Podcast on DOD and Military Ethics

GAO Podcast IconIn the high-stakes realm of national defense, professionalism and sound ethical judgement are essential. But recent investigations have revealed misconduct among DOD and military officials related to sexual behavior, bribery, cheating, and more.

Listen to Brenda Farrell, a director in GAO’s Defense Capabilities and Management team, discuss her team’s recent review of DOD’s ethics and professionalism programs for military servicemembers.

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Our Prescriptions for Prescription Drug Abuse

_OPA6811Prescription drugs are generally safe when taken as directed, but they can also be abused. Moreover, some people try to use their insurance to pay for prescriptions they shouldn’t be getting. Read on for our look at how two federal agencies are trying to prevent some of these prescription drug problems.

Prescription drugs in the wrong hands

Daring raids and piles of seized street drugs and cash. Those are typically the images people conjure when thinking of the Drug Enforcement Agency. That’s great movie material, but the DEA also does a lot to keep drugs from hitting the streets in the first place.

For prescription drugs like OxyContin and Vicodin, that means preventing diversion—when prescription drugs are stolen or illegally sold and, eventually, abused. As these drugs make their way down the supply chain from manufacturers to your local pharmacy, there are multiple opportunities for diversion and for all the dangers that stem from it.

GAO-15-471(Excerpted from GAO-15-471)

To minimize these risks, the DEA requires all drug distributors, pharmacies, and doctors that handle controlled substances to register with the agency. If the DEA sees anything suspicious, it can launch investigations and pursue fines, jail time, or other penalties.

But does trying to keep prescription drugs out of the wrong hands make it harder for them to get into the right ones? When we surveyed businesses and practitioners registered with the DEA in 2014, over half reported changing certain practices due to the potential broader effects of DEA enforcement actions. For example, some distributors put stricter limits on the amount of drugs pharmacies could order, and some pharmacies reported delays in filling prescriptions to check for legitimate medical need.

To help fix these issues, we recommended that the DEA take action to better balance patient access with abuse prevention. While the DEA reported steps it would take to follow our recommendations, we believe it needs to do more to fully address the problems we identified.

Drug benefits can also be abused

Like prescription drugs themselves, drug benefits can also be abused. We recently looked into Medicaid prescription drug fraud. Among other issues, we found indications that thousands of beneficiaries obtained $33 million worth of prescription drugs by doctor shopping—that is, visiting at least 5 doctors in order to receive prescriptions for noncontrolled substances. We also found other indications of fraud perpetrated by individuals and prescribers.

GAO-15-390(Excerpted from GAO-15-390)

To help the Centers for Medicare & Medicaid Services better fight fraud, we identified two potential controls that aren’t in CMS’s current reporting requirements:

  • Lock-in programs for noncontrolled substances. Lock-in programs require suspect patients to use only one healthcare provider, one pharmacy, or both, in order to address doctor shopping. Why use them for noncontrolled substances? We found about 30 Medicaid beneficiaries with no record of having HIV who each got the HIV medication Atripla 12 or more times at a cost to Medicaid of at least $418,000.
  • Prohibition of automatic refills. Ending automatic refills may help limit waste and save money by making it harder for patients to fill unnecessary prescriptions and stockpile drugs.

CMS agreed with our recommendations to require states to report whether they use these controls and determine whether additional guidance is appropriate.


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Shrinking DOD’s Headquarters Could Mean Big Savings

DVIDSThe Pentagon may be the most iconic, but the Department of Defense has numerous headquarters operations around the world. Each is staffed by thousands of people and costs hundreds of millions of dollars—and these headquarters have been growing.

For today’s WatchBlog, we take you on a world tour of DOD headquarters, efforts to trim them, and how these cuts could add up to big savings for DOD.

DOD’s multiple multimillion dollar headquarters

A sprawling agency, DOD has multiple headquarters at multiple levels. Among the top are the headquarters of the Joint Staff, the Office of the Secretary of Defense, military services, and the 3 functional combatant commands. These headquarters combine for a huge workforce and major costs—almost 27,000 authorized military and civilian positions and $4.7 billion in fiscal year 2013.

Then there are headquarters for each of the 6 geographic combatant commands—those responsible for securing specific parts of the globe. Perhaps the best known, the Florida-based U.S. Central Command, or CENTCOM, is responsible for the Middle East, North Africa, and Central Asia.

Moreover, each command can have several components, each again with its own headquarters. For example, the United States Strategic Command—which conducts global operations to deter and detect strategic attacks, like cyberattacks—has 13 components, each with a headquarters.

GAO-14-439 map (Excerpted from interactive graphic in GAO-14-439. To use the interactive features, download the report PDF, go to p.8 of the report, and roll your mouse over the combatant command name to see its headquarters locations.)

DOD headquarters costs are not only large, but we found they have been growing. Take, for example, the headquarters for the 3 functional combatant commands: U.S. Special Operations Command, U.S. Strategic Command, and U.S. Transportation Command.

They spent $215 million in fiscal year 2001 to support their headquarters operations. In fiscal year 2013? About $1.2 billion.

GAO-14-439(Excerpted from GAO-14-439)

Trying to cut back

In July 2013, the Secretary of Defense directed a 20% cut to headquarters spending throughout DOD. However, those cuts were restricted to “management headquarters”—meaning higher-level staff who support headquarters operations. As a result, the cuts applied to only about a quarter of the headquarters staff we examined.

For commands we reviewed, if DOD broadened its headquarters-reduction efforts to include total headquarters budgets, it could save $47 million with every 1% cut (minus any implementation costs). Moreover, the headquarters organizations we examined represent a small fraction of the total DOD headquarters resources. If DOD implemented larger reductions, department-wide savings could be in the hundreds of millions of dollars a year.


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Hurricane Katrina: 10 Years after the Storm

weatherIt’s been a decade since Hurricane Katrina devastated the Gulf Coast. In that time, we’ve examined almost every aspect of federal recovery efforts following the storm. Today, we look back at some of that work and explore how to reduce the costs of future disasters. Continue reading

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Podcast on Federal Employee Engagement

IMG_0154It shouldn’t be surprising that both private and public organizations perform better when employees are more engaged—that is, committed to the mission and organization. But after peaking in 2011, federal employee engagement has declined, primarily at several large agencies. Continue reading

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National Immunization Awareness Month

logo_250Let’s face it: no one likes getting shots. But according to the Centers for Disease Control and Prevention, vaccinations help protect everyone from infants to elderly people against all sorts of dangerous and potentially lethal diseases.

Each August the CDC and others raise awareness Continue reading

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The Short Tenure of the Second Watchdog in Chief, Fred H. Brown

We’ve already introduced you to the first U.S. Comptroller General, John R. McCarl. While McCarl set the course for GAO, his successor didn’t have much time to fill those substantial shoes. Today’s WatchBlog shares the short tenure (1939–1940) of the second CG, Fred H. Brown.

Life before GAO

Despite not having much time to leave a mark on GAO, Fred H. Brown was one of the more colorful—or at least athletic—CGs to-be. Born in 1879 in New Hampshire, he was an avid athlete. He not only Continue reading

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Podcast on Drones in the National Airspace

GAO Podcast IconWithout onboard pilots, drones fly by either remote control or along preprogrammed routes. Commercial uses for these unmanned aerial systems are growing, from wedding photographers snapping aerial photos to companies testing them for delivering goods. Continue reading

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GAO’s Technology Assessments: 3D Printing

Technology_Assessment_MedallionYou may be familiar with our traditional reports, testimonies, and legal decisions, but do you know about our technology assessments? Today’s WatchBlog explains them before highlighting our recent look at 3D printing.

What are technology assessments? Continue reading

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How Is SSA Keeping Up at 80?

SS+Cards-4Eighty years after FDR signed it into existence, the Social Security Administration is managing one of the nation’s largest social safety nets. SSA oversees hundreds of billions in benefits paid to around 60 million retired or disabled Americans every year.

While much of the conversation about Social Security focuses on its projected financial shortfall, SSA faces additional challenges Continue reading

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