December 5, 2021

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Justice Department Files Lawsuit Against Tampa-Area Physician, Pharmacy, and Clinic Owners for Controlled Substances Act Violations

15 min read
<div>The United States filed a civil complaint seeking to permanently enjoin the owners of a Tampa-area clinic and pharmacy from unlawfully dispensing opioids and other controlled substances, the Department of Justice announced today.</div>
The United States filed a civil complaint seeking to permanently enjoin the owners of a Tampa-area clinic and pharmacy from unlawfully dispensing opioids and other controlled substances, the Department of Justice announced today.

More from: February 19, 2021

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  • Defense Contracting: Actions Needed to Explore Additional Opportunities to Gain Efficiencies in Acquiring Foreign Language Support
    In U.S GAO News
    What GAO FoundDOD has taken some steps to gain efficiencies in its approach to contracting for certain types of foreign language support services and products, but its contracting approach for other types remains fragmented across multiple components, and DOD has not explored whether additional opportunities exist to gain efficiencies across this broader range of contracting activity. In 2005, DOD sought to centralize and standardize contracting efforts for foreign language support by designating the Army as an executive agent to manage contracting in this area. In performing its responsibilities, the executive agent has focused its efforts solely on arranging for contracts to acquire translation and interpretation services for contingency operations because of the rapidly increasing requirements for these services. Specifically, from fiscal year 2008 through 2012, the Army, as executive agent, obligated about $5.2 billion for contracts to provide DOD components with translation and interpretation services for contingency operations. During the same time period, we found that multiple DOD components contracted independently for foreign language support outside of the executive agent's management. Specifically, to support the needs of contingency operations, predeployment training, and day-to-day military activities, we identified 159 contracting organizations in 10 different DOD components that obligated approximately $1.2 billion on contracts for foreign language support outside of those managed by the executive agent. In some cases, DOD has gained efficiencies by centralizing contracting for certain foreign language support contracts under an executive agent, but DOD has not comprehensively assessed whether additional opportunities exist to gain efficiencies across a broader range of foreign language support contracts. Best practices for service acquisition suggest that DOD's acquisition approach should provide for an agency-wide view of service contract spending and promote collaboration to leverage buying power across multiple organizations. Implementing such an approach requires an analysis of where an organization is spending its money, which should be the starting point for gaining knowledge that can assist agencies in determining which products and services warrant a more coordinated acquisition approach.8 In commenting on a draft of this report, DOD agreed with our recommendations. DOD also provided technical comments on a draft of this report, which we incorporated, where appropriate. However, DOD has not conducted an analysis of this type to evaluate the whole range of services and products that are currently managed outside the executive agent and determine whether additional efficiencies could be gained. Without a more complete understanding of where the department is spending resources on foreign language support contracts, DOD does not have all of the information it needs to make informed decisions about the types of services and products that could be managed by the executive agent and does not have reasonable assurance that it is fully leveraging its buying power for foreign language support.Why GAO Did This StudyAccording to the Department of Defense (DOD), the ability of U.S. military personnel to communicate and interact with multinational partners, security forces, and local indigenous populations can be critical factors to mission success, as evidenced by operational experiences in Afghanistan and Iraq. DOD utilizes language professionals and regional experts within its ranks of military personnel to provide foreign language support, such as foreign language skills, regional expertise, and cultural awareness capabilities needed to execute missions, as well as contracted interpreters and translators who provide this support. To meet increased demands on the need for foreign language support from ongoing contingency operations, DOD has relied on contactors to supplement the capability provided by military personnel. For example, the number of contractor personnel required to provide foreign language translation and interpretation services for contingency operations more than tripled from 2004 to 2010 (from about 4,000 to about 14,000). As of November 2012, the number of contractor personnel required by DOD was approximately 9,000. As a result, DOD has made considerable investments in providing contract support. For example, DOD obligated about $6.8 billion from fiscal years 2008 through 2012 to acquire a variety of foreign language-related services and products to support its forces.We have identified opportunities for DOD to improve its approach to contracting from a broad perspective as well as in areas related to foreign language support. For example, DOD contract management is on our list of high-risk areas in the federal government. In 2013, we noted that DOD needed to take steps to strategically manage the acquisition of services, including developing the data needed to define and measure desired outcomes to improve outcomes on the billions of dollars that DOD spends annually on goods and services. Furthermore, since 2009 we have identified a number of management challenges that DOD has faced in developing a strategic planning process to transform foreign language and regional proficiency capabilities, identifying training requirements, and reducing unnecessary overlap and duplication in foreign language and cultural awareness training products acquired by the military services.We conducted this work in response to a congressional mandate set forth in Section 21 of Public Law 111-139. That legislation requires that we identify government programs, agencies, offices, and initiatives with duplicative goals and activities and report our findings to Congress. Our objective for this report was to determine the extent to which DOD has taken steps to achieve efficiencies in its approach to contracting for foreign language support, and whether additional opportunities exist to gain further efficiencies.
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  • Venezuela: Additional Tracking Could Aid Treasury’s Efforts to Mitigate Any Adverse Impacts U.S. Sanctions Might Have on Humanitarian Assistance
    In U.S GAO News
    The Venezuelan economy's performance has declined steadily for almost a decade and fallen steeply since the imposition of a series of U.S. sanctions starting in 2015. For example, the economy declined from negative 6.2 percent gross domestic product growth in 2015 to negative 35 percent in 2019 and negative 25 percent in 2020. The sanctions, particularly on the state oil company in 2019, likely contributed to the steeper decline of the Venezuelan economy, primarily by limiting revenue from oil production. However, mismanagement of Venezuela's state oil company and decreasing oil prices are among other factors that have also affected the economy's performance during this period. U.S. agencies have sought input from humanitarian organizations to identify the potential negative humanitarian consequences of sanctions related to Venezuela and taken steps to mitigate these issues. The U.S. Agency for International Development (USAID) and Department of State (State) have solicited input from U.S.-funded humanitarian organizations on challenges they face, including the impact of sanctions. The U.S. Department of the Treasury (Treasury) and State have also taken steps to mitigate negative consequences. For example, Treasury issued licenses permitting various types of humanitarian assistance transactions in Venezuela (see figure). Treasury also maintains a call center and email account through which organizations can receive assistance with compliance issues or other challenges related to sanctions. While Treasury officials told GAO they respond to individual inquiries, Treasury does not systematically track and analyze information from these inquiries to identify trends or recurrent issues. Without collection and analysis of this information, Treasury and its interagency partners may be limited in their ability to develop further actions to ensure that U.S. sanctions do not disrupt humanitarian assistance. U.S. Humanitarian Assistance Supplies for Venezuelans U.S. sanctions related to Venezuela have likely had a limited impact, if any, on the U.S. oil industry. Despite an overall lower supply of oil in the U.S. market from the loss of Venezuelan crude oil due to sanctions, crude oil and retail gasoline prices in the U.S. have not increased substantially. Many other factors in addition to the sanctions simultaneously affected the oil market and the price of crude oil and retail gasoline prices, including production cuts in January 2019 by the Organization of the Petroleum Exporting Countries and decreased demand for energy during the COVID-19 pandemic. According to industry officials to whom GAO spoke, U.S. refineries have adjusted to these changes by shifting to alternative sources and types of crude oil. Venezuela has been experiencing an economic, political, and humanitarian crisis. The U.S. government has imposed sanctions on Venezuela's state oil company, government, and central bank, among others, in response to activities of the Venezuelan government and certain individuals. Treasury and the Department of State lead the implementation of the sanctions program, and USAID is primarily responsible for implementing humanitarian assistance for Venezuelans. GAO was asked to review U.S. sanctions related to Venezuela. This report examines: (1) how the Venezuelan economy performed before and since the imposition of sanctions in 2015; (2) the steps U.S. agencies have taken to identify and mitigate potential negative humanitarian consequences of sanctions related to Venezuela; and (3) what is known about the impact of U.S. sanctions related to Venezuela on the U.S. oil industry. GAO analyzed economic indicators, reviewed documents, interviewed agency officials, and spoke with representatives from selected humanitarian organizations and the U.S oil industry. GAO recommends that Treasury systematically track inquiries made to its call center and email account, including the specific sanctions program and the subject matter of the inquiry to identify trends and recurring issues. Treasury concurred with GAO's recommendation. For more information, contact Kimberly Gianopoulos at (202) 512-8612 or GianopoulosK@gao.gov.
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  • Medicare Physician Services: Payment Rates, Utilization, and Expenditures of Selected Services in Alaska, Hawaii, and the U.S. Territories
    In U.S GAO News
    What GAO Found Using the most recently available Medicare data, GAO found that Medicare Part B fee-for-service (FFS) populations in Alaska, Hawaii, and the U.S. territories—American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands—varied considerably in size, demographic, and other key characteristics. For example, the number of beneficiaries enrolled in Part B FFS at any time in 2019 ranged from 2,091 in CNMI to 122,480 in Hawaii. In terms of Medicare eligibility, most Part B FFS beneficiaries nationally were eligible because they were age 65 or older (85.1 percent), followed by beneficiaries eligible due to a disability (14.6 percent), and beneficiaries with end stage renal disease (ESRD; 0.3 percent). However, the proportions varied across Alaska, Hawaii, and the territories. For example, the proportion of Part B FFS beneficiaries eligible because they were age 65 or older ranged from 71.9 percent in American Samoa to 92.4 percent in the U.S. Virgin Islands; due to a disability ranged from just over half the national rate in the U.S. Virgin Islands (7.4 percent) to 26.3 percent in American Samoa; and due to ESRD ranged from 0.2 percent in Alaska to 2.5 percent in Guam. GAO also analyzed Medicare payment rates—which are adjusted to account for local differences in the costs of providing care—for 12 selected services that each accounted for at least $950 million in Medicare expenditures in 2019. GAO found that Medicare payment rates (that reflect local adjustments) for selected services were higher in Alaska, Hawaii, and the territories compared to national rates (which do not reflect local adjustments). However, utilization of and expenditures for these services were generally lower. Specifically, payment rates in Alaska were considerably higher than the national payment rates, whereas payment rates in Hawaii and the territories were largely somewhat higher than the national payment rates for services examined. For example, payment rates for selected services in Alaska ranged from about 26 percent higher for an eye exam and treatment to about 39 percent higher for an emergency department visit. For Puerto Rico and the U.S. Virgin Islands, payment rates were less than 1 percent greater than the national payment amount. GAO analysis of 2019 Medicare Part B FFS claims data shows that utilization and expenditures for the 12 selected services in its review were generally lower in Alaska, Hawaii, and the territories when compared to national rates. For example, Alaska, Hawaii, and all U.S. territories had lower per beneficiary utilization of outpatient evaluation and management services under the Physician Fee Schedule than national per beneficiary utilization in 2019. Per beneficiary use for these services ranged from 1.1 services in American Samoa to 5.6 services in Hawaii, less than the national rate of 6.1 services. Partly due to lower per beneficiary utilization, per beneficiary expenditures for all selected services were also lower in Alaska, Hawaii, and the territories compared to national Part B FFS per beneficiary expenditures in 2019. Specifically, they ranged from about $183 in American Samoa to about $627 in Alaska, compared with national per beneficiary expenditures of about $735. Why GAO Did This Study Certain state and territory stakeholders have raised questions about payment rates under the Medicare Physician Fee Schedule for Alaska, Hawaii, and the territories. They noted that the rates might not take into account unique characteristics which may affect the delivery of care. The Centers for Medicare & Medicaid Services (CMS) determines payment rates for services covered under the Medicare Physician Fee Schedule based on estimates that the agency assigns to each service. These estimates reflect the time and intensity of provider work, practice expenses (e.g., cost of non-provider labor or office rent), and malpractice premiums needed to provide one service relative to other services. CMS separately adjusts the estimates to account for a provider’s geographic location, which affects the cost of providing care. House Report 116-62 includes a provision for GAO to examine Medicare funding for Alaska, Hawaii, and the U.S. territories. This report describes 1) demographic and other key characteristics of Medicare Part B FFS beneficiaries in Alaska, Hawaii, and the U.S territories; and 2) payment rates, utilization, and expenditures under the Physician Fee Schedule across these states and territories. GAO analyzed Medicare data from 2019—the most recent year of data available at the time of its review—to describe Medicare beneficiaries in Alaska, Hawaii, and the territories. GAO used the Medicare Physician Fee Schedule Search Tool to determine payment rates for the 12 selected services based on Medicare spending in 2019 and compared them to the national payment amount. GAO also analyzed Medicare claims data from 2019 to determine per beneficiary utilization and expenditures for Alaska, Hawaii, and the territories. GAO compared them to national Medicare per beneficiary utilization and expenditures. To supplement this work, GAO obtained information from health officials in the states and territories and examined key documents. For more information, contact Jessica Farb at (202) 512-7114 or FarbJ@gao.gov.
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  • GAO Audits Involving DOD: Status of Efforts to Schedule and Hold Timely Entrance Conferences
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    GAO began 37 new audits that involved the Department of Defense (DOD) in the fourth quarter of fiscal year 2020. Of GAO's 37 requested entrance conferences for those audits, DOD scheduled 33 within 14 days and held 34 within 30 days of GAO's notification. Entrance conferences are initial meetings between agency officials and GAO staff that allow GAO to communicate its audit objectives and enable agencies to assign key personnel to support the audit work. The four entrance conferences that were scheduled more than 14 days after notification were scheduled late due to either difficulties in identifying a primary action officer or aligning the schedules of GAO and DOD officials. The three entrance conferences that were held more than 30 days after notification were scheduled late due to difficulties in aligning the schedules of GAO and DOD officials. GAO's agency protocols govern GAO's relationships with audited agencies. These protocols assist GAO in scheduling entrance conferences with key agency officials within 14 days of their receiving notice of a new audit. The ability of the Congress to conduct effective oversight of federal agencies is enhanced through the timely completion of GAO audits. In past years, DOD experienced difficulty meeting the protocol target for the timely facilitation of entrance conferences. In Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, the Senate Armed Services Committee included a provision for GAO to review DOD's scheduling and holding of entrance conferences. In this report, GAO evaluates the extent to which DOD scheduled entrance conferences within 14 days of receiving notice of a new audit, consistent with GAO's agency protocols, and held those conferences within 30 days. This is the final of four quarterly reports that GAO will produce on this topic for fiscal year 2020. In the first three quarterly reports, GAO found that DOD had improved its ability to meet the protocol target. GAO analyzed data on GAO audits involving DOD and initiated in the fourth quarter of fiscal year 2020 (July 1, 2020, through September 30, 2020). Specifically, GAO identified the number of notification letters requesting entrance conferences that it sent to DOD during that time period. GAO determined the number of days between when DOD received GAO's notification letter for each new audit and when DOD scheduled the entrance conference and assessed whether DOD scheduled entrance conferences within 14 days of notification, which is the time frame identified in GAO's agency protocols. GAO also determined the date that each requested entrance conference was held by collecting this information from the GAO team conducting each audit and assessed whether DOD held entrance conferences for new audits within 30 days of notification, which was the time frame identified in the mandate for this review. For more information, contact Elizabeth Field at (202) 512-2775 or Fielde1@gao.gov.
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  • DATA Act: Audit of GAO’s Fiscal Year 2020, Fourth Quarter, DATA Act Submission
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    Objectives This is a publication by GAO's Office of Inspector General (OIG). The OIG contracted with the independent certified public accounting firm of Williams Adley to audit GAO's compliance with the Digital Accountability and Transparency Act of 2014 (DATA Act), and produce this report. This report addresses (1) the accuracy, completeness, timeliness, and quality of GAO's Fiscal Year (FY) 2020, fourth quarter financial and award data submitted for publication on USASpending.gov and (2) GAO's implementation and use of the Government-wide financial data standards established by the OMB and the Department of Treasury, as required by the DATA Act of 2014. What OIG Found The audit found that GAO's data submitted for the fourth quarter of FY 2020 was accurate, complete, timely, of excellent quality, and in accordance with data standards. For more information, contact Tonya R. Ford at (202) 512-5748 or oig@gao.gov.
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