transfer data between vehicles and automakers could give dealerships a competitive advantage over independent repair shops in conducting some repairs. However, industry and independent repair stakeholders GAO interviewed agreed that telematics data are not currently needed to conduct repairs.The Department of Transportation's National Highway Traffic Safety Administration (NHTSA) is focused on vehicle safety and its role in vehicle right-to-repair issues is limited to cybersecurity issues that could affect vehicle safety. The Federal Trade Commission (FTC) is involved in protecting consumers and promoting competition, including in the vehicle repair market. FTC is taking steps to better understand potential vehicle repair limitations by considering new ways to categorize and analyze potentially relevant consumer complaints. If independent repair shops face limitations in access to the information, data, and tools needed for repair or are otherwise disadvantaged compared to dealerships, consumers may have fewer repair choices, which may reduce competition and make repairs more expensive and inconvenient.Why GAO Did This StudyGAO was asked to review the effects of changing vehicle technologies on vehicle right-to-repair. This report examines how changes in vehicle technologies are affecting competition and consumer choice in the vehicle repair market and NHTSA's and FTC's actions related to this issue.To conduct this work, GAO conducted a literature search and reviewed relevant publications, conducted a non-generalizable review of vehicle and vehicle repair complaints, and interviewed over 50 industry and consumer-focused stakeholders, including vehicle manufacturers, independent repair shops, and others.For more information, contact Elizabeth Repko at (202) 512-2834 or repkoe@gao.gov.
- Roadside Safety: DOT Should Update Public Awareness Materials on Move Over Laws What GAO FoundAll states and the District of Columbia (states) have “Move Over or Slow Down” (Move Over) laws, which generally require drivers to change lanes, slow down, or both when approaching certain vehicles stopped on the roadside with their warning lights activated. These laws can protect vulnerable roadside workers. Move Over law requirements vary, such as in the specific actions required of drivers, potential penalties for a violation, and types of vehicles covered. All states have laws covering first responder vehicles, such as police cars, fire trucks, and ambulances. Move Over laws in all states also cover certain other types of vehicles, which may include highway construction, utility, trash, or disabled vehicles. There is no federal Move Over law.States have promoted their Move Over laws in various ways, including through road signs and social media; targeted law enforcement; and annual public awareness events. When planning these efforts, states consider factors such as available resources and staff expertise.Example of Move Over or Slow Down Road SignWithin the Department of Transportation (DOT), the National Highway Traffic Safety Administration (NHTSA) supports states' efforts to promote Move Over laws through funding, research, and public awareness materials (e.g., sample social media posts, press releases, graphics, banners, and videos). However, NHTSA's public awareness materials generally focus on first responders and do not fully reflect states' Move Over laws, all of which now cover a wider range of vehicles. Officials GAO interviewed from two of the seven selected states said they use NHTSA's materials. State officials also described having limited resources and expertise to develop such materials themselves. Updating NHTSA's materials to more fully reflect the types of vehicles covered by states' laws, such as highway construction, utility, trash, and disabled vehicles, would enable NHTSA to help states better promote their Move Over laws and could ultimately improve safety for all motorists on the side of the road.Why GAO Did This StudyFirst responders, highway construction workers, and others risk being killed or injured when working on the side of the road. Reducing transportation-related fatalities and injuries is one of DOT's top priorities. NHTSA plays a key role in working toward that priority, including by supporting states' efforts to promote their Move Over laws.The Infrastructure Investment and Jobs Act includes a provision for GAO to review issues related to states' Move Over laws. This report (1) identifies the key characteristics of states' Move Over laws, (2) describes how states have promoted these laws, and (3) assesses the extent to which DOT has supported states' efforts to promote these laws.GAO reviewed Move Over laws and certain related legal provisions for all states, as well as online information about states' promotion efforts. GAO compared DOT's public awareness materials related to Move Over laws with DOT strategic plans and federal internal control standards. GAO also interviewed officials in seven states selected for specific characteristics of their Move Over laws, as well as DOT officials and stakeholders from law enforcement, trash and recycling, and other associations.