From the U.S. Government Accountability Office, www.gao.gov Transcript for: Priority Recommendation Letters to DOD, HHS, and VA Description: GAO sends letters to federal agencies with its priority recommendations to help combat waste, fraud, abuse, and mismanagement and achieve significant cost savings. This podcast covers the letters sent to the Departments of Defense, Health and Human Services, and Veterans Administration. Related GAO Work: GAO-19-366SP: Priority Open Recommendations: Department of Defense, GAO-19-364SP: Priority Open Recommendations: Department of Health and Human Services, GAO-19-358SP: Priority Open Recommendations: Department of Veterans Affairs Released: April 2019 [ Background Music ] [ Nikki Clowers: ] With both departments, I would expect to see better delivery services and care to the beneficiaries in a more cost effective way. [ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Matt Oldham. Every year, GAO sends letters to agencies highlighting recommended changes and actions from past reports that remain unaddressed, and we believe priorities should be given to these recommendations because they may significantly improve government operations, and that can include saving taxpayer dollars, eliminating mismanagement, or tackling fraud and abuse. And we're making this year's letters public, a first for GAO. I'm with Nikki Clowers, managing director of the Healthcare team, and Elizabeth Field, our Defense Capabilities and Management director. And they're here to talk about the priority recommendation letters GAO sent to the Departments of Defense, Health and Human Services, and Veterans Affairs. Thank you both for joining me. [ Nikki Clowers: ] Thank you. [ Elizabeth Field: ] Thank you. [ Matt Oldham: ] So, Nikki this is the first time that we're making these priority recommendation letters public. Could you talk a little bit about why we're doing that? What's the purpose? [ Nikki Clowers: ] The purpose is to continue to draw attention to these issues. As you mentioned, we issue hundreds of reports each year that contain a number of recommendations to improve government efficiency and effectiveness, but what we want to do is really focus the attention of the agencies on the -- the recommendations that we feel that are the highest priority that could have the highest impact, both for the people receiving the benefits of the program, as well as the -- improving the efficiency of those programs. [ Matt Oldham: ] Elizabeth, you were involved with the letter to the Department of Defense. Could you talk a little bit about what made those recommendations unique? [ Elizabeth Field: ] Well, there are more open recommendations to DOD that GAO has made than to any other federal agency. We've identified 91 of them as priority for this year, and they are, in many ways, recommendations that would help the department address systemic issues, so issues related to readiness, which is a core issue for the department, or financial management, which, of course, was an issue highlighted in last year's consolidated financial statement audit, the first of its kind for the department. So, I think if the department were to take these priority recommendations and imp -- truly implement them, they would help address some of the core underlying systemic issues that the department faces. [ Matt Oldham: ] And were there some areas that we've seen the Department of Defense making progress in? [ Elizabeth Field: ] They have, so I think it's worth noting that the department's implementation rate has increased over the last year. Last year it was 53 percent overall, this year at 67 percent, which is certainly an improvement, although still below the government-wide average, which is 77 percent. One of the reasons we think they've made improvement in this area is that they have set up new processes for tracking recommendations. They've also established rules that each component of the department responsible for implementing open recommendations develop a corrective action plan to do so. So, we think those are really positive steps. There are also specific areas where they have made progress, one is in preventing sexual harassment. They have improved their process for handling anonymous complaints, and also for standardizing how data related to incidents are tracked and reported. And in the area of cybersecurity, DOD has taken some important steps that we recommended to plan for continuity of operations and integrated cyber environment. [ Matt Oldham: ] Nikki, we sent a letter to HHS, could you talk a little bit about the recommendations in that letter? I assume it involves the Centers for Medicare and Medicaid Services and payments. [ Nikki Clowers: ] It does, we make a number of recommendations throughout the year, but we highlight in the priority recommendation letter that go to a CMS as they operate two of the largest healthcare programs in the nation, Medicare and Medicaid. To give you some information about those programs, Medicare last year served about 60 million beneficiaries at a cost of $700 billion, that program serves beneficiaries that are 65 years and older. Medicaid, on the other hand, serves beneficiaries that are low-income or medically needy, and the Medicaid program last year served approximately 75 million people at a cost of about $630 billion. So, these are massive programs, together totaling about $1.3 trillion in expenditures, and put that in context, the spending for all health care in the nation is just over $3 trillion. And so, we made recommendations to improve the efficiency and effectiveness of those programs that we highlight in the priority recommendation letter. [ Matt Oldham: ] And Nikki, you also worked on the priority recommendations letter to the VA, and I recognized one of those recommendations from a podcast we did last summer dealing with the Veterans Health Administration and the Veterans Choice Program. Could you talk a little bit about that? [ Nikki Clowers: ] The Choice Program is one of VA's Care in the Community Programs. It was created in 2014 in the wake of some news reports and other documented incidences where veterans were not receiving timely care at VA facilities. And what these programs allow is for veterans, if they meet certain eligibility criteria, to go out into the community outside of VHA facilities to receive care. We've looked at a number of aspects of the Choice Program and found problems, such as scheduling delays, and delays in paying the community providers, and made a number of recommendations. And so, in the priority letter, we highlight five of these recommendations to address the problems that we found. Addressing these problems will be very important for VA as it moves forward because under the Mission Act, which was passed last year, VA is to consolidate all the community care programs, including the Choice Program, starting this June and move forward. And we believe our recommendations that we've made over the year can help inform VA as they move forward with this new program. [ Background Music ] [ Matt Oldham: ] So, while these aren't all brand new recommendations, they're based off past GAO work, and it sounds like we're talking about potentially significant savings from priority recommendation letters we're sending out to agencies. Elizabeth, you had mentioned there are 91 priority recommendations that went out to the Department of Defense. What could we expect to see if the Department of Defense implemented all those recommendations? [ Elizabeth Field: ] Perhaps no issue is more central to the department than military readiness. So, one example of a -- of a program related to readiness that we've done a lot of work in and where we have a number of priority recommendations is sustainment of the F-35 Joint Strike Fighter. It is one of DOD's most expensive and ambitious programs, it could end up costing over $1 trillion over its lifetime. It will be important for the department to really make sure that it has plans in place to sustain this critical aviation system. If it doesn't, the department stands to lose significant sums of money. But if it were to implement these recommendations, it would be well-positioned to use that critical aviation system in military operations moving forward. [ Matt Oldham: ] And Nikki, same question for you, if HHS or VA were to implement all of the priority recommendations that were in their letters, what could we expect to see? [ Nikki Clowers: ] With both departments, I would expect to see better delivery services and care to the beneficiaries at a -- in a more cost effective way, which both benefits the beneficiaries in terms of out-of-pocket cost, as well as the American taxpayer. For HHS, we identified 54 priority recommendations. And for VA, we identified 30. And implementing this could have significant benefits for the department. [ Matt Oldham: ] And the priority recommendation letters that we've been talking about are the first of 28 letters GAO is sending to agencies this year. When it comes to DOD, HHS, and VA, what would you say is the bottom line of those letters? [ Elizabeth Field: ] If I'm acting Secretary Shanahan, and I'm trying to figure out where to begin, where am I going to get the best sort of bang for my buck when it comes to implementing these recommendations, this priority recommendations letter is sort of my map -- my roadmap for doing that. [ Nikki Clowers: ] And I would agree with Elizabeth, I think the letter serve as an important to-do list for the agencies in terms of looking at all of our recommendations, but then helping them focus on a number of key recommendations that have significant important benefits for both the beneficiaries that they serve, as well as the American taxpayer. [ Matt Oldham: ] Nikki Clowers is the Health Care team’s managing director, and Elizabeth Field is a Defense Capabilities and Management director, and they were talking about GAO's priority recommendation letters to the Department of Defense, Health and Human Services, and the Veterans Administration. Thank you both for your time. [ Nikki Clowers: ] Thank you. [ Elizabeth Field: ] Thank you. [ Background Music ] [ Matt Oldham: ] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Matt Oldham: ] For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.