December 9, 2021

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Court assesses more than $170M in penalties against two area ophthalmologists

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Two ophthalmologists and their eye clinic must pay millions of dollars for fraudulently billing Medicare in relation to the evaluation and treatment of glaucoma

Read full article at: https://www.justice.gov November 18, 2021
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  • Border Security: Observations on Costs, Benefits, and Challenges of a Department of Defense Role in Helping to Secure the Southwest Land Border
    In U.S GAO News
    What GAO FoundThe National Defense Authorization Act for Fiscal Year 2011 mandated that GAO examine the costs and benefits of an increased Department of Defense (DOD) role to help secure the southwest land border. This mandate directed that GAO report on, among other things, the potential deployment of additional units, increased use of ground-based mobile surveillance systems, use of mobile patrols by military personnel, and an increased deployment of unmanned aerial systems and manned aircraft in national airspace. In September 2011, GAO reported that DOD estimated a total cost of about $1.35 billion for two separate border operations—Operation Jump Start and Operation Phalanx—conducted by National Guard forces in Title 32 status from June 2006 to July 2008 and from June 2010 through September 30, 2011, respectively. Further, DOD estimated that it has cost about $10 million each year since 1989 to use active duty Title 10 forces nationwide, through its Joint Task Force-North, in support of drug law enforcement agencies with some additional operational costs borne by the military services. Agency officials stated multiple benefits from DOD’s increased border role, such as assistance to the Department of Homeland Security (DHS) Border Patrol until newly hired Border Patrol agents are trained and deployed to the border; providing DOD personnel with training opportunities in a geographic environment similar to current combat theaters; contributing to apprehensions and seizures and deterring other illegal activity along the border; building relationships with law enforcement agencies; and strengthening military-to-military relationships with forces from Mexico.GAO found challenges for the National Guard and for active-duty military forces in providing support to law enforcement missions. For example, under Title 32 of the United States Code, National Guard personnel are permitted to participate in law enforcement activities; however, the Secretary of Defense has precluded National Guard forces from making arrests while performing border missions because of concerns raised about militarizing the U.S. border. As a result, all arrests and seizures at the southwest border are performed by the Border Patrol. Further, DOD officials cited restraints on the direct use of active duty forces, operating under Title 10 of the United States Code in domestic civilian law enforcement, set out in the Posse Comitatus Act of 1878. In addition, GAO has reported on the varied availability of DOD units to support law enforcement missions, such as some units being regularly available while other units (e.g., ground-based surveillance teams) may be deployed abroad—making it more difficult to fulfill law enforcement requests.Federal officials stated a number of broad issues and concerns regarding any additional DOD assistance in securing the southwest border. DOD officials expressed concerns about the absence of a comprehensive strategy for southwest border security and the resulting challenges to identify and plan a DOD role. DHS officials expressed concerns that DOD’s border assistance is ad hoc in that DOD has other operational requirements. DOD assists when legal authorities allow and resources are available, whereas DHS has a continuous mission to ensure border security. Further, Department of State and DOD officials expressed concerns about the perception of a militarized U.S. border with Mexico, especially when Department of State and Justice officials are helping civilian law enforcement institutions in Mexico on border issues.Why GAO Did This StudyDHS reports that the southwest border continues to be vulnerable to cross-border illegal activity, including the smuggling of humans and illegal narcotics. Several federal agencies are involved in border security efforts, including DHS, DOD, Justice, and State. In recent years, the National Guard has played a role in helping to secure the southwest land border by providing the Border Patrol with information on the identification of individuals attempting to cross the southwest land border into the United States. Generally, the National Guard can operate in three different statuses: (1) state status—state funded under the command and control of the governor; (2) Title 32 status—federally funded under command and control of the governor; and (3) Title 10 status—federally funded under command and control of the Secretary of Defense.This testimony discusses (1) the costs and benefits of a DOD role to help secure the southwest land border, including the deployment of the National Guard, other DOD personnel, or additional units; (2) the challenges of a DOD role at the southwest land border; and (3) considerations of an increased DOD role to help secure the southwest land border.The information in this testimony is based on work completed in September 2011, which focused on the costs and benefits of an increased role of DOD at the southwest land border. See "Observations on the Costs and Benefits of an Increased Department of Defense Role in Helping to Secure the Southwest Land Border," GAO-11-856R (Washington, D.C.: Sept. 12, 2011).For more information, contact Brian J. Lepore at (202) 512-4523 or leporeb@gao.gov.
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  • Special Operations Forces: DOD’s Report to Congress Generally Addressed the Statutory Requirements but Lacks Detail
    In U.S GAO News
    What GAO Found GAO found that the Department of Defense’s (DOD) report to Congress on special operations forces (SOF) and U.S. Special Operations Command (SOCOM) addressed or partially addressed each of the eight mandated reporting elements, but did not include additional details on the analysis that underpins the department’s conclusions on several reporting elements. Specifically:  Reporting Element 1: The organizational structure of SOCOM and each subordinate component. The report partially addressed this by concluding that the organizational structure of SOCOM is adequate to meet current assigned roles and responsibilities. The report does not provide analysis to justify how the department reached that conclusion. Reporting Element 2: The policy and civilian oversight structures for SOF within DOD. The report partially addressed this by concluding that the oversight and statutory structures and responsibilities meets statutory and assigned oversight responsibilities. The report does not discuss the alignment of resources, including human capital, as it pertains to the offices with oversight responsibilities.  Reporting Element 3: The roles and responsibilities of SOCOM and SOF under Title 10 of the U.S. Code. The report addressed this by concluding that SOCOM and SOF have sufficient statutory authorities to accomplish their roles and responsibilities under section 167 of title 10, United States Code. Reporting Element 4: The current and future special operations-peculiar requirements of the geographic combatant commands and the Theater Special Operations Commands.The report partially addressed this by concluding that current and future special-operations peculiar requirements can be met with current and planned resources.  The report does not specify the GAO found that the Department of Defense’s (DOD) report to Congress on special operations forces (SOF) and U.S. Special Operations Command (SOCOM) addressed or partially addressed each of the eight mandated reporting elements, but did not include additional details on the analysis that underpins the department’s conclusions on several reporting elements. Reporting Element 5: The command relationships between SOCOM, its subordinate component commands, and the geographic combatant commands. The report partially addressed this by concluding that command relationships are adequate. The report includes information on the relationships between SOCOM, the geographic combatant commands, and the Theater Special Operations Commands, but does not discuss command relationships between SOCOM and its service component commands Reporting Element 6: The funding authorities, uses, acquisition processes, and civilian oversight mechanisms of Major Force Program-11. The report addressed this by concluding that these elements of Major Force Program-11 funding, which is used to organize, train, and equip forces to conduct special operations missions and acquire or modify service common systems for special operations when there is no broad conventional force need, are adequate and by including information on the budget development process and uses of Major Force Program-11 funding. The report also addressed the resolution of resourcing disputes between SOCOM and the services; DOD’s assessment of funding authorities and overseas contingency operations requirements; and civilian oversight mechanisms for Major Force Program-11 funding. Reporting Element 7: Changes to areas such as structure, authorities, and oversight mechanisms assumed in the 2014 Quadrennial Defense Review. The report partially addressed this by concluding that the structure, authorities, Major Force Program-11 funding, roles, and responsibilities are adequate. However, the report does not provide justification on how the department reached that conclusion.  Reporting Element 8: Any other matters the Secretary of Defense determined appropriate to ensure a comprehensive review and assessment. The report addressed this by including information on suicide prevention, health, and family readiness programs, and on initiatives to enhance the professionalization of SOF. Why GAO Did This Study Since 2001, DOD has deployed SOF to conduct a range of military operations, particularly in Afghanistan and Iraq. To meet an increase in operational demands for SOF, DOD has increased SOCOM’s funding and SOF force levels. DOD strategic guidance indicates that SOF will continue to play a prominent role in support of the defense strategy. The National Defense Authorization Act for Fiscal Year 2014 (the Act), Section 1086, required the Secretary of Defense to submit to the congressional defense committees a report on SOF organization, capabilities, structure, and oversight. The Act further mandated GAO to submit to the congressional defense committees an evaluation of the DOD report no later than 60 days after the issuance of the DOD report. GAO examined the extent to which DOD’s report addressed the mandated reporting elements. To address this objective, GAO analyzed the Act to identify the reporting elements, assessed DOD’s report to determine whether each of the eight mandated reporting elements were addressed, and interviewed DOD officials.
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  • Financial Audit: Federal Deposit Insurance Corporation Funds’ 2020 and 2019 Financial Statements
    In U.S GAO News
    GAO found (1) the financial statements of the Deposit Insurance Fund (DIF) and of the Federal Savings and Loan Insurance Corporation (FSLIC) Resolution Fund (FRF) as of and for the years ended December 31, 2020, and 2019, are presented fairly, in all material respects, in accordance with U.S. generally accepted accounting principles; (2) although internal controls could be improved, the Federal Deposit Insurance Corporation (FDIC) maintained, in all material respects, effective internal control over financial reporting relevant to the DIF and to the FRF as of December 31, 2020; and (3) with respect to the DIF and to the FRF, no reportable instances of noncompliance for 2020 with provisions of applicable laws, regulations, contracts, and grant agreements GAO tested. In commenting on a draft of this report, FDIC stated that it was pleased to receive unmodified opinions on the DIF's and the FRF's financial statements. In regard to the significant deficiency in internal control over contract payment review processes, FDIC stated that it began taking steps to address this issue and will work to enhance control activities and expand monitoring capabilities in this area. Further, FDIC stated that it recognizes the essential role a strong internal control program plays in an agency achieving its mission. FDIC added that its commitment to sound financial management has been and will remain a top priority. Section 17 of the Federal Deposit Insurance Act, as amended, requires GAO to audit the financial statements of the DIF and of the FRF annually. In addition, the Government Corporation Control Act requires that FDIC annually prepare and submit audited financial statements to Congress and authorizes GAO to audit the statements. This report responds to these requirements. For more information, contact James R. Dalkin at (202) 512-3133 or dalkinj@gao.gov.
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  • Stabilizing and Rebuilding Iraq: U.S. Ministry Capacity Development Efforts Need an Overall Integrated Strategy to Guide Efforts and Manage Risk
    In U.S GAO News
    Iraq's ministries were decimated following years of neglect and centralized control under the former regime. Developing competent and loyal Iraqi ministries is critical to stabilizing and rebuilding Iraq. The President received $140 million in fiscal year 2007 funds and requested an additional $255 million in fiscal year 2008 to develop the capacity of the Iraq's ministries. This report assesses (1) the nature and extent of U.S. efforts to develop the capacity of the Iraqi ministries, (2) the key challenges to these efforts, and (3) the extent to which the U.S. government has an overall integrated strategy for these efforts. For this effort, GAO reviewed U.S. project contracts and reports and interviewed officials from the Departments of State (State), Defense (DOD), and the United States Agency for International Development (USAID) in Baghdad and Washington, D.C.Over the past 4 years, U.S. efforts to help build the capacity of the Iraqi national government have been characterized by (1) multiple U.S. agencies leading individual efforts, without overarching direction from a lead entity that integrates their efforts; and (2) shifting timeframes and priorities in response to deteriorating security and the reorganization of the U.S. mission in Iraq. First, no single agency is in charge of leading the U.S. ministry capacity development efforts, although State took steps to improve coordination in early 2007. State, DOD and USAID have led separate efforts at Iraqi ministries. About $169 million in funds were allocated in 2005 and 2006 for these efforts. As of mid-2007, State and USAID were providing 169 capacity development advisors to 10 key civilian ministries and DOD was providing 215 to the Ministries of Defense and Interior. Second, the focus of U.S. capacity development efforts has shifted from long-term institution-building projects, such as helping the Iraqi government develop its own capacity development strategy, to an immediate effort to help Iraqi ministries overcome their inability to spend their capital budgets and deliver essential services to the Iraqi people. U.S. ministry capacity efforts face four key challenges that pose a risk to their success and long-term sustainability. First, Iraqi ministries lack personnel with key skills, such as budgeting and procurement. Second, sectarian influence over ministry leadership and staff complicates efforts to build a professional and non-aligned civil service. Third, pervasive corruption in the Iraqi ministries impedes the effectiveness of U.S. efforts. Fourth, poor security limits U.S. advisors' access to their Iraqi counterparts, preventing ministry staff from attending planned training sessions and contributing to the exodus of skilled professionals to other countries. The U.S. government is beginning to develop an integrated strategy for U.S. capacity development efforts in Iraq, although agencies have been implementing separate programs since 2003. GAO's previous analyses of U.S. multiagency national strategies demonstrate that such a strategy should integrate the efforts of the involved agencies with the priorities of the Iraqi government, and include a clear purpose and scope; a delineation of U.S. roles, responsibilities, and coordination with other donors, including the United Nations; desired goals and objectives; performance measures; and a description of benefits and costs. Moreover, it should attempt to address and mitigate the risks associated with the four challenges identified above. U.S. ministry capacity efforts to date have included some but not all of these components. For example, agencies are working to clarify roles and responsibilities. However, U.S. efforts lack clear ties to Iraqi-identified priorities at all ministries, clear performance measures to determine results at civilian ministries, and information on how resources will be targeted to achieve the desired end-state.
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  • Afghanistan and Iraq: DOD Should Improve Adherence to Its Guidance on Open Pit Burning and Solid Waste Management
    In U.S GAO News
    From the start of military operations in Afghanistan and Iraq, the U.S. military and its contractors have burned solid waste in open burn pits on or near military bases. According to the Department of Defense (DOD), burn pit emissions can potentially harm human health. U.S. Central Command (CENTCOM) guidance directs the military's use of burn pits, and the Department of Veterans' Affairs (VA) provides healthcare and other benefits to veterans and their families. GAO was asked to report on the (1) extent of open pit burning in Afghanistan and Iraq, and whether the military has followed its guidance; (2) alternatives to burn pits, and whether the military has examined them; and (3) extent of efforts to monitor air quality and potential health impacts. GAO visited four burn pits in Iraq, reviewed DOD data on burn pits, and consulted DOD and VA officials and other experts. GAO was unable to visit burn pits in Afghanistan.The military has relied heavily on open pit burning in both conflicts, and operators of burn pits have not always followed relevant guidance to protect servicemembers from exposure to harmful emissions. According to DOD, U.S. military operations in Afghanistan and Iraq generate about 10 pounds of solid waste per soldier each day. The military has relied on open pit burning to dispose of this waste mainly because of its expedience. In August 2010, CENTCOM estimated there were 251 burn pits in Afghanistan and 22 in Iraq. CENTCOM officials said the number of burn pits is increasing in Afghanistan and decreasing in Iraq, which reflects U.S. troop reallocations and efforts to install waste incinerators. Despite its reliance on burn pits, CENTCOM did not issue comprehensive burn pit guidance until 2009. Furthermore, to varying degrees, operators of burn pits at four bases GAO visited in Iraq were not complying with key elements of this guidance, such as restrictions on the burning of items, including plastic, that produce harmful emissions. DOD officials also said that, from the start of each conflict, operators routinely burned items that are now prohibited. The continued burning of prohibited items has resulted from a number of factors, including the constraints of combat operations, resource limitations, and contracts with burn pit operators that do not reflect current guidance. Waste management alternatives could decrease the reliance on and exposure to burn pits, but DOD has been slow to implement alternatives or fully evaluate their benefits and costs, such as avoided future costs of potential health effects. Various DOD guidance documents discourage long-term use of burn pits, encourage the use of incinerators and landfills, or encourage waste minimization such as source reduction. DOD has installed 39 solid waste incinerators in Iraq and 20 in Afghanistan, and plans to install additional incinerators in Afghanistan. To date, source reduction practices have not been widely implemented in either country and recycling consists primarily of large scrap metals. DOD plans to increase recycling at its bases in Iraq, but recycling at bases in Afghanistan has been limited. Further, DOD has not fully analyzed its waste stream in either country and lacks the information to decrease the toxicity of its waste stream and enhance waste minimization. U.S. Forces in Afghanistan and Iraq do not sample or monitor burn pit emissions as provided by a key CENTCOM regulation, and the health impacts of burn pit exposure on individuals are not well understood, partly because the military does not collect required data on emissions or exposures from burn pits. Army public health officials have, however, sampled the ambient air at bases in each conflict and found high levels of particle pollution that causes health problems but is not unique to burn pits. These officials identified logistical and other challenges in monitoring burn pit emissions, and U.S. Forces have yet to establish pollutant monitoring systems. DOD and VA have commissioned studies to enhance their understanding of burn pit emissions, but the lack of data on emissions specific to burn pits and related exposures limit efforts to characterize potential health impacts on service personnel, contractors, and host-country nationals. Among other things, GAO recommends that the Secretary of Defense improve DOD's adherence to relevant guidance on burn pit operations and waste management, and analyze alternatives to its current practices. In commenting on a draft of this report, DOD said that it concurred with five of the six recommendations and partially concurred with the sixth. GAO addressed a DOD suggestion to clarify the sixth recommendation. VA reviewed the draft report and had no comments.
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  • Veterans Health Care: VA’s Medical Support Role in Emergency Preparedness
    In U.S GAO News
    Since the terrorist attacks on September 11, 2001, the Department of Veterans Affairs (VA) has increased its efforts to plan for and respond to national emergencies, including acts of terrorism and natural disasters. Additionally, in August 2004, the Federal Bureau of Investigation and the Department of Homeland Security announced that military and VA medical facilities were potential terrorist targets. In light of military casualties from conflicts in Afghanistan and Iraq and continued threats of terrorist incidents, Congress asked us to review VA's medical support role in emergency preparedness. Specifically, we agreed to provide information on the following questions: (1) What is VA's role in providing medical support within the U.S. to military personnel in wartime and during national emergencies? (2) What actions has VA taken to improve its internal emergency preparedness to ensure that it is ready to maintain continuity of operations and provision of medical services to veterans? (3) What is VA's role in participating in emergency medical response measures with other federal, state, and local agencies?GAO found that Public Law 97-174 authorizes VA to provide inpatient medical care to active duty members of the armed services during or immediately following their involvement in armed conflicts during wartime and national emergencies. According to VA, while the Department of Defense (DOD) has never requested priority care from VA based on this law, VA has routinely reported to the Congress and DOD the number of inpatient beds available for military personnel. We also found that VA has taken numerous actions to improve emergency preparedness, such as developing educational and training materials for its staff, training staff at 134 VA medical centers, and increasing security at its facilities by requiring a minimum of two patrolling VA police officers on duty at all times. Other activities, such as developing a systemwide strategy for protecting its facilities and acquiring decontamination equipment, are still in progress. Finally, VA participates in emergency medical response measures with other federal, state, and local agencies by providing assistance in seven support functions outlined in the Department of Homeland Security's National Response Plan. For example, if requested, the types of support VA would provide include public health and medical services, emergency management, and public safety and security.
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  • Covid-19: Key Insights from GAO’s Oversight of the Federal Public Health Response
    In U.S GAO News
    More than a year after the U.S. declared COVID-19 a public health emergency, the pandemic continues to result in catastrophic loss of life and substantial damage to the economy. It also continues to lay bare the fragmented nature of our public health sector, the fragility of the nation's medical supply chain, and longstanding disparities in health care access, treatment, and outcomes. GAO has made 44 recommendations to federal agencies. Of these recommendations, 16 relate to the following public health topics: COVID-19 Testing. GAO has made two recommendations to date to improve the federal government's efforts in diagnostic testing for COVID-19, critical to controlling the spread of the virus. In January 2021, GAO recommended that the Department of Health and Human Services (HHS) develop and make publicly available a comprehensive national COVID-19 testing strategy. Vaccines and Therapeutics. GAO has made two recommendations to improve transparency, communication, and coordination around the government's efforts to develop, manufacture, and distribute vaccines and therapeutics to prevent and treat COVID-19. For example, in September 2020, GAO recommended that HHS establish a time frame for a national vaccine distribution and administration plan that follows best practices, with federal and nonfederal coordination. Medical Supply Chain. GAO has made seven recommendations for the federal government to respond to vulnerabilities highlighted by the pandemic in the nation's medical supply chain, including limitations in personal protective equipment and other supplies necessary to treat individuals with COVID-19. In January 2021, GAO recommended that HHS establish a process for regularly engaging with Congress and nonfederal stakeholders as the agency refines and implements its supply chain strategy for pandemic preparedness, to include the role of the Strategic National Stockpile. COVID-19 Health Disparities. GAO has made three recommendations to improve COVID-19 data by race and ethnicity, as available data show communities of color bear a disproportionate burden of COVID-19 positive tests, cases, hospitalizations, and deaths. In September 2020, GAO recommended that the Centers for Disease Control and Prevention involve key stakeholders to help ensure the complete and consistent collection of demographic data. COVID-19 Data. GAO has made two recommendations to improve the collection of data needed to respond to COVID-19 and prepare for future pandemics. GAO recommended in January 2021 that HHS establish an expert committee to help systematically define and ensure the collection of standardized data across the relevant federal agencies and related stakeholders; the absence of such data hinders the ability of the government to respond to COVID-19, communicate the status of the pandemic with citizens, or prepare for future pandemics.  Although the responsible agencies generally agreed with the majority of the 16 recommendations, only one has been fully implemented. GAO maintains that implementing these recommendations will improve the federal government's public health response and ability to recover as a nation. As of February 17, 2021, the U.S. had about 27 million cumulative reported cases of COVID-19 and more than 486,000 reported deaths, according to the Centers for Disease Control and Prevention. The country also continues to experience serious economic repercussions. Five relief laws, including the CARES Act, have appropriated $3.1 trillion to address the public health and economic threats posed by COVID-19. The CARES Act also includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to COVID-19. This testimony summarizes GAO's insights from its oversight of the federal government's pandemic response in a series of comprehensive reports issued from June 2020 through January 2021. In particular, the statement focuses on the public health response, including testing, vaccines and therapeutics, medical supply chain, health disparities, and health data. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials and stakeholders for the series of reports on which this testimony is based. See https://www.gao.gov/coronavirus/. GAO has made 44 recommendations for agencies and four matters for congressional consideration in its comprehensive series of bimonthly reports on the federal response to COVID-19 over the last year. GAO will issue its next report in this series in March 2021. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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  • Questions for the Record Related to the Benefits and Medical Care for Federal Civilian Employees Deployed to Afghanistan and Iraq
    In U.S GAO News
    GAO appeared before the House Subcommittee on Oversight and Investigations, Committee on Armed Services on September 18, 2007, to discuss the benefits and medical care for federal civilian and U.S. government contract employees deployed to Iraq and Afghanistan. This report responds to Congress' request that GAO provide answers to questions for the record from the hearing. The questions are (1) What are the congressional requirements for medical tracking of deployed military servicemembers and civilians? and (2) What work has GAO conducted on this topic?Following GAO's May 1997 report, Congress enacted legislation3 that required the Secretary of Defense to establish a medical tracking system to assess the medical condition of servicemembers before and after deployments to locations outside of the United States. This legislation was amended by a provision in the John Warner National Defense Authorization Act for Fiscal Year 2007. The current legislation amends elements of the system and the quality assurance program as well as adds criteria for referral for further evaluations and minimum mental health standards for deployment. Since the 1990s, GAO has highlighted shortcomings with respect to the Department of Defense's (DOD) ability to assess the medical condition of servicemembers both before and after their deployments. Following GAO's May 1997 report, Congress enacted legislation that required the Secretary of Defense to establish a medical tracking system for assessing the medical condition of servicemembers before and after deployments. In September 2003, we reported that the Army and Air Force did not comply with DOD's force health protection and surveillance requirements for many servicemembers deploying in support of Operation Enduring Freedom in Central Asia and Operation Joint Guardian in Kosovo. Our report also raised concerns over a lack of DOD oversight of departmentwide efforts to comply with health surveillance requirements. In September 2004, we reported similar issues related to DOD's ability to effectively manage the health status of its reserve forces. In November 2004, we reported that overall compliance with DOD's force health protection and surveillance policies for servicemembers who deployed in support of Operation Iraqi Freedom varied by service, by installation, and by policy requirement. In October 2005, we reported that evidence suggested that reserve component members have deployed into theater with preexisting medical conditions that could not be adequately addressed in theater, and that DOD had limited visibility over the health status of reserve component members after they are called to duty and is unable to determine the extent of care provided to those members deployed with preexisting medical conditions despite the existence of various sources of medical information. In February 2007, the Office of the Deputy Assistant Secretary of Defense for Force Health Protection and Readiness published a new instruction on force health protection quality assurance. This policy applies to military servicemembers, as well as applicable DOD and contractor personnel. The new policy requires the military services to implement procedures to monitor key force health protection elements such as pre- and post-deployment health assessments. In our June 2007 report on DOD's compliance with the legislative requirement to perform pre- and post-deployment medical examinations on servicemembers, DOD lacked a comprehensive oversight framework to help ensure effective implementation of its deployment health quality assurance program, which included specific reporting requirements and results-oriented performance measures to evaluate the services' adherence to deployment health requirements.
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