In 2013, the Transportation Security Administration (TSA) introduced the concept of third party testing—having an independent testing entity verify that a security screening system meets certain requirements. The concept is that screening system vendors would take this additional step either prior to submitting their technologies to TSA or if their system failed TSA's test and evaluation process. The goal is for third party testing to reduce the time and resources that TSA spends on its own testing. However, since introduced, TSA has directed only three vendors that failed TSA tests to use third party testing, with varying outcomes. In two other cases, TSA supplemented its test capabilities by using third party testers to determine that systems installed at airports were working properly. TSA officials and industry representatives pointed to several reasons for third party testing's limited use since 2013, such as the cost to industry to use third party testers and TSA's reluctance to date to accept third party test data as an alternative to its own. Despite this, TSA officials told GAO they hope to use third party testing more in the future. For example, in recent announcements to evaluate and qualify new screening systems, TSA stated that it will require a system that fails TSA testing to go to a third party tester to address the identified issues (see figure). Example of Use of Third Party Testing When a System Experiences a Failure in TSA's Testing TSA set a goal in 2013 to increase screening technology testing efficiency. In addition, TSA reported to Congress in January 2020 that third party testing is a part of its efforts to increase supplier diversity and innovation. However, TSA has not established metrics to determine third party testing's contribution toward the goal of increasing efficiency. Further, GAO found no link between third party testing and supplier diversity and innovation. Some TSA officials and industry representatives also questioned third party testing's relevance to these efforts. Without metrics to measure and assess the extent to which third party testing increases testing efficiency, TSA will be unable to determine the value of this concept. Similarly, without assessing whether third party testing contributes to supplier diversity and innovation, TSA cannot know if third party testing activities are contributing to these goals as planned. TSA relies on technologies like imaging systems and explosives detection systems to screen passengers and baggage to prevent prohibited items from getting on board commercial aircraft. As part of its process of acquiring these systems and deploying them to airports, TSA tests the systems to ensure they meet requirements. The 2018 TSA Modernization Act contained a provision for GAO to review the third party testing program. GAO assessed the extent to which TSA (1) used third party testing, and (2) articulated its goals and developed metrics to measure the effects of third party testing. GAO reviewed TSA's strategic plans, acquisition guidance, program documentation, and testing policies. GAO interviewed officials from TSA's Test and Evaluation Division and acquisition programs, as well as representatives of vendors producing security screening systems and companies providing third party testing services. GAO is recommending that TSA develop metrics to measure the effects of third party testing on efficiency, assess its effects on efficiency, and assess whether third party testing contributes to supplier diversity and innovation. DHS concurred with GAO's three recommendations and has actions planned to address them. For more information, contact Marie A. Mak at (202) 512-4841 or MakM@gao.gov.
Cargo was flown by air between more than 97 countries within the selected regions of Africa, Europe, Latin America, and the U.S. that may affect air cargo expansion in Puerto Rico. However, according to Department of Transportation (DOT) and European Union data, most international air cargo transportation was concentrated at a handful of countries and at airports in these regions. For example, four countries in Europe accounted for 72 percent of the U.S.-European Union air cargo transported, by weight. Likewise for airports, Miami International Airport accounted for 70 percent of air cargo transported between the U.S. and Latin America. Worldwide, cargo-only carriers transported on average 13.8 billion pounds of air cargo to and from the U.S. from 2016 through 2018. Of that cargo, two of the selected regions—Latin America and Europe—when combined accounted for 46 percent. Air Cargo Transported by Cargo-Only Airlines between the U.S. and Global Regions, Average Weight in Millions of Pounds, 2016 through 2018 Based on interviews with industry stakeholders and studies reviewed. GAO identified four factors that are generally associated with an airport's ability to attract air cargo traffic: (1) an airport's geographical location; (2) its proximity to transportation networks; (3) its supporting airport infrastructure and resources; and (4) the governmental and regulatory environments. For example, an airport located near businesses that generate large volumes of both inbound and outbound cargo that could be transported by air may be an important geographic factor for air carriers. Puerto Rican government and industry stakeholders GAO spoke with said that increased air cargo would benefit its airports and lead to positive effects on the Puerto Rican economy. For example, officials noted that expansion of air cargo operations could increase the use of underutilized airports and create opportunities for existing industry—such as the pharmaceutical, medical device, and aerospace industries—and help develop new ones. Puerto Rican and industry stakeholders had varying perspectives on the potential for Puerto Rico's expanding its air cargo operations. For example, some stakeholders said Puerto Rico's geographic location may allow it to serve as a refueling and cargo distribution point, particularly for flights between Europe and Latin America, while others said the island may be too close to some Latin American destinations to serve that purpose. Whether and to what extent Puerto Rico can increase air cargo operations depends on how air carriers weigh the various factors discussed above. Puerto Rico's economy has been in decline for much of the last 15 years and was devastated by hurricanes in 2017. Puerto Rico has sought to increase air cargo and passenger traffic at its international airports as a means to bolster and diversify its economy. Specifically, Puerto Rico seeks to serve as a transshipment point for transferring cargo between air carriers flying from Europe to Latin America. Air cargo, whether carried in the holds of passenger aircraft or by cargo-only aircraft, is an important component of global trade. The FAA Reauthorization Act of 2018 includes a provision for GAO to study the international air cargo transportation services among the United States and the African, Latin American, and European regions and the potential expansion of air cargo operations in Puerto Rico. This report addresses (1) what is known about air cargo operations between these world regions; (2) factors affecting the development of air cargo markets; and (3) Puerto Rican officials' and selected industry stakeholders' views on the economic effect and potential of expanding air cargo operations in Puerto Rico. GAO analyzed DOT and European air cargo data for flights between the U.S. and the selected regions for 2016 through 2018 (the latest available data). GAO also interviewed officials from DOT, and stakeholders from Puerto Rico and the air-cargo industry, selected based on prior GAO work and stakeholder mission. For more information, contact Heather Krause at (202) 512-2834 or email@example.com.
The Department of Energy's (DOE) Order 140.1 included provisions inconsistent with the Defense Nuclear Facilities Safety Board's (DNFSB) original enabling statute—the statute in place when the order was issued—and with long-standing practices. For example, GAO found that Order 140.1 contained provisions restricting DNFSB's access to information that were not included in the statute. GAO also found Order 140.1 to be inconsistent with long-standing DNFSB practices regarding staff's access to certain National Nuclear Security Administration (NNSA) meetings at the Pantex Plant in Texas, where nuclear weapons are assembled and disassembled (see fig.). In December 2019, the National Defense Authorization Act for Fiscal Year 2020 (FY20 NDAA) amended DNFSB's statute to clarify and confirm DNFSB's authority and long-standing practices between the agencies. DOE replaced Order 140.1 with Order 140.1A in June 2020. National Nuclear Security Administration's Pantex Plant, Located Near Amarillo, Texas DNFSB, DOE, and NNSA officials that GAO interviewed identified concerns with Order 140.1 that GAO found are not addressed under DOE's Order 140.1A. In particular, DOE's Order 140.1A was not part of a collaborative effort to address DNFSB's remaining concerns related to access to information and other regular interagency interactions. For example, DNFSB officials cited concerns that DOE could interpret a provision of DNFSB's statute authorizing the Secretary of Energy to deny access to information in a way that could limit DNFSB access to information to which it has had access in the past. GAO has previously recommended that agencies develop formal written agreements to enhance collaboration. By collaborating to develop an agreement that, among other things, incorporates a common understanding of this provision, DOE and DNFSB could lessen the risks of DNFSB being denied access to information important for conducting oversight. DOE and NNSA officials, as well as contractor representatives involved in operating the facilities, also raised concerns that insufficient training on Order 140.1 contributed to uncertainties about how to engage with DNFSB staff when implementing the order, a problem that GAO found could persist under Order 140.1A. Providing more robust training on Order 140.1A would help ensure consistent implementation of the revised order at relevant facilities. Established by statute in 1988, DNFSB has broad oversight responsibilities regarding the adequacy of public health and safety protections at DOE defense nuclear facilities. In May 2018, DOE issued Order 140.1, a new order governing DOE's interactions with DNFSB. DNFSB raised concerns that the order could affect its ability to perform its statutory mandate. Congressional committee reports included provisions for GAO to review DOE Order 140.1. This report examines (1) the extent to which the order was consistent with DNFSB's original enabling statute and with long-standing practices, as well as actions DOE has taken in light of changes to the statute outlined in the FY20 NDAA; and (2) outstanding areas of concern that DNFSB and DOE identified, and the potential effects of these concerns on how the two agencies cooperate. GAO reviewed legislation and agency documents; visited DOE sites; and interviewed DNFSB, DOE, and NNSA officials and contractor representatives. GAO is making a recommendation to DOE and DNFSB that they collaborate to develop a written agreement, and an additional two recommendations to DOE, including that it develop more robust training on Order 140.1A. DOE and DNFSB agreed to develop a written agreement. DOE agreed with one of the other two recommendations, but did not agree to provide more robust training. GAO maintains that the recommended action is valid. For more information, contact Allison Bawden at (202) 512-3841 or firstname.lastname@example.org.
The Navy's July 2020 report identified two key causes and several contributing factors regarding maintenance delays for aircraft carriers, surface ships, and submarines, but did not identify other causes. For public shipyards, the Navy's report identified the key cause of maintenance delays as insufficient capacity relative to growing maintenance requirements. For private shipyards, the Navy's report identified the key cause as the addition of work requirements after a contract is awarded. These causes and other identified factors generally align with factors that GAO has previously identified as originating during the maintenance process. However, the Navy's report did not consider causes and factors originating in the acquisition process or as a result of operational decisions, as shown below. GAO-Identified Factors Contributing to Maintenance Delays That the Navy Identified in Its July 2020 Report The report identified stakeholders needed to implement action plans, but did not fully incorporate other elements of results-oriented management, including achievable goals, metrics to measure progress, and resources and risks. Some examples from the report: Stakeholders: Identified Naval Sea Systems Command as the primary implementer of most initiatives related to maintenance at shipyards. Goals: Included a goal of reducing days of maintenance delay by 80 percent during fiscal year 2020.The Navy did not achieve this goal based on GAO's analysis of Navy data. Metrics: Included some metrics. The Navy is still identifying and developing other key metrics. Resources: Did not identify costs of the actions in the report. Risks: Identified as risks the coronavirus pandemic, unstable funding, and limited material availability. However, the report did not assess additional risks that GAO previously identified. The Navy generally has been unable to complete ship and submarine maintenance on time, resulting in reduced time for training and operations, and additional costs. The Navy's ability to successfully maintain its ships is affected by numerous factors throughout a ship's life cycle, such as decisions made during acquisition, which occurs years before a ship arrives at a shipyard for maintenance. Others manifest during operational use of the ship or during the maintenance process. The conference report accompanying a bill for the Fiscal Year 2020 Consolidated Appropriations Act directed the Secretary of the Navy to submit a report identifying the underlying causes of maintenance delays for aircraft carriers, surface ships, and submarines and to include elements of results-oriented management. The conference report also included a provision for GAO to review the Navy's report that was released in July 2020. This report evaluates the extent to which the Navy's report (1) identifies the underlying causes of maintenance delays and (2) incorporates elements of results-oriented management. GAO reviewed the Navy's report and interviewed Navy officials. Since 2015, GAO has made 39 unclassified recommendations related to Navy maintenance delays. The Navy or the Department of Defense concurred or partially concurred with 37 recommendations, and had implemented six of them as of September 2020. For more information, contact Diana Maurer at (202) 512-9627 or MaurerD@gao.gov.
Since 2016, U.S. Customs and Border Protection (CBP), within the Department of Homeland Security (DHS), has increased its resources to enforce a prohibition on importing goods made with forced labor, but has not determined its workforce needs. CBP formed the Forced Labor Division in 2018 to lead its efforts, and increased expenditures for the division from roughly $1 million in fiscal year 2018 to $1.4 million in fiscal year 2019. However, CBP has not assessed and documented the staffing levels or skills needed for the Forced Labor Division. For example, the division suspended some ongoing investigations due to a staff shortage and has plans to expand and train its workforce; however, the division has not assessed the number, type, locations, or specialized skills of positions it needs to achieve programmatic results. Without assessing its workforce needs, the division lacks reasonable assurance that it has the right number of people, with the right skills, in the right places. CBP has increased forced labor investigations and civil enforcement actions, but managers lack complete and consistent data summarizing cases. CBP detained shipments under 13 Withhold Release Orders (WRO) from 2016 through 2019, as shown in the figure below. However, the Forced Labor Division uses incomplete and inconsistent summary data to monitor its investigations. For example, data were missing on the sources of evidence collected for almost all active cases. Incomplete and inconsistent summary data on the characteristics and status of cases may hinder managers' effective monitoring of case progress and enforcement efforts. Figure: U.S. Customs and Border Protection (CBP) Forced Labor Withhold Release Orders, 2016 through 2019 With regard to criminal violations, DHS's U.S. Immigration and Customs Enforcement (ICE) has increased its resources to investigate allegations of forced labor, including those related to U.S. imports. ICE coordinates criminal investigations of forced labor, conducted in the U.S. and abroad. ICE reported spending about $40 million on forced labor investigations in fiscal year 2019, an increase of over 50 percent since 2016. Forced labor investigations often involve a range of criminal violations, including violations that are not related to the importation of goods. As such, reported expenditures include costs for cases on related issues, such as human trafficking. Forced labor is a global problem in which individuals are exploited to perform labor or services. The International Labour Organization estimates that forced labor generates profits of $150 billion a year globally. CBP is responsible for enforcing Section 307 of the Tariff Act of 1930, which prohibits the importation of goods made with forced labor. CBP has authority to detain shipments when information indicates that forced labor produced the goods. ICE is responsible for investigating potential crimes related to forced labor, and importers may be subject to prosecution. GAO was asked to review the status of DHS resources for implementing the Section 307 prohibition on forced labor imports, following an amendment of the law in 2016. This report examines (1) the extent to which CBP assessed agency needs for the enforcement of the prohibition on forced labor imports, (2) the outcome of CBP enforcement activities and monitoring of such efforts, and (3) ICE resources for investigations on forced labor. GAO reviewed CBP and ICE documents and data, and interviewed agency officials. This is a public version of a sensitive report GAO issued in July 2020. Information that CBP deemed sensitive has been omitted. GAO is making three recommendations, including that CBP assess the workforce needs of the Forced Labor Division, and improve its forced labor summary case data. CBP concurred with all three recommendations. For more information, contact Kimberly Gianopoulos at (202) 512-8612 or email@example.com.
The European Union (EU) and U.S. approaches to enforcing intellectual property rights (IPR) differ with respect to counterfeit goods in small packages, which are often sent through express carrier services or international mail. The EU uses a streamlined, application-based procedure to destroy suspected counterfeits in small packages. Through this procedure, rights holders request that member state customs authorities take action against such packages. The procedure allows customs authorities to bill rights holders for certain associated costs, and gives customs authorities discretion in sharing data with rights holders. In the U.S., U.S. Customs and Border Protection (CBP)—a component of the Department of Homeland Security (DHS)—is required to seize any goods it determines to be counterfeit, and typically destroys such goods, regardless of shipment size. CBP does not bill rights holders for the cost of enforcement, and is required to provide specific information to rights holders after seizure of goods. EU and U.S. customs officials reported common challenges in combating the flow of counterfeit goods in small packages. For example, EU and U.S. officials said the large volume of small packages makes it difficult for customs agencies to prioritize resources among competing needs such as drug enforcement and security. EU and U.S. officials also reported that a lack of adequate data on these packages is a challenge in taking enforcement action against them. Bags of Small Packages at Mail Facilities in Germany and France While CBP has taken steps to address these challenges, its primary enforcement processes are not tailored to combat counterfeit goods in small packages. According to CBP officials, from 2014 to 2018, CBP piloted a program to help address the volume of such packages by facilitating the abandonment of goods that it suspected—but had not determined—to be counterfeit. In 2019, CBP initiated a program to obtain additional data, and as of July 2020 had begun using these data to assess the risk that such packages contained counterfeit goods. However, CBP officials said that the seizure and forfeiture processes they are required to use for goods determined to be counterfeit are time and resource intensive. In April 2019, the White House required DHS to identify changes, including enhanced enforcement actions, to mitigate the trafficking of counterfeit goods. In January 2020, DHS proposed several actions that CBP could take, but CBP has not decided which to pursue to streamline its enforcement. Without taking steps to develop a streamlined enforcement approach, CBP will continue to face difficulty in addressing the influx of counterfeit goods in small packages. Counterfeit goods infringe on IPR, and can harm the U.S. economy and threaten consumer safety. CBP, the U.S. agency tasked with enforcement against counterfeits at the border, has reported that the annual number of small packages sent to the U.S. since fiscal year 2013 more than doubled, and small packages seized often contain counterfeit goods. The European Union Intellectual Property Office noted similar economic and consumer safety impacts in Europe, as well as increases in counterfeit goods in small packages. GAO was asked to review IPR enforcement practices in other advanced economies, and the extent to which CBP could apply those practices. This report examines: (1) how elements of the EU and U.S. approaches to combating counterfeit goods in small packages compare, (2) any enforcement challenges posed by these goods, and (3) the extent to which CBP has taken steps to address these challenges. GAO reviewed agency documents; interviewed CBP and customs officials in the EU; and met with private sector stakeholders, such as express carriers. GAO recommends that CBP take steps to develop a streamlined enforcement approach against counterfeit goods in small packages. CBP concurred with the recommendation. For more information, contact Kimberly Gianopoulos at (202) 512-8612 or firstname.lastname@example.org.
Literature GAO reviewed indicated that private insurance payments for anesthesia services on average were more than 3-1/2 times those of Medicare payments. This payment difference increased from what GAO reported in 2007—average private insurance payments for certain anesthesia services in 2004 were about 3 times those of Medicare. While Medicare rates for anesthesia services are set by the Centers for Medicare & Medicaid Services (CMS), private insurance rates are set through negotiations between providers and private insurers. GAO identified three recent studies with analyses of private insurance and Medicare payments for anesthesia services: Researchers from Yale University calculated that private insurance payments were 3.67 times Medicare payments, on average, for services provided by anesthesiologists for one large private insurer in 2015 operating across all 50 states and the District of Columbia. The Health Care Cost Institute calculated that in 2017 private insurance payments ranged from 2 to 7 times Medicare payments, on average, across six common services provided by anesthesiologists in 33 states. Wide state-to-state variation within specific services was reported. The American Society of Anesthesiologists reported that private insurance payments were 3.46 times Medicare payments, on average, based on a survey of its members in 2019. According to studies GAO reviewed and stakeholders GAO interviewed, market factors likely enhanced anesthesia providers' negotiating position and allowed them to secure higher private payments. For example, several studies and stakeholders cited market concentration as a key factor that increased private payments for anesthesia services. In a market with high provider concentration—or relatively few providers in a given market—there is little competition between providers, enabling the providers within that market to negotiate for higher payments from private insurers. Studies also indicated that specialists, including anesthesia providers, could negotiate higher in-network payment rates because they were able to leave an insurer's network with little risk of losing patients or revenue. In addition, when anesthesia providers are not a part of a private insurer's network, they are typically able to bill for a higher amount than the insurer would pay for an in-network provider, known as out-of-network billing. This dynamic decreases providers' incentives to participate in insurer networks because it creates an attractive alternative to network participation. GAO's interviews with stakeholders, literature review, and review of agency data generally did not indicate that the supply of anesthesia providers was insufficient for Medicare beneficiaries. CMS data indicate that the number of active anesthesia providers per 100,000 Medicare beneficiaries increased from 2010 through 2018 and that a very small number of anesthesia providers opted out of the Medicare program. Furthermore, researchers and stakeholders GAO interviewed were not aware of any issues with access to anesthesia services for Medicare beneficiaries, including those in traditionally underserved rural areas. In 2018, Medicare paid over $2 billion for anesthesia services, such as general anesthesia administered to beneficiaries undergoing surgical or other invasive procedures. The joint explanatory statement for the Further Consolidated Appropriations Act, 2020 included a provision for GAO to update its 2007 report and examine how differences in payment rates for anesthesia services have changed since that time. In 2007, GAO reported that Medicare payments in 2004 for certain anesthesia services provided by anesthesiologists were on average 67 percent lower than private insurance payments in certain geographic areas—indicating that private payments were about 3 times more than Medicare payments at that time. This report describes what is known about (1) recent trends in differences between Medicare and private payments for anesthesia services, and (2) the sufficiency of the supply of anesthesia providers for Medicare beneficiaries. GAO reviewed literature and available published data on payment differences for anesthesia services, published in the United States since 2010. GAO also reviewed data from CMS on the number of anesthesia providers from 2010, 2018, and 2020. GAO also interviewed a nongeneralizable selection of three research groups, two beneficiary advocacy groups, and five stakeholder groups, including those representing anesthesiologists, nurse anesthetists, and hospitals, to obtain their perspectives on these issues. The Department of Health and Human Services provided no comments on this report. For more information, contact Jessica Farb at (202) 512-7114 or email@example.com.