Government Accountability Office Report Research Articles

A Century of Progress: U.S. Government Accountability Office Procedures, Reports, and Performance Measures

SYNOPSIS In 2021, the U.S. Government Accountability Office (GAO) celebrated its 100th anniversary, and its mission has never been more critical. This study documents the 100-year history of GAO, examining how Congressional law changes and leadership influences of the Comptroller General of the United States have shaped GAO’s role, services, and products. GAO has transformed from focusing on providing oversight through its audits of federal government expenditures during its early years (e.g., to assess legality) to emerging as a leader in providing insights to Congress through program evaluation audits and, more recently, to providing Congress the foresight necessary to confront the challenges and opportunities that lie ahead.

Always Watchful: Political Context and Congressional Oversight through the Government Accountability Office

Oversight of the executive branch is one of Congress’s most critical functions. It is meant to ensure accountability, consistency, and fairness in the implementation of programs by the federal bureaucracy. Much previous scholarship has argued that oversight is more common when Congress and the White House are controlled by different parties. However, much of this research has focused principally on committee hearings, and other tools of oversight have received less attention. One such tool is the Government Accountability Office (GAO). I test competing theories of GAO usage: one which argues that GAO reports are simply another tool of oversight, like hearings, and tend to follow similar patterns and thus are more common in conditions of divided government. The other theory argues that the GAO, because of its commitment to providing useful, nonpartisan information, is more likely to be used when legislative and presidential priorities are aligned. Leveraging reports from the GAO between 1995 and 2022, I find support for the latter proposition, at least in the modern Congress. There is evidence that Congress changes its methods of oversight in response to political incentives, but oversight continues regardless.

Effect of the COVID-19 Pandemic on Maternal Health in the United States.

The COVID-19 pandemic is responsible for over 1 million deaths in the United States. More than 500 of those deaths were among pregnant and postpartum women. The recent United States Government Accounting Office report on the effects the pandemic on maternal health is summarized. While the efforts in reporting these data in detail are appreciated, it is past time for taking action to prevent preventable maternal deaths in the United States including the racial and ethnic disparities these deaths represent rather than gathering information about them each year.

Social Justice Suite

Social Justice Suite (SJS) is a collection of five HeinOnline databases in the areas of historical slavery, civil and human rights, and gun regulation and legislation. The databases were added between 2016 and 2022. The majority of the databases include Supreme Court briefs. Other databases include hearings, legislative histories, and Congressional Research Service (CRS) and Government Accountability Office (GAO) reports. Databases can be searched individually or at once. Scholarly articles are available only to HeinOnline Core subscribers. The databases are complimentary for Core subscribers and free to interested organizations (requires registration). SJS benefits from a clean and uncluttered interface, and the top navigational menu and search components are the same across databases.

Failing Grade: The Pandemic Legacy of HHS

On January 27, 2022, the Government Accountability Office (GAO) issued its ninth report on the efforts of the federal government to respond to and recover from the coronavirus disease 2019 (COVID-19) pandemic.1 The GAO report reaches as far back as January 2020 to encompass both the Trump and Biden Administrations. Turning its attention to HHS (home to agencies such as the Food and Drug Administration and the Centers for Disease Control and Prevention [CDC]), the GAO found persistent deficiencies in the preparedness and response efforts in several areas.

Members Report Uptick in Plans’ Claims Denials, Scrutiny, and Hassles

Members Report Uptick in Plans’ Claims Denials, Scrutiny, and Hassles

Increased Medicaid Funding for Territories Urgently Needed, Experts Say

Increased Medicaid Funding for Territories Urgently Needed, Experts Say

GAO points to populations at high risk of BH effects of COVID

Americans have reported feeling more isolated and stressed, and many have experienced economic hardship as a result of COVID‐19, causing an increase in demand for behavioral health services, including those from mental health and substance use, according to a new Government Accountability Office (GAO) report. People most at risk of the effects of the pandemic include health care workers, children and adolescents, and people with preexisting behavioral health conditions, the GAO report stated.

Identifying and Addressing Basic Needs Insecurity Among Medical Students: A Curriculum for Trainees, Administrators, and Faculty.

IntroductionData from a 2018 United States Government Accountability Office report show that basic needs insecurity undermines the postsecondary educational experiences of many students. In recent years, basic needs insecurity among undergraduate students has gained attention in the literature, but published data regarding medical trainees are extremely limited.MethodsA 60-minute interactive workshop consisting of a PowerPoint presentation and case discussions was created. Our aim was to increase awareness and understanding of basic needs insecurity among medical students. The workshop included a basic needs survey and national and local resource guides. The workshop was evaluated through pre- and postworkshop questionnaires.ResultsThere were a total of 61 participants with diverse identities, including premedical and medical students, faculty, staff, and administrators. A comparison of pre- and postworkshop data showed increases in all knowledge-based questions, two of which were statistically significant. Most learners somewhat or strongly agreed the learning objectives were met. Participants positively commented on the interactive and collaborative nature of the workshop, the perspective the case discussions offered, and the tangible resources provided to them.DiscussionThis single session serves as a starting point to bring awareness that basic needs insecurity exists among medical trainees. It is a step toward a cross-departmental approach to assess the scope of the problem and find solutions to address it. Through the widespread implementation of this session, we hope participants can enact sustainable institutional changes that will support the basic needs of students.

Prevalence and Risk Factors for Intimate Partner Physical Violence-Related Acquired Brain Injury Among Visitors to Justice Center in New York.

The recent United States Government Accountability Office report highlights the need for improved data on the prevalence of intimate partner violence (IPV)-related acquired brain injury (ABI) to help direct Health & Human Services public efforts. This article identifies the prevalence and risk factors for IPV-related ABI among survivors of IPV at a Justice Center in New York. Community Justice Center. Forty survivors of IPV, aged 17 to 73 years (median 32, interquartile range: 25.25, 42) were assessed within 60 days of sustaining physical violence. Retrospective chart review. The HELPS and the Danger Assessment-Revised were used at the initial Center visit. Of the 40 physical IPV survivors screened, all (100%) reported a prior history of partner-induced ABI within the past 60 days. Thirty-seven (92.5%) survivors also reported sustaining at least 1 potential hypoxic brain injury from strangulation. However, only 16 (40%) survivors screened positive on the HELPS for a history of IPV-related mild traumatic brain injury. Females (95%) and individuals with low income (67.5%) largely comprised our sample. Compared with the County's average, the proportion of African Americans/Blacks and refugees was 227% higher (42.5% vs 13%) and 650% higher (7.5% vs 1.09%), respectively. Refugee status (P = .017) also correlated with number of previous ABIs. On an exploratory binary logistic regression with stepwise selection, only balance difficulties (P = .023) and difficulty concentrating/remembering (P = .009) predicted a positive screen for mild traumatic brain injury. Consistent with previous findings, our data indicate a high prevalence of IPV-related ABI among visitors to a New York Justice Center. An overrepresentation of African Americans/Blacks and refugees in our sample relative to the region signified a higher prevalence of IPV in these populations and warrants a provision of more trauma-informed ABI resources to these groups/communities. Intimate partner violence survivors visiting Justice Centers should be screened for motor/neurocognitive symptoms suggestive of mild traumatic brain injury. Further research to identify the prevalence and risk factors of IPV-related ABI statewide and nationwide is urgently needed to improve resource allocation and clinical management.

Most US Nursing Homes Had Multiple, Sustained COVID-19 Outbreaks, GAO Reports.

The majority of US nursing homes experienced 2 or more outbreaks of COVID-19 from May 2020 through January 2021, and many such outbreaks had weeks of sustained transmission, according to a report from the federal government’s Government Accountability Office (GAO).

GAO report examines access challenges, workforce shortages

Taking note of the long‐standing concerns about the availability of behavioral health treatment, particularly for low‐income individuals, a new report from the Government Accountability Office (GAO) suggests that one potential barrier to treatment access has been shortages of qualified behavioral health professionals, particularly in rural areas.

Food and Drug Administration Beyond the 2001 Government Accountability Office Report: Promoting Drug Safety for Women.

A 2001 U.S. Government Accountability Office (GAO) report indicated 8 of 10 drugs withdrawn from the U.S. market between 1997 and 2000 posed greater risk to women than men. We examined drugs withdrawn from the market for safety-related reasons from January 1, 2001, to January 1, 2018. To be included, drugs must be listed as discontinued on Drugs@FDA and either listed in the Federal Register or cited in literature as being withdrawn for safety-related reasons. Biologics, over-the-counter products, and medical devices were excluded. During the 17-year time span, 19 drugs were withdrawn from the market for safety-related reasons, fewer drugs per year compared to the 3-year period examined in the GAO report. Food and Drug Administration (FDA) has not recommended the market removal of any drug approved since 2005 due to the time from the start of the Q wave to the end of the T wave (QT) interval prolongation resulting in torsades de pointes (TdP) or other abnormal heart rhythms. Furthermore, no drugs approved after the implementation of FDA's 2009 guidance on drug-induced liver injury (DILI) have been withdrawn because of hepatoxicity. All, but one of the drugs discontinued from the market for safety-related reasons during the period examined were approved between 1957 and 2002. TdP and DILI are two relevant examples of drug-induced adverse events posing greater risk to women than men. FDA has made measurable progress incorporating consideration of sex and gender differences into drug trial development and FDA review of these data, supporting inclusion of women in clinical trials, providing a comprehensive drug safety review, and advancing postmarket surveillance and risk assessment, thus strengthening FDA's ability to protect public health.

Teacher Support for Zero Tolerance Is Associated With Higher Suspension Rates and Lower Feelings of Safety

Zero tolerance as an approach to school safety has been around for almost 3 decades. Despite widespread criticisms of zero tolerance policies, few empirical studies have investigated the relationship of zero tolerance with school safety. More generally, the Government Accountability Office report on school shootings noted the need for research on the link between school discipline and school safety. Using a statewide survey from 108,888 students and 10,990 teachers from almost all Virginia middle schools, we found that a majority of surveyed teachers (74%) supported the use of zero tolerance as an effective discipline practice. Analysis using both linear and logistic regression indicated that support for zero tolerance was associated with higher rates of out-of-school suspension. Contrary to the goals of zero tolerance, both students and teachers in schools with greater support for zero tolerance had lower feelings of safety at school, even after controlling for school and student characteristics associated with safety. These findings offer new evidence to support efforts by school psychologists to discourage the use of zero tolerance and promote more effective school discipline practices. Impact Statement Despite widespread criticism of zero tolerance policies, approximately 74% of middle school teachers in Virginia supported the use of zero tolerance as an effective disciplinary practice. Higher support for zero tolerance was associated with higher out-of-school student suspension rates and lower feelings of safety as reported by both students and teachers. Alternative disciplinary practices that advocate for the use of nonexclusionary disciplinary sanctions should consider teacher beliefs about the value of zero tolerance policies.

Food Loss Waste in the United States Food Supply Chain: An Analysis of Its Functions, Oversight, and Recent Impacts from the Coronavirus Pandemic

Government oversight of the food supply chain consists of a complicated regulatory framework involving multiple executive branch agencies, congressional committees, and state governments. The agencies primarily involved with food safety issues are the Food and Drug Administration (FDA), the Food Safety and Inspection Service (FSIS), the US Department of Agriculture (USDA), the Environmental Protection Agency (EPA), and the National Marine Fisheries Service (NMFS). Although the above entities divide responsibility for different aspects of food safety and quality, according to a 2019 Government Accountability Office (GAO) report, the patchwork of statutes and regulations has led to “inconsistent oversight, ineffective coordination, and inefficient use of resources.”

Quality Measurement in Assisted Living: Emerging Practices

Quality Measurement in Assisted Living: Emerging Practices

GAO report highlights deficiencies in traditional oversight of parity

The process of monitoring whether health plans are complying with mental health and substance use parity requirements consists of a patchwork of federal and state oversight practices, leading Congress's Government Accountability Office (GAO) to state in a new report that “the full extent of compliance with [mental health/substance use] parity requirements is not known.”

Winning the War on Kidney Disease: Perspective from the American Society of Nephrology.

Nephrology is unique. Having saved the lives of millions of people with kidney failure and advocated successfully for the federal government to cover every American on dialysis, the specialty now faces challenges that obstruct advances in care and innovation. More than one half of Americans who

Hospitalizations With Observation Services and the Medicare Part A Complex Appeals Process at Three Academic Medical Centers

Hospitalists and other providers must classify hospitalized patients as inpatient or outpatient, the latter of which includes all observation stays. These orders direct hospital billing and payment, as well as patient out-of-pocket expenses. The Centers for Medicare & Medicaid Services (CMS) audits hospital billing for Medicare beneficiaries, historically through the Recovery Audit program. A recent U.S. Government Accountability Office (GAO) report identified problems in the hospital appeals process of Recovery Audit program audits to which CMS proposed reforms. In the context of the GAO report and CMS's proposed improvements, we conducted a study to describe the time course and process of complex Medicare Part A audits and appeals reaching Level 3 of the 5-level appeals process as of May 1, 2016 at 3 academic medical centers. Of 219 appeals reaching Level 3, 135 had a decision--96 (71.1%) successful for the hospitals. Mean total time since date of service was 1663.3 days, which includes mean days between date of service and audit (560.4) and total days in appeals (891.3). Government contractors were responsible for 70.7% of total appeals time. Overall, government contractors and judges met legislative timeliness deadlines less than half the time (47.7%), with declining compliance at successive levels (discussion, 92.5%; Level 1, 85.4%; Level 2, 38.8%; Level 3, 0%). Most Level 1 and Level 2 decision letters (95.2%) cited time-based (24-hour) criteria for determining inpatient status, despite 70.3% of denied appeals meeting the 24-hour benchmark. These findings suggest that the Medicare appeals system merits process improvement beyond current proposed reforms. Journal of Hospital Medicine 2017;12:251-255.

The Fault in Our Stars: Does the Five-Star System Fall Short?

The Fault in Our Stars: Does the Five-Star System Fall Short?