In 17 of the 31 new areas where agencies may be able to achieve greater efficiency or effectiveness, we found evidence of fragmentation, overlap, or duplication among federal programs or activities. As described in table 1, these programs or activities cover a wide range of federal functions and missions. We consider programs or activities to be fragmented when more than one federal agency (or more than one organization within an agency) is involved in the same broad area of national need and opportunities may exist to improve how the government delivers services. We identified fragmentation in multiple programs we reviewed, including the following: Combat Uniforms: We found that the Department of Defense’s (DOD) fragmented approach to developing and acquiring combat uniforms could be more efficient. Further, DOD has not taken steps to ensure equivalent levels of uniform performance and protection for service members conducting joint military operations in different uniforms, potentially exposing them to increased risk on the battlefield. Since 2002, the military services have shifted from using two camouflage patterns to seven service-specific camouflage uniforms with varying patterns and colors. Although DOD established a board to help ensure collaboration and DOD-wide integration of clothing and textile activities, we continue to identify inefficiencies in DOD’s uniform acquisition approach. For example, we found that none of the services had taken advantage of opportunities to reduce costs through partnering on inventory management or by collaborating to achieve greater standardization among their various camouflage uniforms. We have identified several actions DOD should take to realize potential efficiencies. In addition, DOD reported that it could save up to $82 million in development and acquisition cost savings through increased collaboration among the military services. These actions include directing the Secretaries of the military departments to actively pursue partnerships for the joint development and use of uniforms. Renewable Energy Initiatives: Federal support for wind and solar energy, biofuels, and other renewable energy sources has increased significantly in recent years. Specifically, third-party estimates indicate that federal spending over the 7-year period from 2002 through 2008 averaged about $4 billion per year and increased to almost $15 billion in fiscal year 2010, in part because of additional spending through the American Recovery and Reinvestment Act of 2009. We found that federal support for renewable energy is fragmented, as 23 agencies and their 130 subagencies implemented hundreds of initiatives in fiscal year 2010. We could not comprehensively assess the potential for overlap or duplication among these nearly 700 renewable energy initiatives, because existing agency information was not sufficiently complete to allow for such an assessment. However, fragmentation can be a harbinger of potential overlap or duplication. For example, we assessed federal wind energy initiatives and found that most of the 82 wind-related initiatives that we examined had overlapping characteristics, and several of them have provided duplicative financial support to deploy wind energy projects. Such duplicative federal financial support may not have been needed in all cases for the projects to be built. To help ensure effective use of financial support, we suggested that the Department of Energy and the U.S. Department of Agriculture, to the extent possible within their statutory authority, assess and document whether the financial support of their initiatives is needed when considering applications. In some of the programs and activities where there was fragmentation, we also found instances of overlap. Overlap occurs when multiple agencies or programs have similar goals, engage in similar activities or strategies to achieve them, or target similar beneficiaries. We found overlap among federal programs or initiatives in a variety of areas, such as joint veterans and defense health care services, export promotion activities, drug abuse prevention and treatment programs, and veterans’ employment and training programs, as well as the following: Department of Homeland Security Research and Development: Within the Department of Homeland Security (DHS), we found at least six department components involved in research and development activities. We examined 47 research and development contracts awarded by these components and found 35 instances among 29 contracts in which the contracts overlapped with activities conducted elsewhere in the department. Taken together, these 29 contracts were worth about $66 million. In one example of the overlap we found that two DHS components awarded five separate contracts that each addressed detection of the same chemical. While we did not identify instances of unnecessary duplication among these contracts, DHS has not developed a policy defining who is responsible for coordinating research and development and what processes should be used to coordinate it, and does not have mechanisms to track research and development activities at DHS that could help prevent overlap, fragmentation, or unnecessary duplication. We suggested that developing a policy defining the roles and responsibilities for coordinating research and development, and establishing coordination processes and a mechanism to track all research and development projects could help DHS mitigate existing fragmentation and overlap, and reduce the risk of unnecessary duplication. Overlap and fragmentation among government programs or activities can lead to duplication, which occurs when two or more agencies or programs are engaged in the same activities or provide the same services to the same beneficiaries. Our 2013 report includes several areas where we identified potentially duplicative federal efforts, including the following: Medicaid Program Integrity: We identified duplication in the Medicaid Integrity Program, which provides federal support and oversight of state programs. In particular, the use of two sets of federal contractors in the National Medicaid Audit Program—one contractor to review states’ paid claims in order to identify potential aberrant claims or billing anomalies and another contractor to audit such aberrant claims—increased inefficiencies in data analysis and led to duplication of effort. To address this duplication, we suggested that the Centers for Medicare & Medicaid Services (CMS) merge certain functions of the federal review contractors and federal audit contractors and discontinue the annual state program integrity assessment to eliminate or avoid duplicative activities. Partly in response to our suggestion, CMS is not renewing its federal review contractors when their contracts expire this year, which has the potential for saving $15 million or more. In addition to these 17 areas of fragmentation, overlap, and duplication in federal efforts, we present 14 areas in which we identified opportunities to reduce the cost of government operations or enhance revenue collections for the Treasury. These opportunities for executive branch or congressional action exist in a wide range of federal government missions (see table 2). Among the 14 areas of opportunity to reduce costs or enhance revenue identified in our 2013 annual report are the following examples of opportunities for executive branch agencies or Congress to take action to address the issues we reported: Medicare Advantage Quality Bonus Payment Demonstration: We report concerns about CMS’s Medicare Advantage Quality Bonus Payment Demonstration, which is expected to cost $8.35 billion over 10 years, most of which will be paid to plans with average performance. Medicare Advantage provides health care coverage through private health plans offered by organizations under contract with CMS. The agency’s stated research goal for the demonstration is to test whether an alternative bonus structure leads to larger and faster annual quality improvement for Medicare Advantage plans. We found that the demonstration’s design precludes a credible evaluation of its effectiveness because it lacks an appropriate comparison group needed to isolate the demonstration’s effects, and because the demonstration’s bonus payments are based largely on plan performance that predates the demonstration. Based on these concerns, we suggest that Department of Health and Human Services (HHS) cancel the Medicare Advantage Quality Bonus Payment Demonstration. In addition, the demonstration’s design raises legal concerns about whether it falls within HHS’s demonstration authority. Although the demonstration is now in its second year, HHS still has an opportunity to achieve significant cost savings—about $2 billion, based on GAO’s analysis of CMS actuaries’ estimates—if it cancels the demonstration for 2014. that authority, to correct errors during tax return processing. These and other actions we have identified could help the federal government increase revenue collections by billions of dollars. We have previously reported that the government would generate an additional $3.8 billion per year if service and enforcement improvements reduced the tax gap by 1 percent. Department of Energy’s Isotope Program: Opportunities may also exist for the Department of Energy (Energy) to generate additional revenue by increasing the price for isotopes that it sells to commercial customers. Energy’s Isotope Development and Production for Research and Applications program sells isotopes to commercial customers for a variety of uses, such as medical procedures and radiation detection equipment. To achieve its mission, the program relies on annual appropriations and revenues from isotope sales. Although revenues from sales of isotopes alone totaled over $25 million in fiscal year 2012, we found that Energy may be forgoing revenue because it is not using thorough assessments to set prices for commercial isotopes. Thus, we suggested that Energy examine the prices it sets for commercial isotopes to determine if prices can be increased. With the issuance of our 2013 report, we have completed a systematic examination to identify major instances of fragmentation, overlap, or duplication across the federal government. Through our three annual reports, we have identified 162 areas in which there are opportunities to reduce fragmentation, overlap, or duplication or to achieve cost savings or enhance revenue. Within these 162 areas, we identify approximately 380 actions that the executive branch or Congress could take to address the issues we identified. These areas span a wide range of government missions, covering activities within all 15 cabinet-level executive departments and 17 other federal entities (see fig. 2). Collectively, if the actions we suggest are implemented, the government could potentially save tens of billions of dollars annually. Our 2013 annual report completes our 3-year systematic examination across the federal government to identify major instances of fragmentation, overlap, or duplication. Our systematic examination required a multiphased approach. First, we reviewed the budget functions of the federal government representing nearly all of the overall federal funds obligated in fiscal year 2010.budget resources by national need (such as National Defense, Energy, or Agriculture), and instances in which multiple federal agencies obligate funds within a particular budget function may indicate potential duplication or cost savings opportunities (see fig. 3).