Nominations of Christi A. Grimm and Neil H. MacBride (S. Hrg. 117-692, September 22, 2021)
Summary
Senate Hearing 117-692 records the September 22, 2021 hearing of the Committee on Finance, with Chairman Ron Wyden presiding, on the nominations of Christi A. Grimm to be Inspector General of the Department of Health and Human Services and Neil H. MacBride to be General Counsel of the Department of the Treasury. Wyden notes Grimm joined the HHS Office of Inspector General in 1999 and has performed the Inspector General role for more than a year. Mike Crapo criticizes the proposed $3.5-trillion tax-and-spending package and says HHS programs account for roughly $2.4 trillion in taxpayer dollars. Mark R. Warner and Tim Kaine introduce both nominees. The record closes with a letter urging the committee to vote favorably on Grimm's nomination.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
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“Nominations of Christi A. Grimm and Neil H. MacBride (S. Hrg. 117-692, September 22, 2021).”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/senate-hearing-117th-congress-nominations-of-christi-a-grimm-to-be-ins-e139340bcd/
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[Senate Hearing 117-692]
[From the U.S. Government Publishing Office]
S. Hrg. 117-692
NOMINATIONS OF CHRISTI A. GRIMM
AND NEIL H. MacBRIDE
=======================================================================
HEARING
before the
COMMITTEE ON FINANCE
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
on the
NOMINATIONS OF
CHRISTI A. GRIMM, TO BE INSPECTOR GENERAL, DEPARTMENT OF HEALTH AND
HUMAN SERVICES; AND NEIL H. MacBRIDE, TO BE GENERAL COUNSEL, DEPARTMENT
OF THE TREASURY
__________
SEPTEMBER 22, 2021
__________
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Finance
______
U.S. GOVERNMENT PUBLISHING OFFICE
52-803 PDF WASHINGTON : 2023
COMMITTEE ON FINANCE
RON WYDEN, Oregon, Chairman
DEBBIE STABENOW, Michigan MIKE CRAPO, Idaho
MARIA CANTWELL, Washington CHUCK GRASSLEY, Iowa
ROBERT MENENDEZ, New Jersey JOHN CORNYN, Texas
THOMAS R. CARPER, Delaware JOHN THUNE, South Dakota
BENJAMIN L. CARDIN, Maryland RICHARD BURR, North Carolina
SHERROD BROWN, Ohio ROB PORTMAN, Ohio
MICHAEL F. BENNET, Colorado PATRICK J. TOOMEY, Pennsylvania
ROBERT P. CASEY, Jr., Pennsylvania TIM SCOTT, South Carolina
MARK R. WARNER, Virginia BILL CASSIDY, Louisiana
SHELDON WHITEHOUSE, Rhode Island JAMES LANKFORD, Oklahoma
MAGGIE HASSAN, New Hampshire STEVE DAINES, Montana
CATHERINE CORTEZ MASTO, Nevada TODD YOUNG, Indiana
ELIZABETH WARREN, Massachusetts BEN SASSE, Nebraska
JOHN BARRASSO, Wyoming
Joshua Sheinkman, Staff Director
Gregg Richard, Republican Staff Director
(II)
C O N T E N T S
----------
OPENING STATEMENTS
Page
Wyden, Hon. Ron, a U.S. Senator from Oregon, chairman, Committee
on Finance..................................................... 1
Crapo, Hon. Mike, a U.S. Senator from Idaho...................... 2
Warner, Hon. Mark R., a U.S. Senator from Virginia............... 4
CONGRESSIONAL WITNESS
Kaine, Hon. Tim, a U.S. Senator from Virginia.................... 5
ADMINISTRATION NOMINEES
Grimm, Christi A., nominated to be Inspector General, Department
of Health and Human Services, Washington, DC................... 6
MacBride, Neil H., nominated to be General Counsel, Department of
the Treasury, Washington, DC................................... 8
ALPHABETICAL LISTING AND APPENDIX MATERIAL
Crapo, Hon. Mike:
Opening statement............................................ 2
Prepared statement........................................... 27
Grimm, Christi A.:
Testimony.................................................... 6
Prepared statement........................................... 28
Biographical information..................................... 29
Responses to questions from committee members................ 40
Kaine, Hon. Tim:
Testimony.................................................... 5
MacBride, Neil H.:
Testimony.................................................... 8
Prepared statement........................................... 74
Biographical information..................................... 75
Responses to questions from committee members................ 86
Warner, Hon. Mark R.:
Opening statement............................................ 4
Wyden, Hon. Ron:
Opening statement............................................ 1
Prepared statement with attachments.......................... 102
Communication
Keckler, Charles N. W............................................ 111
(III)
NOMINATIONS OF CHRISTI A. GRIMM, TO BE
INSPECTOR GENERAL, DEPARTMENT OF
HEALTH AND HUMAN SERVICES; AND NEIL
H. MacBRIDE, TO BE GENERAL COUNSEL,
DEPARTMENT OF THE TREASURY
----------
WEDNESDAY, SEPTEMBER 22, 2021
U.S. Senate,
Committee on Finance,
Washington, DC.
The hearing was convened, pursuant to notice, at 10 a.m.,
via Webex, in Room SD-215, Dirksen Senate Office Building, Hon.
Ron Wyden (chairman of the committee) presiding.
Present: Senators Brown, Bennet, Warner, Whitehouse, Cortez
Masto, Warren, Crapo, Grassley, Thune, Toomey, Lankford, Young,
and Sasse.
Also present: Democratic staff: Ian Nicholson, Investigator
and Nominations Advisor; and Joshua Sheinkman, Staff Director.
Republican staff: Gable Brady, Health Policy Advisor; Lincoln
Foran, Policy Advisor; and Catherine Fuchs, Senior Counsel.
OPENING STATEMENT OF HON. RON WYDEN, A U.S. SENATOR FROM
OREGON, CHAIRMAN, COMMITTEE ON FINANCE
The Chairman. There are two nominations for key roles in
the Biden administration, jobs that deal with sound management
and good government within major Federal agencies. Christi
Grimm is the President's nominee for Inspector General for the
Department of Health and Human Services. Neil MacBride is the
President's nominee to serve as General Counsel of the Treasury
Department.
Ms. Grimm brings to her nomination more than 2 decades of
experience within the HHS Office of Inspector General. She
first joined that office in 1999. She has held a variety of
roles over the years, and she currently serves as Principal
Deputy Inspector General and has been performing the role of
the Inspector General for more than a year. She knows this
office inside out. She knows the importance of working with
Congress, and this committee in particular. She has a proven
commitment to maintaining and strengthening the integrity of
America's health-care programs. I appreciate that she is
willing to take on the top job as Inspector General during such
a challenging time. Setting all other issues aside, studying
the Nation's response to the pandemic would keep the Inspector
General and the staff of more than 1,500 busy through the end
of the decade. The pandemic response, however, is just one of
many challenges ahead for the HHS Inspector General. The
committee takes its role very seriously. We look forward to
working closely with Ms. Grimm, if and when she is confirmed.
Neil MacBride also brings decades of service to his
nomination. Currently in private practice, he previously served
in the Obama administration as Associate Deputy Attorney
General for Criminal Enforcement, and as the U.S. Attorney for
the Eastern District of Virginia. He also served as Chief
Counsel for then-Senator Biden's Judiciary Committee, which
means he certainly knows his way around the Dirksen Senate
Office Building.
If and when he is confirmed, Mr. MacBride will join the
Treasury Department, which is working hard to build back better
from the economic crash that wiped out tens of millions of jobs
through the early stages of the pandemic. Democrats in Congress
are working closely with Secretary Yellen and her team on
policies that will create high-skill, high-wage jobs, make it
easier to support a family, build more affordable housing, and
ensure that the mega-fortunate will pay their fair share of
taxes. Members of this committee will count on Mr. MacBride to
support these efforts.
As I mentioned, the Finance Committee is committed to
oversight. I had a chance to speak with Mr. MacBride about
oversight issues during our recent meeting, particularly
certain abuses by the previous administration. I was pleased to
have his commitment to work with the committee on improving
oversight, particularly in comparison to what we went through
over the last 4 years.
Bottom line: I think these are two highly qualified
nominees. I want to thank them for their willingness to serve
in challenging roles at a time when the HHS IG and the Treasury
Department are working long nights as a result of the pandemic.
We look forward to hearing from them in the questions and
answers, and let us hear from Senator Crapo.
[The prepared statement of Chairman Wyden appears in the
appendix.]
OPENING STATEMENT OF HON. MIKE CRAPO,
A U.S. SENATOR FROM IDAHO
Senator Crapo. Thank you, Senator Wyden.
Today, we welcome two nominees to the committee: Mr.
MacBride to be General Counsel of the Treasury and Ms. Grimm to
be Inspector General of the Department of Health and Human
Services. Welcome to both of you, and congratulations on your
nominations.
I am interested in learning more about each of your
perspectives and reviewing your responses to questions for the
record that our members will submit after today's hearings.
Let's start with you, Mr. MacBride. The General Counsel of
the Treasury should be able to provide nonpartisan legal and
policy advice to the Secretary and other senior Department
officials. As head of the Treasury Legal Division, the General
Counsel is also responsible for all legal work in the
Department, with the exception of the legal work in the Office
of the Comptroller of the Currency and the Offices of the
Inspectors General.
Your role as General Counsel, if confirmed, will be
important to the Secretary and the Treasury Department, given
the health and economic challenges currently facing our
country, and it is imperative that you take on this role with
the best interests of the United States, not the President or
the Senators sitting before you today or any one political
party.
Today, the United States is experiencing unprecedented
economic pressures on multiple fronts, including significant
inflation and record price increases, significant legislative
and regulatory changes, and international economic competition
and threats. Congress is considering a $3.5-trillion tax-and-
spending package that would change the social fabric of our
country. These changes would impose massive tax hikes on
America's small businesses and job creators, and expand the
role of the IRS to monitor the transactions of Americans at
every income level. Many Americans are justifiably concerned.
Mr. MacBride, you would play a large role in the regulatory
process to implement this partisan $3.5-trillion package, if it
were to pass. You would also be closely involved in the ongoing
international tax negotiations occurring at the OECD. These
matters will require transparency and accountability.
They will also require you to follow the law and serve the
best interests of our Nation, not a partisan agenda, and that
you keep Treasury's authorizing committee--the Finance
Committee--fully informed. To date, this administration and the
Treasury Department have failed to be fully transparent and
accountable to this committee. I expect you to be a transparent
and responsive leader, if confirmed. And I appreciate the
conversation we had.
Now, turning to Ms. Grimm. If confirmed as Inspector
General of HHS, you will continue to serve as the chief
watchdog over the Department of Health and Human Services, one
of the largest Federal agencies, whose programs account for
roughly $2.4 trillion in taxpayer dollars. It will continue to
be your responsibility to lead OIG's efforts to fight waste,
fraud, and abuse in some of our most important and far-reaching
Federal programs, including Medicare and Medicaid. Together,
these programs account for more than one-fifth of all Federal
outlays and serve some of our country's most vulnerable
citizens.
It is imperative that the HHS Inspector General avoid
politicization and maintain independence. HHS OIG is the
largest civilian Office of the Inspector General across the
entire Federal Government, with a workforce of around 1,650
employees. Given the substantial size and unparalleled purview
of your office, I hope you will continue to serve as a
principled and nonpartisan steward of vital programs,
initiatives, and taxpayer dollars.
I look forward to working together with you to bolster
program integrity, as well as to continue adapting our fraud
and abuse regulations and oversight infrastructure to keep pace
with cutting-edge technology and health-care innovation.
Thank you, very much.
[The prepared statement of Senator Crapo appears in the
appendix.]
The Chairman. Thank you, Senator Crapo.
Ms. Grimm, you have the good fortune to be introduced by
Senator Warner.
OPENING STATEMENT OF HON. MARK R. WARNER,
A U.S. SENATOR FROM VIRGINIA
Senator Warner. Thank you, Mr. Chairman and Ranking Member
Crapo. It is my great honor--I am going to actually introduce
both Virginians who are here, with apologies to Senator Kaine.
I do not know if I jumped the line there, but let me go ahead
and start with Christi Grimm, who is joined today by her
husband Drew, and I had a chance to say ``hello'' to both of
them.
Christi is, as you know, the Principal Deputy Inspector
General at HHS already, residing in Northern Virginia. She has
been nominated to be the Inspector General. I think we all
know, the chairman knows, the ranking member mentioned,
Inspectors General are extraordinarily important. They do not
get a lot of attention until they are in the spotlight, and we
unfortunately saw Inspectors General too many times overruled
or jerked out of their jobs, the last time, when Inspectors
General simply did their job. And I think, as Senator Crapo
indicated, Ms. Grimm, I hope you will be confirmed, and I
believe your background and professionalism and willingness to
do what is right as opposed to what is partisan for either
team, are critically important. I know this committee is
continuing to look at ways where we can support Inspectors
General, protect whistleblowers, and I wholeheartedly endorse
Christi Grimm to be approved by this committee.
Neil MacBride is somebody I have known since the late
1990s. He is joined by his spouse Chris and two of his
children, Charlotte and Alistair. My understanding is his third
child, Duncan, has graduated from UVA. He thought this was
really important, but not important enough--this session--to
break apart his post-college trip, but I understand he is at
least viewing this and will get some computerized version of
this.
So, I personally met Neil in the late 1990s when he was
really just starting into his legal career. Back when Senator
Webb and I were the Senators from Virginia, we nominated him to
be the U.S. Attorney for the Eastern District. He was confirmed
by the Senate and did a great, great job. He served actually in
all three branches of government. He went to Houghton College.
He got his J.D. from UVA. Again, he's passed that on to at
least two of the three kids, who either went there or are going
there at this point.
He clerked in the Eastern District. He served as a Federal
prosecutor in the United States Attorney's Office for the
District of Columbia. He served as Chief Counsel to then-
Senator Biden on the Senate Judiciary Committee. And finally,
he joined the Obama-Biden administration as an Associate Deputy
Attorney General for Criminal Enforcement in the Department of
Justice. He now serves as the Chief Litigation Partner in the
firm of Davis, Polk, and Wardwell. He is one of the Nation's
top white-collar litigators. I think he brings a great deal of
background and expertise to this position.
I am going to go ahead and skip the rest of the
biographical information, other than just noting what I think
that Senator Kaine will probably note as well: we both have
such high regard for Neil's judgment. He serves, and has served
for some time, on a group that reviews our judicial nominees in
Virginia. The quality of the nominees, all of whom have been
confirmed, shows that he has done a good job.
I absolutely, without reservation, recommend Neil to the
committee.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Warner.
And, Senator Kaine, in the interest of fairness, it seems
that we should afford you the right to introduce multiple
Virginians as well this morning. Why don't you just go ahead?
STATEMENT OF HON. TIM KAINE,
A U.S. SENATOR FROM VIRGINIA
Senator Kaine. Well, thank you, Senator Wyden, Ranking
Member Crapo, and committee members. I will be brief. I am
very, very happy to be here with this panel. I wrote a letter
of recommendation for Christi Grimm for the position that she
has been nominated for, and I am a strong supporter and echo
the comments that Senator Warner made about her professional
track record and her ability to handle the important job as IG
in a fair and careful and balanced way.
I am here particularly to talk about my friend Neil
MacBride. He is a great Virginian and a great public servant,
and also a personal friend. Neil has served in all three
branches of government, as Senator Warner mentioned. And he has
done public service in six different chapters of his political
career. I know he does not look that old. He has also done work
in the private sector, but six different times he has worked,
from judicial law clerk, to prosecutor, to U.S. Attorney, to
positions at main Justice. This would be a sixth chapter. I
think anybody who is signing up for a sixth term as a public
servant deserves the title ``patriotic glutton for
punishment,'' and Neil is a patriotic glutton for punishment.
I think in particular, his service in this body as the
Chief Counsel for the Judiciary Committee for President Biden,
when he was the chair of the committee, right in the days after
9/11, put him at front and center of really important policies
such as reauthorization of the Violence Against Women Act.
As many of you know--because there are members of this
committee who are also members of Judiciary--the Eastern
District of Virginia, where Neil was the chief prosecutor, has
one of the most complex dockets of any district in the United
States, because it includes the Pentagon, the CIA, and many
national security and also very significant financial
enforcement, financial corruption cases that come from the
Eastern District.
And so, Neil's work, both in criminal enforcement at main
Justice, but then his work supervising over 300 people in the
Eastern District of Virginia, gives him significant expertise
in the very areas that he would be working on as General
Counsel at Treasury.
As Senator Warner mentioned, we rely on Neil's advice,
because we have a panel of lawyers that gives us
recommendations both for U.S. Attorney nomination
recommendations to the White House, but also judicial
recommendations. And Neil and his colleagues have had a superb
track record of giving us recommendations that, when we
recommended them to the Obama administration or the Trump
administration or the Biden administration, we have a really
high batting average, Senator Warner and I, and I think it is
because we have people like Neil giving us advice about good
people to recommend.
The last thing I will say is that Neil has a tremendous
amount of bipartisan support for the position. Thirteen former
Treasury General Counsels from both parties, including the
previous administration, have written to the committee to
recommend Neil. And also, nearly 150 former DOJ officials,
appointed by both parties, have written to the committee to
recommend Neil. He comes with great credentials, and the people
who know him best, who have worked with him, might be the ones
whose opinions matter the most, and they very much understand
that Neil would do a great job in this role, and I am proud to
be here and recommend him to the committee.
The Chairman. Thank you, Senator Kaine. It has been good to
see the endorsements flowing fast and furious from Virginians
for Virginia nominees, and I share their judgment with respect
to the quality of service of the nominees.
Senator Kaine, we can excuse you. Senator Warner, we will
start with the regular process of the committee. And I also
want to put into the record several letters of support for Mr.
MacBride and Ms. Grimm. Without objection, so ordered.
[The letters appear in the appendix beginning on p. 102.]
The Chairman. We will now have opening statements from you,
Ms. Grimm, and from you, Mr. MacBride. Then we have a process
where we have to ask you some questions, and I think you are
aware of what those will be. With that, let's go forward and
begin with you, Ms. Grimm.
STATEMENT OF CHRISTI A. GRIMM, NOMINATED TO BE INSPECTOR
GENERAL, DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON,
DC
Ms. Grimm. Hi. Good morning, Chairman Wyden, Ranking Member
Crapo, and members of the committee. I thank Senator Warner for
his gracious introduction and Senator Kaine for his kind
statement of support. I thank the President for nominating me
to serve as the Inspector General for the Department of Health
and Human Services. I am honored to appear before the Senate
Committee on Finance as it considers my nomination.
I believe that public service is a calling--a calling to
which generations of my family have responded through military
and other public service. I draw inspiration from my family's
commitment to serve this country and improve government. As a
child growing up in Edgewater, CO, I watched my grandfather,
Albert Mackinson, the head of the Public Works Department,
strive to improve the infrastructure of that small town. I saw
his pride when water could reach the homes of hardworking
families, when parks were well maintained, and when new roads
and sidewalks connected the community.
I was proud of how he made our town better. It is
personally meaningful for me to continue this tradition of
ensuring that government works for the people it serves. I
thank my family, each and every one, for their inspiration. My
husband Drew, a Federal law enforcement agent, is with me
today. Drew, thank you for being my partner as we try to model
public service for our 4-year old daughter, Hazel.
Inspectors General perform an essential public service.
They root out fraud, waste, and abuse and help make programs
more efficient and effective. It is critical to have Inspectors
General who understand the value of objective and independent
oversight. Through independence, objectivity, and transparency,
IG's help government better serve the American people. A strong
Inspector General makes a stronger department and a stronger,
more trusted Federal Government.
With more than 20 years of executive branch service and
more than a decade of holding top management and strategic
positions within HHS-OIG, I offer unique qualifications to lead
this agency. I have been performing the duties of IG since
January 2020, directing oversight of HHS's COVID-19 pandemic
response while transitioning a workforce of over 1,600
professionals to a mostly virtual environment.
We have not allowed unprecedented challenges to disrupt our
mission, and we have excelled in productivity, employee
satisfaction, and maintaining standards of excellence. If
confirmed, I will be honored to lead HHS-OIG's mission-driven
team of program integrity experts.
I am deeply committed to ensuring that we remain a modern
organization with a high-performing, diverse, and inclusive
workforce. Continued investment in data analytics and
information technology will ensure that HHS-OIG's dedicated
professionals have the tools they need to succeed. I am steeped
in the disciplines central to the work of an Inspector General.
I understand the everyday challenges of ensuring program
integrity. If confirmed, I will deliver practical results to
help address the most consequential issues facing HHS:
financial integrity of HHS programs; access, quality, and
safety of care, including for some of the Nation's most
vulnerable populations; safeguarding public health; appropriate
administration of HHS programs at the Federal and State levels;
and preventing fraud, waste, and abuse that harm people and
divert critical resources.
OIG's work is vital to ensure that HHS programs deliver the
services and outcomes that Congress intends, and that
beneficiaries and taxpayers deserve. If confirmed, I will
maintain strong partnerships with stakeholders, including the
Department of Justice, HHS, the Pandemic Response
Accountability Committee, States, and other law enforcement
agencies so that we can continue our fight against fraud,
waste, and abuse. And I will continue a rigorous program of
audits and evaluations that aim to drive positive change for
HHS programs and the people they serve.
If confirmed, I will uphold the IG's dual reporting
obligations to Congress and the Department. That includes my
commitment to inform Congress as HHS-OIG conducts its work and
to be accessible to Senators, Representatives, committees, and
their staffs.
As a career public servant who rose through the ranks, I am
humbled and honored to be considered for the position of the
Inspector General. During my career, I have marshaled
experience in the craft of oversight and the art of leading a
high-performing workforce. It would be my privilege to serve
and lead HHS-OIG, an organization to which I am deeply
committed.
I thank the Senate Committee on Finance for considering my
nomination and for its strong support of independent and
objective oversight. I look forward to answering your
questions.
[The prepared statement of Ms. Grimm appears in the
appendix.]
The Chairman. Thank you. We look forward to that shortly.
And now, Mr. MacBride.
STATEMENT OF NEIL H. MacBRIDE, NOMINATED TO BE GENERAL COUNSEL,
DEPARTMENT OF THE TREASURY, WASHINGTON, DC
Mr. MacBride. Thank you, Chairman Wyden, Ranking Member
Crapo, members of the committee, for the opportunity to appear
before you today. Thank you to Senators Warner and Kaine for
their kind introductions. I am deeply honored that President
Biden has nominated me to serve as General Counsel for the
Treasury Department, and I am grateful to Secretary Yellen for
her confidence in me.
I would like to begin by quickly introducing my family: my
amazing wife of 29 years, Christina Jackson MacBride, and our
three children. Duncan could not be here today, but I am joined
by our daughter Charlotte and my son Alistair. As you all know,
public service can place great demands on one's family, and I
am very thankful to Chris and our children for their constant
love and support throughout the last several months, and
especially during my prior 15 years of public service.
I would also like to acknowledge my incredible parents: my
mom, Ruth Parkerson MacBride--who just turned 90 and is
watching today's hearing from her home in Charlotte--as well as
my dad, Harvey MacBride--who passed away several years ago. And
if I may, I would like to acknowledge my wonderful in-laws,
Rear Admiral Grady Jackson and Linda Jackson, who are watching
from home in Falls Church.
My parents instilled in me a deep commitment to public
service. They were children of the Great Depression and both
from humble roots. My mom grew up in rural Indiana while my
dad, the son of immigrants, was raised in the South Bronx. My
parents both modeled hard work and personal responsibility, but
also firmly believed that government has an obligation to help
out those who are down on their luck, and that Americans should
give back to a country that had given them so much opportunity.
My parents' personal example led me to law school and
subsequently into 15 years as a government attorney, serving in
all three branches of government. The highlight of my public
service, however, was spent right here in the U.S. Senate, when
I was incredibly fortunate to spend 4 years as Chief Counsel to
then-
Senator Joe Biden on the Judiciary Committee. I joined Senator
Biden's staff 1 week before the September 11th terrorist
attacks on our Nation, and I witnessed first-hand the strength,
resolve, and resilience of this great body and its members
during those challenging days. It is now humbling for me to be
seated on the ``other side'' of the committee dais in a Senate
hearing room, after I logged hundreds of hours on the back
bench of Dirksen 226, just down the hallway.
Having spent 4 years working on the Judiciary Committee,
including with now Finance Committee members Senator Cantwell,
Senator Grassley, Senator Cornyn, and former Senator Hatch, I
have enormous respect for the significant work of this
committee in ensuring that the people's work is done.
I learned so much about the law and public service from
then-Senator Biden and was privileged to work with him on
important bipartisan legislation to protect vulnerable victims,
whether of domestic violence, corporate fraud, or terrorism. I
believe that experience, including seeing up close Congress
enacting laws that are then carried out by the executive
branch, was incredibly helpful when I was later honored to
serve as the United States Attorney in the Eastern District of
Virginia.
As U.S. Attorney, I partnered frequently with Treasury's
enforcement offices to tackle banking and financial crimes, and
worked closely with FinCEN, OFAC, SIGTARP and IRS CID, and I
know first-hand the importance of their missions. Treasury's
responsibilities cover a range of issues that generate no
shortage of complex, difficult legal questions. The Department
has a crucial role to play in promoting a more fair and
equitable economy, in maintaining an effective tax system, in
bolstering our national security, and in ensuring the continued
dynamism of the U.S. economy.
If confirmed, my job as General Counsel will be, as
Congress directed in its authorizing legislation, to be ``the
chief law officer of the Department.'' My role will not be to
make policy or to oversee enforcement actions but to, as the
regulations provide, to provide legal advice to Secretary
Yellen and other component heads, to manage Treasury's
litigation positions, and to ensure that the Department's
regulatory actions comply with the laws Congress enacts.
I would be very fortunate to work alongside the
Department's dedicated, experienced, and immensely talented
Legal Division lawyers and staff. And if confirmed, most
importantly, I look forward to working closely with Congress,
and especially members of this committee. I have enormous
respect for this institution, and I am personally committed to
maintaining a close working relationship between Treasury and
this committee.
Thank you again, Mr. Chairman and Ranking Member Crapo, for
the opportunity to appear before the committee, and I look
forward to answering your questions.
[The prepared statement of Mr. MacBride appears in the
appendix.]
The Chairman. Thank you both.
There are some obligatory questions we have to ask each of
the nominees after they have given their opening statements. I
think you both have been apprised of that.
So, is there anything you are aware of in your background
that might present a conflict of interest with the duties of
the office to which you have been nominated? Ms. Grimm?
Ms. Grimm. No.
The Chairman. Mr. MacBride?
Mr. MacBride. No, Senator.
The Chairman. Second, do you know of any reason, personal
or otherwise, that would in any way prevent you from fully and
honorably discharging the responsibilities of the office to
which you have been nominated? Ms. Grimm?
Ms. Grimm. No, Mr. Chairman.
The Chairman. Mr. MacBride?
Mr. MacBride. No, Senator.
The Chairman. Third, do you agree, without reservation, to
respond to any reasonable summons to appear and testify before
any duly constituted committee of the Congress if you are
confirmed? Ms. Grimm?
Ms. Grimm. Yes, Senator.
The Chairman. Mr. MacBride?
Mr. MacBride. Yes, I do, Senator.
The Chairman. Finally, do you commit to provide a prompt
response in writing to any questions addressed to you by any
Senator of the committee?
Ms. Grimm. Yes, Senator.
Mr. MacBride. Yes, I do.
The Chairman. Very good. I thank you both. We will now go
to rounds of questions. We have a fair number of members
coming, so we will try to address a lot of concerns in a
relatively short period of time. I am going to start with you,
Ms. Grimm.
Given the devastating consequences of the pandemic on
mental health in America, mental health claims have gone
through the stratosphere. Just as we recognized 9/11 a few days
ago, I had an event with veterans' groups who reported
tremendous increases in the demand for mental health services.
And the CDC said adults were almost twice as likely to report a
mental health or substance abuse issue during the pandemic
compared to pre-pandemic levels. And I find, based on meetings
that I have been having with high school students across
Oregon, that is the same pattern with high school students.
So, the question for you, as a potential public official in
this key position, is what to do when patients are facing
hurdles like prior authorization, or narrow provider networks,
when they are seeking behavioral help?
And my concern--and I saw this years ago, and I have
followed this. My brother was schizophrenic, and for years we
went to bed at night worrying he might hurt himself or somebody
else. And when the parity law came into being, we said, ``What
a great moment for Jeff Wyden and everyone else who faces these
mental health challenges.''
And I am concerned that big insurance companies are
honoring the parity law more in the breach than in the
observance. And they have some clever strategies. They seem to
be taking a long time to pay any bills. They seem to have fewer
staff. And when you add it all up, these changes in their
administrative policies, it really denies patients who need
these services.
So, if confirmed, would your office undertake analyses to
examine behavioral health-care, particularly mental health
needs, and identify inequities in how those claims are being
handled--particularly between mental health claims and physical
health claims? Would you take that on and make it a priority?
Ms. Grimm. Thank you, Chairman Wyden. The topic of
behavioral health and mental health, and access to those
services, is a priority for my organization. Yesterday we
released two reports looking at the use of telehealth to access
behavioral health services.
We looked at it across 37 states, Medicaid Managed Care, to
see how much those services were being accessed, if programs
keep track of them, and obstacles to telehealth in accessing
behavioral health services.
I am definitely committed to looking at issues related to
health, which includes mental health. We know from----
The Chairman. And the parity law, specifically.
Ms. Grimm. We do not have work that I am aware of currently
looking at equity between mental health and regular health. And
we are happy to come up and talk to you about your interest in
this area. I want to underscore our commitment to looking at
behavioral health issues, and that is really covered in the
report.
The Chairman. Let me move on. I would like, in writing, the
commitment that outlines what you would do with respect to the
parity law that says mental health is treated like physical
health, and particularly how you would investigate these
dodges--like the companies being slow to pay mental health
bills, not having adequate staff to process them, and basically
using all of the implementation dodges to essentially get
around the commitment to parity.
So I would like you to give me that in writing, let us say
within 48 hours--your commitment on that.
Ms. Grimm. Absolutely, Senator.
The Chairman. All right.
And now on the telehealth issue, tell us also in writing
how you would ensure access to the telehealth services while
not creating a path to some of the fraudsters that we are
hearing about. And my sense is that you have probably done some
work on that. So I would like both of those in writing within
the next 48 hours. Okay?
Ms. Grimm. Okay.
The Chairman. Very good.
One other question for you. We are very troubled by the
pandemic's impact on nursing home residents, particularly
residents of color. If confirmed as Inspector General of HHS,
how will you build on HHS IG efforts related to COVID-19 in
nursing homes and the disproportionate impact on nursing home
residents of color?
Ms. Grimm. Senator, nursing homes, and the toll that the
pandemic has taken on nursing home residents, is tragic. And we
have identified improving nursing home care as a top priority.
And the number one issue that I plan to tackle as a leader is
the data that shows disparities in nursing homes. One of our
reports found that, of beneficiaries who either had COVID or
likely had COVID, 50 percent were from populations of color, as
compared to 41 percent of white residents. And we see similar
results with outcomes.
We owe our Nation's aging population better, and I plan to
tackle a strategy that includes looking at performance at
nursing homes, putting residents first, and better oversight
from the Federal and State perspective, as a top priority of
mine, Senator.
The Chairman. Let me finish with you, Mr. MacBride,
quickly. As I indicated to you when you came to visit in the
office, we did not have a particularly constructive
relationship with your predecessors. We need a more open and
accountable one for both sides, Democrats and Republicans, to
get the information we need.
Are you going to do that?
Mr. MacBride. Thank you, Mr. Chairman, and thank you for
your time in our earlier meeting. I feel very strongly about
the institutional importance of Congress and its oversight
role. I saw that firsthand 20 years ago on the Judiciary
Committee, and I believe agencies work best when they are in
collaboration and partnership with their authorizing
committees.
I know this is a priority to you, and therefore it will be
a high priority to me. I want to look into it, if I am so
fortunate to be confirmed, to understand from you and from my
future colleagues, as I am not in the building yet, what past
practice has been, what the issues have been, and how to get a
process that is transparent and predictable and gets the
information this committee needs as quickly and efficiently as
possible.
The Chairman. The past practice has been to be
unresponsive, and we need you to be responsive.
Let me do one other question really quickly. I am over my
time. One thing that has been particularly important for
Congress is reports required to be made by the institutions
under the Bank Secrecy Act.
For 20 years, these documents have been physically produced
to Congress and committee chairs for the purposes of doing
critical oversight. Can you assure us that this critical
oversight relationship between Congress and Treasury will
continue under your watch?
Mr. MacBride. Yes, Mr. Chairman, it will. I am not familiar
with the history of the particulars, but I pledge to look into
that as soon as I can, as this process moves forward, and
ensure that it continues.
The Chairman. It is 20 years of history.
Senator Crapo?
Senator Crapo. Thank you, Mr. Chairman.
Ms. Grimm, I will start with you also. Last November the
Department of Health and Human Services and the OIG issued the
rebate rule, which would modify the Anti-Kickback Statute's
safe harbors for Medicare Part B plans and drug manufacturers.
While reports indicate the Department is currently
reviewing the regulation, I have heard from stakeholders across
the health-care system with concerns over uncertainty around
the rule's implementation, as discussions regarding next year's
bid submissions are already underway.
Can you tell me when, if at all, does your office currently
expect the rebate rule to go into effect?
Ms. Grimm. Senator, unfortunately, because of ongoing
litigation, I cannot speak to the rebate rule.
Senator Crapo. I assume then you cannot tell me if there
have been internal documents or deliberations over its
implementation?
Ms. Grimm. Senator, unfortunately I cannot.
Senator Crapo. All right; thank you.
Mr. MacBride, the debt limit could be breached by as early
as sometime in October unless the Democrats in Congress use
tools they have available for them to increase the limit.
Nearing the breach, we know from subpoenaed information from
Treasury and the Federal Reserve that both agencies set up
plans for prioritizing payments. And we know that those plans
involve sharing of information between Treasury and the Fed and
private-sector financial firms.
While I am not going to opine on prioritization, I will ask
you whether you believe that Treasury should provide to this
committee, which is Treasury's authorizing committee, plans
that it is making with the Fed and sharing with Wall Street
firms? And if you do not think so, please explain why.
Mr. MacBride. Thank you, Ranking Member Crapo, and thank
you for your time and courtesy in meeting with me earlier this
summer. I know that this is obviously a very important issue
that Congress and the Department are focused on.
I am not familiar with some of the particulars that you
mentioned, since I am not yet in the building, but I pledge to
you--should I be so fortunate to be confirmed--to dig into this
immediately and come back and have further discussion with you
about the issue and how we can get the appropriate information
to this committee.
Senator Crapo. All right; thank you. And at Treasury, and
if confirmed, you will also have a large role in tax policy and
financial stability through FSOC. Do you believe that financial
stability regulation is important in maintaining stability of
our global banking system?
Mr. MacBride. Yes. Yes, I do.
Senator Crapo. I thought you would. Do you agree that we
should not be in the business of taxing activities that are
required by a regulatory mandate?
Mr. MacBride. So, Ranking Member Crapo, I am not sure if
there is a particular example you have in mind. I certainly
agree that the role of FSOC has been set up in the Dodd-Frank
authorizing legislation, and it is clear. I know that it is--
from press reports, I am aware that FSOC is currently engaged
in various review activity. What I can say is that, should I be
fortunate enough to move forward with this process and get in
the building, I can be briefed more on this issue and would
welcome the chance to continue this discussion.
Senator Crapo. All right; we will take you up on that.
Because I think it really would be a more productive discussion
once you are in the building and have been briefed up. These
are issues that are brewing right now.
One last question for you, Mr. MacBride. Are you familiar
with Operation Choke Point? Do you know what I mean when I say
that?
Mr. MacBride. Yes, I am familiar with it from press
reports, Ranking Member Crapo.
Senator Crapo. Well, Operation Choke Point was a program
that was started under the Obama administration--and finally, I
think we have got it stopped. But it took us awhile and several
years and several administrations to get that done.
It was a program that essentially was using regulatory
authority to identify legal businesses that are engaged in
legal activities but which are politically incorrect in the
minds of some, and it ranged to everything from the firearms
industry to the oil and gas industry to, I do not know why,
stamp collectors and several dozen industries. And it subjected
them to, frankly, inappropriate regulatory pressures.
And really the effort was, as I see it, the effort was to
try to make it so that these businesses would have a much
harder time getting the regulatory approvals in the financial
sector and elsewhere that they were entitled to as law-abiding
companies, and to utilize the regulatory burden as a way to
depress these industries.
We have that stopped now. My question to you is, what
assurances can you give businesses engaged in legal activities
that they will not be subjected to unfair, politically
motivated investigations?
Mr. MacBride. Thank you, Ranking Member Crapo. I am not
familiar with the particulars of Choke Point and how that has
been resolved. What I can say is, my general view is that what
you described, you know, sounds unusual to me, in the sense
that I think that is something that would have to be looked at
very carefully.
I am not aware, from press reports--and since I am not in
the building--of anything comparable that is in flight, but I
would want to sit with you, should this process move forward,
to have a deeper understanding of what happened in the past,
whether you have current or ongoing concerns. And I would look
forward to that discussion.
Senator Crapo. I appreciate it. My time is up, but this was
a situation in which lawful businesses were unable to get
banked, for example, because the banks were worried that they
were going to get undue political and regulatory pressure from
their regulators if they took them on as clients--things like
that. And I would be glad to have a further discussion with you
once you get in place--and I am confident that you will--and as
we move forward.
Mr. MacBride. Thank you, Senator.
Senator Crapo. Thank you.
Senator Grassley. I guess it is my turn now.
Congratulations to both of you. I work with so many Inspectors
General, so I spend a lot of time on who is going to be an
Inspector General. I probably have worked with hundreds of them
over the years I have been in the Senate. I have only, I think,
had to lead the way to get four or five of them fired. Twenty
years ago, one of them was your predecessor in HHS.
On July 27th, I gave a speech in regard to the EcoHealth
investigation, and I said things along this line: ``I expect
the Inspector General to be aggressive and unrelenting to get
the records, the emails, the memos, run the transcribed
interviews, and question everyone up the leadership chain.
Leave no stone unturned. If punches are pulled, the audit will
be a waste of everybody's time and taxpayers' money. The
Inspector General has a tremendous responsibility to get this
done right away.''
So in regard to that--the National Institutes of Health and
EcoHealth complying with Federal requirements with respect to
the coronavirus grants--does your investigation's scope include
a determination as to what research was actually done under the
subgrants that EcoHealth got, and the Wuhan Institute of
Virology, and whether it was gain of function research? Is that
part of your investigation?
Ms. Grimm. Senator Grassley, I thank you for your very
strong support of the Inspectors General over decades. You are
describing grants oversight work. NIH must manage and
administer Federal awards to ensure that funding is expended
and associated programs are implemented in full accordance with
statutory and policy requirements.
We are conducting a grant oversight review of EcoHealth
Alliance, as you referenced your strong desire to make sure we
are getting our records. I can tell you that, to date we are
getting cooperation with the records that we have requested
from NIH, from EcoHealth.
Our work aims to take a look at whether the rules for
grants are being followed. As part of that, we are looking at
whether gain of function--which should not be happening--
whether the rules are being followed from a compliance audit
perspective. I will tell you that the scope of this work does
not include identifying the source of the coronavirus.
We are in coordination and in frequent discussion with GAO,
which is doing a deeper dive into some of these issues. So both
from the executive branch and legislative branch, we are
talking to our partners. But those are the contours of the
EcoHealth review that we have ongoing, sir.
Senator Grassley. I think you answered this question, so I
think you are telling me that your audit does include a review
of all relevant communications between the National Institutes
of Health and EcoHealth? I think you said that.
Ms. Grimm. Senator, to the extent that that involves
oversight of grants--and I mentioned oversight of that grant
and the EcoHealth Alliance grant--in my view that would include
communications.
Senator Grassley. Okay. With respect to any documents and
record requests that have been made, have the National
Institutes of Health complied fully? I think you have answered
that, that they are complying fully.
Ms. Grimm. Yes, Senator, to date.
Senator Grassley. At this point, have you determined the
amount of taxpayers' money sent to EcoHealth for coronavirus
research in China? If so, how much?
Ms. Grimm. Senator, I do not have those figures in front of
me, but we can get back to you with the dollar amounts that we
have so far.
Senator Grassley. Okay; you can answer that question in
writing.
Why did you decide to perform an audit instead of an
investigation?
Ms. Grimm. Senator, the process, when something is referred
to us, includes a broad review across all of our disciplines.
So once a week, we meet and talk about possible work that we
might undertake. After those meetings, as the deputy for
investigations--we take a look at it from a broad scope that
would include looking at it from an investigative lens. And I,
of course, would not be able to confirm or deny an ongoing
investigation.
Senator Grassley. Thank you.
Senator Wyden's staff said I should recognize Senator
Lankford.
Senator Lankford. Thank you.
Senator Grassley. And thank you for answering.
Senator Lankford. Thank you both for the ongoing work. I do
have multiple questions here, and so I want to be able to try
to get through them as quickly as I can on this.
Ms. Grimm, HHS coordinated with the Department of Justice
to dismiss a lawsuit against the University of Vermont Medical
Center for knowingly, willfully, and repeatedly violating the
Church Amendment, which is a Federal conscience law. And that
was a case that was already going through the process. We are
trying to be able to figure out why that case suddenly got
dropped.
It was interesting, on the Church Amendment side of it,
that now HHS has determined they are going to enforce the
Church Amendment in Texas on abortion providers there but have
dropped it in Vermont where a nurse given a conscience
protection there--historically given a conscience protection--
had it suddenly taken away.
Are you aware of that situation with the inequality of the
application of the Church Amendment, and of why HHS would drop
that case suddenly?
Ms. Grimm. I am not familiar with that.
Senator Lankford. It is a legal matter, and it is a serious
matter. I wish you would get a chance to be able to take a look
at that on just the equal application of the law for HHS.
Ms. Grimm. We would be happy to come up and talk to you
about your interest in that matter.
Senator Lankford. Xavier Becerra also mentioned during his
confirmation hearings that he would recuse himself from any
case that he was also involved in as the Attorney General in
California. It was not long after he came to HHS that suddenly
the cases dealing with California and some of the conscience
protection issues there under the Weldon Amendment were
suddenly dropped.
Do you know of any situation there suddenly where
California cases suddenly got dropped from HHS shortly after
the Secretary became confirmed?
Ms. Grimm. I am not aware of cases that fit that
description.
Senator Lankford. That would be one we could certainly walk
you through. There are some obvious questions that are there,
that we think need to be addressed, and it is one of those
cases that we look at and go, that seems odd, to say the least
on it.
It also does not allow the people of California to continue
to have conscience protections there, as they do in other parts
of the country.
Of late, there is a division within HHS called the
Conscience and Religious Freedom Division. I am sure you are
aware of that. We are hearing that HHS is looking to dissolve
that division. Do you know the status of that division, whether
it is being dissolved or what structural changes are being
proposed for the Conscience and Religious Freedom Division?
Ms. Grimm. I do not have any specifics on the dissolution
of that office, or what is happening.
Senator Lankford. That will be one that we will want to be
able to follow up with you on, to be able to find out what is
actually happening there. Because there are obviously a lot of
questions and a lot of concerns about what actually happens
there, and what political appointees may or may not do to be
able to deal with some issues that are legal issues. There is,
as you know, a whole series of legal protections for conscience
protections that have been in law for decades and decades that
this division was created to be able to make sure that those
were actually enforced.
If suddenly that goes away, there is an obvious question as
to whether those are no longer going to be enforced at HHS.
Ms. Grimm. Senator, I think it would make sense for us to
come up and talk to you about your concerns in this area.
Senator Lankford. Okay. Let's plan to be able to do that.
Mr. MacBride, let me ask you some questions. Over the last
several months, we have all seen the articles from the
ProPublica organization on some obvious leaks that are coming
out of the IRS that are attributed to be filings from quote/
unquote ``wealthy Americans.''
There have been a lot of questions on where that
information came from. There is also a legal issue there as
well, that it is a felony to release private tax records. It is
also a felony to be able to publish known tax records.
ProPublica has announced that they are very aware that
these are tax records, and they are publishing them anyway for
the public good, which is clearly a felony to do that, and it
is also an issue if someone has released these documents as
well.
Are you tracking that? Is that a course of investigation
that you would be engaged in? What is your consideration on
that?
Mr. MacBride. Thank you, Senator Lankford. So I am aware
generally of the issue that you have raised, from press
reports. I am not in the Treasury building yet. But I agree
with you that the unauthorized release of confidential or
proprietary government information is unlawful. My
understanding, mainly from press reports, is that there are
multiple investigations ongoing with the Inspector General's
office at Treasury, and I believe with the U.S. Attorney's
Office in the District of Columbia.
If I am so fortunate to be confirmed, I would want to get
read in on this issue and understand what happened, and how to
make sure that it is brought to a swift conclusion and does not
happen again.
Senator Lankford. It seems to be something that achieves a
political end, and some people are saying, ``It is wealthy
people and I do not care; we can release their tax records.''
It is illegal, regardless of who it is. I do not care if it
is you, or if it is me, or if it is Senator Whitehouse, or any
of my 4 million constituents in my State, or whoever it may be,
it is not legal to be able to release tax records, and people
should know that the IRS is a closed system, and that there are
individuals within the IRS who have their political agenda
trying to be able to release those documents--and that it is a
felony and does need to be enforced to regain the confidence of
the American people in the days ahead.
So, we would be eager for you to actually apply the law and
to be able to do a thorough investigation to be able to find
out what is actually happening there, because the American
people, when they file their tax records, should have some
level of confidence that they are going to be kept confidential
in that process.
So thank you both. I now have the great joy of recognizing,
as we are passing the football back and forth, Senator
Whitehouse for the next questions.
Senator Whitehouse. Thank you, Senator Lankford.
Mr. MacBride, welcome. We have gone through considerable
effort to pass what we call beneficial ownership legislation
which allows the Treasury Department, FinCEN specifically, to
understand who the real beneficial owner is, who is really
behind American shell corporations--because there were
appalling stories of foreigners and criminals using American
shell corporations to hide misbehavior.
That effort is now at the Treasury Department for the
regulations that will implement what we are doing. We fought
through considerable opposition to all of this because, sadly,
there are professionals and people who make a lot of money
servicing this illicit, dark, international, corrupt economy.
And they do not want the spotlight shone on themselves and
their clients.
I worry that they will be hard at work in the regulatory
process to try to have you and the Department of Justice have
the most weak-kneed possible regulations regarding enforcement.
Could you assure me, particularly as the former DOJ prosecutor,
that you understand the importance of this and will see to it
that congressional intent gets followed in putting out strong,
clear, enforceable regulations that enable us to take on this
menace?
Mr. MacBride. Thank you, Senator Whitehouse, for the
question, and thank you for meeting with me earlier this
summer. The short answer is ``yes.'' I want to acknowledge your
active role here and your leadership, along with a number of
members of this committee, who are----
Senator Whitehouse. Senator Crapo is perhaps the major lead
on all of this in his role on Banking, with Senator Brown.
Mr. MacBride. Yes. And as we talked about in your office,
Senator, this is a law that I really could have used when I was
at the Justice Department, and that will have broad
application, from white collar cases to organized crime cases
to international terrorism cases. And not just in the criminal
context, but in civil asset forfeiture cases.
It is an age-old problem of not being able to follow the
money and to follow the ownership.
Senator Whitehouse. Let me jump in to add that I see this
as a national security issue. I think that most of the evil
that has befallen the country in the last 20, 30 years has come
from non-rule-of-law entities where autocrats and kleptocrats
and criminals are able to run and steal from countries.
The problem with being one of those crooked people is that
you have to find a place to hide your money. And they want to
hide their money behind the shelter of rule-of-law nations. And
when we aid and abet them in doing that, we are really giving
aid and comfort to very significant enemies of America.
There is a kleptocracy and anti-kleptocracy summit coming
up. I think they call it The Democracy Summit. I hope you will
push hard to make sure that we are forceful at expanding the
spotlight that we brought on our own shell companies so that
there is an international agreement that we are simply not
going to tolerate this kind of misbehavior any longer. And if
countries want to participate in international trade and in
international commerce, they cannot be the custodians of
international criminals' accounts.
Mr. MacBride. I fully agree with that, Senator. I would
simply add, when I was U.S. Attorney, we did a number of
extraterritorial cases in my old district, and I saw there was
a direct proportion of extraterritorial threats emanating from
countries that you described where there is not a traditional
rule of law, or where kleptocracies operate.
Senator Whitehouse. Last, I want to point you at the
501(c)(3), 501(c)(4) problem of hidden political dark money.
When the Citizens United decision allowed unlimited money, they
said it was going to be transparent. But of course, the big
forces do not want the money to be transparent, so they ran off
to 501(c)(3)s and 501(c)(4)s, and they started spending
enormous amounts of political money hidden through those
enterprises.
And when the IRS tried to push back, those forces blew
everything up. They referred IRS employees for criminal
prosecution. They repeatedly threatened the IRS Commissioner
with impeachment. They flooded the right-wing media with faux
outrage, and sadly the Obama administration wilted in front of
that pressure, and we still have 501(c)(3)s and we still have
501(c)(4)s operating politically, in plain violation of
Congress's intent and the words of the statute that set them
up.
Moreover, when they file, they seem to be making false
statements. They say to the IRS, ``We did not spend a single
dollar on political work.'' And then they go to the Federal
Election Commission or a State election commission and say,
``Oh, we spent $70 million on political ads.''
To me, that is at least predication for a false-statement
case, because both are under oath, and it is hard to imagine
how both can be true. And yet, the DOJ has always refused to
prosecute those plain bread-and-butter false-statement cases,
because the IRS has never bothered to refer them.
I hope you will take a second look at this policy. It makes
no sense from DOJ's perspective. I do not think they should
wait for those referrals when it is something as plain as the
false statement, as bread-and-butter as that.
But we have gotten into a situation now where neither DOJ
nor IRS-Treasury is playing by the rules. And as a result,
there is this huge gap in which false statements, dark money,
and what I believe is, at the end of the day, illegal spending
continues to occur.
Would you promise me you will take a look at that?
Mr. MacBride. Yes, Senator, I will. I thank you for the
question. I know you are a leader on these issues. I know you
have talked with Secretary Yellen about them, and she is
committed to looking into them. And if I am so fortunate to be
confirmed, I would look forward to working on this issue with
you further.
Senator Whitehouse. Thank you, Mr. MacBride. My time has
expired, and I turn the podium over--I hear that Senator Young
is online. So we will go back and forth, and then Senator
Warren.
Is Senator Young on the line, and can people----
Senator Young. I am, indeed. Thank you, Senator Whitehouse.
Mr. MacBride, early in its term the Biden administration
announced it would be reviewing all U.S. sanction programs. We
understand Deputy Secretary Wally Adeyomo is currently
conducting this top-to-bottom review and has completed several
roundtables and other consultations.
While we await the results of this review, I would like to
hear more about your perspective on sanctions, and what counsel
you would provide the Treasury, if confirmed. Specifically,
sir, what is your view on the legal standard necessary to
confirm serious human rights abuses in the context of our
sanctions program?
Mr. MacBride. Thank you, Senator Young, for that question.
And I want to say first, I agree fully with you that U.S.
sanctions play an incredibly important role in protecting our
national security and are part of our foreign policy.
When I was U.S. Attorney in Virginia, I partnered with
OFAC, and we worked collaboratively to target drug cartels and
money launderers and other common targets between the Treasury
Department and the Justice Department. And so that is where I
start from.
Senator Young. Can we dive--because my time is limited--
into either a multifactor standard you have, or some other
legal standard that you would draw upon, should you be
confirmed, sir?
Mr. MacBride. So, the specific issue, Senator Young, that
you raised in terms of the human rights side, that is an issue
that I would want to be briefed on. I am not in the building
yet, so I would like to dig into that, if this process moves
forward, and I would very much like the ability to come back
and talk with you once I am up to speed.
Senator Young. Okay. If you have any follow-on writing
about that, that would be important as I consider your
confirmation. Thank you.
What is your view on the legal standard necessary to
confirm corruption of foreign government officials in the
context of our sanctions program?
Mr. MacBride. So, Senator Young, my understanding is that
OFAC has broad discretion--after its internal fact-finding--to
make findings about corrupt government officials, and it has
done so in a number of countries.
I understand it is a fact-specific issue. I would want to,
if I am confirmed, understand more of the legal issues that
they consider, but my general view is that they have great
discretion in being able to move forward.
Senator Young. Okay. Let's set aside legal standards for a
moment and discuss your view on global Magnitsky sanctions
implementation and enforcement.
Mr. MacBride. Senator Young, I believe that also--my
understanding, mostly from press reports, is that is something
that Treasury is looking into to conduct a review of its use,
and if it can be used in other contexts. So again, it is not an
issue that I am currently familiar with, but I will commit to
looking at it and discussing this further with you.
Senator Young. In your view, does Treasury have the
resources and authorities necessary to target serious human
rights' abuses and corruption with sanctions?
Mr. MacBride. To my knowledge, Senator, they do. I am not
familiar with whether there have been offline discussions
between Treasury and the Congress about the need for additional
authorities. If there are, I would obviously support those.
Senator Young. Okay.
In June, the Biden administration issued Executive Order
14032 to ensure that the U.S. markets are not used to fund the
Chinese military industrial complex. It is a welcome step that
builds upon President Trump's executive order protecting vital
national security interests and holding China accountable.
Looking forward, I welcome further details about the
criteria that Treasury will use to identify companies that are
part of this Chinese military industrial complex.
Mr. MacBride, if confirmed, what are the standards you
would advise for determining whether a company has operated in
the defense or surveillance tech sectors of the Chinese
economy?
Mr. MacBride. Senator, I agree with you fully about the
strategic threat that China poses to our country, to our
national security, to our economy. I saw that firsthand in the
work I did at the Justice Department.
I would look forward to, if confirmed, digging into that
executive order. I am generally familiar with it, but have not
had occasion to work on it or be briefed by my future
colleagues, but I would commit to do so and come back to you
for a more fulsome discussion.
Senator Young. I see that my time has expired. If you have
any further written correspondence as it relates to these
questions, I will welcome it. Thank you.
Mr. MacBride. Thank you, Senator.
Senator Warren. And I think that means that I am up next.
I want to have a chance to talk about the revolving door.
One of our nominees today, Mr. MacBride, has been in and out of
government multiple times. And just to give a partial list,
since his last turn through the revolving door, Mr. MacBride
has sued Treasury to overturn a fine on ExxonMobil for
violating sanctions on Russia; defended S&P in ratings fraud
cases; defended Cisco Systems over a, quote, ``vast kickback
corruption scheme,'' end quote; defended AstraZeneca against
terrorism financing charges; and done all sorts of legal work
for Wells Fargo, J.P. Morgan, and Facebook, in just the past
year.
Now, I do not think that private-sector work is
disqualifying, but with this record, the public might wonder
each time he passes through the revolving door whether he is
actually working for the public, or if he is thinking about his
next high-paying client, or his past high-paying clients.
So let me do this, Mr. MacBride. I want to secure some
commitments from you that you will at least reduce the speed of
the revolving door. So, Mr. MacBride, will you commit to recuse
yourself from working on any matters related to your former
clients, including ExxonMobil, Wells Fargo, Morgan Stanley,
AstraZeneca, and others, for 4 years, if you are confirmed? Can
you commit to that?
Mr. MacBride. Thank you, Senator Warren, for the question.
Thank you for meeting with me earlier.
I know you are a leader in this area, and these are issues
of enormous concern to you: the revolving door, and not just
the reality but the perception of fairness and impartiality and
doing the people's work, and I fully agree with that first
principle.
This would be my sixth opportunity to work for the American
people, should this process go forward. I have spent 15 years
previously working as a government attorney. I have always
taken these issues extremely seriously----
Senator Warren. Mr. MacBride, my time is limited here. I
asked you just a very simple question. Will you agree to a 4-
year period in which you will not be involved in decisions
involving people you have been representing up to and including
the past few weeks?
Mr. MacBride. Senator Warren, I am fully committed to the
Biden ethics pledge. It is the toughest pledge----
Senator Warren. So is that a ``no''?
Mr. MacBride. I am in full compliance with the Biden ethics
pledge, and its enhanced recusals with respect to former
clients and employers.
Senator Warren. What I am asking is not what it is that you
have already been asked to do by the Biden administration,
which I understand is 2 years. I am asking for a commitment of
4 years. That is a good start, what you have already got, but I
take it you are saying ``no'' to a 4-year commitment?
Mr. MacBride. Senator, I enjoyed the opportunity to talk
with you previously and wanted to know your views. I would like
to know----
Senator Warren. That's right. That means you have now had
2\1/2\ months to think about this since we spoke.
Mr. MacBride. Yes, and I welcome the opportunity to
continue----
Senator Warren. And you know that other administration
officials, including Defense Secretary Lloyd Austin, were
willing to commit to 4 years of recusals, not making decisions
that directly affect the people that you have been taking money
from up to this point. And I take it you are saying, no, you
will not agree to do that for a 4-year period. Is that right?
Mr. MacBride. Senator, I am happy to continue this
conversation----
Senator Warren. I do not want to continue the conversation.
I want a ``yes'' or ``no.'' We are going to have to vote on
this. And I am taking it, because you will not say ``yes,''
that your answer is ``no,'' and you are trying to dance around
like I am not going to notice.
So let me ask you another question. Let's ask, on the other
side of the revolving door, Mr. MacBride, can you pledge not to
seek employment with or be compensated by any company that you
interact with during your time in government for 4 years after
you leave government service? Just slow down that revolving
door a little bit?
Mr. MacBride. Senator, the Biden ethics pledge has a number
of very specific----
Senator Warren. I am not asking you about what other
pledges you have taken. I am asking you if will you make a
commitment that after you leave government service, for 4 years
you will at least not work for the specific people for whom you
are making decisions while you are in government service.
Mr. MacBride. Senator, I take these issues very seriously.
I have----
Senator Warren. How about taking them seriously enough to
agree that you will not do this? That is what I am asking for,
so that the American people can have confidence that, while you
are in your government official role, that you are not thinking
about the people you have already taken money from and will be
taking money from as soon as you leave government service. That
is what I am asking for. Can I have that commitment?
Mr. MacBride. Senator, I believe I have conducted all of
my----
Senator Warren. I think that is a ``no.'' Whether it is
Democrats or Republicans, the revolving door between government
officials and industries they regulate undermines confidence in
government officials and whether they are working for
themselves or working for the American people. That is why I
have introduced legislation that would strengthen ethics and
conflict of interest rules, and that would lock this revolving
door for good.
I am tired of waiting on this. We need to change the way
that Washington does business, and we need to change it now.
So, with that, I think we are ready to--oh, we are going to
Senator Cortez Masto.
Senator Cortez Masto. Thank you. And to the nominees,
congratulations on your nominations.
Let me start with Ms. Grimm. First of all, let me thank you
for the incredible work that you are doing within the
Department of Health and Human Services. I know the goal for
the Office of the Inspector General is to fight fraud, abuse,
and waste in Medicare and Medicaid and HHS programs.
I also know, coming from Nevada, that the pandemic has
posed challenges for all industries and continues to do so, and
fraud has not been exempt from that. We have heard in
conversations that fraud is associated with public health
emergency spending, and the COVID-19 pandemic in general is an
issue that I know your office is investigating.
So, Ms. Grimm, my question is, how will OIG rise to address
these new fraud concerns? And what should Congress be
considering as we work to build better, more robust Federal
programs?
Ms. Grimm. Thank you for your question, Senator. Just this
last week, we had a fraud takedown that included a variety of
COVID schemes. We have seen, unfortunately, the best and the
worst of humanity during the COVID crisis. The fraud cases have
evolved. Initially, they were offering fake cleaning kits to
fake vaccines to now fake cards.
We are working aggressively with our law enforcement
partners to combat these pernicious fraud schemes that have
taken advantage of the crisis and vulnerable people. You had
asked what--I'm sorry, could you repeat the second part of your
question? I apologize.
Senator Cortez Masto. Yes. What should we be considering in
Congress? Obviously, you are at the forefront of addressing the
fraud, seeing the types of fraud. As we work to expand and
build more robust Federal programs, what should we be
considering as well? And let me just say this: to somebody who
has worked as an Attorney General for the State of Nevada, I
obviously know that any time Federal funds and support are
coming out, there is always fraud and abuse to some extent,
unfortunately.
So what should we be considering in Congress as well to
address the fraud, if there is anything we can do?
Ms. Grimm. Senator, I really appreciate that question, from
the perspective that thinking about public integrity up front
is always critical to better ensure that programs are working
the way that Congress intends, and that the American public
intends.
So, what Congress can do as it considers new legislation
and new programs is the importance of program integrity. I will
say--I do not want to get ahead of the President's budget--but
our resources have declined over time to be able to keep pace
with the increasing amounts coming to and through HHS. So, the
resources in the President's 2022 budget are very important to
us. But I do ask that, with new programs, program integrity be
considered. And we are working with the Pandemic Response
Accountability Committee, as new programs are being stood up at
HHS and across other departments, to sit down with those
running those programs to talk about the imperative of program
integrity, the controls that should exist, monitoring of data
so that you can detect aberrancies in some of the enforcement
tools that are absolutely critical.
Senator Cortez Masto. Thank you. I appreciate your
response.
Mr. MacBride, you mentioned in your opening remarks working
closely with the IRS in the past to tackle banking and
financial crimes. And we have discussed the issue of tax
enforcement in this committee recently, and the need to give
the IRS the tools to increase enforcement to close the tax gap.
President Biden has also been vocal in his support of
increasing the enforcement capabilities of the IRS. How will
you work with Treasury to address issues of tax enforcement and
the growing need for IRS to work more proactively in that area?
Mr. MacBride. Thank you, Senator, for that question. And as
you noted, I spent 4 years working on a number of significant
financial and bank fraud cases, partnering with Treasury
components including IRS-CID.
I am not yet in the building, but if I am confirmed, I
would want to be read up on the issues that you have mentioned.
I am aware from press reports, of course, of statistics about
underpayment of taxes, and the need for sufficient resources
for the IRS to make sure that folks just pay the taxes that are
due.
I am aware of the President's commitment, and Secretary
Yellen's commitment to make sure that there are resources in
place to execute the core mission. And so I would look forward,
if confirmed, to being part of that in the General Counsel's
office, to the extent we have a role, and would very much like
to hear further from you thoughts that you have about how
Treasury can be most effective in this important area.
Senator Cortez Masto. Thank you. I appreciate your view. I
know my time is up. I will submit the rest of my questions for
the record. Congratulations to all of you.
I believe Senator Toomey is next.
[The questions appear in the appendix.]
Senator Toomey. Thank you very much, Senator Cortez Masto.
Let me begin with Mr. MacBride. I just want to talk a
little bit about the Biden administration's agreement at the
OECD. And as you know, it consists of two pillars, as they are
described. The first is called the Market Jurisdiction Tax
Allocation, which for the first time in history that I know of
would be allowing other countries to tax the income of American
companies based on sales in other countries. That is Pillar
One.
Pillar Two is this Global Minimum Tax, which, by the way,
seems to be the priority of the administration. It is also the
conflicted confession that the big increase in the Global
Minimum Tax that the Biden administration wants to impose on
American multinationals puts us at a competitive disadvantage
if the rest of the world does not go along and, similarly,
punishes the multinational businesses, which is why it is such
a big priority. And the Secretary has made a big deal about the
agreement of most of the OECD countries.
Despite that importance that they implicitly acknowledge,
the rate of this Global Minimum Tax that the Biden
administration wants to impose is considerably higher than the
one that was negotiated with most OECD countries, and there are
some who are not going to do it at all. Having said all that,
the OECD wants to grab a piece of American tax revenue. It is a
tax shift from U.S. coffers to foreign government coffers, if
you ask me.
But my question for you, Mr. MacBride, is about
implementation. There is no question that Pillar One--there is
no question in my mind--would require superseding current
bilateral tax treaties. And as such, it will require a new
treaty, or at least a modification of an existing treaty. And
that requires a two-thirds vote in the Senate to ratify.
So my question, Mr. MacBride, is, do you share the view
that the implementation of Pillar One will require a treaty
vote in the Senate?
Mr. MacBride. Thank you, Senator Toomey. I appreciate the
question and know this is an important issue to you.
Unfortunately, it is one that I have not yet been read into. I
have seen some press reports at a very high level, but I have
not studied the treaties or authorities that you mentioned.
My view is that, as the chief legal officer for Treasury,
my job is to ensure that the Department carries out all its
activities in compliance with law generally, and obviously the
acts of Congress in particular. And so, if I am fortunate
enough as to move forward, I would want to immediately dig into
this issue to just get educated about it so that we could have
a further conversation.
Senator Toomey. Well, I would strongly encourage you to
look at this as soon as you possibly can. It is going to be
extremely important. I should point out, I am certainly not the
only one who has the view that this is a straightforward matter
that requires a treaty. PWC has written about this, saying
Pillar One and the passage of a treaty in the Senate, however,
may be more difficult. And they go on to discuss the
difficulties, clearly accepting the premise that Pillar One
requires a new treaty. And Deloitte, in their analysis, talks
about Pillar One. They refer to it as ``Amount A.'' That is
just their vernacular for this in this particular write-up. And
they say Amount A, the Pillar One market reallocation, will
require both a treaty-based response to permit market countries
to tax Amount A, and a local country response to impose tax on
Amount A. Ernst and Young similarly, in their writings, talk
about the likelihood of requiring a treaty ratification.
So nobody disputes that the Constitution assigns to the
Senate the responsibility to approve or reject treaties. That
is going to be an important part of this discussion going
forward.
And that pretty much consumes my time, Mr. Chairman, so I
will yield back the remainder.
The Chairman. Thank you for your courtesy, Senator Toomey.
We are at an end. I just want to do a brief recap so everybody
understands where we are.
I am going to need from you, Ms. Grimm, within 48 hours,
the two areas I talked about: what your strategy is for making
sure that our country is dealing with these policies that seem
to be breaching the commitment and the text of the black-letter
law to make sure that mental health gets treated like physical
health. We are going to need you to look at the billing
practices, because there is a lot of delaying and staff
patterns and the like, because I think when you add it all up
together, mental health does not get a fair shake. And that is
contrary to what the law says.
So we are going to want to see, within 48 hours, your plan
for doing that, and we talked about that.
And then I would like an extension of what we talked about
before. It sounds like you are doing important work with
respect to telehealth, and I want to see how you would make
sure that these services that were added continue to stay in
place, but we also have a path to deal with the fraudsters,
because we have seen that fraud. That from you within 48 hours.
Thank you.
Mr. MacBride, on this question I asked you about with
respect to bank secrecy, we have a 20-year history of
physically producing these documents. I am going to expect that
you are going to continue to stay with that 20-year tradition.
If you have some reason to do otherwise, you need to tell us
that very quickly as well. Okay?
All right. Thank you both. We appreciate your willingness
to serve.
One other bit of business regarding questions for the
record: the deadline for members to submit questions for the
record will be next Wednesday, September 29th, at 5 p.m. That
is a firm deadline, colleagues.
We thank all for their cooperation and appreciate the
patience of our guests, and the hearing is adjourned.
[Whereupon, at 11:35 a.m., the hearing was concluded.]
A P P E N D I X
Additional Material Submitted for the Record
----------
Prepared Statement of Hon. Mike Crapo, a U.S. Senator From Idaho
Today, we welcome two nominees to the committee: Mr. MacBride to be
General Counsel of the Treasury and Ms. Grimm to be Inspector General
of the Department of Health and Human Services. Congratulations on your
nominations.
I am interested in learning more about each of your perspectives
and reviewing your responses to questions for the record that our
members will submit after today's hearings. Let's start with Mr.
MacBride.
The General Counsel of the Treasury should be able to provide
nonpartisan legal and policy advice to the Secretary and other senior
Department officials. As head of the Treasury Legal Division, the
General Counsel is also responsible for all legal work in the
Department, with the exception of the legal work in the Office of the
Comptroller of the Currency and the Offices of the Inspectors General.
Your role as General Counsel, if confirmed, will be important to
the Secretary and the Treasury Department, given the health and
economic challenges currently facing our country, and it is imperative
that you take on this role with the best interests of the United
States, not the President or Senators sitting before you today or any
one political party.
Today, the United States is experiencing unprecedented economic
pressures on multiple fronts, including significant inflation and
record price increases, significant legislative and regulatory changes,
and international economic competition and threats. Yet Congress is
considering a $3.5-trillion tax-and-spending package that would change
the social fabric of our country. These changes would impose massive
tax hikes on America's small businesses and job creators, and expand
the role of the Internal Revenue Service to monitor the transactions of
Americans at every income level. Many Americans are justifiably
concerned.
Mr. MacBride, you would play a large role in the regulatory process
to implement this partisan $3.5-trillion package, if it were to pass.
You would also be closely involved in the ongoing international tax
negotiations occurring at the OECD. These matters will require
transparency and accountability. They will also require you to follow
the law and serve the best interests of our Nation, not a partisan
agenda, and that you keep Treasury's authorizing committee--the Finance
Committee--fully informed. To date, this administration and Treasury
Department have failed to be fully transparent and accountable to this
committee. I expect you to be transparent and responsive, if confirmed.
Turning to Ms. Grimm, if confirmed as Inspector General of HHS, you
will continue to serve as the chief watchdog over the Department of
Health and Human Services, one of the largest Federal agencies, whose
programs account for roughly $2.4 trillion in taxpayer dollars. It will
continue to be your responsibility to lead OIG's efforts to fight
waste, fraud, and abuse in some of our most important and far-reaching
Federal programs, including Medicare and Medicaid. Together, these
programs account for more than one-fifth of all Federal outlays and
serve some of our country's most vulnerable citizens.
It is imperative the HHS Inspector General avoid politicization and
maintain independence. HHS-OIG is the largest civilian Office of the
Inspector General across the entire Federal Government, with a
workforce of around 1,650 employees. Given the substantial size and
unparalleled purview of your office, I hope you will continue to serve
as a principled and nonpartisan steward of vital programs, initiatives,
and taxpayer dollars.
I look forward to working together to bolster program integrity, as
well as to continue adapting our fraud and abuse regulations and
oversight infrastructure to keep pace with cutting-edge technology and
health-care innovation.
______
Prepared Statement of Christi A. Grimm, Nominated to be Inspector
General, Department of Health and Human Services
Good morning, Chairman Wyden, Ranking Member Crapo, and members of
the committee. I thank Senator Warner for the gracious introduction and
Senator Kaine for his kind statement of support. I thank the President
for nominating me to serve as the Inspector General for the Department
of Health and Human Services. I am honored to appear before the Senate
Committee on Finance as it considers my nomination.
I believe that public service is a calling--a calling to which
generations of my family have responded through military and other
public service. I draw inspiration from my family's commitment to serve
this country and improve government. As a child growing up in
Edgewater, CO, I watched my grandfather, the head of the Public Works
Department, strive to improve the infrastructure of that small town. I
saw his pride when water could reach the homes of hardworking families,
when parks were well maintained, and when new roads and sidewalks
connected the community. I was proud of how he made our town better. It
is personally meaningful for me to continue this tradition of ensuring
that government works for the people it serves. I thank my family, each
and every one, for their inspiration. My husband Drew, a Federal law
enforcement agent, is with me today. Drew, thank you for being my
partner as we try to model public service for our 4-year-old daughter,
Hazel.
I also want to recognize the many mentors who have generously
shared their wisdom, support, and time during my career at HHS. These
mentors include Ellen Vinkey, Jodi Nudelman, Larry Goldberg, Giovanna
``Joanne'' Chiedi, and Daniel R. Levinson. I thank them for seeing and
cultivating my potential. I commit every day to do the same for future
leaders.
Inspectors General perform an essential public service. They root
out fraud, waste, and abuse and help make programs more efficient and
effective. It is critical to have Inspectors General who understand the
value of objective and independent oversight. Through independence,
objectivity, and transparency, Inspectors General help government
better serve the American people. A strong Inspector General makes a
stronger department and a stronger, more trusted Federal Government.
With more than 20 years of executive branch service and more than a
decade of holding top management and strategic positions within HHS-
OIG, I offer unique qualifications to lead this agency. I have been
performing the duties of the Inspector General since January 2020,
directing oversight of HHS's COVID-19 pandemic response while
transitioning a workforce of over 1,600 professionals to a mostly
virtual environment. We have not allowed unprecedented challenges to
disrupt our mission, and we have excelled in productivity, employee
satisfaction, and maintaining standards of excellence.
If confirmed, I will be honored to lead HHS-OIG's mission-driven
team of program integrity experts. I am deeply committed to ensuring
that we remain a modern organization with a high-performing, diverse,
and inclusive workforce. Continued investment in data analytics and
information technology will ensure that HHS-OIG's dedicated
professionals have the tools they need to succeed.
I am steeped in the disciplines central to the work of an Inspector
General. I understand the everyday challenges of ensuring program
integrity. If confirmed, I will deliver practical results to help
address the most consequential issues facing HHS: financial integrity
of HHS programs; access, quality, and safety of care, including for
some of our Nation's most vulnerable populations; safeguarding public
health; appropriate administration of HHS programs at the Federal and
State levels; and preventing fraud, waste, and abuse that harm people
and divert critical resources.
OIG's work is vital to ensure that HHS programs deliver the
services and outcomes that Congress intends, and that beneficiaries and
taxpayers deserve. If confirmed, I will maintain strong partnerships
with stakeholders, including the Department of Justice, HHS, the
Pandemic Response Accountability Committee, States, and other law
enforcement agencies so that we can continue our fight against fraud,
waste, and abuse. And I will continue a rigorous program of audits and
evaluations that aim to drive positive change for HHS programs and the
people they serve.
If confirmed, I will uphold the Inspector General's dual reporting
obligations to Congress and the Department. That includes my commitment
to inform Congress as HHS-OIG conducts its work and to be accessible to
Senators, Representatives, committees, and your staffs.
As a career public servant who rose through the ranks, I am humbled
and honored to be considered for the position of Inspector General.
During my career, I have marshaled experience in the craft of oversight
and the art of leading a high-
performing workforce. It would be my privilege to serve and lead HHS-
OIG, an organization to which I am deeply committed.
I thank the Senate Committee on Finance for considering my
nomination and for its strong support of independent and objective
oversight. I look forward to answering your questions.
______
SENATE FINANCE COMMITTEE
STATEMENT OF INFORMATION REQUESTED
OF NOMINEE
A. BIOGRAPHICAL INFORMATION
1. Name (include any former names used): Christi Anne Grimm; former
name, Christi Anne Macrina (maiden name); name occasionally used in
publications, Christi Macrina Grimm.
2. Position to which nominated: Inspector General for the Department
of Health and Human Services (HHS).
3. Date of nomination: June 24, 2021.
4. Address (list current residence, office, and mailing addresses):
5. Date and place of birth: March 10, 1975, Denver, Colorado.
6. Marital status (include maiden name of wife or husband's name):
7. Names and ages of children:
8. Education (list all secondary and higher education institutions,
dates attended, degree received, and date degree granted):
New York University, Robert F. Wagner Graduate School of Public
Service, Master of Public Administration in Health Policy, May
2004.
Additional:
Harvard University, Kennedy School of Government, Senior
Managers in Government, 2015. Immersive certificate program
designed for senior-level public leaders. Program focused on
public policy and management, leadership skills, and managerial
practice.
American University, Experienced Leaders in the OIG Community,
2011. Multi-week certificate program designed to transition
proven leaders into executives.
9. Employment record (list all jobs held since college, including the
title or description of job, name of employer, location of work, and
dates of employment for each job):
From January 3, 1999 to the present date, I have been employed
by the Federal Government at HHS. The following is a listing of
positions I have held and titles I have used, from most recent
to oldest, at HHS:
Principal Deputy Performing Duties of Inspector General, HHS
Office of Inspector General (OIG), Washington, DC, 1/1/2020-
present (9/2021)
As Principal Deputy Inspector General Performing Duties of
Inspector General, I lead an independent and objective
organization of more than 1,600 auditors, evaluators,
investigators, lawyers, and management professionals who carry
out OIG's mission of protecting the integrity of HHS programs
as well as the health and welfare of program beneficiaries.\1\
In this role, I ensure effective use of OIG's approximately
$397 million budget and $12 million of COVID-19 supplemental
resources (2020 enacted), plus approximately $250 million in
grants for Medicaid Fraud Control Units, to oversee $2.4
trillion in HHS base and supplemental expenditures. I am
responsible for the oversight of HHS and all the agencies
operating within HHS including the Centers for Medicare and
Medicaid Services (CMS), Administration for Children and
Families, Centers for Disease Control and Prevention, Food and
Drug Administration, National Institutes of Health, and Office
of Global Affairs.
---------------------------------------------------------------------------
\1\ In keeping with the OIG succession plan implemented by former
Inspector General Daniel R. Levinson, I assumed the role of Principal
Deputy Inspector General following the retirements of IG Levinson in
May 2019 and PDIG Joanne Chiedi in January 2020. I have been performing
the duties of Inspector General since January 2020.
---------------------------------------------------------------------------
Chief of Staff, HHS OIG, Washington, DC, 8/2014-12/2019
As Chief of Staff to the Inspector General, I was the second
highest-ranking career official at OIG. I was directly
responsible for effective execution of priority initiatives and
providing counsel on a wide variety of policy and operational
matters and ensuring high quality work products. I was further
responsible for ensuring that OIG's budget advanced innovation,
focused on impactful work most likely to produce improvements
in programs and in the lives of beneficiaries, and considered
input from stakeholders. I served as an executive liaison,
responsible for communicating and coordinating with government
partners, national professional associations, and the private
sector. As Chief of Staff, I also:
Advocated for the financial, human, and technical resource
allocation needs of OIG. These instrumental efforts culminated
in a $65 million funding increase from Congress between 2014-
2017, that enabled OIG to end a hiring freeze, launch new
oversight activities, and make critical investments to
modernize its IT infrastructure. These improvements enabled OIG
to seamlessly transition to near total remote operations during
the COVID-19 pandemic without compromising productivity.
Oversaw OIG efforts to assist the Secretary of HHS in efforts
to reduce regulatory barriers and accelerate the transformation
of the health-care system into one that better pays for value
and promotes care coordination.
Helped to establish OIG's Affirmative Litigation Team, to
leverage OIG's unique enforcement authorities to independently
bring civil monetary penalty actions when the Department of
Justice cannot support prosecution under the False Claims Act.
Within 6 months of its launch, the team returned $45 million to
the Medicare trust fund.
Managed OIG's Media Communications and approved the design and
execution of sophisticated media strategies for press
conferences, press kits, video series, and podcasts.
Led negotiation discussions with HHS's top leaders on
recommended improvements to HHS programs and operations (341
recommendations implemented in Fiscal Year (FY) 2019).
Held a primary responsibility for the quality and timeliness of
OIG work products, amounting to over 300 products generated in
FY 2019 that included OIG audits, evaluations, fraud alerts,
annual reports, and congressional correspondence and testimony.
In FY 2019, the combined expected audit recoveries, questioned
costs, and potential savings identified in OIG reports exceeded
$2.5 billion. Additionally, OIG's investigative work led to
$5.04 billion in expected investigative recoveries.
Director of Policy and Programs, HHS OIG, Washington, DC, 1/
2013-7/2014
As the Director of Policy and Programs, I supervised the day-
to-day operations of the Immediate Office to the Inspector
General, consisting of the Chief Medical Officer, Senior
Counselor for Health Information Technology, the Office of
Congressional Affairs, the Office of Regulatory Affairs, Media
Communications, the Executive Secretariat, and the Freedom of
Information Act Office. As the Director of Policy and Programs,
I also:
Collaborated with budget and planning experts to align OIG
resource requests with planned work and to develop budget
justification information submitted to appropriators; conducted
cost-benefit analyses of proposed evaluations and audits to
ensure projected human and financial capital investments were
sound and reflected priorities.
Provided technical expertise for OIG oversight strategies and
tactical approaches and collaborated with senior staff to
identify and collect data for performance metrics.
Regularly communicated with key HHS and congressional
stakeholders and identified opportunities to better integrate
key stakeholders' interests and concerns, as appropriate, into
OIG's Strategic Plan, Semiannual Work Plan, and Semiannual
Report to Congress.
Senior Advisor to the Principal Deputy, HHS OIG, Washington,
DC, 11/2009-1/2013
As the Senior Advisor to the Principal Deputy, I advised and
represented the Principal Deputy and Inspector General on OIG
policy, operations, and program matters. I regularly prepared
written products and oral presentations on behalf of the
Principal Deputy and Inspector General for senior officials in
HHS, the Legislative Branch, other Federal Executive agencies,
State or local governments, public interest groups, industry,
members of the press or media, and the public. I also worked
closely with managers and staff to set strategies and lead
priority initiatives.
Senior Program Analyst, HHS OIG, Office of Evaluation and
Inspections, Dallas, TX (2005-2009); New York, NY (1999-2005)
As a Senior Program Analyst within OIG, I applied program
knowledge and technical skills to gauge potential risk to
programs and beneficiaries and designed, managed, and executed
award-winning national evaluations of HHS programs and
policies.
Insurance Specialist, Centers for Medicare and Medicaid
Services, New York, NY, 1/1999-8/1999
As an Insurance Specialist within CMS, I conducted program
evaluations for Medicare Part A and Part B contractors located
in Nebraska, Texas, New York, Florida, and Puerto Rico. I led
several teams of insurance specialists to examine contractor
compliance with local and national medical review policies and
procedures and adherence to financial reporting requirements.
These results were communicated for review and action to CMS
executive leadership and its contractors.
Additional positions held after college:
1999--Banana Republic, Sales Associate, New York, NY (part
time, approx. 10 hours/week). Position entailed retail sales
(clothing).
1998--Vectra Bank, Personal Banker, Denver, CO. Position
entailed opening personal loans, home equity loans, and bank
accounts for customers.
1998--Banana Republic, Sales Associate, Denver, CO. Position
entailed retail sales (clothing).
1998 (approx.)--U.S. Bank, Bank Teller, Denver, CO. Position
entailed electronically entering deposits and withdrawals,
balancing checking accounts for customers, filling ATMs with
cash, and balancing cash drawers.
10. Government experience (list any current and former advisory,
consultative, honorary, or other part-time service or positions with
Federal, State, or local governments held since college, including
dates, other than those listed above):
I list my government experience in my response to Question A.9.
11. Business relationships (list all current and former positions held
as an officer, director, trustee, partner (e.g., limited partner, non-
voting, etc.), proprietor, agent, representative, or consultant of any
corporation, company, firm, partnership, other business enterprise, or
educational or other institution):
I serve on the Board of Directors for Worldwide Assurance for
Employees of Public Agencies (WAEPA), a nonprofit 501(c)(9)
providing life insurance and financial service benefits to
Federal civilian employees. In this role, I serve on two
committees within WAEPA: the Finance Committee and the
Governance Committee. If confirmed, I will resign from this
position, in accordance with a commitment in my June 17, 2021
ethics agreement with the Office of Government Ethics (OGE). I
will also comply with the additional requirements outlined in
this agreement.
12. Memberships (list all current and former memberships, as well as
any current and former offices held in professional, fraternal,
scholarly, civic, business, charitable, and other organizations dating
back to college, including dates for these memberships and offices):
As the Principal Deputy Inspector General Performing Duties of
Inspector General, I am OIG's lead representative for
intragovernmental memberships established to better effectuate
communication and coordination across agencies. Examples of
these memberships include the Council of the Inspectors General
on Integrity and Efficiency (CIGIE), the Pandemic Response
Accountability Committee (PRAC), and the PRAC Health Care
Subgroup that I lead. My interaction with some of these
organizations--like CIGIE--precede my current role and are
associated with my employment at OIG.
The following list does not include memberships and offices
held solely in my official capacity and instead includes only
those that I have chosen to hold and perform in my capacity as
a private citizen.
My husband and I are members of St. Aidan's Episcopal Church,
located in Alexandria, VA. We have been members of this church
since the winter of 2018.
WAEPA Board of Directors member. Since the fall of 2019 I have
served as a member of the Board of Directors at WAEPA, as
discussed above. If confirmed, I will resign from this position
in accordance with a commitment in my June 17, 2021 ethics
agreement with OGE. I will also comply with the additional
requirements outlined in this agreement.
Tennessee Walking Horse Association. From 2013-2014 (approx.) I
was a member of the Tennessee Walking Horse Association. My
membership is not active.
13. Political affiliations and activities:
a. List all public offices for which you have been a candidate
dating back to the age of 18.
None.
b. List all memberships and offices held in and services
rendered to all political parties or election committees,
currently and during the last 10 years prior to the date of
your nomination.
None.
c. Itemize all political contributions to any individual,
campaign organization, political party, political action
committee, or similar entity of $50 or more for the past 10
years prior to the date of your nomination.
One-time contribution to Heidi Heitkamp, October 9, 2018. Amount
= $100, via ActBlue.
14. Honors and awards (list all scholarships, fellowships, honorary
degrees, honorary society memberships, military medals, and any other
special recognitions for outstanding service or achievement received
since the age of 18):
Honors and Awards:
CIGIE, Excellence in Management, 2019. In recognition of my
``outstanding management efforts to revolutionize HHS OIG's
work planning process through the creation of the Engagement
Committee and Living Work Plan.''
HHS Secretary's Award for Excellence in Management, 2015.
HHS Inspector General's Bronze Medal for Outstanding Employee
of the Year, 2011 and 2010.
HHS Inspector General's Award for Cooperative Achievement,
2012, 2011.
HHS Inspector General's Award for Exceptional Evaluation and
Collaboration, Adverse Events in Hospitals, 2009.
HHS Inspector General's Award for Creative Investigation and
Analysis in Identifying Durable Medical Supplier Associations,
2009.
HHS Inspector General's Award for Outstanding Contributions in
Strengthening Controls in Medicaid Eligibility, 2006.
HHS Inspector General's Award for Major Contributions Toward
OIG Goals, 2005, 2004, and 2002.
Special Act and Time Off Awards: Over the course of my career I
have received over 40 Special Act, time off, or performance-
based cash awards. I can provide a list of these awards if it
would be helpful to the Senate Committee on Finance.
Scholarships: At both New York University and the University of
Colorado at Denver, I received merit-based scholarships to
cover tuition costs directly from the school.
15. Published writings (list the titles, publishers, dates and
hyperlinks (as applicable) of all books, articles, reports, blog posts,
or other published materials you have written):
Please note, although many audit and/or evaluation reports that
represent the views and work of my office have been signed out
under my name and title (e.g., Principal Deputy Inspector
General), I do not list these reports here. Nor do I list OIG
reports for which I was a team leader or member earlier in my
career. My understanding of this question is to include
published writings that were written or co-written directly by
me.
``Four Crucial Lessons for Improving COVID-19 Testing,''
Opinion by C. A. Grimm, M. E. Horowitz, CNN.com Opinion, April
9, 2021.
``Why Drug Prescriptions Should Include Diagnoses,'' C. A.
Grimm, J. K. Taitsman, STAT News, March 1, 2021.
``Medicare Advantage Should Not `Game the System' But
Prioritize Patient Care, Honest Billing,'' C. A. Grimm,
HealthcareDive, September 2020.
``Commercial Influences on Electronic Health Records and
Adverse Effects on Clinical Decision-Making,'' J. K. Taitsman,
A. VanLandingham, and C. A. Grimm, JAMA Intern. Med. May 11,
2020;180(7):925-926.
``Protecting Patient Privacy and Data Security,'' J. K.
Taitsman, C. M. Grimm, and S. Agrawal, New England Journal of
Medicine, March 14, 2013: 368:11, 977-979.
``Navigating OIG's New Website to Find Compliance
Information,'' J. Taitsman and C. Grimm, Compliance Today,
December 2012: 14:12, 67-70.
``The Importance of Accurate, Complete, and Usable
Documentation,'' C. Grimm, MPA and J. Taitsman, MD, JD,
Compliance Today, January 2012: 14:1, 5-7.
``Buprenorphine Treatment Services in the 50 States and
District of Columbia: Lessons for New York City,'' C. Macrina,
V. Shier, and J. Sturtz, New York University, Wagner School of
Public Service Graduate School Capstone.*
---------------------------------------------------------------------------
* Please note that the final item was completed as part of a
capstone in my graduate school program. The work was conducted for the
benefit of the New York City Department of Health and Mental Hygiene
(NYCDHMH) and was provided to NYCDHMH upon completion. While I am able
to provide what exists of the capstone online, I am unaware of whether
the full project was further disseminated or published, and I do not
currently have a copy of it.
16. Speeches (list all formal speeches and presentations (e.g.,
PowerPoint) you have delivered during the past 5 years which are on
topics relevant to the position for which you have been nominated,
including dates. Provide the committee with one digital copy of each
---------------------------------------------------------------------------
formal speech and presentation):
American Health Law Association (AHLA), Update on Oversight of
COVID-19-Related Programs, 2021 Virtual Annual Meeting, June
29, 2021.
AHLA Panel, Conversation with Dr. Fauci, 2021 Virtual Annual
Meeting, June 29, 2021.
Partnership for Public Service, Excellence in Government
Fellows, Navigating Change Perspective, Virtual Engagement,
June 16, 2021.
Health Care Compliance Association (HCCA), HHS OIG Update, 2021
Virtual Compliance Institute, April 19, 2021 (keynote).
Additional materials, including handouts, video, and
presentations, available on the OIG website.
National Association of Medicaid Fraud Control Units (NAMFCU),
OIG Updates, Annual Conference, Directors Symposium, October
19, 2020.
Council of the Inspectors General on Integrity and Efficiency
(CIGIE), Annual Awards Ceremony: Conversation with Dr. Anthony
Fauci (video), October 13, 2020.
AHLA, Connecting the Dots: An OIG Update, Fraud and Compliance
Forum, October 1 2020 (keynote).
U.S. House of Representatives, Committee on Oversight and
Reform, Opening Statement for Member Briefing on the
administration's Coronavirus Response, May 26, 2020. Full video
archived on the committee's website.
HCCA, OIG Update, 2020 Virtual Compliance Institute, March 30,
2020 (keynote).
Philadelphia Regional HCCA, HHS-OIG Compliance Priorities for
2019 and Beyond, May 31, 2019.
NAMFCU, OIG Updates, Annual Conference, Directors Symposium,
March 21, 2018.
U.S. House of Representatives, Committee on Energy and
Commerce, Subcommittee on Oversight and Investigations,
Combating Waste, Fraud, and Abuse in Medicaid's Personal Care
Services Program, May 2, 2017. Full video here: https://
www.youtube.com/watch?v=vRaQBJEvukg. Additional committee
materials archived on the committee's website.
HCCA Annual Conference, Strategic Priorities of the OIG, April
2017 (panel discussion).
NAMFCU, OIG Updates, Annual Conference, Directors Symposium,
March 22, 2017 (panel discussion).
The 2016 Healthcare Information and Management Systems Society
Annual Conference and Exhibition, OIG 101: An Introduction to
the HHS OIG, March 3, 2016.
Please note, I have omitted media engagements, e.g., CBS Evening
News and National Public Radio, from this list since these engagements
appear to fall outside the scope of the question (i.e., they were not a
formal ``speech,'' nor did they involve a presentation of supporting
data and materials accompanied by graphics). I am happy to provide
further information upon request.
As an additional item, please be aware that I do not have copies of
or notes from my remarks for the March 21, 2018 and March 22, 2017
presentations for NAMFCU. Further, I am unable to locate these remarks
in any format online.
Upcoming Speeches and Presentations:
CIGIE Identity Fraud Reduction and Redress Working Group, title
of speech to be determined, August 3, 2021.
AHLA, title of speech to be determined, Fraud and Compliance
Forum, September 22, 2021 (keynote).
NAMFCU, title of speech to be determined, Annual Training
Program, September 28, 2021.
Please note that I will provide to the Senate Committee on Finance
copies of the prepared remarks in connection with the above
presentations following delivery of the remarks.
17. Qualifications (state what, in your opinion, qualifies you to
serve in the position to which you have been nominated):
I am Christi A. Grimm, the Principal Deputy Inspector General
for the U.S. Department of Health and Human Services (HHS). I
have been successfully performing the duties of Inspector
General since January 2020. I am a proven public servant
dedicated to independent and tenacious oversight to protect
taxpayer investments and ensure the health and welfare of
people served by HHS programs. My more than 20 years of
government service includes serving in top leadership and
strategic positions within the Office of Inspector General
(OIG) for over a decade. As the senior most executive for the
largest civilian Federal OIG, I lead an independent and
objective organization of more than 1,600 auditors,
investigators, evaluators, lawyers, and management officials
who carry out OIG's mission. I have deep experience leading a
complex organization, high profile initiatives, and a highly
skilled workforce.
I drew on this experience to navigate OIG through the
unprecedented challenges of the COVID-19 pandemic. I recognize
that OIG's people are its most valuable asset. When the
pandemic struck, workforce safety was paramount. I worked with
our leadership team to adapt work practices to fulfill our
mission while keeping our staff and the public we serve as safe
as possible. This included, for example, new safety protocols
and equipment for our front-line law enforcement agents. OIG
also seamlessly transitioned to a virtual working environment
for most tasks. Our quick and successful move to remote work
was possible because of prior investments in information
technology.
During my tenure as Chief of Staff and then Principal Deputy, I
was instrumental in leading and securing significant change in
the way OIG leverages technology and data. These changes
yielded dramatic benefits but required sustained commitment,
investment, and culture changes. Collaborating with partners
across OIG, I obtained substantial added budget resources and
executed a strategy that enabled OIG to be among the first
Inspectors General to hire a Chief Data Officer, to create a
centralized advanced data analytics division, and to deploy
mobile-first, cloud-based tools to OIG's nationwide staff.
These infrastructure investments paid off during the pandemic,
enabling OIG's workforce to shift to virtual work in two days
with adaptable technology and data analytics capabilities
available regardless of where an employee works.
Amidst these monumental changes and challenges, OIG did not
miss a beat. We maintained high productivity levels in FY 2020,
producing 178 audit reports with over $1.6 billion in expected
audit recoveries or questioned costs and 44 evaluation reports
that contained valuable insights to improve HHS programs and
the beneficiaries they serve. This represented an increase in
the number of reports issued over the prior year; OIG is on
track to maintain or exceed this productivity level in the
current fiscal year.
I am proud to say that, under my leadership, in 2020, OIG
ranked as the top place to work in HHS and as the top OIG among
large Offices of Inspector General, according to the annual
Federal Employee Viewpoint Survey (FEVS). Areas of notably high
scores relative to other agencies include effective leadership,
leadership empowering staff, and teamwork. High scores
notwithstanding, I am committed to ensuring OIG remains a
learning organization that cultivates employees' ideas and uses
FEVS and other feedback to make meaningful improvements. It is
mission critical that every employee feels engaged, valued, and
respected. In 2020, expanding on an already successful program
and at my direction, we hired our first diversity and inclusion
specialist, established a Diversity and Inclusion Advisory
Board to offer insights and feedback to leadership, and
empowered a variety of employee-led initiatives sparked by
their high level of interest in this area. Additionally, I have
prompted and supported innovative ideas from our workforce for
oversight projects to help advance health equity in HHS
programs.
Under my leadership, OIG continues to be at the forefront of
fighting fraud in Health and Human Services programs and
promoting programs' economy, efficiency, and effectiveness by
using data-driven analysis, technology, and a highly skilled
and motivated workforce to achieve results. I am uniquely
prepared to lead the organization specifically charged with
safeguarding the integrity of HHS programs at the enterprise
level and, if confirmed, to elevate our oversight work to meet
the challenges of a rapidly changing Health and Human Services
landscape. Having risen through the ranks in OIG and served in
a range of staff and leadership positions in headquarters and
regional offices, I am steeped in the critical needs and
disciplines of evaluation, auditing, data analysis,
investigations, and business management. I frequently represent
OIG in interactions at the most senior levels of government,
including with members of Congress. I have thought deeply about
the challenges of ensuring program integrity and how the OIG
can produce optimal value for the American people. I do not
give credence to whether the work I lead will be popular; my
driving concern is delivering independent, objective, credible,
standards-based information and results that identify cost
savings and advance better outcomes for the American public.
I am committed to combating fraud aggressively and preventing
people from becoming victimized. During the pandemic, OIG has
protected the public from many types of COVID-19 fraud and held
accountable the perpetrators who took advantage of this global
emergency to harm patients and steal money. This effort used
advanced data analytics and leveraged strong partnerships with
law enforcement agencies, the Department of Justice, the
Pandemic Response Accountability Committee (PRAC), States, and
private industry to quickly detect COVID fraud schemes, shut
them down, and alert the public in order to prevent further
harm.
In FY 2020, OIG's investigative work (in total, not limited to
COVID-19 fraud) contributed to 824 indictments, 624 criminal
actions, 791 civil actions, over $3 billion in total monetary
recoveries, and 2,148 exclusions of untrustworthy individuals
and entities from participating in Federal health-care
programs. OIG played a leading role in the 2020 National Health
Care Fraud Takedown, which targeted individuals allegedly
involved in a tele-fraud scheme to elicit money and personal
information from beneficiaries. Under my leadership this
takedown was safely conducted during the pandemic with novel
search, seizure, and arrest procedures to better protect agents
and the communities in which they serve. More than 345
defendants were charged with submitting over $6 billion in
false and fraudulent claims to Federal health-care programs and
private insurers. Perhaps more importantly, the 2020 takedown
sent a message that a pandemic would not deter our efforts to
combat fraud. In response to growing cybersecurity risk to HHS
programs and beneficiaries, I substantially expanded OIG's
enforcement and oversight capabilities in this area. For
example, under my leadership, OIG completed an HHS-wide review
of critical cybersecurity incident response capabilities.
I am equally committed to protecting taxpayer funds from waste
and misuse through a rigorous program of audits and
evaluations. For example, in response to billions of dollars
appropriated for HHS's pandemic response, under my leadership
OIG has launched over 70 reviews related to this funding, with
more being planned. I am a forward-leaning leader in the PRAC
community and serve on behalf of OIG, which is one of the
statutorily required Inspectors General established under the
CARES Act. To protect the historic levels of financial
investment Congress provided for pandemic relief, I led the
development of PRAC's Strategic Plan that covers 22 Federal
agencies and $5 trillion in Federal spending and which received
unanimous support by PRAC members. I also chair PRAC's Health
Care Subgroup, which produced a first of its kind data brief on
coronavirus testing frequency, costs, and turnaround times
across six Departments that pay for or provide health care.
Under my leadership, OIG has conducted, and continues to
conduct, vital work to ensure that HHS programs deliver the
services and outcomes for beneficiaries and consumers that
Congress intends. This includes work looking at patient safety
and quality of care; services for children; emergency
preparedness and response; access to, and affordability of,
care and services; innovation in health-care delivery,
including telehealth; and equity in HHS programs.
Recent examples of work generated under my leadership include
the following: (1) a report identifying COVID-19's devastating
effects on Medicare beneficiaries residing in nursing homes;
(2) a review outlining additional monitoring needs for
buprenorphine, a medication-assisted treatment for opioid
addiction; (3) a report identifying critical supply, equipment,
and personnel shortages hospitals faced in confronting the
novel coronavirus as of March 2020; (4) an early alert
outlining deficiencies in background checks for staff working
with native American and American Indian children; and (5) a
report highlighting challenges for HHS in reunifying
unaccompanied children who were separated from their parents.
Further, in 2020, OIG issued groundbreaking regulations under
the Federal anti-kickback statute to advance properly designed,
beneficial care coordination arrangements and value-based care.
The success of an Inspector General is measured not only by the
number of reports issued, but also by the impact of those
reports. To maximize positive impact, OIG's stakeholders,
including HHS, Congress, and the American people, must trust
that our work meets the highest standards of the Inspector
General community. It is a topmost priority of mine that OIG
unfailingly meets or exceeds relevant professional standards.
During my time as Chief of Staff and Principal Deputy, OIG
underwent six peer reviews through the Council of the
Inspectors General on Integrity and Efficiency, and I am
pleased to say we passed each of them. I believe productive
relationships with stakeholders inside and outside government
are essential to maximizing the impact of OIG's work. I strive
to ensure that, within HHS, OIG is viewed as a proven, trusted,
objective voice at the table that shares HHS's interest in
effective program operations and can be a go-to resource for
ideas to prevent and correct problems. I have open lines of
communication with officials across HHS. I take an
evidence-based approach in persuading officials to implement
OIG recommendations. I meet regularly with members of Congress
to hear concerns and inform our work planning. I am frequently
invited to speak at conferences of major professional
associations engaged in health-care compliance. In response to
feedback from these stakeholders, I am spearheading a new
initiative to modernize OIG's industry guidance and to use
open, modern data approaches to improve industry compliance.
This initiative will also reduce compliance burden on health-
care providers without compromising program integrity. If
confirmed, I will continue to hold the OIG workforce to the
highest possible Inspector General community standards, and I
will pursue further opportunities to build and sustain
relationships with stakeholders to maximize the impact of OIG's
independent, objective work.
To heighten impact, OIG must deploy its appropriated resources
prudently and pursue high-value projects. To this end, as Chief
of Staff I conceptualized and implemented a novel advancement
in OIG's work plan development. I established an Engagement
Committee, comprised of senior executives from each OIG
component that meets weekly to assess data and deliberate on
the merits of work proposals presented by audit and evaluation
teams, with an eye toward optimizing use of resources and
achieving impact. The Engagement Committee has been successful
at strengthening OIG's work planning and providing greater
transparency across the organization, in turn spurring more
component collaboration and teamwork.
Inspectors General are the eyes and ears of taxpayers,
Congress, and policy makers seeking to drive positive change in
government. It is more important than ever to have experienced
and thoughtful oversight leaders in Inspectors General
positions to carry out this important function. I am uniquely
and especially qualified for the HHS-OIG position. Through my
on-the-ground, practical leadership experience and my record of
leading OIG through unprecedented times, I have demonstrated
the qualifications and capabilities of a forward-thinking,
trusted Inspector General. If confirmed, I will be the rare
Inspector General who has come up through the ranks as a career
professional, along the way marshaling experience in the craft
of oversight and art of leading a high performing workforce, to
serve and lead an organization to which I am deeply committed.
I thank the Senate Committee on Finance for its strong support
of independent and objective oversight and look forward to
discussing my qualifications with committee members.
B. FUTURE EMPLOYMENT RELATIONSHIPS
1. Will you sever all connections (including participation in future
benefit arrangements) with your present employers, business firms,
associations, or organizations if you are confirmed by the Senate? If
not, provide details.
I am a current Federal employee, with the attendant health
care, retirement, and other benefits that come with this
employment. Since my status as a Federal employee will not
change should I be confirmed, my participation in these benefit
systems will continue. Further, since I am presently serving in
the agency at which I hope to be confirmed to lead, my
connection to my present employer will also continue.
2. Do you have any plans, commitments, or agreements to pursue
outside employment, with or without compensation, during your service
with the government? If so, provide details.
No. I do not have any plans, commitments, or agreements to
pursue outside employment, with or without compensation, during
my service with the government.
3. Has any person or entity made a commitment or agreement to employ
your services in any capacity after you leave government service? If
so, provide details.
No. No person or entity has made a commitment or agreement to
employ my services in any capacity after I leave government
service.
4. If you are confirmed by the Senate, do you expect to serve out
your full term or until the next presidential election, whichever is
applicable? If not, explain.
Yes.
C. POTENTIAL CONFLICTS OF INTEREST
1. Indicate any current and former investments, obligations,
liabilities, or other personal relationships, including spousal or
family employment, which could involve potential conflicts of interest
in the position to which you have been nominated.
As identified above, I am presently on the Board of Directors
for WAEPA, a nonprofit 501(c)(9) providing life insurance and
financial service benefits to Federal civilian employees. If
confirmed, I will resign from this position in accordance with
a commitment in my June 17, 2021 ethics agreement with OGE. I
will also comply with the additional requirements outlined in
this agreement.
2. Describe any business relationship, dealing, or financial
transaction which you have had during the last 10 years (prior to the
date of your nomination), whether for yourself, on behalf of a client,
or acting as an agent, that could in any way constitute or result in a
possible conflict of interest in the position to which you have been
nominated.
As identified above, I am presently on the Board of Directors
for WAEPA, a nonprofit 501(c)(9) providing life insurance and
financial service benefits to Federal civilian employees. If
confirmed, I will resign from this position in accordance with
a commitment in my June 17, 2021 ethics agreement with OGE. I
will also comply with the additional requirements outlined in
this agreement.
3. Describe any activity during the past 10 years (prior to the date
of your nomination) in which you have engaged for the purpose of
directly or indirectly influencing the passage, defeat, or modification
of any legislation or affecting the administration and execution of law
or public policy. Activities performed as an employee of the Federal
government need not be listed.
None.
4. Explain how you will resolve any potential conflict of interest,
including any that are disclosed by your responses to the above items.
(Provide the committee with two copies of any trust or other
agreements.)
I will comply with the terms outlined in my June 17, 2021
ethics agreement with OGE.
5. Two copies of written opinions should be provided directly to the
committee by the designated agency ethics officer of the agency to
which you have been nominated and by the Office of Government Ethics
concerning potential conflicts of interest or any legal impediments to
your serving in this position.
It is my understanding that the OGE has provided the Senate
Committee on Finance with this information.
D. LEGAL AND OTHER MATTERS
1. Have you ever been the subject of a complaint or been
investigated, disciplined, or otherwise cited for a breach of ethics
for unprofessional conduct before any court, administrative agency
(e.g., an Inspector General's office), professional association,
disciplinary committee, or other ethics enforcement entity at any time?
Have you ever been interviewed regarding your own conduct as part of
any such inquiry or investigation? If so, provide details, regardless
of the outcome.
No, not that I know of.
2. Have you ever been investigated, arrested, charged, or held by any
Federal, State, or other law enforcement authority for a violation of
any Federal, State, county, or municipal law, regulation, or ordinance,
other than a minor traffic offense? Have you ever been interviewed
regarding your own conduct as part of any such inquiry or
investigation? If so, provide details.
No.
3. Have you ever been involved as a party in interest in any
administrative agency proceeding or civil litigation? If so, provide
details.
The following list itemizes responsive matters in my
professional capacity. A copy of the docket sheet for each case
is attached.
Case Name: Kogan, L.A.C. v. Becerra et al.
Case Number: 3:2021cv10856.
Court: United States District Court for the District of New
Jersey.
Role: Defendant (In Official Capacity).
Date Complaint Filed: May 13, 2021.
Nature of Case: Action seeking review of an order of exclusion
and requesting declaratory judgment to declare that the final
order excluding Plaintiff acupuncturist from participation in
all Federal health-care programs was unlawful.
Status of Case: Pending.
Case Name: Baxter v. Becerra et al.
Case Number: 1:2021cv00451.
Court: United States District Court for the Eastern District of
Virginia.
Role: Defendant (In Official Capacity).
Date Complaint Filed: April 13, 2021.
Nature of Case: Action for temporary restraining order,
preliminary injunction, and permanent injunction to prevent
enforcement of order excluding Plaintiff doctor from
participation in all Federal health-care programs.
Status of Case: Dismissed by Stipulation following Settlement
on May 7, 2021.
Case Name: Pharmaceutical Care Management Association v. United
States Department of Health and Human Services et al.
Case Number: 1:2021cv00095.
Court: United States District Court for the District of
Columbia.
Role: Defendant (In Official Capacity).
Date Complaint Filed: January 12, 2021.
Nature of Case: Action brought under the Administrative
Procedure Act and the Declaratory Judgment Act, challenging and
seeking declaratory relief from a final agency rule--Removal of
Safe Harbor Protection for Rebates Involving Prescription
Pharmaceuticals, 85 Fed. Reg. 76666 (November 30, 2020).
Status of Case: Pending.
Case Name: Pfizer Inc. v. United States Department of Health
and Human Services et al.
Case Number: 1:2020cv04920
Court: United States District Court for the Southern District
of New York.
Role: Defendant (In Official Capacity).
Date Complaint Filed: June 26, 2020.
Nature of Case: Action seeking declaratory judgment and to set
aside the Department of Health and Human Services Office of
Inspector General's determination that Plaintiff's proposed
copay assistance programs implicate the Anti-Kickback and
Beneficiary Inducement statutes.
Status of Case: Pending.
The following list itemizes responsive matters in my personal
capacity.
Civil litigation (personal): adoption of child, State of
Michigan, finalized in December 2017.
Divorce, State of Texas, finalized in 2007.
4. Have you ever been convicted (including pleas of guilty or nolo
contendere) of any criminal violation other than a minor traffic
offense? If so, provide details.
No.
5. Please advise the committee of any additional information,
favorable or unfavorable, which you feel should be considered in
connection with your nomination.
None.
E. TESTIFYING BEFORE CONGRESS
1. If you are confirmed by the Senate, are you willing to appear and
testify before any duly constituted committee of the Congress on such
occasions as you may be reasonably requested to do so?
Yes.
2. If you are confirmed by the Senate, are you willing to provide
such information as is requested by such committees?
Yes, to the greatest extent possible.
______
Questions Submitted for the Record to Christi A. Grimm
Questions Submitted by Hon. Ron Wyden
Question. Please outline your commitment regarding the work HHS OIG
plans to take on with respect to health parity laws (which say mental
health should be treated like physical health) and particularly how you
would investigate the types of dodges we're seeing today by companies,
insurers and other entities, that essentially get around the commitment
to parity.
Answer. The Department of Health and Human Services, Office of
Inspector General (HHS-OIG) is committed to continuing and expanding
our oversight of equitable access to behavioral health services in HHS
programs, including issues related to mental health parity
requirements. This critically important topic would continue to be a
priority if I am confirmed. Appendix 1 describing reports recently
issued and currently underway related to behavioral health is attached.
With respect to the specific issue of health parity laws, HHS-OIG
is developing work assessing Medicaid managed care organization (MCO)
compliance with applicable provisions of the Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA). MHPAEA parity requirements apply to coverage offered by
Medicaid MCOs.\1\ This work is still being planned and specific
elements may change as the proposal is finalized. Potential areas of
focus under consideration for this audit include potential barriers
created by the MCOs, such as placing limits on mental health service
utilization; other MCO actions that may create financial barriers to
beneficiaries accessing mental health services, such as applying
increased copayments and deductibles; and how State Medicaid agencies
ensure that MCOs comply with applicable parity laws and related MCO
contract requirements. HHS-OIG would be pleased to provide a scope and
methodology briefing once an audit proposal is completed and approved.
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\1\ The Social Security Act applies the MHPAEA parity requirements
to coverage offered by Medicaid MCOs, Medicaid benchmark and benchmark-
equivalent plans (referred to as Medicaid Alternative Benefit Plans),
and the Children's Health Insurance Program (Sec. Sec. 1932(b)(8),
1937(b)(6), and 2103(c)(7), and (f)(2) of the Social Security Act,
respectively).
Focusing on compliance with MHPAEA through the lens of Medicaid
managed care provides us with our strongest opportunity to produce
high-impact work regarding MHPAEA compliance, given our jurisdiction
and data available to us. Medicaid managed care currently covers over
80 percent of all Medicaid beneficiaries, and Medicaid is the largest
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payor for mental health services.
We anticipate that findings and recommendations related to Medicaid
MCOs would be valuable to policymakers considering a range of parity
issues across various plans that provide coverage to approximately 65
million individuals.
Our oversight plan with respect to MHPAEA compliance is to start
with Medicaid MCOs, as described above, and to continue to research
other potential options for oversight on this important issue. In
addition to Medicaid MCOs, MHPAEA and related laws apply to a broad
range of health insurance plan types, including
employer-sponsored plans, group health plans, and individual market
plans. In most instances, HHS-OIG does not have the authority to
oversee plan compliance with the MHPAEA and related laws because HHS
does not regulate or fund most health plans subject to MHPAEA. HHS-OIG
is authorized to conduct, supervise, and coordinate audits and
investigations relating to HHS programs and operations. For issuers and
health plans that do not receive HHS funding and do not constitute HHS
programs or operations, HHS-OIG does not have jurisdiction to examine
those issuers or health plans. HHS-OIG would be happy to provide a
briefing and would appreciate an opportunity to assess how the
committee's interests in mental health parity issues align with
potential work that falls under HHS-OIG's authorities.
More broadly, HHS-OIG is committed to examining issues of access,
equity, and parity of behavioral health services, beyond the specific
application of MHPAEA. In addition to ongoing work described in the
Appendix 1, future work could include looking at parity through
Medicare data, for example. The Medicare Payment Advisory Commission
issued a report describing concerns that some Medicare Advantage plans
may discriminate against beneficiaries who require mental health
services by requiring cost-sharing amounts substantially higher than
Medicare fee-for-service levels. This is an area of potential interest
as HHS-OIG considers future work. HHS-OIG is also exploring new work to
examine the use of prior authorization and other administrative steps
by Medicare Advantage organizations and Medicaid managed care
organizations that may result in burdens or delays for beneficiaries to
access behavioral health services.
Based on our previous communication with the Senate Committee on
Finance staff, HHS-OIG has been developing new work to evaluate the
availability of behavioral health-care providers in traditional
Medicare, Medicare Advantage, and Medicaid managed care. This work may
assess and compare across these programs the extent to which behavioral
health providers, including those listed in managed care plans'
networks, are serving enrollees and able to offer appointments to new
patients.
Should I be confirmed, I look forward to engaging with you and your
staff as we further develop and prioritize these and other ideas for
new work to address required parity and equitable beneficiary access to
mental and behavioral health care.
Question. Please detail how the HHS OIG would take on work (and
review the work done to date) that would ensure access to telehealth
services while not creating a path to fraud.
Answer. HHS-OIG has a comprehensive telehealth oversight and
enforcement strategy. It is important that new telehealth policies and
technologies with potential to improve care and enhance access achieve
these goals and are not compromised by fraud, abuse, or misuse. To
accomplish that, OIG's telehealth strategy involves: conducting
significant oversight work to ensure that services are paid
appropriately, to better understand potential telehealth challenges and
opportunities, and to further target high-risk areas with subsequent
work; monitoring telehealth claims continually for aberrant trends,
outliers, and potential improper payments; taking law enforcement
action, as appropriate, against bad actors who exploit telehealth
technology and conduct sham remote visits to bill fraudulently for
other items and services; and informing congressional and HHS
stakeholders of the results of our work and of recommendations for
program improvements to promote access and safeguard against fraud,
abuse, or misuse.
telehealth oversight
HHS-OIG recently announced seven work plan items and issued three
reports addressing the telehealth used to provide behavioral health
services in Medicaid. These recent work plan items and reports are
described in the attached Appendix 2.
HHS-OIG's telehealth oversight will provide objective findings and
recommendations to further inform policymakers and other stakeholders
as they consider changing telehealth beyond the public health
emergency. For example, we are: (1) assessing potential program
integrity risks associated with expanded telehealth services authorized
by the public health emergency; (2) assessing important telehealth
utilization and access issues, such as how the use of telehealth during
the pandemic compares to the use of the same services delivered in-
person; and (3) making an early assessment of whether services such as
evaluation and management and psychotherapy comply with Medicare
requirements.
Many of these telehealth oversight reports are expected to be
completed in calendar year (CY) 2022. As appropriate, HHS-OIG's
telehealth oversight will recommend suitable safeguards to help ensure
that telehealth operates effectively and efficiently to enhance access;
deliver quality health care; improve health outcomes; and mitigate
potential fraud, abuse, and misuse.
As HHS-OIG's oversight informs how and the extent to which the
public health emergency affected the delivery of telehealth services,
HHS-OIG will assess any associated risks. HHS-OIG continuously plans
for new work using a risk-based approach. As such, the results of
ongoing telehealth work will inform planning for future additional work
targeted to high-risk areas.
We are coordinating with other Offices of Inspector General as part
of the Pandemic Response Accountability Committee to plan work related
to telehealth issues that affect multiple Federal agencies. Although
work planning is still ongoing, HHS-OIG expects this work will provide
valuable insights into telehealth service delivery and payment across
several Federal agencies. These insights may further inform
policymakers and other stakeholders about the successes and challenges
that span Federal programs.
monitoring telehealth claims
HHS-OIG's direct access to Medicare data allows for sophisticated
monitoring of telehealth claim utilization patterns. By identifying
outliers and other patterns, HHS-OIG generates potential leads for
investigations or spots potential program integrity risks that would
benefit from further oversight. We have been monitoring these data
since the beginning of the pandemic in spring 2020 via automated
reports that are shared with the Centers for Medicare and Medicaid
Services (CMS) and our law enforcement partners. HHS-OIG will continue
this effort and improve our data analytics by incorporating field
intelligence from our law enforcement agents, auditors, and evaluators.
law enforcement actions addressing telefraud and telehealth fraud
HHS-OIG is committed to taking swift action against bad actors who
seek to exploit telehealth and remote care. To date, most of our
enforcement has involved telefraud schemes that use phone calls or sham
remote visits to engage with a beneficiary to order or prescribe
medically unnecessary testing, equipment, or prescriptions.
These telefraud scams target Medicare beneficiaries through
aggressive telemarketing techniques to confuse and take advantage of
the growing acceptance of remote care. The amount of alleged fraud
associated with these schemes is in the billions of dollars and is
largely associated with fraud related to medically unnecessary claims
for durable medical equipment (DME), various types of laboratory tests,
and pain medication.
To protect beneficiaries and recover billions in alleged fraud,
HHS-OIG, the Department of Justice (DOJ) and our law enforcement
partners have conducted four large-scale takedowns that have targeted
telefraud schemes: Operation Brace Yourself,\2\ the 2020 National
Health Care Fraud Takedown,\3\ the 2021 COVID-19 Takedown,\4\ and the
2021 National Health Care Fraud Enforcement Action.\5\
---------------------------------------------------------------------------
\2\ https://www.justice.gov/opa/pr/federal-indictments-and-law-
enforcement-actions-one-largest-health-care-fraud-schemes.
\3\ https://www.justice.gov/opa/pr/national-health-care-fraud-and-
opioid-takedown-results-charges-against-345-defendants.
\4\ https://www.justice.gov/opa/pr/doj-announces-coordinated-law-
enforcement-action-combat-health-care-fraud-related-covid-19.
\5\ https://www.justice.gov/opa/pr/national-health-care-fraud-
enforcement-action-results-charges-involving-over-14-billion.
Although the schemes charged in these takedowns are not identical,
most leverage phone calls or sham remote visits to expand the reach of
the fraud to Medicare beneficiaries no matter where the criminals might
be. Perpetrators ``cold call'' Medicare beneficiaries to connect them
with co-conspirator health-care providers who conduct sham remote
visits. The health-care provider then orders unnecessary DME, testing,
or prescriptions. In some cases, the health-care provider signs
fraudulent orders from their desk without even attempting to talk with
the beneficiaries. The criminal organizations sell those fraudulent
orders to DME companies, laboratories, or pharmacies, who then bill
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Medicare fraudulently.
HHS-OIG continues to work with our law enforcement partners and the
CMS to prevent and take action against the bad actors perpetrating
telefraud schemes. For example, CMS revoked the billing privileges of
256 medical professionals for their involvement in telefraud schemes in
the 2020 National Takedown. We have published materials on our website
and social media and have partnered with government and private
stakeholders to make Medicare beneficiaries aware of these telefraud
scams so they can take steps to protect themselves.
In most telefraud cases to date, the criminals are not engaging in
telehealth fraud. The main target for these schemes is medically
unnecessary ordering of DME and laboratory tests, and prescriptions.
HHS-OIG is aware of allegations of telehealth fraud by health-care
facilities and providers--the billing for a telehealth service that
does not occur or upcoding of telehealth claims. Although such
allegations make up a small portion of our enforcement work as of
September 2021, HHS-OIG is monitoring for indicators of increases in
fraudulent billing for telehealth services. In the instances where this
has occurred already, HHS-OIG and DOJ have taken action against those
health-care providers.
As we continue to learn from our significant body of telehealth
oversight and enforcement work, HHS-OIG will continually assess the
need for additional compliance materials to help those providers who
want to comply with laws and provide high-quality telehealth services
to their patients.
informing stakeholders
In instances where HHS-OIG finds significant risks that are
supported by data and our analysis, audits, evaluations, and
investigations, HHS-OIG is committed to keeping this committee,
Congress, and other stakeholders informed. HHS-OIG recognizes the
importance of providing timely, independent, and objective information
as policymakers consider telehealth expansion or other changes beyond
the public health emergency. We have already provided technical
assistance to Congress, including the Senate Committee on Finance,
earlier this year that highlight potential risks based on high-level,
early data analyses.
Should I be confirmed, I look forward to continued engagement with
the Senate Committee on Finance on HHS-OIG's telehealth oversight and
enforcement work.
Question. Over the last 19 months, Congress has passed several
COVID-19 relief bills containing more than $175 billion in financial
relief for health-care providers. Providers have faced enormous
challenges in responding to this pandemic, including lower revenues and
higher costs. This support has been essential to their ability to
continue serving their communities. Oversight of these funds will be
critical to ensuring these funds are utilized for their intended
purpose, and to understand the impact of the pandemic on providers. I
understand HHS OIG is currently conducting an audit of the Provider
Relief Funds.
If confirmed, what will be your focus in conducting oversight of
these funds?
Answer. If confirmed, I will continue to focus on ensuring that the
Department's distribution of Provider Relief Fund (PRF) payments are
accurate and funds were used as intended and not wasted. PRF payments
were distributed quickly to address an emergency, and some controls may
not have been in place. These circumstances increase the risk of
improper payments, including payments being calculated incorrectly,
being unsupported by reasonable and appropriate documentation, or being
paid to ineligible providers.
HHS-OIG has ongoing work looking at PRF payments. We are conducting
a series of audits on the PRF general and targeted distributions in
three stages. The first two audits focus on HHS and Health Resources
and Services Administration (HRSA) controls, and the third focuses on
provider compliance. HRSA is the HHS agency administering the PRF.
First, HHS-OIG is assessing the effectiveness of HHS and HRSA's
controls over the accuracy of payments, ensuring payments met Federal
requirements and grant terms, and provider eligibility of funds
received for the automatic distributions. Second, we are assessing HHS
and HRSA's controls over the accuracy of payments, provider eligibility
of funds received, and other PRF program requirements (e.g., provider
documentation) for the application-based and other general
distributions. Third, we are conducting a series of audits of
providers' compliance with PRF reporting and expenditure requirements
to determine whether claims for services complied with Federal
requirements.
Through this ongoing oversight work, HHS-OIG expects to make
recommendations to improve HHS and HHS program oversight of any ongoing
emergency spending and future emergency spending. Potential
improvements may include more effective communications and internal
controls among entities involved in determining, allocating, and
distributing the funding, as well as recommendations to recover any
identified overpayments. Additionally, HHS-OIG is conducting an
evaluation of the geographic distribution of provider relief funds to
communities disproportionally impacted by adverse COVID-19 outcomes.
Looking forward, HHS-OIG is exploring a potential evaluation of PRF
payments to nursing homes.
HHS-OIG is continuing to coordinate on oversight of cross-cutting
issues related to pandemic funds with the Pandemic Response
Accountability Committee (PRAC), which promotes transparency and
ensures coordinated, comprehensive oversight of the Government's
spending and COVID-19 response to prevent and detect fraud, waste, and
abuse, and mismanagement.
HHS-OIG would be happy to provide a briefing for you and your staff
on this issue.
Question. Today, over 25 million Medicare beneficiaries enroll in
private health plans in order to access their Medicare benefits, as
well as supplemental benefits, such as post-hospital meals delivered to
their homes and lower cost-sharing for doctor visits.
By 2025, the Congressional Budget Office expects half of all
Medicare beneficiaries will enroll in a Medicare Advantage plan. Last
year, Medicare spent $320 billion in payments to private plans, which
is about 40 percent of all Medicare spending. In testimony before the
House, the Government Accountability Office reported that the improper
payment rate within the Medicare Advantage program is 10 percent. If
correct, that means in 2020, $32 billion in Medicare payments in
Medicare Advantage should not have been made. Oversight of this program
will be critical to ensure Medicare beneficiaries receive benefits they
are entitled to and longevity of the program remains for all Medicare
recipients.
Can you tell us why Medicare Advantage's improper payment rate is
so high? What can Congress do to reduce these improper payments?
Answer. With respect to the Medicare Advantage, the Centers for
Medicare and Medicaid Services (CMS) is responsible for calculating the
Medicare Part C/
Medicare Advantage gross improper payment estimate. In the Department's
Fiscal Year (FY) 2020 Agency Financial Report,\6\ CMS reported a 6.78-
percent error rate or $16.27 billion. This is a decrease from the prior
year's estimate of 7.87 percent.
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\6\ https://www.hhs.gov/about/agencies/asfr/finance/financial-
policy-library/agency-financial-reports/index.html.
As context, the methodology that CMS uses for the Medicare Part C
error rate estimates improper payments resulting from errors in
beneficiary risk scores used in risk adjustment. The primary component
of most beneficiary risk scores is clinical diagnoses submitted by the
plan. If medical records do not support the diagnoses submitted to HHS,
the risk scores may be inaccurate and result in payment errors. The
Part C improper payment estimate is based on medical record reviews
conducted under HHS's annual Part C Improper Payment Measurement
process, through which HHS identifies unsupported diagnoses and
calculates corrected risk scores. CMS risk-adjusts payments by paying
higher capitated payments to Medicare Advantage companies for
beneficiaries expected to have higher-than-average medical costs based
on their diagnoses. This practice may create financial incentives for
Medicare Advantage companies to make beneficiaries appear as sick as
---------------------------------------------------------------------------
possible.
With respect to one of the causes of improper payments in Medicare
Advantage (errors in risk scores used in risk adjustment), findings
from HHS-OIG reports raise concerns about the extent to which Medicare
Advantage companies may have inappropriately leveraged chart reviews
and beneficiary health risk assessments to maximize risk-adjusted
payments. HHS-OIG found that diagnoses that Medicare Advantage
companies reported only on chart reviews (a review of beneficiaries'
medical records to identify unreported or misreported diagnoses)--and
not on any service records in the encounter data--resulted in an
estimated $6.7 billion in added risk-adjustment payments for 2017. HHS-
OIG also found that in 2017 Medicare Advantage companies received an
estimated $2.6 billion in risk-adjustment payments from diagnoses
reported only on health risk assessments. Although these assessments
are intended to promote access to and coordination of needed care,
there were no encounter records for any other services for these
beneficiaries for these diagnoses. A small number of companies drove
most of these risk-adjustment payments deriving solely from chart
reviews and health risk assessments. These findings raise a payment
integrity concern. If diagnoses from these chart reviews or health risk
assessments are inaccurate or unsupported, the associated risk-adjusted
payments would be inappropriate.
In addition, HHS-OIG has performed a number of risk-adjustment data
validation audits to determine whether diagnosis codes that were
submitted by Medicare Advantage companies to receive a higher payment
were supported by underlying medical records as required. HHS-OIG used
data analytics to help identify particularly high risk diagnosis codes
and focused some of our audit work in these high-risk areas. HHS-OIG's
audits found that overpayments existed where Medicare Advantage
companies submitted diagnosis codes that increased risk scores but were
not supported by underlying medical records. As a result, these
Medicare Advantage companies should not have received these risk-
adjustment payments from CMS. HHS-OIG risk-adjustment data validation
audits are a key oversight tool in Medicare Advantage and result in the
identification of overpayments that can be returned to the program.
HHS-OIG plans to continue to perform audits in this area.
HHS-OIG does not currently have legislative recommendations
regarding reducing improper payments in Medicare Advantage; however, we
have numerous recommendations to CMS to target and strengthen its
oversight of Medicare Advantage companies' use of chart reviews and
health risk assessments. We have also recommended that CMS reconsider
whether to allow Medicare Advantage companies to use chart reviews that
are not linked to service records and in-home health risk assessments
as sources of diagnoses for risk adjustment.
Although the Part C improper payment rate has improved over the
last couple of years, CMS has not implemented a recovery audit program
in Part C, especially for risk-adjustment payments--the primary
vulnerability in Part C. HHS-OIG recommends that CMS explore
alternative ways to conduct Part C recovery audits.
HHS-OIG briefed your staff in May 2021 about our Medicare Advantage
body of work, and we would be happy to provide follow-up briefings for
you and your staff.
______
Questions Submitted by Hon. Maria Cantwell
Question. Nursing homes and skilled nursing facilities have been
particularly hard hit during the COVID-19 pandemic. A nursing facility
in Kirkland, WA was the site of the first U.S. death from the
coronavirus, and 39 residents of the facility died within 4 weeks.
In a recent report, the HHS Inspector General's Office found that
during 2020, two in five Medicare beneficiaries in nursing homes were
diagnosed with COVID-19. It is also found that almost 1,000 more deaths
occurred per day in the facilities during April 2020 than during April
2019, increasing the mortality rate by 5 percent.
Long-term care facilities have been entrusted to take care of our
seniors and residents should not have to fear for their own safety
while having lived in isolation away from friends, family, and visitors
during the pandemic. This situation is preventable and unacceptable.
Answer. I share your commitment to protecting nursing home
residents and appreciate your reference to HHS-OIG's extensive work in
this area. The devastating toll that the COVID-19 pandemic has taken on
Medicare beneficiaries in nursing homes demonstrates the need for
increased action to mitigate the effects of the ongoing pandemic and to
avert such tragedies from occurring in the future. Nursing homes should
be places of comfort and healing, and we owe our Nation's aging
population better. If confirmed, I plan to tackle this issue as my top
priority, employing an oversight strategy to raise nursing home
performance, put residents first, and improve oversight to ensure that
problems are detected and remedied quickly. HHS-OIG greatly appreciated
the opportunity to testify before the Senate Committee on Finance at a
hearing entitled ``Promoting Elder Justice: A Call for Reform'' \7\ on
July 23, 2019, and I look forward to continuing a collaborative dialog
with this committee should I be confirmed.
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\7\ https://oig.hhs.gov/documents/testimony/65/20190723_-
_Tinker_Testimony.pdf.
HHS-OIG has work underway that will build on the report you
reference, seeking to better understand nursing home challenges
resulting from the COVID-19 pandemic and strategies to combat those
challenges. The goal of this body of work is to help protect the health
and safety of the vulnerable nursing home population as the pandemic
continues, and to use these lessons to improve nursing home safety and
---------------------------------------------------------------------------
quality moving forward.
Question. The American Rescue Plan Act that Congress passed in
March included $250 million for States to deploy nursing home strike
teams to assist with cases of COVID-19 among residents and staff. I
have heard concerns, including from my home State of Washington, that
recipients have had difficulty understanding the requirements to
receive HHS program funding. Do States have the necessary resources and
clear information to access funding for nursing home strike teams? If
not, what do you think are the barriers preventing States from
accessing this money?
Answer. HHS-OIG does not currently have work examining American
Rescue Plan Act funding to States for deployment of nursing home strike
teams. We have work related to other pandemic-related appropriations,
such as distributions to health-care entities through the PRF. HHS-OIG
continually conducts work planning to identify areas that warrant our
review, and examples of HHS-OIG's extensive nursing home work are
provided in the next response. We note your interest in this funding
and would like to hear more about these reported difficulties and your
related concerns.
Question. The same report that I mentioned also found that about 50
percent of Black, Hispanic, and Asian Medicare beneficiaries in nursing
homes contracted COVID-19, compared to 41 percent of white
beneficiaries. What is the reason behind this disparity? How do you
recommend that we address this issue?
Answer. Thank you for your attention to our work. As you reference,
we reported disturbing differences in infection and death rates for
nursing home residents, with Black, Hispanic, and Asian Medicare
beneficiaries experiencing higher rates of infection and greater
increases in mortality as compared with White beneficiaries. This
initial report did not evaluate the causes of these differences, and we
did not make recommendations. Follow-up reports on nursing home
challenges and strategies will address problems maintaining resident
safety and infection control. This work may uncover issues related to
disparities, but it will not study the causes of the differences we
found in infection and death rates.
Additionally, HHS-OIG has ongoing work focused on the collection
and use of data on disparities in COVID-19 cases and outcomes by the
Centers for Disease Control and Prevention (CDC). This study will
examine data that CDC collects and maintains that can be used to assess
racial, ethnic, and socioeconomic disparities in COVID-19 cases and
outcomes, as well as how CDC uses those data as part of its activities
to address the COVID-19 pandemic. HHS-OIG will also examine CDC's
lessons learned about how to best protect communities of color and
economically disadvantaged communities in future public health
emergencies.
More broadly, our extensive work focusing on nursing homes may be
useful as you, Congress, and other stakeholder look for ways to address
the significant problems at nursing homes. HHS-OIG has made substantial
investments in oversight, enforcement, compliance, and outreach to
protect nursing home residents. HHS-OIG has an extensive body of
completed and ongoing work and recommendations looking at the
vulnerability of nursing home residents to COVID-19 and other
emergencies; abuse, neglect, and failures of care in nursing homes;
States' oversight of nursing homes; risks to quality of care and well-
being for residents in nursing homes.
HHS-OIG investigates potential criminal and civil violations to
hold accountable those who victimize residents of nursing homes. HHS-
OIG investigates and works with DOJ to resolve False Claims Act cases,
which may lead to the subject provider entering into a Corporate
Integrity Agreement that contains provisions addressing policies and
procedures, training, internal monitoring, and other requirements to
improve quality of care. In addition, HHS-OIG may exclude the nursing
home or chain from participating in Federal health-care programs. HHS-
OIG runs the Federal grant program for State Medicaid Fraud Control
Units (MFCUs); MFCU investigations and prosecutions of nursing home
abuse or neglect cases are a core component of their grant
responsibilities. HHS-OIG also engages providers in protecting
residents. In July 2020, HHS-OIG staff contacted 493 nursing homes and
236 emergency medical services providers that serve nursing homes. HHS-
OIG provided information on how to report concerns about unsafe COVID-
19 practices, quality of care, patient abuse, neglect, and health-care
fraud or misconduct. HHS-OIG is planning future engagements with
nursing homes regarding emergency preparedness and response.
Implementation of pending HHS-OIG recommendations would help
protect vulnerable residents. Among unimplemented HHS-OIG
recommendations related to nursing homes, a top recommendation is that,
to ensure that nursing homes are implementing actions to prevent the
spread of COVID-19 and that they are protecting residents, CMS should
assess the results of infection control surveys of nursing homes and
revise surveys as appropriate, and clarify expectations for States to
complete backlogs of standard surveys and high priority complaint
surveys that were suspended in the early months of the pandemic.
HHS-OIG would be pleased to brief you and your staff on this body
of work.
Question. Crowding in nursing facilities was one of the main
reasons that COVID-19 was able to spread so quickly to so many
residents. I have led efforts here in the Senate to expand the Money
Follows the Person program, which aims to transfer people from
institutional settings to the comfort of their own homes and
communities. In your opinion, are programs like Money Follows the
Person helpful in preventing this tragedy from happening again in the
future?
Answer. Throughout my career at HHS-OIG, I have demonstrated
commitment to improving home and community-based services (HCBS) to
ensure that these services are delivered effectively and efficiently
and provide improved quality of life and health. Improving access to,
and the quality of, HCBS, such as personal care services, social
services for adults, and group homes for people with developmental
disabilities, is essential. These services help ensure that the
millions of individuals can continue to live independently outside of
institutions and nursing facilities. HCBS provide individuals leaving
institutional care more options to do so. As with nursing home care, we
must ensure that HCBS providers maintain safe, high quality services
for beneficiaries. HHS-OIG has ongoing work examining HCBS, including
an audit to assess State and provider compliance with health and safety
requirements involving Medicaid beneficiaries residing in
individualized supported living settings. This review will include an
assessment of resident safety measures for infectious diseases such as
COVID-19.
Other HHS-OIG work supports strengthening HCBS practices. Our
Office of Audit Services conducts extensive audits of State claims for
Federal Financial Participation, including audits addressing Money
Follows the Person (MFP) expenditures. Further, HHS-OIG has an
extensive body of work addressing HCBS in dozens of States under a wide
range of Medicaid waivers and in various service settings, including
home health, hospice, personal care service, group homes, and adult day
centers.
We do not have work focused on the value and role of MFP in
supporting beneficiaries who wish to receive home care rather than
nursing facility care. HHS-OIG would like to learn more about your
interest in this topic to inform our ongoing work planning and further
explore how our existing HCBS work may inform for your efforts.
Looking toward the future in health care, value-based care models
increasingly promote care in home and community settings through in-
person home visits, remote monitoring, and other technologies. At-home
care is often preferred by patients. An HHS-OIG evaluation of
strategies used by Medicare accountable care organizations (ACOs) found
that many ACOs provided beneficiaries with a range of at-home services.
In 2020, HHS-OIG issued new regulations under the Federal anti-kickback
statute and the civil monetary penalties law to promote improved care
coordination and value-based care, including arrangements that can
facilitate more care in peoples' homes. It will be important to ensure
that new models that provide more care in peoples' homes operate as
intended for the person's benefit and are not compromised by fraud,
waste, or abuse. HHS-OIG's work on telehealth is described in the
responses to your next question.
Question. Telemedicine services have been extremely helpful and
popular during the public health emergency. The University of
Washington School of Medicine, a leading health provider in my State,
has offered telehealth services for its patients across the Pacific
Northwest since the 1970s. Over the past 5 years, the number of people
seeking telehealth services has steadily grown to around 21,000 per
year in 2019. After the pandemic began, that number ballooned to over
20,000 per month, accounting for approximately 20 percent of all
ambulatory visits.
There have been numerous reports that telehealth fraud has become
more and more prevalent in recent years. Just this week, the Department
of Justice charged 43 individuals with exploiting more than $1.1
billion in telemedicine fraud schemes.
Public trust in the health-care delivery system is imperative for a
successful health-care network that provides high quality service,
especially during the COVID-19 pandemic.
Who, or which demographics, were the main targets of telehealth
fraud? What can we do to improve telehealth literacy and security so
that people are aware when they are being targeted?
Answer. To date, most of HHS-OIG's enforcement in this area has
involved ``telefraud''--schemes that use phone calls or sham remote
visits to engage with a beneficiary to order or prescribe medically
unnecessary testing, equipment, or prescriptions. The alleged fraud
associated with these schemes is in the billions of dollars and is
largely associated with fraud related to medically unnecessary claims
for durable medical equipment (DME), various types of laboratory tests,
and pain medication.
These telefraud schemes intentionally target Medicare
beneficiaries. In four national law enforcement actions, HHS-OIG
identified hundreds of thousands of elderly and disabled individuals
who were targeted by the schemes and had medically unnecessary items
ordered or prescribed on their behalf. During the pandemic, fraudsters
are victimizing unsuspecting Medicare beneficiaries and stealing from
Federal health-care programs through aggressive telemarketing
techniques to confuse beneficiaries and take advantage of the growing
acceptance of remote care. HHS-OIG remains committed to taking swift
action against bad actors who engage in telefraud schemes or seek to
exploit telehealth services and remote care.
To spread awareness of scams, HHS-OIG has published materials and
fraud alerts on our website and social media and has partnered with
Government and private stakeholders to alert Medicare beneficiaries on
emerging telefraud scams so they can take steps to protect themselves.
For example, we regularly share information with the Senior Medicare
Patrol (SMP), which has published specific educational materials
related to telefraud scams. HHS-OIG is developing additional
educational materials for beneficiaries and doctors about additional
practical steps they can take to avoid telefraud scams. Once those
materials are public, HHS-OIG will notify your office.
HHS-OIG will continue to assess the need for additional HHS-OIG
compliance materials to help providers who want to comply with laws and
provide high-quality telehealth services to their patients. More
broadly, with respect to improving telehealth literacy, a range of
Government and private stakeholders, especially those who interact
directly with patients and consumers, can play important roles in
educating the public.
HHS-OIG has oversight work underway looking at telehealth in
Medicare and Medicaid, described more fully in the response to your
next question. Further, HHS-OIG is coordinating with other Offices of
Inspector General as part of the Pandemic Response Accountability
Committee to plan oversight work related to telehealth issues that
affect multiple Federal agencies. Although work planning is ongoing,
the expectation is that this work will provide valuable insights into
telehealth service delivery and payment across several Federal
agencies. These insights may further inform policymakers and other
stakeholders about the successes and challenges that span Federal
programs. HHS-OIG would be pleased to provide a briefing for you and
your staff on this work.
Question. I understand that the Departments of Justice and Health
and Human Services operate a joint initiative, the Medicare Fraud
Strike Force, to prevent and deter health-care fraud around the
country. Has the joint initiative been successful in decreasing the
volume of fraudulent claims? Is there any room for expansion of scope
beyond Medicare to include other government health-care programs?
Answer. To protect beneficiaries and recover billions in alleged
fraud, HHS-OIG and our law enforcement partners have conducted four
successful, large-scale takedowns that have targeted telefraud schemes:
Operation Brace Yourself,\8\ the 2020 National Health Care Fraud
Takedown,\9\ the 2021 COVID-19 Takedown,\10\ and the 2021 National
Health Care Fraud Enforcement Action.\11\ These actions were conducted
as part of the Strike Force initiative.
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\8\ https://www.justice.gov/opa/pr/federal-indictments-and-law-
enforcement-actions-one-largest-health-care-fraud-schemes.
\9\ https://www.justice.gov/opa/pr/national-health-care-fraud-and-
opioid-takedown-results-charges-against-345-defendants.
\10\ https://www.justice.gov/opa/pr/doj-announces-coordinated-law-
enforcement-action-combat-health-care-fraud-related-covid-19.
\11\ https://www.justice.gov/opa/pr/national-health-care-fraud-
enforcement-action-results-charges-involving-over-14-billion.
These joint enforcement actions can reduce potentially fraudulent
claims to Medicare. For example, in the 16 weeks prior to and during
the week of Operation Brace Yourself, the 130 DME suppliers that were
targets of the takedown submitted $754 million of claims to the
Medicare program and were paid$389 million by CMS. In the 16 weeks
following the takedown, the same 130 DME suppliers that were suspended
by Medicare submitted $279,000 of claims and were paid $133,000.
Furthermore, there was a 48 percent decrease in Medicare payments for
products related to Operation Brace Yourself (primarily DME) and 74 DME
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suppliers voluntarily withdrew from billing the Medicare program.
The telefraud takedowns mostly involve fraud against Medicare
because the schemes specifically target Medicare beneficiaries.
However, other Strike Force operations have taken action against fraud
that affected other Government health-care programs, including Medicaid
and TRICARE. We continually monitor fraud trends and share them with
our government program integrity partners, including other Offices of
Inspectors General and law enforcement partners. Coordinated
enforcement is critical to success, and HHS-OIG routinely seeks
opportunities to work with law enforcement partners to strengthen
oversight and protect programs and patients.
Question. In terms of technology, how can health care and
technological providers collaborate in improving security features to
stamp out attempts of fraud?
Answer. It is important that new telehealth technologies with
potential to improve care and enhance access achieve these goals are
not compromised by fraud, abuse, or misuse. HHS-OIG recognizes that the
increased demand for telehealth services raise privacy and security
concerns as providers and patients adopt new technology for telehealth
and other virtual care.
HHS-OIG has recently announced seven reviews addressing telehealth,
that endeavor to provide objective findings and recommendations to
further inform policymakers and other stakeholders as they consider
changing telehealth beyond the public health emergency. HHS-OIG is also
currently developing two reviews that will assess security- and
privacy-related issues associated with telehealth:
Medicare Part B Telehealth Services During the COVID-19 Public
Health Emergency: HHS-OIG will conduct a series of audits of Medicare
Part B telehealth services, including a review of telehealth technology
and potential effects of Health Insurance Portability and
Accountability Act (HIPAA) waivers during the public health emergency.
Audit of IHS Telehealth Technologies' Cybersecurity Controls:
HHS-OIG is conducting an audit that will determine whether Indian
Health Services has implemented cybersecurity controls to protect its
telehealth technologies from emerging risks.
Earlier this year, HHS-OIG provided technical assistance to
Congress, including the Senate Committee on Finance and your staff,
that highlighted potential risks based on high-level early data
analyses. In that technical assistance, HHS-OIG identified the
following potential safeguards to increase security and minimize risk
of telehealth services: ensure expanded telehealth technology meets a
consistent level of security expectations; ensure that security
requirements take into account the patient role and potential
vulnerabilities and harmonize security requirements as much as possible
across service types; create a system between provider and patient to
verify the provider (e.g., technology verification ``handshake'' or
something similar to multifactor authentication or to the electronic
visit verification system for home health and personal care services);
continue addressing patient access to reliable Internet connection to
ensure that patients can securely communicate with their providers; and
ensure training on telehealth-specific health-care privacy and security
training for providers and staff who provide telehealth services.
HHS-OIG is committed to keeping this committee, Congress, and other
stakeholders informed in instances where significant risks are found
that are supported by data and our analysis, audits, evaluations, and
investigations. HHS-OIG recognizes the importance of providing timely,
independent, and objective information as policymakers consider
telehealth expansion or other changes beyond the public health
emergency, including potential impacts on security and privacy.
______
Questions Submitted by Hon. Catherine Cortez Masto
Question. In response to the COVID-19 pandemic, both Congress and
the Department of Health and Human Services (HHS) expanded access to
telehealth for a wide range of services. What kind of data and
utilization information is the OIG currently working to collect and
what will be important for Congress to consider as we seek to make some
of these expansions permanent?
Answer. HHS-OIG's direct access to Medicare data allows for
sophisticated monitoring of telehealth claim utilization patterns. By
identifying outliers and other patterns, HHS-OIG generates potential
leads for investigations or spots potential program integrity risks
that would benefit from further oversight. We have been monitoring
Medicare claims data since the beginning of the pandemic in spring 2020
via automated reports that are shared with the CMS and our law
enforcement partners. HHS-OIG will continue this effort and improve our
data analytics by incorporating field intelligence from our law
enforcement agents, auditors, and evaluators.
HHS-OIG recently announced seven reviews and issued three reports
addressing the telehealth used to provide behavioral health services in
Medicaid. Several of these reviews will assess specific aspects
telehealth utilization. For example, HHS-OIG is conducting a data
snapshot,\12\ which will describe the extent to which Medicare
beneficiaries had established relationships with providers from whom
they received telehealth services. These recently announced reviews and
reports are described in the attached Appendix 2.
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\12\ https://oig.hhs.gov/reports-and-publications/workplan/summary/
wp-summary-0000613.asp.
Many of these telehealth oversight reports are expected to be
completed in calendar year (CY) 2022. As appropriate, HHS-OIG's
telehealth oversight will recommend suitable safeguards to help ensure
that telehealth operates effectively and efficiently to enhance access;
deliver quality health care; improve health outcomes; and mitigate
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potential fraud, abuse, and misuse.
In instances where HHS-OIG finds significant risks that are
supported by data and our analysis, audits, evaluations, and
investigations, HHS-OIG is committed to keeping this committee,
Congress, and other stakeholders informed. HHS-OIG recognizes the
importance of providing timely, independent, and objective information
as policymakers consider telehealth expansion or other changes beyond
the public health emergency. We have already provided technical
assistance to Congress, including the Senate Committee on Finance,
earlier this year that highlight potential risks and safeguards based
on high-level, early data analyses.
Question. In your opinion, would it be beneficial to extend
telehealth access to be able to further study and review the effects
that the expanded access to telehealth during the pandemic has had on
access, cost, and quality of care?
Answer. I recognize the potential positive effects of telehealth
expansion. It offers opportunities to increase access to services,
decrease burdens for both patients and providers, and enable better
care, including enhanced mental health care. A 2019 HHS-OIG study \13\
found that telehealth can be an important tool to improve patient
access to behavioral health services. And as we observed in a
rulemaking in December 2020,\14\ HHS-OIG recognizes the promise that
telehealth and other digital health technologies have for improving
care coordination and health outcomes.
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\13\ https://oig.hhs.gov/oei/reports/oei-02-17-
00490.asp?utm_source=oig-web&utm_medium=oig
-grimm-letter&utm_campaign=oig-OEI-02-17-00490.
\14\ https://www.federalregister.gov/documents/2020/12/02/2020-
26072/medicare-and-state-health-care-programs-fraud-and-abuse-
revisions-to-safe-harbors-under-the#p-403.
It is important that new policies and technologies with potential
to improve care and enhance access achieve these goals and are not
compromised by fraud, abuse, or misuse. HHS-OIG's oversight work
referenced in response to your first question can help ensure that the
potential benefits of telehealth are realized for patients, providers,
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and HHS programs.
As HHS-OIG's work and the national conversation regarding
telehealth continues, I believe there is a shared goal: ensuring that
telehealth delivers quality, convenient care for patients and is not
compromised by fraud. If I am confirmed, I look forward to providing
objective, independent information to stakeholders and policymakers to
help achieve the goal.
Question. Recently published OIG reports looked at State Medicaid
programs using telehealth to provide behavioral health services and
noted the various challenges and opportunities in this space. In one
report, OIG recommended that CMS conduct evaluations on the effects of
telehealth on access, cost, and quality of behavioral health services
and monitor for fraud, waste and abuse in this space. The report stated
that CMS did not explicitly state if it concurred with these
recommendations, despite that many States believe that telehealth has
increased access to care and they are unsure of the impacts it has on
quality and cost. Do you foresee any impediment to CMS implementing
these recommendations and does Congress have a role to play in carrying
out this recommendation?
Answer. Consistent with normal HHS-OIG report follow-up processes,
CMS has 6 months from the issuance date of the report to submit a Final
Management Decision in response to the recommendation. In the Final
Management Decision, CMS should provide details about any plans or
progress to implement this recommendation and should indicate whether
it concurs or non-concurs. HHS-OIG will continue to follow up with CMS
on the status of this recommendation through this process. HHS-OIG
would be happy to provide you and your staff a briefing on this work
and explore ways that Congress might support evaluation of telehealth.
Further, HHS-OIG will keep you and your staff updated on the
recommendation status following receipt of CMS's Final Management
Decision.
Question. Recent increases in unaccompanied minors seeking asylum
at the southern border, combined with the ongoing COVID-19 pandemic,
have strained immigration resources and exposed intolerable conditions
in detention facilities. As Inspector General, how will you guide
oversight of the Office of Refugee Resettlement's Unaccompanied
Children programs?
Answer. The safety and care of unaccompanied children in HHS
custody has been and remains a key focus for HHS-OIG. If I am
confirmed, HHS-OIG will continue to provide independent oversight of
the Office of Refugee Resettlement (ORR) Unaccompanied Children (UC)
Program, and actionable recommendations for improvements.
Past HHS-OIG work has uncovered significant safety and well-being
concerns at the care facilities, and not all of HHS-OIG's
recommendations for improvements have been implemented. Earlier this
year, we released a toolkit \15\ of insights from our audits,
evaluations, and investigations that outlines consequential actions
that HHS program officials and care facility administrators can take to
ensure the health and safety of unaccompanied children, especially
children at new influx care facilities and emergency intake sites--two
types of facilities that are not required to be State licensed.
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\15\ https://oig.hhs.gov/oei/reports/OEI-09-21-00220.asp.
If confirmed, I will guide our work using a dynamic, risk-based
approach that will help HHS-OIG anticipate and respond to emerging
issues and vulnerabilities with the resources available. To enhance the
impact of this work, HHS-OIG will leverage data, modern technology,
specialized expertise, and strategic partnerships. I will also further
our work in automating our ability to monitor reports of sexual abuse
and other Federal crimes committed against unaccompanied children. This
will allow HHS-OIG to coordinate more efficiently with ORR, law
enforcement partners, and non-governmental organizations to
appropriately investigate and respond to allegations. I am also
committed to continuing to alert HHS to trends and concerns that HHS-
OIG teams have identified from site visits to facilities for
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unaccompanied children, or through other work.
Two areas of pressing concern are health and safety vulnerabilities
in ORR care facilities and ensuring appropriate placement of
unaccompanied children. HHS-OIG has been closely monitoring the ORR
response to the 2021 surge, including conducting oversight on the
ground at care facilities. We have work underway assessing influx
facilities and emergency intake sites with regard to background checks,
COVID-19 protocols, and case management, including work at Fort Bliss.
Other ongoing work includes assessing children's initial placements and
subsequent transfers to identify any challenges that ORR and facilities
may have encountered in the placement and transfer process. Information
on HHS-OIG's completed and ongoing work is available on the
Unaccompanied Children \16\ page of the featured topic section of our
website. We appreciated the opportunity to brief your staff on HHS-
OIG's UC Program work in April 2019 and the continued engagement with
your staff since then. We would be happy to provide additional
briefings to you and your staff on this issue.
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\16\ https://oig.hhs.gov/reports-and-publications/featured-topics/
uac/.
Question. According to a 2016 GAO report, ORR lacked a process for
annually updating and documenting its plan to care for unaccompanied
children, including planning for housing and educational, medical, and
therapeutic service needs. What are your goals to ensure the Department
of Health and Human Services is properly monitoring and documenting
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care for unaccompanied children in ORR custody?
Answer. After responsibility for unaccompanied children was
transferred to HHS by the Homeland Security Act of 2002, HHS-OIG has
provided extensive oversight to the ORR UC Program, including issuing
23 reports since 2017. Similar to findings from GAO's 2016 report, HHS-
OIG has identified concerns with ORR's oversight of the UC program and
provided recommendations to support program improvements, including
recommendations related to monitoring and documenting care.
In fiscal year 2021, HHS-OIG released four new reports on the UC
Program, and we currently have eight ongoing oversight reviews. If I am
confirmed, HHS-OIG will continue its independent oversight of the UC
Program, including providing actionable recommendations for program
improvements that better protect children. This work and my approach
are further described in the preceding response. Although it is up to
HHS and care facilities to implement HHS-OIG recommendations, if
confirmed, I will continue to ensure that HHS-OIG is actively tracking
recommendations that remain unimplemented. In addition, to further my
goal to drive positive change, I will oversee the launch of a
streamlined, transparent, and interactive approach to provide
stakeholders better access to our findings and open recommendations via
our public website.
______
Questions Submitted by Hon. Mike Crapo
Question. I am concerned about the potential for the work of HHS
OIG, and indeed that of all inspectors general, to become politicized,
despite their offices' intended independence.
What is your understanding of your role in reviewing policy
decisions made by career officials and political appointees?
Answer. The role of an Inspector General is to oversee programs and
operations of the Department; to make recommendations to promote the
economy, efficiency, and effectiveness of Department programs; and to
prevent and detect fraud and abuse in such programs, acting at all
times with independence and objectivity. Under the IG Act, an Inspector
General cannot engage in program operating responsibilities.
Accordingly, an Inspector General does not make program decisions or
substitute her judgement for the discretion of a program official. If I
am confirmed, I will provide independent, objective oversight of
Department programs and operations consistent with the IG Act.
Question. How will you work to ensure OIG acts as an independent
investigator?
Answer. Inspectors General perform an essential public service.
They root out fraud, waste, and abuse and help make programs more
efficient and effective. Their ability to do that is rooted in their
independence and objectivity. Through independence, objectivity, and
transparency, Inspectors General help Government better serve the
American people. A strong Inspector General makes a stronger department
and a stronger, more trusted Federal Government.
One way that I will ensure independence and objectivity, if I am
confirmed, is by ensuring that HHS-OIG continues to closely follow the
standards for work products, such as audits and evaluations. This means
that HHS-OIG will continue to keep an arm's length from the agencies
and programs it oversees. The IG Act provides Inspectors General with
several means to maintain independence, such as an OIG having its own
legal counsel and the ability to hire its own personnel and contract
for goods and services. Independence also means that Department
officials have to make program decisions without the approval of their
Inspector General. If I am confirmed, HHS-OIG will continue to follow
the facts wherever they lead and conduct itself in a wholly nonpartisan
manner.
Maintaining independence does not mean that HHS-OIG cannot have
productive relationships with Department leaders and officials. I meet
regularly with Department officials to talk about HHS-OIG's findings
and recommendations. I encourage our senior leaders and subject matter
experts to do the same with their counterparts. Those relationships are
critical to ensure understanding of our work and resultant
recommendations and will continue if I am confirmed. When I meet with
HHS officials, I often say that they may not always like what we say,
but I hope they will take our input as a blueprint for what can be done
better.
Question. Last year, HHS OIG took an important step towards driving
value for American patients from all walks of life with its updates to
the Anti-Kickback Statute's (AKS) safe harbor regulations, which will
help to facilitate high-quality and dynamic value-based arrangements
(VBAs), in addition to bolstering cybersecurity safeguards and adapting
to some of the pressing technological needs of the health-care system.
These safe harbor modernization efforts, however, included a number of
exclusions that risk retaining barriers to effective VBAs, medication
adherence programs, and other patient-centered initiatives,
particularly with respect to medical device and life sciences
innovators. While well-intentioned, exclusions along these lines can
hinder efforts to promote positive health outcomes and reduce health
disparities.
Can you commit to continuing to engage with my office, along with
the offices of other interested members, to ensure that our vital anti-
fraud and abuse laws protect patients while also keeping pace with an
evolving and technologically advancing health-care ecosystem?
Answer. Yes, I can commit to engaging with your office and offices
of other interested members on this issue. Congress intended safe
harbor regulations to evolve as the health-care industry and technology
changed. To this end, HHS-OIG has issued new and modified safe harbors
from time to time and annually solicits suggestions from the public on
new and amended safe harbors. HHS-OIG's goal is to promulgate safe
harbor regulations that protect beneficial arrangements for patients
and at the same time protect against fraud and abuse. Safe harbor work
is conducted with public input, including through notice-and-comment
rulemaking, and in consultation with the Department of Justice (DOJ).
Question. Effective coordination among Federal agencies enables
more efficient and informed responses to policy challenges, as HHS OIG
has demonstrated through its partnership with the Department of Justice
(DOJ) in overseeing and enforcing important anti-fraud and abuse laws
like the Anti-Kickback Statute (AKS).
With respect to this partnership in particular, what role does DOJ
play with respect to AKS oversight and enforcement, and how does HHS
OIG work with DOJ on this front?
Answer. HHS-OIG and DOJ have a long and successful collaboration
regarding AKS oversight and enforcement. DOJ has primary responsibility
for enforcement of the AKS, which is a criminal statute. DOJ prosecutes
criminal cases in Federal court. HHS-OIG's Office of Investigations
(OI) investigates AKS cases, often in coordination with other law
enforcement partners, including DOJ and the FBI. OI works closely with
DOJ and U.S. attorneys to charge and resolve cases and HHS-OIG
attorneys frequently consult to provide legal expertise regarding the
AKS.
DOJ also brings or intervenes in False Claims Act cases predicated
on AKS violations on behalf of the government; HHS-OIG investigates
those cases, often in coordination with other law enforcement partners,
and is signatory for HHS on settlement agreements. HHS-OIG's other
roles with respect to the AKS include negotiating corporate integrity
agreements with companies settling AKS cases, issuing advisory opinions
and other guidance regarding the application of the AKS, and
promulgating safe harbor regulations. HHS-OIG coordinates closely with
DOJ on all matters related to the AKS and, as required by statute,
consults with DOJ before issuing advisory opinions and safe harbor
regulations. HHS-OIG also has administrative enforcement authority to
impose civil monetary penalties, program exclusion, or both for
violations of the AKS. In this area, we coordinate with DOJ to ensure
that the government is pursuing the most appropriate remedy for the
conduct in the particular case.
Question. Do you see areas for improvement or opportunity in terms
of coordination between HHS OIG and DOJ?
Answer. I see tremendous opportunity to continue to build on our
outstanding partnerships with DOJ and other law enforcement entities to
best combat fraud and protect individuals served by HHS programs from
harm. The Health Care Fraud Strike Force model has proven to be
successful since the first team launched in March 2007. Strike Force
partnerships between HHS-OIG, DOJ, U.S. Attorney's Offices, the Federal
Bureau of Investigation, and the Drug Enforcement Administration are a
force multiplier that utilize a coordinated and data-driven approach to
identifying, investigating, and prosecuting fraud. Since its inception,
Strike Force prosecutors have filed more than 2,100 cases charging more
than 4,600 defendants who collectively billed Federal health-care
programs and private insurers approximately $23 billion; more than
3,000 defendants pleaded guilty and over 390 others were convicted in
jury trials; and more than 2,800 defendants were sentenced to
imprisonment for an average term of approximately 50 months.
Our coordinated law enforcement operations both remove bad actors
from participation in HHS programs through convictions and exclusions
and effect widespread change in behavior by serving as a deterrent for
others. This coordination has also been critical to OIG's enforcement
efforts and other work to address the prescribing and treatment
dimensions of the opioid crisis, as discussed in HHS-OIG's testimony
before the Senate Committee on Finance in a hearing entitled, ``OIG
Efforts to Address the Prescribing and Treatment Dimensions of the
Opioid Crisis'' \17\ on October 24, 2019.
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\17\ https://oig.hhs.gov/documents/testimony/68/20191024_-
_Cantrell_Testimony.pdf.
Medicare payment trends demonstrate the positive impact of Strike
Force enforcement and prevention efforts. As just one example, at its
peak, Medicare was billed $472 million in April 2019 for CPT codes
covering genetic testing, and paid out $111 million. The numbers were
similar in May, June, and July, 2019. When we made our first arrest in
August as part of an initiative known as Operation Double Helix, which
was led by the Health Care Fraud Strike Force, billing dipped to $154
million, with $48 million paid. In October, the month after the
coordinated law enforcement takedown, the numbers decreased to $51
million billed, $15 million paid, a roughly 87-percent drop in money
out the door. That November, Medicare paid out only $2 million for
these codes--a 98-percent drop from the peak of $111 million 6 months
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earlier.
HHS-OIG will continue to collaborate closely with DOJ and other law
enforcement partners to direct investigative resources to areas of
greatest need, and explore new opportunities to expand efforts, to best
protect HHS programs and the individuals they serve.
Question. While HHS OIG has no oversight over Medicare Part D's
programmatic requirements or payment policies, its work to combat fraud
and abuse can have implications for Part D beneficiaries, as well as a
range of stakeholders across program and the health-care system more
broadly.
Given that reports indicate the administration is unlikely to move
forward with implementation of the Rebate Rule finalized in November
2020, does HHS OIG have any plans, at this point, to revisit
prescription drug rebate reform, either through potential rulemaking or
other policy mechanisms?
Answer. The rebate rule, which is a safe harbor rulemaking under
the Federal anti-kickback statute, is the subject of ongoing
litigation, and I cannot comment on it or any related matters. As a
general matter, under the IG Act, HHS-OIG may audit, evaluate, and
investigate program vulnerabilities in Medicare Part D and make
recommendations to mitigate them. HHS-OIG does not, however, set
program policy and implement reforms to the Medicare Part D program;
these would be implemented by Congress or CMS, which administers the
program.
Understanding what drives high drug spending for programs and
beneficiaries is critical and a priority for HHS-OIG. HHS-OIG has
conducted, and continues to conduct, a wide range of reviews addressing
rebates and other drug-related topics in the Medicare and Medicaid
programs. HHS-OIG's goal is to identify opportunities to reduce drug
spending for patients and HHS programs (i.e., Part D, Part B, and
Medicaid), while ensuring access for beneficiaries. HHS-OIG does this
by focusing on three main areas: (1) determining whether HHS program
and patients are overpaying for prescription drugs based on current HHS
program and drug reimbursement rules, (2) assessing the impact of
current HHS program and drug reimbursement rules on drug spending, and
(3) assessing compliance with prescription drug reimbursement statutes
and regulations. HHS-OIG would be happy to provide a briefing about our
work in this area.
______
Questions Submitted by Hon. Chuck Grassley
Question. Recently, the Department of Justice, along with the HHS
Office of Inspector General (OIG) and other law enforcement agencies,
announced criminal charges against 138 defendants, including doctors
and nurses, for over $1.4 billion in alleged losses. The largest amount
of fraud charged--more than $1 billion--relates to telemedicine
services. The second largest amount of fraud charged--more than $29
million--relate to COVID-19 fraud. These figures are startling and
represent lost taxpayer dollars. The Federal government must do all
that it can to stop these fraudsters from taking advantage of the
COVID-19 pandemic.
Please provide examples of the types of fraudulent conduct
identified during HHS OIG's recent enforcement action.
Answer. The majority of cases brought in the 2021 National
Enforcement Action (NEA) are ``telefraud'' schemes, which accounted for
over $1.1 billion in allegedly false claims submitted by 43 defendants.
``Telefraud'' schemes use phone calls or sham remote visits to engage
with a beneficiary to order or prescribe medically unnecessary testing,
equipment, or prescriptions. Some characteristics of the alleged
``telefraud'' activities in the NEA include: paying illegal kickbacks
and bribes to health-care providers in exchange for the referral of
Medicare beneficiaries; preying on the elderly via telemarketing and
health fairs; and providing orthotic braces, genetic testing, and
compounded pain creams that were medically unnecessary, not eligible
for Medicare reimbursement, and/or not provided as represented.
The NEA demonstrated the Government's continued focus on
investigating and prosecuting evolving COVID-19 health-care fraud and
schemes involving the Provider Relief Fund. Examples of alleged
fraudulent conduct include:
Providing COVID-19 tests to Medicare beneficiaries to induce
the beneficiaries to provide their personal identifying information and
a saliva or blood sample. The defendants are alleged to have then
misused the information and samples to submit claims to Medicare for
unrelated, medically unnecessary, and far more expensive laboratory
tests, including cancer genetic testing, allergy testing, and
respiratory pathogen panel tests.
Misappropriating Provider Relief Fund moneys to spend on
personal expenses.
Additionally, the NEA included charges involving sober homes, where
defendants allegedly referred patients to substance abuse treatment
facilities where they could be subjected to medically unnecessary drug
testing, as well as enforcement against defendants related to the
illegal prescription and/or distribution of opioids.
Question. In your opinion, what are the contributing factors that
have caused the increase in Medicare and Medicaid fraud we've witnessed
during the pandemic?
Answer. As with past public health emergencies, the COVID-19
pandemic has resulted in rapid evolution of health-care fraud schemes
that exploit the exigent circumstances of the moment. Although we are
still in the midst of understanding the magnitude of fraud schemes that
proliferated during the pandemic, HHS-OIG has received thousands of
complaints related to purported COVID-19 fraud. In March 2020, when
store shelves were emptied of hand sanitizer, the fraud scams offered
``senior care packages'' complete with hand sanitizer and a face mask.
Later, we saw sham contact tracing to steal personal information. And
then fake vaccines before vaccines were approved and available. Most
recently, we see people selling fake proof of vaccinations.
Additionally, the fraudsters specifically targeted Medicare
beneficiaries recognizing that many were isolated at home during many
parts of the pandemic.
In addition to exigent circumstances, fraudsters are aware of the
increased funding and emergency flexibilities appropriately established
to support the pandemic response. The risk of improper payments rises
when funds are distributed fast to address an emergency, or rules are
waived to help the vast majority of health-care providers seeking to
provide needed care during a pandemic. As a result, there is increased
risk of payments being calculated incorrectly, not being supported with
reasonable and appropriate documentation, or not being paid to eligible
providers.
HHS-OIG remains committed to taking swift action against bad actors
who exploit the public health emergency. HHS-OIG continually monitors
fraud trends--for example, by using our direct access to Medicare
claims to spot outliers and aberrant trends--and share them with our
Government program integrity partners, including other Offices of
Inspectors General and law enforcement partners. This trend information
helps identify potential targets and schemes for further investigation.
Question. I applaud the Federal Government's efforts to prosecute
COVID-19-
related fraud, but these are reactive measures. What types of proactive
measures can the Federal Government take now to prevent fraud before it
occurs?
Answer. I wholeheartedly agree with the importance of preventing
fraud before it occurs. If I am confirmed, I am committed to helping
HHS identify proactive measures that can be adopted as new programs are
established and existing programs improved. Integrating program
integrity features into the programs early provides the best
opportunity to prevent fraud before it occurs. In my experience,
program integrity can be an afterthought during program implementation,
and agencies later struggle to retrofit program integrity measures. To
this end, for example, HHS-OIG provided technical assistance as HHS
stood up the Provider Relief Fund so that program officials had an
understanding of key program integrity risk factors and HHS-OIG
insights from prior work on other funding programs. Similarly, HHS-OIG
has been providing technical assistance to the Department on program
integrity for new programs under the American Rescue Plan. This
technical assistance drew from HHS-OIG's prior oversight work that made
recommendations to improve program integrity activities in the
administration for Children and Family's Child Care and Development
Fund (CCDF) block grant program.
Improving the availability and usability of data within programs is
key to ensuring that agency officials have needed information to
identify and mitigate emerging risks. Although preventing fraud
entirely through data analysis may not be possible, improving
transparency of program operations based on better data can allow
program officials to identify problems early and mitigate the effects
of fraud. HHS-OIG has consistently identified the need to improve HHS
data operations and governance as part of the HHS Top Management
Challenges.\18\
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\18\ https://oig.hhs.gov/reports-and-publications/top-challenges/
2020/index.asp.
Additionally, more useable and accessible data will support
deployment of modern tools to perform key program integrity functions,
such as improving how the government authenticates or verifies who it
is doing business with or paying. For example, effective deployment of
artificial intelligence (AI) is primarily dependent on having access to
large datasets that can be analyzed to teach the AI. With better data,
programs may be able to deploy AI to assess claims for payments to
rapidly identify risks or outliers. HHS-OIG is also assessing how
multifactor authentication technology could be used to reduce the
effect of medical identify theft, where a health-care provider's
identity is stolen to commit health-care fraud. Additional
authentication may limit the opportunity for criminals to use stolen
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health-care provider identities to bill for wholly fraudulent claims.
HHS-OIG's collaboration with private-sector stakeholders enhances
the opportunities to prevent health-care fraud schemes from growing.
The Healthcare Fraud Prevention Partnership and National Health Care
Anti-Fraud Association are
public-private partnerships that foster a proactive approach to
preventing fraud through data and information sharing. Together, we
examine emerging health-care fraud trends and develop key
recommendations and strategies to address them. Enhancing these
partnerships and ensuring resources are shared across Federal health-
care programs, State programs, and private payors help mitigate the
spread of fraud schemes and can prevent future losses.
Finally, as a general matter, I would urge that when Congress
considers new programs, it also considers commensurate oversight and
program integrity resources.
Question. In HHS OIG's strategic plan to conduct oversight of
COVID-19 response and recovery efforts, the OIG has indicated that it
plans to ``audit whether known cybersecurity vulnerabilities related to
networked medical devices, telehealth platforms, and other technologies
being used in COVID-19 response has been mitigated.'' What is the
status of this audit?
Answer. The remediation of known vulnerabilities is key to ensuring
IT systems are properly secured from cyberattacks. Ongoing HHS-OIG
audits related to known vulnerabilities associated with technologies
being used for the COVID-19 response, networked medical devices, and
telehealth technologies include:
1. Ongoing audit of HHS Protect and TeleTracking Systems, critical
systems that HHS recently implemented to capture important COVID-19
data, such as hospital capacity, utilization, and inventory. The report
(restricted distribution) will be issued soon.
2. An issued report in June 2021 entitled Medicare Lacks
Consistent Oversight of Cybersecurity for Networked Medical Devices in
Hospitals.\19\ This work evaluated hospital surveyors' oversight of
networked device security, found that this issue is not sufficiently
considered in the survey process, and recommended that CMS address this
in its hospital quality oversight. CMS's final management decision is
due to OIG in December 2021.
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\19\ https://www.oig.hhs.gov/oei/reports/OEI-01-20-00220.asp.
3. Ongoing audit of the Indian Health Service's newly implemented
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telehealth technologies. This audit is in the field work stage.
HHS-OIG continues to review the status of open audit
recommendations related to the remediation of known vulnerabilities and
plan audits that include follow-up work to confirm proper corrective
actions. For example, HHS-OIG will begin new cybersecurity audits that
will perform network cyber threat hunts at HHS. These audits will
determine whether: (1) network defenses are effective to detect and
mitigate threats or attacks, (2) there is an active threat on HHS's or
one of its Operating Division's networks, or (3) there has been a past
cyber breach. This work builds on our significant body of cybersecurity
work assessing HHS systems.
Question. Since the COVID pandemic began, I have engaged in
oversight on two fronts: (1) the origins of the virus; and (2) the
connection between the Department of Health and Human Services and the
National Institutes of Health with the Wuhan lab and coronavirus
research. In my July 27, 2021 Senate floor speech, I challenged the
Federal Government's failure to oversee grants sent by NIH to EcoHealth
which then sub-awarded the money to the Wuhan lab. In that speech, I
also challenged the HHS Inspector General's audit, which focuses on
NIH's compliance requirements and EcoHealth's as well. I stated, ``I
expect the Inspector General to be aggressive and unrelenting. Get the
records, the emails and the memos. Run the transcribed interviews and
question everyone up the leadership chain. Leave no stone unturned and
make as much public as possible. If punches are pulled, this audit will
be a waste of everyone's time and taxpayer money. The Inspector General
has a tremendous responsibility to get this done the right way.'' I
appreciate your responses to my questions at the September 22, 2021
Finance Committee nomination hearing. I also appreciate our
conversation on September 29, 2021 to answer my follow-up questions on
this work. With respect to the verbal answers that you provided to me
on our September 29th call, I request that you provide written answers
to the same in the interest of the Finance committee's work and for the
purposes of public transparency.
Based on your testimony, I understand that your work does not
include identifying the source of the coronavirus. I want to make sure
that I understood your testimony with respect to gain of function
research. Will your audit determine if gain of function research
occurred at the Wuhan Institute of Virology and whether it was
connected to taxpayer money? If not, in order to understand whether NIH
and its components followed Federal rules, don't you have to determine
if gain of function research was performed?
Answer. HHS-OIG's ongoing audit, Audit of National Institutes of
Health and Grantee Compliance With Federal Requirements To Ensure
Proper Monitoring and Use of Grant Funds by Selected Grantees and
Subgrantees \20\ is designed to assess whether NIH monitored grants to
EcoHealth Alliance (EcoHealth) in accordance with Federal regulations
and whether EcoHealth similarly provided oversight to ensure compliance
by its sub-awardees. The audit will not examine the origins of
coronavirus and will not assess research to determine whether gain of
function research occurred during the grant performance period. For
grants awards that may have included a specific prohibition of gain of
function research, the audit will examine the oversight and monitoring
activities performed by NIH and EcoHealth to ensure that the grantees
and subgrantees adhered to the grant requirements.
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\20\ https://oig.hhs.gov/reports-and-publications/workplan/summary/
wp-summary-0000592.
asp.
HHS-OIG has coordinated this audit with the Government
Accountability Office (GAO). They are performing additional oversight
specific to gain-of-function research that will complement our audit.
HHS-OIG will continue to closely coordinate with GAO and will ensure
that our collective work provides the Senate Committee on Finance and
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Congress with independent, objective information about this issue.
In July 2021, HHS-OIG provided a scope and methodology briefing for
your staff regarding this audit. We would be happy to provide
additional briefings for you and your staff.
Question. Do you plan to run any transcribed interviews of
government employees and EcoHealth employees? Have you done so already?
Answer. For this audit, the team held virtual meetings with
officials at NIH and NIH's subcomponent, the National Institute of
Allergy and Infectious Diseases (NIAID). In addition, the audit team
held in-person meetings with EcoHealth officials. As standard audit
practice, the interviews are documented in writing by the audit team
and kept as part of the audit file. None of the interviews were
recorded. As needed, HHS-OIG may request additional interviews of NIH
or EcoHealth officials as HHS-OIG continues to conduct the audit.
Question. I asked you about how much taxpayer money had been sent
to EcoHealth for coronavirus research in China. At the hearing, you
said you didn't have those numbers yet. Do you now?
Answer. Based on information collected for the audit referenced in
the preceding responses, NIH has awarded EcoHealth approximately $8
million from October 2014 to September 2021. The audit is still ongoing
and HHS-OIG is still assessing the specifics of the EcoHealth awards.
The technical nature of the grant awards does not provide for an easy
classification as to whether the research is specifically for
coronavirus. However, based on award titles and descriptions of planned
research, it appears that of the $8 million, approximately $3,750,000
is for coronavirus research and $4,210,000 could be coronavirus related
research. In addition, EcoHealth made subawards to two Chinese
organizations: Wuhan Institute of Virology was awarded approximately
$600,000 and Wuhan University School of Public Health was awarded
approximately $200,000. Both of these subawards relate to the
$3,750,000 awarded for coronavirus research.
Question. And finally, I asked about why you decided to do an audit
versus an investigation. Can you explain that decision in more detail
and under what circumstances an investigation would be opened?
Answer. HHS-OIG evaluates specific oversight work through an
Engagement Committee. This committee meets weekly to assess potential
work and includes representatives from all HHS-OIG components,
including our Office of Investigations (OI). When the Engagement
Committee assesses information regarding new work that assessment
includes representatives from OI, which is the component that reviews
to determine whether there are colorable violations of law that warrant
criminal or civil investigations. For the specific work related to NIH
and EcoHealth grants, HHS-OIG's Engagement Committee determined that an
audit was appropriate based on the information it had at the time.
As with all of our oversight work, HHS-OIG continually assesses the
specific facts and circumstances as oversight work is conducted. HHS-
OIG's Office of Audit Services (OAS) has expertise in identifying
potential referrals to OI for conduct such as grant fraud. HHS-OIG does
not operate in silos and OAS teams may consult with OI investigators to
assess specific facts and circumstances as warranted. To the extent
that the audit teams and OI determine that a referral is appropriate
(based on the specific facts and circumstances of the particular
matter), OAS would make a referral and OI would begin an investigation.
Question. Based on concerns raised by Congress, NIH, and other
Federal law enforcement agencies, OIG identified four priority areas
for NIH oversight in their FY 2022 budget request: (1) cybersecurity
protections, (2) compliance with Federal requirements and NIH policies
for grants and contracts, (3) integrity of grant application and
selection processes, and (4) intellectual property and research
integrity. OIG recently released a report that found NIH did not
consider national security risks when permitting and monitoring foreign
principal investigators' access to U.S. citizens' genomic data. NIH did
not concur with all of OIG's findings. Given that we still do not know
the origins of COVID-19 and the startling information that continues to
be released on NIH's involvement with institutions associated with the
Chinese Communist Party, where does auditing and investigating
relationships, financial or otherwise, between HHS and its
subcomponents with problematic foreign governments and the potential
information sharing between them fall in your list of priorities to
tackle?
Answer. As an independent, objective oversight and enforcement
agency, HHS-OIG follows the facts wherever they lead. To do so, HHS-OIG
continually assesses risks to HHS that may jeopardize the economy,
efficiency, effectiveness, and integrity of HHS programs. Through this
approach of assessing vulnerabilities, HHS-OIG is aware of increased
risks posed by foreign actors in a number of areas, including health-
care fraud, cybersecurity, and medical research. If confirmed, I am
committed to ensuring HHS-OIG continues to assess and address, as
appropriate, risks to HHS programs due to inappropriate foreign
influence that are within our jurisdiction as a top priority.
Our commitment to addressing these risks is exemplified by HHS-
OIG's recent enforcement and oversight work that helps ensure the
integrity of taxpayer-funded medical research against foreign threats.
Although inappropriate foreign influence associated with taxpayer-
funded medical research is a high-profile, complex issue, the cases
under HHS-OIG's purview all involve aspects of grant fraud--which HHS-
OIG has extensive experience in investigating. Oversight and
enforcement of grant fraud and related grant program integrity is an
HHS-OIG priority.
Our grant fraud investigations with a foreign influence nexus often
involve close collaboration with our law enforcement partners at the
Department of Justice, the Federal Bureau of Investigation (FBI), and
other Offices of Inspector General, as well as HHS awarding agencies
and the Office of National Security (ONS). We also coordinate with
various other agencies to protect the integrity of medical research. In
some instances, we work on matters with the FBI's Joint Terrorism Task
Forces and National Cyber Investigative Joint Task Force, the National
Counterintelligence Taskforce, the Department of Homeland Security, and
components at FBI Headquarters and local field offices. When
appropriate, we work with NIH and ONS to develop follow-up approaches
and/or mitigating strategies. Foreign influence research cases are
investigated by the HHS-OIG in a similar manner to other grant fraud
matters, with coordination and awareness of potential law enforcement
sensitivities handled by our partners and other agencies. HHS-OIG is
not involved in gathering counterintelligence data pertaining to
inappropriate foreign influence.
In addition to the NIH audit referenced in your question, HHS-OIG
has also recently issued five audits and studies to improve NIH vetting
of peer reviewers, improve NIH policies and procedures related to
foreign conflicts of interest, and review NIH grantee institutions'
actions to strengthen policies to protect intellectual property and
research integrity.
HHS-OIG briefed your staff twice in July 2021 on recent work in
this area, including CMS's assessment of national security risks to
genomic testing data and our ongoing audit related to NIH and
EcoHealth. In addition, I wanted to thank you for your leadership in
this area and for holding a hearing entitled ``Foreign Threats to
Taxpayer-Funded Medical Research: Oversight Opportunities and Policy
Solutions'' \21\ on June 5, 2019 where HHS-OIG testified on foreign
influence before the Senate Committee on Finance. The hearing was an
excellent opportunity for HHS-OIG to discuss our work, in conjunction
with HHS and law enforcement partners, to protect taxpayer-funded
medical research. I look forward to continuing to work with you and
your staff on this important topic.
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\21\ https://www.finance.senate.gov/imo/media/doc/
05JUN2019HollieSMNT.pdf.
______
Questions Submitted by Hon. John Thune
Question. As you know, in South Dakota, there have been far too
many challenges with the Indian Health Service (IHS). This includes
specific instances of abusive providers and facilities that fail to
meet safety standards, as well as overall concern about the quality of
care received there.
I appreciate the work that OIG has done thus far to examine these
issues. If confirmed, how would you prioritize IHS in your work plan?
How do you balance the need for proactive reviews versus those that are
responsive to specific complaints?
Answer. HHS-OIG has a longstanding commitment to providing
impactful oversight of Indian Health Service (IHS) to help ensure the
quality and safety of services provided to the American Indian and
Alaska Native community. If confirmed, I will continue that commitment.
Prioritizing work, including balancing proactive and responsive
reviews, is part of our work planning process. HHS-OIG work is
developed and considered through a process by which an Engagement
Committee consisting of the Deputy Inspectors General for each HHS-OIG
component carefully considers new work proposals with an eye toward
ensuring that HHS-OIG's work has the greatest impact and makes the best
use of limited resources. HHS-OIG's work planning process is dynamic,
and adjustments are made throughout the year to meet priorities and to
anticipate and respond to emerging issues with the resources available.
If I am confirmed, HHS-OIG will continue to plan new oversight work
based on risk assessment and focus on key vulnerabilities. We will
leverage data, modern technology, specialized expertise, and strategic
partnerships to conduct oversight and develop actionable
recommendations.
HHS-OIG work has identified critical challenges that hinder IHS's
ability to provide quality care, ensure sound management of Federal
funds, and comply with standards. IHS has taken significant action to
address the recommendations provided in our reviews.
During Fiscal Year 2021, we released seven reviews focused on IHS-
funded care, including on topics such as adverse events, maternity
care, opioids, and patient protection policies. Most recently, we
released a report \22\ finding that IHS use of critical care response
teams helped to meet facility needs during the COVID-19 pandemic. The
report also provides recommendations to further leverage the successes
of the critical care response team model in support of IHS's broader
care improvement efforts.
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\22\ https://oig.hhs.gov/oei/reports/OEI-06-20-00700.asp.
HHS-OIG has six additional reviews of IHS-funded care underway.
This ongoing work will address such issues as whether IHS-operated
facilities and tribally operated facilities met background verification
requirements for employees, contractors, and volunteers in contact with
children and IHS's coordination of the distribution, allocation, and
administration of the COVID-19 vaccine to Tribal Health Programs.
Information about our completed and ongoing IHS reviews and recent
enforcement actions is available on the Indian Health and Human
Services \23\ featured topic page of our website. HHS-OIG would welcome
the opportunity to provide you and your staff briefings on this work.
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\23\ https://oig.hhs.gov/reports-and-publications/featured-topics/
ihs/index.asp.
Question. Thank you for OIG's active engagement and responsiveness
on projects related to telehealth and the pandemic. As we consider
whether longer-term policy decisions need to be made on this issue, can
you provide additional commentary to the committee about the timelines
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for the various reports the agency is working on?
Answer. Thank you for recognizing HHS-OIG's commitment to
conducting oversight of telehealth. HHS-OIG has announced seven reviews
and issued three reports addressing telehealth used to provide
behavioral health services in Medicaid. We expect the remaining seven
telehealth oversight reports to be completed in calendar year 2022,
starting with Data Snapshot: Review of Beneficiaries Relationships With
Providers for Telehealth Services.\24\
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\24\ https://oig.hhs.gov/reports-and-publications/workplan/summary/
wp-summary-0000613.
asp.
HHS-OIG is committed to keeping the Senate Committee on Finance,
Congress, and other stakeholders informed in instances where HHS-OIG
finds significant risks that are supported by data and our analysis,
audits, evaluations, and investigations. HHS-OIG recognizes the
importance of providing timely, independent, and objective information
as policymakers consider telehealth expansion or other changes beyond
the public health emergency. We have already provided technical
assistance to Congress, including the Senate Committee on Finance,
earlier this year that highlight potential risks based on high-level,
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early data analyses.
HHS-OIG looks forward to continued engagement with the Senate
Committee on Finance on our telehealth oversight and enforcement work.
Question. HRSA has informed my office that it referred six
pharmaceutical manufacturers to OIG for failing to provide 340B
discounts to contract pharmacies. While I trust that you cannot divulge
the details of a matter under active review, can you provide any
additional context or timeline for the when the agency might complete
the review and issue a decision?
Answer. I am somewhat limited in what I can share at this time
regarding the 340B referrals issue, but I hope the following
information is helpful.
HHS-OIG can confirm that we received the six referrals from HRSA on
September 22 and are reviewing them. When considering whether to impose
Civil Monetary Penalties (CMPs), HHS-OIG carefully reviews the
applicable facts and available evidence relating to each matter. Based
on the facts and evidence, HHS-OIG makes a decision about whether to
pursue a CMP. General information on the CMP process can be found in
HHS-OIG's CMP regulation at 42 CFR 1003,\25\ and more specific
information about the CMPs relating to the 340B program can be found in
the 340B ceiling price and CMP final rule.\26\ Unfortunately, HHS-OIG
cannot discuss its ongoing review of the referrals, and HHS-OIG is not
able to provide a timetable for review and decision-making. Our staffs
have been in contact on this issue as recently as September 2021. We
will keep you and your staff updated should there be any new
information we are able to share on the referrals matter.
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\25\ https://www.ecfr.gov/current/title-42/chapter-V/subchapter-B/
part-1003?toc=1.
\26\ https://www.govinfo.gov/content/pkg/FR-2017-01-05/pdf/2016-
31935.pdf.
HHS-OIG also has an established body of public reports focused on
340B issues. We would welcome the opportunity to provide a briefing on
our 340B related work. For example: some of our past work identified
issues \27\ with whether 340B entities were getting the discounts
required by law and HRSA's ability to oversee the 340B program; HHS-OIG
has looked at 340B duplicate discounts with Medicaid;\28\ and HHS-OIG
continues to recommend increased transparency for States to ensure
compliance and that States get the rebates to which they are entitled.
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\27\ https://oig.hhs.gov/oei/reports/oei-05-02-00072.pdf.
\28\ https://oig.hhs.gov/oei/reports/oei-05-14-00430.asp.
______
Questions Submitted by Hon. Richard Burr
Question. Oversight is an important function of the Congress, and I
look forward to working with you, should you be confirmed, to safeguard
Federal programs and their beneficiaries from waste, fraud, and abuse.
In order to work together, however, we need to have open lines of
communication. Do you commit to providing me and my staff with
information or documentation we request within a specified time frame?
Answer. I agree that open lines of communication are critically
important. If confirmed, I commit to respond to all congressional
requests within my authority under the IG Act and other applicable
statutes. HHS-OIG endeavors to be timely and as responsive as possible
to all requests from Congress for information. If I am confirmed, I
commit to continuing that practice. HHS-OIG strives to meet deadlines
and regularly coordinates with committee and member staff to set
reasonable time frames for responses. For both pragmatic and legal
reasons, HHS-OIG cannot serve as a conduit between Congress and the
Department for information or document requests. It is important that
HHS-OIG's maintain its independence, and there are statutory and other
legal limits on information that HHS-OIG releases.
Question. Currently, Congress is undergoing a partisan mad dash to
pass transformational legislation that would radically increase the
Federal Government's role in the daily lives of Americans. These
proposals would dramatically increase spending on health programs--on
top of the more than $1.5 trillion in existing annual HHS spending--
without so much as a Senate hearing.
If you are confirmed and these efforts are successful, you will
have the unenviable task of investigating the Department at a time when
unprecedented amounts of taxpayer funds are being spent and new
programs are being implemented in the midst of responding to a once-in-
a-century pandemic. What specific steps will you take to ensure that
the Office of the Inspector General is able to enhance its oversight
capacity to keep pace with such an extreme influx of Federal resources
that could have immediate impact on the American people? Will you
provide regular reports to Congress on the expenditures of these funds?
Answer. I share your concern with the need to keep pace, and
enhance oversight, to meet a growing portfolio of HHS programs. HHS-OIG
has deep experience with oversight of large new programs and conducting
work to ensure that they work as Congress intends. For example, after
the passage of the Affordable Care Act, we conducted extensive
oversight of issues ranging from eligibility for marketplace insurance
to accurate subsidy payments, program management, and security of data.
More recently, for example, we are conducting a series of audits of
distributions from the Provider Relief Fund. HHS-OIG will continue
monitoring new programs and providing regular reports to Congress on
findings and recommendations from this oversight work. Moreover, in
instances where HHS-OIG finds significant risks that are supported by
data and our analysis, audits, evaluations, and investigations, HHS-OIG
is committed to keeping this committee, Congress, and other
stakeholders informed. HHS-OIG recognizes the importance of providing
timely, independent, and objective information to policymakers. As a
general matter, I would urge that when Congress considers new programs,
it also considers commensurate oversight and program integrity
resources.
In my current role, and if I am confirmed, HHS-OIG will continue to
plan new oversight work based on risk assessment and focus on key
potential vulnerabilities. To enhance the impact of this work, we will
leverage data, modern technology, specialized expertise, and strategic
partnerships to conduct oversight and develop actionable
recommendations focused on high-risk programs and operations. We will
use advanced data analytics and multidisciplinary, state-of-the-art
investigative techniques to maximize our limited resources and bolster
program integrity in HHS programs and services.
______
Questions Submitted by Hon. Patrick J. Toomey
Question. The Office of Inspector General (OIG) at the Department
of Health and Human Services (HHS) has previously reported on the
pervasiveness of improper payments within the Medicaid program, failure
by the Centers for Medicare and Medicaid Services (CMS) to adequately
recoup Medicaid overpayments, and recommendations for improving upon
these program integrity measures.\29\ Despite OIG's findings and
recommendations, the improper payment rate remains persistently high in
Medicaid. In 2020, CMS estimated that improper payments accounted for
21.35 percent of Federal program expenditures, and for the 10 years
prior, the improper payment rate was routinely above 9 percent.\30\
---------------------------------------------------------------------------
\29\ https://oig.hhs.gov/reports-and-publications/compendium/files/
compendium2020.pdf.
\30\ https://www.cms.gov/Research-Statistics-Data-and-Systems/
Monitoring-Programs/Medicaid-and-CHIP-Compliance/PERM/
PERMErrorRateFindingsandReport.
Congressional Democrats are now in the process of drafting and
marking up a multi-trillion-dollar legislative package that would make
substantial benefit expansions to the existing Medicaid program and
establish a look-a-like program for certain individuals in non-
expansion States. Such expansions certainly risk exacerbating fraud,
waste, and abuse, especially since the proposals are unaccompanied by
---------------------------------------------------------------------------
long-term, structural reforms to address program solvency.
While Congress still lacks a comprehensive understanding of the
extent to which specific factors, such as eligibility errors and
documentation mistakes, contribute to improper payments, it is
nevertheless clear there remain critical gaps in program integrity.
Based on OIG's previous findings, do you believe current oversight
incentives for State Medicaid programs are sufficient?
Answer. I share your concern about the Medicaid error rate and
addressing it is a top HHS-OIG priority. The high error rates indicate
that the current oversight incentives for State Medicaid programs are
not working as intended. More work is needed to better understand
recent program changes directly related to how CMS measures Medicaid
improper payments and how CMS works with States to address the causes
of the errors. CMS's Payment Error Rate Measurement (PERM) program
measures Medicaid and CHIP improper payments in all 50 States and the
District of Columbia annually and produces a national improper payment
rate for each program. In 2017, CMS published a new final rule
implementing substantive changes to the PERM program that, among other
things, were aimed at improving program integrity and promoting State
accountability through policy and operational improvements.
These changes were a step in the right direction and have produced
a more realistic picture of the beneficiary eligibility errors that are
occurring at the State level. This estimated error rate increased since
the reintegration of beneficiary eligibility testing in 2019. Based on
the CMS PERM regulation, States should be taking action to correct the
problems causing high error rates specific to their State programs.
HHS-OIG is currently conducting three audits that will assess the
adequacy of the PERM program by determining the accuracy of
determinations for the eligibility, fee-for-service, and managed care
components of the PERM error rate. The results of this work may
identify ways in which CMS and States can improve PERM and address
causes of the high improper payment rate. HHS-OIG would be happy to
brief you and your staff on this work.
Question. What are the most significant, outstanding
recommendations that OIG has previously made to CMS with regard to
improving the state of improper payments and overpayments, and what
justifications has CMS provided for not implementing these
recommendations?
Answer. HHS-OIG has a large body of work assessing several of the
major causes of high Medicaid improper payment rates. For example, HHS-
OIG audits have identified substantial improper payments identifying
significant errors with State Medicaid eligibility determinations. The
Senate Committee on Finance provided HHS-OIG with a much-appreciated
opportunity to discuss our work on Medicaid beneficiary eligibility
determinations and what more can be done to secure the future of this
important program at an October 30, 2019 hearing, entitled ``Medicaid:
Compliance with Eligibility Requirements.''\31\ Additionally, HHS-OIG
has conducted several studies assessing State Medicaid agency provider
screening and enrollment. Finally, HHS-OIG work has found that CMS has
not always recovered the overpayments from State Medicaid agencies
identified by HHS-OIG audit reports.
---------------------------------------------------------------------------
\31\ https://oig.hhs.gov/documents/testimony/70/20191030_-
_Ritchie.pdf.
The following information provides examples of unimplemented
recommendations made to CMS or specific State Medicaid agencies for
three categories of work that have significant connection to improper
payments and overpayments: Medicaid eligibility, provider screening and
enrollment, and overpayment collection. OIG's Compendium of
Unimplemented Recommendations \32\ includes more detail on our Medicaid
unimplemented recommendations and HHS-OIG is happy to provide you and
your staff with a briefing on any of this work.
---------------------------------------------------------------------------
\32\ https://oig.hhs.gov/reports-and-publications/compendium/files/
compendium2020.pdf.
---------------------------------------------------------------------------
medicaid eligibility
HHS-OIG audited four States' (New York, California, Colorado, and
Kentucky) Medicaid eligibility determinations and found that during
2014 and 2015 Medicaid payments were made on behalf of 109 of 460
sampled newly eligible beneficiaries and 98 of 515 sampled non-newly
eligible beneficiaries who did not meet or may not have met Medicaid
eligibility requirements. On the basis of our sample results, we
estimated that the four States made Federal Medicaid payments on behalf
of newly eligible beneficiaries totaling almost $1.4 billion for more
than 700,000 ineligible or potentially ineligible beneficiaries. We
also estimated that the four States made Federal Medicaid payments on
behalf of non-newly eligible beneficiaries totaling more than $5
billion for almost 5 million ineligible or potentially ineligible
beneficiaries.
A majority of HHS-OIG's recommendations to the States addressed the
deficiencies related to our findings. Although the States concurred
with all 31 recommendations, 18 recommendations remain unimplemented.
Specifically, as of 2021, most States have not provided responses to
our recommendations to demonstrate that: eligibility caseworkers
accurately input case actions and properly verify eligibility
requirements (12 unimplemented recommendations); eligibility
verification systems are improved to properly and timely verify all
eligibility information (3 unimplemented recommendations); and
additional policies and procedures are developed to produce more
accurate eligibility determinations and to resolve eligibility
discrepancies timely (3 unimplemented recommendations).
States' progress in implementing these recommendations varies.
provider screening and enrollment
Provider screening problems are a significant contributing factor
to the high Medicaid PERM error rates. HHS-OIG has a noteworthy set of
unimplemented recommendations related to Medicaid provider screening
and enrollment. Across four reports, there are a total of 17 open
recommendations.
We have six outstanding recommendations to CMS from HHS-OIG's
evaluation States Could Do More To Prevent Terminated Providers From
Serving Medicaid Beneficiaries (OEI-03-19-00070),\33\ issued in March
2020. These are that CMS should: recover from States the Federal share
of inappropriate fee-for-service Medicaid payments associated with
terminated providers; implement a method to recover from States the
Federal share of inappropriate managed care capitation payments
associated with terminated providers; follow up with States to remove
terminated providers that HHS-OIG identified as inappropriately
enrolled in Medicaid; confirm that States do not continue to have
terminated providers enrolled in their Medicaid programs; safeguard
Medicaid from inappropriate payments associated with terminated
providers; and review States' contracts with MCOs to ensure that they
specifically include the required provision that prohibits terminated
providers from participating in Medicaid managed care networks.
---------------------------------------------------------------------------
\33\ https://oig.hhs.gov/oei/reports/oei-03-19-00070.asp.
We have four outstanding recommendations from HHS-OIG's evaluation
Twenty-Three States Reported Allowing Unenrolled Providers To Serve
Medicaid Beneficiaries (OEI-05-19-00060),\34\ issued in March 2020.
These are that CMS should: take steps to disallow Federal
reimbursements to States for expenditures associated with unenrolled
MCO network providers, including seeking necessary legislative
authority; work with States to ensure that unenrolled providers do not
participate in Medicaid managed care and assist States in establishing
ways to do so; work with States to ensure that they have the controls
required to prevent unenrolled ordering, referring, or prescribing
providers from participating in Medicaid fee-for-service; and work with
States to ensure that they are complying with requirements to collect
identifying information and ownership information on Medicaid provider
enrollment forms.
---------------------------------------------------------------------------
\34\ https://oig.hhs.gov/oei/reports/oei-05-19-00060.asp.
We have three outstanding recommendations from HHS-OIG's evaluation
Problems Remain for Ensuring All High-Risk Medicaid Providers Undergo
Criminal Background Checks, OEI-05-18-00070 (July 2019).\35\ These are
that CMS should: ensure that all States fully implement fingerprint-
based criminal background checks for high-risk Medicaid providers;
amend its guidance so that States cannot forego conducting criminal
background checks on high-risk providers applying for Medicaid that
have already enrolled in Medicare unless Medicare has conducted the
checks; and compare high-risk Medicaid providers' self-reported
ownership information to Medicare's provider ownership information to
help States identify discrepancies.
---------------------------------------------------------------------------
\35\ https://oig.hhs.gov/oei/reports/oei-05-18-00070.pdf.
We have four outstanding recommendations from HHS-OIG's evaluation
Medicaid Enhanced Provider Enrollment Screenings Have Not Been Fully
Implemented, OEI-05-13-00520 (May 2016).\36\ These are that CMS should:
help States implement
fingerprint-based criminal background checks for all high-risk
providers; develop a central system by which States can submit and
access screening results from other States; strengthen minimum
standards for fingerprint-based criminal background checks and site
visits; and work with States to develop a plan to complete their
revalidation screening in a timely way.
---------------------------------------------------------------------------
\36\ https://oig.hhs.gov/oei/reports/oei-05-13-00520.pdf.
CMS responses to each of these reports and recommendations vary,
and so has its progress in implementing the recommendations.
cms uncollected medicaid overpayments
Although uncollected overpayments are not part of the PERM error
rate, CMS's failure to collect and States' failure to pay illustrates a
significant financial stewardship vulnerability in the management of
the Medicaid program. In a December 2018 audit report,\37\ HHS-OIG
found that CMS had recovered about $900 million of the $2.7 billion in
Medicaid overpayments identified in prior HHS-OIG audit reports issued
to State Medicaid agencies. However, CMS had not collected the
remaining $1.8 billion. In response, CMS informed us that they continue
to explore options for improving the timeliness of recovering
identified overpayments.
---------------------------------------------------------------------------
\37\ https://oig.hhs.gov/oas/reports/region5/51700013.asp.
Question. What are the greatest obstacles for OIG when it comes to
monitoring improper payments and overpayments within Medicaid, and what
steps, if any, does OIG plan to take going forward to improve its
---------------------------------------------------------------------------
abilities to conduct oversight within Medicaid?
Answer. Two of the most significant obstacles for monitoring
improper payments relate to: (1) access to complete and accurate
Medicaid data and (2) challenges involving State-level systems.
Effective oversight of Medicaid requires access to complete and
accurate data. In an effort to improve the completeness and accuracy of
Medicaid data, CMS established the Transformed Medicaid Statistical
Information System (T-MSIS). Although access to Medicaid payment data
made by States has improved for Medicaid fee-for-service payments,
continued improvement is needed. Most States are not providing complete
or accurate payment data in T-MSIS for managed care payments to
providers. The lack of encounter data continues to be a challenge for
overseeing States that heavily rely on managed care.
In addition to challenges related to complete and accurate data,
HHS-OIG has continually found that States experience challenges in
implementing the appropriate systems needed to properly administer
their Medicaid programs and maintain the necessary documentation to
support Medicaid services claimed for reimbursement. HHS-OIG encounters
these same challenges during audits because the lack of developed
systems and missing documentation can sometimes impede our ability to
properly assess whether overpayments exist and to accurately quantify
the overpayment amounts. For example, in prior audits of four States'
Medicaid eligibility determinations, we found that Medicaid payments
were made on behalf of 31 of 460 sampled newly eligible beneficiaries
and 78 of 515 sampled non-newly eligible beneficiaries who may not have
met Medicaid eligibility requirements. In these instances, because
States did not maintain all of the necessary documentation and their
eligibility verification systems were underdeveloped, we were not able
to determine whether some beneficiaries were eligible for Medicaid, and
whether overpayments related to these beneficiaries truly existed.
HHS-OIG has long been at the forefront of measuring, monitoring,
and recommending actions to prevent improper payments. HHS-OIG's future
work will continue to identify root causes for improper payments and
feasible action steps to reduce the percentages. To this end, HHS-OIG
is crafting a comprehensive multidisciplinary strategy to will target
three areas: (1) Medicaid payments made to managed care organizations
for beneficiaries who are concurrently enrolled in multiple States; (2)
the adequacy of the eligibility and other components of the PERM
program review, as well as CMS's oversight of the corrective action
plans that States submit to address the causes of improper payments;
and (3) States' processes to screen providers for enrollment in the
Medicaid program, along with the inappropriate enrollment of terminated
providers. In addition, HHS-OIG will continue to review and report on
HHS's annual improper payment information as required by the Payment
Integrity Information Act. We are happy to brief you and your staff on
this strategy and on any work related to this issue.
______
Questions Submitted by Hon. Bill Cassidy
Question. If confirmed, how would you plan to leverage artificial
intelligence and machine learning to address fraud, waste, and abuse in
HHS programs? Are there particular data where these tools are best
suited or should be prioritized?
Answer. If confirmed, I am committed to expanding HHS-OIG's use of
sophisticated data analytics, including leveraging artificial
intelligence (AI) and machine learning (ML), to proactively monitor and
address fraud, waste, and abuse in HHS programs. Currently, HHS-OIG
uses AI and ML to assist aspects of our oversight and enforcement.
Primarily, we use advanced data analytics and AI to assess risk more
effectively across HHS programs and geographic locations, and to
efficiently deploy resources and increase the impact of our oversight
and enforcement. In deploying AI and ML capabilities, HHS-OIG follows
best practices to ensure that solutions are responsible, equitable,
traceable, reliable, and governable.
HHS-OIG has successfully leveraged AI and ML to support oversight
of HHS grants and contracts. Specifically, HHS-OIG developed a Grants
and Acquisitions Analytics Portal (GAP) that streamlines access to and
delivers a comprehensive view of HHS awards and single audit findings.
We implemented ML and advanced AI capabilities, including neural
networks and text mining, to identify audit findings buried in millions
of pages of A-133 single-audit reports. The impact of this effort was
immediate. The time needed for auditors' and investigators' researching
has been reduced from a matter of months to minutes.
HHS-OIG has also deployed predictive models that use AI to assign
risk scores to Medicare providers for professional services,
prescribing, home health, hospice, and pharmacies. Results from these
models assist HHS-OIG in identifying targets for investigation as well
as in assessing highest risk among providers that are already known to
investigators.
The size of the HHS program portfolio continues to increase,
health-care systems are becoming more complex, and fraud cases are
becoming more sophisticated. These factors--accompanied with a
significant increase in the amount of health-care data--push HHS-OIG to
streamline and automate time-consuming and manual analytic and business
processes. If confirmed, I will continue to invest in our data and
analytics infrastructure and improve capabilities that support AI, ML,
natural language processing, robotics process automation, and
predictive analytics. Further investment in cutting-edge technology for
data will equip HHS-OIG's teams with the ability to keep up with the
growing size and complexity of HHS programs, especially Medicare and
Medicaid.
In the near future, HHS-OIG is prioritizing deploying text
analytics capabilities to draw insights from Medicaid managed care
contracts, using predictive coding to support document review in
preparation for prosecutions of health-care fraud, and automating audit
process related to assessments of the quality and accuracy of Medicare
and Medicaid claims.
APPENDIX 1: HHS-OIG Behavioral Health Reviews
HHS-OIG's Recently Published Reports on Behavioral Health
The following table contains a description of HHS-OIG's recently
published reports related to behavioral health. Work related to
behavioral health and telehealth is listed in Appendix 2.
------------------------------------------------------------------------
Title of
Review Description Issued
------------------------------------------------------------------------
1 Behavioral The Behavioral Health-- May 2021
Health--Medi Medication-Assisted
cation- Treatment Viewer (BH-
Assisted MAT) is a web mapping
Treatment application that
Viewer \1\ combines publicly
available data to
policymakers and program
administrators to
provide additional
analysis for making
decisions to improve
access to medication-
assisted treatment (MAT)
for those with opioid
use disorder.
------------------------------------------------------------------------
2 Choctaw The Choctaw Nation met January
Nation of some program goals for 2021
Oklahoma its Tribal Opioid
Made Response grant during
Progress the first grant year.
Toward Specifically, the
Meeting Choctaw Nation met
Program program goals in the
Goals During areas of prevention and
the First recovery. The Choctaw
Year of Its Nation also made
Tribal progress toward meeting
Opioid treatment program goals
Response but encountered some
Grant \2\ challenges that
prevented it from
increasing the
availability of MAT
services for Tribal
members within its
health-care system.
------------------------------------------------------------------------
3 New York New York did not always December
Provided comply with Projects for 2020
Projects for Assistance in Transition
Assistance From Homelessness (PATH)
in program requirements.
Transition Specifically, 7 of the
From 50 consumers we sampled
Homelessness lived in permanent
Grant housing settings and
Services to documentation in their
Ineligible case files did not
Individuals indicate that they
and Did Not continued to need PATH
Contribute services to prevent a
Any Required recurrence of
Non-Federal homelessness. In
Funds \3\ addition, New York did
not meet its funding
obligation for non-
Federal contributions to
its PATH program and did
not have written
agreements with PATH
providers, as required.
------------------------------------------------------------------------
4 In Selected Most health centers in November
States, 67 the 30 States did not 2020
of 100 use their AIMS (Access
Health Increases in Mental
Centers Did Health and Substance
Not Use Abuse Services) grant
Their HRSA funding in accordance
Access with Federal
Increases in requirements and grant
Mental terms. Sixty-seven of
Health and the 100 health centers
Substance in our sample did not
Abuse meet mental health and
Services substance use disorder
Grant service expansion
Funding in requirements (30),
Accordance claimed unallowable
With Federal costs (34), and did not
Requirements properly allocate
\4\ salaries and other
expenditures to their
AIMS grants (34).
------------------------------------------------------------------------
5 Opioid Opioid treatment programs November
Treatment (OTPs) reported a 2020
Programs variety of: (1)
Reported challenges they have
Challenges encountered during the
Encountered COVID-19 pandemic and
During the (2) actions they have
COVID-19 taken to address those
Pandemic and challenges while
Actions ensuring the continuity
Taken To of needed services and
Address Them protecting the health
\5\ and safety of their
patients and staff.
------------------------------------------------------------------------
6 HRSA's The Health Resources and July 2020
Monitoring Services Administration
Did Not (HRSA) followed its
Always policies and procedures
Ensure for awarding AIMS grants
Health but did not always
Centers' follow its policies and
Compliance procedures when
With Federal monitoring health
Requirements centers' compliance with
for HRSA's supplemental funding
Access requirements.
Increases in Specifically, HRSA did
Mental not follow its policies
Health and and procedures when
Substance monitoring health
Abuse centers' progress toward
Services meeting AIMS grant award
Supplemental conditions related to
Grant ongoing and one-time
Funding \6\ funding and did not
always respond timely to
health centers' requests
to carry over grant
funds.
------------------------------------------------------------------------
7 SAMHSA's The Substance Abuse and March 2020
Oversight of Mental Health Services
Accreditatio Administration (SAMHSA)
n Bodies for performed inspections at
Opioid selected OTPs but did
Treatment not: (1) meet its goal
Programs Did for the number of OTPs
Not Comply it would inspect, (2)
With Some take actions to address
Federal accreditation bodies'
Requirements noncompliance with
\7\ survey requirements, or
(3) determine whether
OTPs complied with the
Federal standards when
patient charts were
incomplete. In addition,
SAMHSA reviewed
accreditation bodies'
survey reports, but the
reports were
inconsistent and did not
contain sufficient
information to determine
whether the OTPs met the
Federal standards.
Finally, SAMHSA's
evaluations of
accreditation bodies'
accreditation elements
were not documented or
retained.
------------------------------------------------------------------------
8 ACOs' This report highlighted July 2019
Strategies high-performing Medicare
for Accountable Care
Transitionin Organizations'
g to Value- strategies to address
Based Care: behavioral health needs
Lessons From (among other
the Medicare strategies), including
Shared recruiting behavioral
Savings health providers and
Program \8\ integrating behavioral
and physical health care
into primary care
settings.
------------------------------------------------------------------------
\1\ https://hhs-oig-geo-hub-hhsoigbeta.hub.arcgis.com/apps/
b9963de2160f44839550115c4c37fdea/explore.
\2\ https://www.oig.hhs.gov/oas/reports/region7/72004121.asp.
\3\ https://www.oig.hhs.gov/oas/reports/region2/21902006.asp.
\4\ https://www.oig.hhs.gov/oas/reports/region2/21902001.asp.
\5\ https://www.oig.hhs.gov/oas/reports/region9/
92001001.asp?utm_source=web&utm_medium=web&utm_camPpaign=covid-A-09-20-
01001.
\6\ https://oig.hhs.gov/oas/reports/region2/21802010.asp.
\7\ https://www.oig.hhs.gov/oas/reports/region9/91801007.asp.
\8\ https://oig.hhs.gov/oei/reports/oei-02-15-00451.asp.
HHS-OIG's Ongoing Work
The following table contains a description of HHS-OIG's ongoing
behavioral health audits and evaluations.
------------------------------------------------------------------------
Title of Expected
Review Description Issuance
------------------------------------------------------------------------
1 Medicare Part In 2020, Medicare paid $1 FY 2022
B Payments billion for
for psychotherapy services.
Psychotherap We have a series of
y Services audits under way at
(Including selected providers and
Services have started a
Provided via nationwide audit of
Telehealth psychotherapy services.
During the As part of our body of
Public work related to
Health psychotherapy, we are
Emergency) \ considering analyzing
1\ Medicare claims data to
determine whether
Medicare payment amounts
for mental health
services have decreased
over the years. If so,
we will also analyze
whether this reduction
in Medicare payment
amounts has resulted in
a decrease in the mental
health providers that
accept Medicare, which
may impact beneficiary
access to care.
------------------------------------------------------------------------
2 Audit of Certified community FY 2023
SAMHSA's behavioral health
Certified clinics (CCBHCs) are
Community designed to provide
Behavioral comprehensive 24/7
Health access to: (1) community-
Clinic based mental health and
Expansion substance use disorder
Grants \2\ services, (2) treatment
of co-occurring
disorders, and (3)
physical health care in
one location. For FY
2020, SAMHSA awarded 179
expansion grants to
CCBHCs located in 32
States, totaling
approximately $450
million through the
Coronavirus Aid, Relief,
and Economic Security
(CARES) Act. We will
determine whether SAMHSA
followed its policies
and procedures for
awarding and monitoring
CCBHC expansion grants.
Subsequently, we will
conduct additional audit
to determine whether
CCBHCs used expansion
grant funds in
accordance with Federal
requirements and
applicable grant terms.
------------------------------------------------------------------------
3 Projects for HHS provides Federal FY 2022
Assistance funds to various States
in to administer the PATH
Transition program. The PATH
from program supports the
Homelessness delivery of outreach and
Program \3\ various services to
individuals with serious
mental illness and those
with co-occurring
substance use disorders
who are experiencing
homelessness or are at
imminent risk of
becominghomeless. We
will determine whether
grant recipients
complied with Federal
requirements in
providing PATH program
services.
------------------------------------------------------------------------
4 Post-Award SAMHSA has awarded a FY 2022
State or series of grants to
Tribal combat opioid use
Audits of disorder. The purpose of
Substance these grants is to
Abuse and increase access to
Mental treatment, reduce unmet
Health treatment need, and
Services reduce opioid overdose
Administrati related deaths. The
on's Opioid audit will determine how
Response select States or Tribal
Grants \4\ agencies implemented
programs under these
grants and whether the
activities complied with
Federal regulations and
met program goals.
------------------------------------------------------------------------
5 Audit of SAMHSA's Substance Abuse FY 2022
States' Prevention and Treatment
Administrati Block Grant (SABG)
on of program is the largest
SAMHSA's Federal program
Substance dedicated to improving
Abuse publicly funded
Prevention substance abuse
and prevention and treatment
Treatment systems. The program
Block Grant provides funds to all 50
Funding \5\ States, the District of
Columbia, and U.S.
Territories to prevent
and treat substance
abuse. Federal
requirements for the
SABG program state that
fiscal control and
accounting procedures
must permit the tracing
of funds to a level of
expenditure adequate to
establish that such
funds were not used in
violation of block-grant
restrictions and
statutory prohibitions
(45 CFR Sec. 96.30). We
will determine whether
the States' SABG
expenditures for
subrecipients, including
expenditures for
contracted transitional
housing providers,
complied with Federal
and State requirements.
------------------------------------------------------------------------
6 Audit of Autism spectrum disorder FY 2022
Medicaid (autism) is a
Applied developmental disability
Behavior that can cause
Analysis for significant social,
Children communication, and
Diagnosed behavioral challenges
with Autism for children. A common
\6\ treatment for autism is
Applied Behavior
Analysis (ABA), which
can help an autistic
child improve social
interaction, learn new
skills, maintain
positive behaviors, and
minimize negative
behaviors. We will audit
Medicaid claims for ABA
services provided to
children diagnosed with
autism to determine
whether a State Medicaid
agency's ABA payments
complied with Federal
and State requirements.
------------------------------------------------------------------------
7 Utilization The opioid crisis remains FY 2022
of a public health
PMedication- emergency. The current
Assisted COVID-19 pandemic makes
Treatment in the need to focus on the
Medicare \7\ opioid crisis even more
pressing. Recent HHS-OIG
studies have found that
the utilization of drugs
for MAT is low and that
concerns exist related
to access. This study
will assess the extent
to which Medicare
beneficiaries with
opioid use disorder are
receiving MAT drugs
through Medicare and the
extent to which they are
receiving counseling or
behavioral therapies. It
will also determine
whether Medicare
beneficiaries with
opioid use disorder who
are not receiving MAT
drugs have certain
characteristics in
common.
------------------------------------------------------------------------
\1\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000241.asp.
\2\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000609.asp.
\3\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000371.asp.
\4\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000427.asp.
\5\ https://www.oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000602.asp.
\6\ https://www.oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000601.asp.
\7\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000484.asp.
APPENDIX 2: HHS-OIG Telehealth Reviews
HHS-OIG's Recently Published Reports on Telehealth
The following table contains a description of HHS-OIG's recently
published reports related to telehealth access. PWe would be happy to
provide information on other work if requested.
------------------------------------------------------------------------
Title of
Review Description Issued
------------------------------------------------------------------------
1 Opportunities This data brief provides September
Exist To insight into State 2021
Strengthen evaluations and
Evaluation oversight of telehealth
and for behavioral health
Oversight of services as of January
Telehealth and February 2020,
for before the expansion of
Behavioral telehealth due to the
Health in COVID-19 pandemic. It
Medicaid \1\ provides a useful
foundation to inform CMS
and State decisions
about how to evaluate
the impacts of
telehealth on access,
cost, and quality of
behavioral health
services and to
strengthen oversight of
program integrity.
Evaluating the effects
of telehealth on access,
cost, and quality is
particularly important
in helping States make
decisions about how to
best use telehealth and
about which populations
benefit most from these
services. Understanding
States' efforts to
oversee telehealth can
help States protect
their Medicaid programs.
Further, States'
expansion of telehealth
during the COVID-19
pandemic has been
largely on a temporary
basis. As States
consider making
telehealth expansions
permanent, States can
use information in this
data brief to help
determine which services
best support enrollees.
This data brief is a
companion report to a
data brief that
describes the challenges
States reported with
using telehealth to
provide behavioral
health services to
Medicaid enrollees.
------------------------------------------------------------------------
2 States This data brief provides September
Reported insight into States' 2021
Multiple challenges as reported
Challenges in January and February
With Using 2020, before the
Telehealth expansion of telehealth
To Provide due to the COVID-19
Behavioral pandemic. It provides a
Health useful foundation for
Services to CMS and States by
Medicaid highlighting
Enrollees \2 longstanding challenges
\ with the use of
telehealth that existed
prior to the additional
challenges caused by the
pandemic. Understanding
States' challenges with
using telehealth to
provide behavioral
health services can help
States improve their
Medicaid program and
assist enrollees with
accessing needed care.
Further, States'
expansion of telehealth
during the COVID-19
pandemic has been
largely on a temporary
basis. As States
consider making
telehealth expansions
permanent, they can use
information in this data
brief to develop
effective programs and
troubleshoot challenges
in implementation. This
data brief is a
companion report to a
data brief that
describes the extent to
which States evaluate
the effects of
telehealth on access,
cost, and quality of
behavioral health
services and the extent
to which States oversee
telehealth for fraud,
waste, and abuse.
------------------------------------------------------------------------
3 Provider Shortages of providers September
Shortages and difficulty arranging 2019
and Limited services has resulted in
Availability limited availability of
of behavioral health care
Behavioral for New Mexico's
Health Medicaid managed care
Services in enrollees. The
New Mexico's challenges faced by New
Medicaid Mexico are likely shared
Managed Care by other States and
\3\ require both State and
national attention. Both
CMS and New Mexico
agreed with HHS-OIG's
recommendations to help
address these
challenges, including
expanding the behavioral
health workforce,
improving transportation
options for enrollees,
and expanding the use of
telehealth.
------------------------------------------------------------------------
\1\ https://oig.hhs.gov/oei/reports/OEI-02-19-00401.asp.
\2\ https://oig.hhs.gov/oei/reports/OEI-02-19-00400.asp.
\3\ https://oig.hhs.gov/oei/reports/oei-02-17-00490.pdf.
HHS-OIG's Ongoing Work
The following table contains the full description of HHS-OIG's ongoing
telehealth audits and evaluations.
------------------------------------------------------------------------
Title of Expected
Review Description Issuance
------------------------------------------------------------------------
1 Data In response to the COVID- FY 2022
Snapshot: 19 pandemic, both
Review of Congress and HHS
Beneficiarie expanded access to
s telehealth for a wide
Relationship range of services. This
s With expansion enhanced the
Providers ability of health-care
for providers to offer care
Telehealth to Medicare
Services \1\ beneficiaries remotely
during the COVID-19
pandemic. During the
expansion, HHS used its
enforcement discretion
to relax the requirement
that a beneficiary must
have an established
relationship with a
provider to receive
certain telehealth
services. This data
snapshot will describe
the extent to which
Medicare beneficiaries
had established
relationships with
providers from whom they
received telehealth
services. We will also
look for any differences
in these relationships
between traditional
Medicare and Medicare
Advantage and among the
different types of
telehealth services.
------------------------------------------------------------------------
2 Audit of Home On March 13, 2020, FY 2022
Health President Trump declared
Services a national emergency in
Provided as response to the COVID-19
Telehealth pandemic, which allowed
During the CMS to take proactive
COVID-19 steps to support the
Public response to COVID-19
Health through the use of
Emergency \2 section 1135 waivers. By
\ means of this authority,
CMS waived certain
requirements to expand
Medicare telehealth
benefits to health-care
professionals who were
previously ineligible,
including physical
therapists, occupational
therapists, speech
language pathologists,
and others. However, the
waiver does not allow
for payment of
telehealth services on
home health claims. In
the COVID-19 Public
Health Emergency Interim
Final Rule With Comment,
CMS amended regulations
on an interim basis to
allow home health
agencies to use
telecommunications
systems in conjunction
with in-person visits.
In the CY 2021 Home
Health Prospective
Payment System Final
Rule, CMS permanently
finalized these changes.
The final amended
regulations state that
the plan of care must
include any provision of
remote patient
monitoring or other
services furnished via
telecommunications
technology or audio-only
technology, and that
such services must be
tied to patient-specific
needs as identified in
the comprehensive
assessment. The
regulations further
state that telehealth
services cannot
substitute for a home
visit ordered as part of
the plan of care and
cannot be considered a
home visit for the
purposes of patient
eligibility or payment.
We will evaluate home
health services provided
by agencies during the
COVID-19 public health
emergency to determine
which types of skilled
services were furnished
via telehealth, and
whether those services
were administered and
billed in accordance
with Medicare
requirements. We will
report as overpayments
any services that were
improperly billed. We
will make appropriate
recommendations to CMS
based on the results of
our review.
------------------------------------------------------------------------
3 Audits of Telehealth is playing an FY 2022
Medicare important role during
Part B the public health
Telehealth emergency, and CMS is
Services exploring how telehealth
During the services can be expanded
COVID-19 beyond the public health
Public emergency to provide
Health care for Medicare
Emergency \3 beneficiaries. Because
\ of telehealth's changing
role, we will conduct a
series of audits of
Medicare Part B
telehealth services in
two phases. Phase one
audits will focus on
making an early
assessment of whether
services such as
evaluation and
management, opioid use
order, end-stage renal
disease, and
psychotherapy (Work Plan
number W-00-21-35801)
meet Medicare
requirements. Phase two
audits will include
additional audits of
Medicare Part B
telehealth services
related to distant and
originating site
locations, virtual check-
in services, electronic
visits, remote patient
monitoring, use of
telehealth technology,
and annual wellness
visits to determine
whether Medicare
requirements are met.
------------------------------------------------------------------------
4 Home Health Home health agencies FY 2022
Agencies' (HHAs) have faced
Challenges unprecedented challenges
and to providing care during
Strategies the COVID-19 pandemic.
in Reported challenges
Responding include, but are not
to the COVID- limited to, procuring
19 Pandemic necessary equipment and
\4\ supplies, implementing
telehealth to treat
patients remotely, and
addressing staffing
shortages. However, the
full spectrum of these
challenges, including
how challenges have
evolved over time, is
unknown. HHAs have used
strategies to address
these challenges, but
the array of strategies
and the extent to which
HHAs found them helpful
are also unknown. This
nationwide study will
provide insights into
the strategies HHAs have
used to address the
challenges presented by
COVID-19, including how
well their emergency
preparedness plans
served them during the
COVID-19 pandemic.
------------------------------------------------------------------------
5 Medicare In response to the COVID- FY 2022
Telehealth 19 pandemic, CMS
Services implemented a number of
During the waivers and
COVID-19 flexibilities that
Pandemic: allowed Medicare
Program beneficiaries to access
Integrity a wider range of
Risks \5\ telehealth services
without having to travel
to a health-care
facility. This review
will be based on
Medicare Parts B and C
data and will identify
program integrity risks
associated with Medicare
telehealth services
during the pandemic. We
will analyze providers'
billing patterns for
telehealth services. We
will also describe key
characteristics of
providers that may pose
a program integrity risk
to the Medicare program.
------------------------------------------------------------------------
6 Use of In response to the COVID- FY 2022
Medicare 19 pandemic, CMS made a
Telehealth number of changes that
Services allowed Medicare
During the beneficiaries to access
COVID-19 a wider range of
Pandemic \6\ telehealth services
without having to travel
to a health-care
facility. CMS proposes
to make some of these
changes permanent. This
review will be based on
Medicare Parts B and C
data and will look at
the use of telehealth
services in Medicare
during the COVID-19
pandemic. It will look
at the extent to which
telehealth services are
being used by Medicare
beneficiaries, how the
use of these services
compares to the use of
the same services
delivered in person, and
the different types of
providers and
beneficiaries using
telehealth services.
------------------------------------------------------------------------
7 Medicaid--Tel As a result of the COVID- FY 2022
ehealth 19 pandemic, State
Expansion Medicaid programs have
During COVID- expanded options for
19 Emergency telehealth services.
\7\ Rapid expansion of
telehealth may pose
challenges for State
agencies and providers,
including State
oversight of these
services. Our objective
is to determine whether
State agencies and
providers complied with
Federal and State
requirements for
telehealth services
under the national
emergency declaration,
and whether the States
gave providers adequate
guidance on telehealth
requirements.
------------------------------------------------------------------------
\1\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000613.asp.
\2\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000553.asp.
\3\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000556.asp.
\4\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000557.asp.
\5\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000535.asp.
\6\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000491.asp.
\7\ https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-
summary-0000488.asp.
______
Prepared Statement of Neil H. MacBride, Nominated
to be General Counsel, Department of the Treasury
Thank you, Chairman Wyden, Ranking Member Crapo, and members of the
committee, for the opportunity to appear before you today. Thank you,
Senators Warner and Kaine, for your kind introductions. I am deeply
honored that President Biden nominated me to be General Counsel for the
Department of Treasury, and I am grateful to Secretary Yellen for her
confidence in me.
I would like to begin by introducing my family: my amazing wife of
29 years Christina Jackson MacBride, and our three children, Duncan,
Charlotte, and Alistair. As you all know, public service places great
demands on one's family, and I am very thankful to Chris and my
children for their constant love and support throughout the last
several months, and especially during my prior 15 years of public
service.
I would also like to acknowledge my incredible parents: Ruth
Parkerson MacBride--who just turned 90 and is watching today's hearing
from home--as well as my dad, Harvey MacBride, who passed away several
years ago. And I'd like to acknowledge my wonderful in-laws, Rear
Admiral Grady Jackson (USN Ret.) and Linda Jackson, who are watching
from home.
My parents instilled in me a deep commitment to public service.
They were children of the Great Depression and both from humble roots.
My mom grew up in rural Indiana while my dad, the son of immigrants,
was raised in the South Bronx. My parents modeled hard work and
personal responsibility but also firmly believed that government had an
obligation to help out those who were down on their luck, and that
Americans should give back to a country that had given them so much
opportunity.
My parents' example led me to law school and subsequently into 15
years as a government attorney, serving in all three branches of
government. The highlight of my public service, however, was spent
right here in the United States Senate, when I was incredibly fortunate
to spend 4 years as Chief Counsel to then-Senator Joe Biden on the
Judiciary Committee.
I joined Senator Biden's staff 1 week before the September 11th
terrorist attacks on our Nation and witnessed first-hand the strength,
resolve, and resilience of this great body and its members during those
challenging days. It is humbling to be seated on the ``other side'' of
the dais in a Senate hearing room, after logging hundreds of hours on
the back bench in Dirksen 226. Having spent 4 years working on the
Judiciary Committee--including with Senator Cantwell, Senator Grassley,
Senator Cornyn, and former Senator Hatch--I have enormous respect for
the significant work of this committee in ensuring that the people's
work is done.
I learned so much about the law and public service from then-
Senator Biden, and I was privileged to work with him on important
bipartisan legislation to protect vulnerable victims, whether of
domestic violence, corporate fraud, or terrorism. I believe that
experience, including seeing up close Congress enacting laws that are
carried out by the executive branch, was incredibly helpful when I was
later honored to serve as the United States Attorney in the Eastern
District of Virginia. As U.S. Attorney, I partnered frequently with
Treasury's enforcement offices to tackle banking and financial crimes--
working closely with FinCEN, OFAC, SIGTARP, and IRS Criminal
Investigation--and know first-hand the importance of their missions.
Treasury's responsibilities cover a range of issues that generate
no shortage of complex, difficult legal questions. The Department has a
crucial role to play in promoting a more fair and equitable economy,
maintaining an effective tax system, bolstering our national security,
and ensuring the continued dynamism of the U.S. economy.
My job as General Counsel will be, as Congress directed in its
authorizing legislation, ``the chief law officer of the Department.''
My role will not be to make policy or to oversee enforcement actions,
but to provide legal advice to Secretary Yellen and other component
heads, to manage Treasury's litigation positions, and to ensure that
the Department's regulatory actions comply with the laws Congress
enacts. I would be very fortunate to work alongside the Treasury Legal
Division's dedicated, experienced, and immensely talented lawyers and
professional staff.
If I am confirmed, I look forward to working closely with Congress,
and especially members of this committee. I have enormous respect for
this institution, and I am committed to maintaining a close working
relationship between Treasury and Congress.
Thank you again, Mr. Chairman, for the opportunity to appear before
this committee, and I look forward to answering your questions.
______
SENATE FINANCE COMMITTEE
STATEMENT OF INFORMATION REQUESTED
OF NOMINEE
A. BIOGRAPHICAL INFORMATION
1. Name (include any former names used): Neil Harvey MacBride.
2. Position to which nominated: General Counsel, U.S. Department of
Treasury.
3. Date of nomination: June 8, 2021.
4. Address (list current residence, office, and mailing addresses):
5. Date and place of birth: October 14, 1965, Schenectady, New York.
6. Marital status (include maiden name of wife or husband's name):
7. Names and ages of children:
8. Education (list all secondary and higher education institutions,
dates attended, degree received, and date degree granted):
University of Virginia School of Law, J.D., May 1992 (attended
8/89-5/92).
Houghton College, B.A., May 1987 (attended 8/83-5/87).
9. Employment record (list all jobs held since college, including the
title or description of job, name of employer, location of work, and
dates of employment for each job):
Partner
Davis Polk and Wardwell, LLP
901 15th Street, NW
Washington, DC 20005
April 2014-present
United States Attorney, Eastern District of Virginia
U.S. Attorney's Office
2100 Jamieson Avenue
Alexandria, Virginia 22314
September 2009-September 2013
Associate Deputy Attorney General
U.S. Department of Justice
950 Pennsylvania Avenue, NW
Washington, DC 20530
January 2009-September 2009
General Counsel and Vice President
Business Software Alliance
1150 18th Street, NW
Washington, DC 20036
November 2005-January 2009
Chief Counsel and Staff Director
U.S. Senator Joseph R. Biden, Jr.
United States Senate
Committee on the Judiciary
305 Senate Hart Office Building
Washington, DC 20510
August 2001-November 2005
Assistant United States Attorney
United States Attorney's Office for the District of Columbia
555 4th Street, NW
Washington, DC 20001
April 1997-August 2001
Associate
Verner, Liipfert, Bernhard, McPherson and Hand
901 15th Street, NW
Washington, DC 20005
September 1993-April 1997
Judicial Law Clerk
U.S. District Court Judge Henry C. Morgan, Jr.
U.S. District Court for the Eastern District of Virginia
600 Granby Street
Norfolk, Virginia 23510
August 1992-September 1993
Summer Honors Program Intern
U.S. Department of Justice, Antitrust Division
555 4th Street, NW
Washington, DC 20001
July 1991-August 1991
Summer Associate
Verner, Liipfert, Bernhard, McPherson and Hand
901 15th Street, NW
Washington, DC 20005
May 1991-July 1991
Summer Associate
Green, Stewart and Farber
2600 Virginia Avenue
Washington, DC 20037
May 1990-August 1990
Paralegal
Brown and Wood
One World Trade Center
New York, New York 10048
January 1989-August 1989
Deputy Press Secretary
Frank Lautenberg for U.S. Senate Campaign
Street Address Unknown
New Brunswick, New Jersey
March 1988-November 1988
Regional Field Coordinator
Paul Simon for President Campaign
Street Address Unknown
Des Moines, Iowa
November 1987-February 1988
Field Organizer
Joe Biden for President Campaign
Street Address Unknown
Manchester, New Hampshire
July 1987-September 1987
10. Government experience (list any current and former advisory,
consultative, honorary, or other part-time service or positions with
Federal, State, or local governments held since college, including
dates, other than those listed above):
Former Member, U.S. Judicial Conference's Ad Hoc Committee to
Review the Criminal Justice Act (2015-2017).
Former Ex Officio Member, Virginia State Bar Criminal Law
Section Board of Governors (2010-2013).
11. Business relationships (list all current and former positions held
as an officer, director, trustee, partner (e.g., limited partner, non-
voting, etc.), proprietor, agent, representative, or consultant of any
corporation, company, firm, partnership, other business enterprise, or
educational or other institution):
None.
12. Memberships (list all current and former memberships, as well as
any current and former offices held in professional, fraternal,
scholarly, civic, business, charitable, and other organizations dating
back to college, including dates for these memberships and offices):
Member, Edward Bennett Williams Inn of Court (2005-present).
Member, National Association of Former U.S. Attorneys (2013-
present).
Member, U.S. Supreme Court Historical Society (2018-present).
Member, White Collar Committee, American Bar Association (2017-
present).
Board of Advisors, National Security Institute, George Mason
University Law School (2016-present).
Board of Advisors, The Network Group, Inc. (2017-2020).
Former Board of Advisors, The Center on Law and Security, New
York University Law School (2007-2009).
Former Co-Chair, Trans-National Crimes Subcommittee, American
Bar Association (2014-2017).
Former Member, ABA Cybersecurity Legal Task Force, American Bar
Association (2012-2014).
Member, Washington Golf and Country Club (2014-present).
Member, Metropolitan Club, Washington DC (2019-present).
Member, Cannon Club, Lothian Maryland (2015-present)..
Member, UVA Club of New York (2018-present).
Member, Overlee Community Association Pool, Arlington, Virginia
(2004-2013).
13. Political affiliations and activities:
a. List all public offices for which you have been a candidate
dating back to the age of 18.
None.
b. List all memberships and offices held in and services
rendered to all political parties or election committees,
currently and during the last 10 years prior to the date of
your nomination.
None.
c. Itemize all political contributions to any individual,
campaign organization, political party, political action
committee, or similar entity of $50 or more for the past 10
years prior to the date of your nomination.
$2,900 contribution to Sean Patrick Maloney for Congress (3/31/
21).
$2,900 contribution to Sean Patrick Maloney for Congress (3/31/
21).
$2,500 contribution to Terry McAuliffe (2/19/21).
$1,250 contribution to Phil Weiser for Attorney General (2/7/
21).
$1,000 contribution to BackPAC Leadership Political Action
Committee
(10/21/20).
$2,800 contribution to Abigail Spanberger for Congress (10/15/
20).
$25,000 contribution to Biden Victory Fund (9/29/20).
$2,800 contribution to Biden Victory Fund (9/13/20).
$2,800 contribution to Biden For President (4/13/20).
$2,800 contribution to Sean Patrick Maloney for Congress (3/4/
20).
$2,800 contribution to Friends of Don Beyer (3/4/20).
$5,000 contribution to Unite The Country (3/3/20).
$2,800 contribution to Barry Grissom for U.S. Senate (7/17/19).
$2,800 contribution to Biden For President (4/25/19).
$2,800 contribution to John Walsh for Senate (4/17/19).
$1,000 contribution to Friends of Don Beyer (2/25/19).
$1,000 contribution to Theo Stamos for Arlington Commonwealth's
Attorney (2/23/19).
$5,000 contribution to Friends of Mark Warner (2/11/19).
$500 contribution to Jennifer Wexton for Congress (10/12/18).
$1,000 contribution for to Friends of Don Beyer (7/13/18).
$1,000 contribution to Bob Casey for Senate (6/21/18).
$5,000 contribution to Tim Kaine Victory Fund (5/21/18).
$5,000 contribution to the American Possibilities PAC (3/14/18).
$2,700 contribution to Sheldon Whitehouse for Senate (3/13/18).
$1,000 contribution to Paul Pelletier for Congress (12/8/17).
$1,000 contribution to Doug Jones for Senate (12/8/17).
$1,000 contribution to Friends of Don Beyer (10/16/17).
$2,700 contribution to Sean Patrick Maloney for Congress (9/30/
17).
$1,000 to Justin Fairfax for Lt. Governor of Virginia (4/25/17).
$2,700 contribution to Sean Patrick Maloney for Congress (3/31/
17).
$500 contribution to Gene Rossi for Lt. Governor of Virginia (3/
16/17).
$1,500 contribution to Kaine for Virginia (3/13/17).
$2,700 contribution to Evan Bayh Committee (10/24/16).
$2,700 contribution to Hillary for America (8/30/16).
$10,000 contribution to Hillary Victory Fund (8/30/16).
$7,300 contribution to Hillary Victory Fund (8/30/16).
$1,000 contribution to Conner Eldridge for Arkansas (2/18/16).
$1,000 contribution to Friends of Don Beyer (12/20/15).
$2,700 contribution to Sean Patrick Maloney for Congress (9/26/
15).
$250 contribution to Theo Stamos for Arlington County
Commonwealth's Attorney (4/21/15).
$250 contribution to Friends of Don Beyer (4/17/15).
$2,600 contribution to Sean Patrick Maloney (5/6/14).
$1,000 contribution to Friends of Don Beyer (3/11/14).
14. Honors and awards (list all scholarships, fellowships, honorary
degrees, honorary society memberships, military medals, and any other
special recognitions for outstanding service or achievement received
since the age of 18):
Phi Alpha Theta, History Honor Society (1986).
Merritt Memorial Pre-Law Scholarship, Houghton College, applied
at University of Virginia School of Law (1989-1992).
U.S. Department of Justice Special Achievement Awards (1996,
1997).
15. Published writings (list the titles, publishers, dates, and
hyperlinks (as applicable) of all books, articles, reports, blog posts,
or other published materials you have written):
``House passes insider trading bill,'' Davis Polk Client Alert
Memorandum (May 25, 2021), https://www.davispolk.com/.
``SEC and CFTC enforcement update,'' Davis Polk Client
Newsletter (May 4, 2021), https://www.davispolk.com/.
``SEC establishes Enforcement Division Climate and ESG Task
Force,'' Davis Polk Client Memorandum (March 5, 2021), https://
www.davispolk.com/.
``SEC changes enforcement practice for settlement offers in
cases involving waivers,'' Davis Polk Client Alert Memorandum
(February 12, 2021), https://www.davispolk.com/.
``SEC acknowledges that disgorgement principles in Liu apply to
administrative proceedings,'' Davis Polk Client Memorandum
(February 9, 2021), https://www.davispolk.com/.
``DOJ and SEC FCPA Resolution Tracker,'' Davis Polk Client
Newsletter (January 29, 2021), https://www.davispolk.com/.
``Supreme Court relies on `Bridgegate' case to vacate Second
Circuit insider trading decision,'' Davis Polk Client
Memorandum (January 26, 2021), https://www.davispolk.com/.
``Veto override enacts expanded SEC disgorgement authority,''
Davis Polk Client Memorandum (January 4, 2021), https://
www.davispolk.com/.
``CFTC Reports Record Year for Enforcement,'' Davis Polk Client
Memorandum (December 4, 2020), https://www.davispolk.com/sites/
default/files/cftc_reports
_record_year_for_enforcement.pdf.
``SEC Announces 2020 Enforcement Results,'' Davis Polk Client
Memorandum (November 3, 2020), https://www.davispolk.com/sites/
default/files/sec_
announces_2020_enforcement_results.pdf.
``DOJ and SEC Publish Updated FCPA Resource Guide,'' Davis Polk
Client Memorandum (July 9, 2020), https://www.davispolk.com/
sites/default/files/
doj_and_sec_publish_updated_fcpa_resource_guide.pdf.
``Supreme Court Preserves SEC's Disgorgement Authority, But
with Limits,'' Davis Polk Client Memorandum (June 23, 2020),
https://www.davispolk.com/sites/default/files/2020-06-
23_supreme_court_preserves_secs_disgorgement_au
thority_but_with_limits.pdf.
``COVID-19 Pandemic Spurs Renewed State and Federal Focus on
Price Gouging Enforcement,'' Davis Polk Client Memorandum (May
21, 2020), https://www.davispolk.com/sites/default/files/2020-
05-21-covid-19-pandemic-spurs-renewed-state-and-federal-focus-
on-price-gouging-enforcement.pdf.
``Supreme Court Reverses `Bridgegate' Convictions, Clarifies
Meaning of `Property' Under Federal Fraud Statutes,'' Davis
Polk Client Memorandum (May 11, 2020), https://
www.davispolk.com/sites/default/files/supreme_court_reverses_
bridgegate_convictions_clarifies_meaning_of_property_under_feder
al_fraud_
statutes.pdf.
``CARES Act Enforcement: A Landscape of Potential Risk,'' Davis
Polk Client Memorandum (April 14, 2020), https://
www.davispolk.com/sites/default/files/2020-04-
14_cares_act_enforcement_landscape_potential_risk.pdf.
``How the SEC Enforcement Division Responds to a Crisis,''
Davis Polk Client Memorandum (March 25, 2020), https://
www.davispolk.com/sites/default/files/2020-03-
25_how_the_sec_enforcement_division_responds_to_a_crisis.pdf.
``Federal Judge Acquits Ex-Alstom Executive on FCPA Charges
Post Jury Verdict,'' Davis Polk Client Memorandum (March 2,
2020), https://www.
davispolk.com/sites/default/files/2020-03-
02_federal_judge_acquits_ex-alstom
_executive_on_fcpa_charges_post_jury_verdict.pdf.
``SEC Office of Compliance Inspections and Examinations (OCIE)
Issues Observations on Cybersecurity and Resiliency
Practices,'' Davis Polk Client Memorandum (January 30, 2020),
https://www.davispolk.com/sites/default/files/2020-01-
30_sec_office_of_compliance_inspections_and_examinations_ocie_is
sues_
observations_on_cybersecurity_and_resiliency_practices.pdf.
``House Passes 8-K Trading Gap Act,'' Davis Polk Client
Memorandum (January 21, 2020), https://www.davispolk.com/sites/
default/files/2020-01-21_
house_passes_8-k_trading_gap_act.pdf.
``Financial Institutions Enforcement Update,'' Davis Polk
Client Memorandum (January 13, 2020), https://
www.davispolk.com/sites/default/files/2020-01-
13_financial_institutions_enforcement_update.pdf.
``Second Circuit Lowers the Bar for Charging Criminal Insider
Trading,'' Davis Polk Client Memorandum (January 7, 2020).
``DOJ Clarifies Position on Agency Liability under the FCPA
post-Hoskins; New FCPA Chief Named,'' Davis Polk Client
Memorandum (December 3, 2019), https://www.davispolk.com/
insights/client-update/doj-clarifies-position-agency-liability-
under-fcpa-post-hoskins-new-fcpa.
``Leaning into Fairness: Executive Order on Enforcement,''
Davis Polk Client Memorandum (November 18, 2019), https://
www.davispolk.com/.
``SEC Describes Active Enforcement Program and Focus on
Corporate Conduct in 2019 Annual Report,'' Davis Polk Client
Memorandum (November 14, 2019), https://www.davispolk.com/
insights/client-update/sec-describes-active-enforcement-
program-and-focus-corporate-conduct-2019.
``Supreme Court to Review SEC's Authority to Seek
Disgorgement,'' Davis Polk Client Memorandum (November 4,
2019), https://www.davispolk.com/insights/client-update/
supreme-court-review-secs-authority-seek-disgorgement.
``Leaning Into Transparency: Executive Order on Guidance,''
Davis Polk Client Memorandum (October 17, 2019), https://
www.davispolk.com/.
``District Court Opens the Door to Potential Restitution Claims
in FCPA Cases,'' Davis Polk Client Memorandum (September 10,
2019), https://www.
davispolk.com/.
``SFO Announces New Corporate Cooperation Guidance,'' Davis
Polk Client Memorandum (August 13, 2019), https://
www.davispolk.com/.
``DOJ Expands Opportunities for Cooperation Credit in Criminal
Antitrust Investigations,'' Davis Polk Memorandum (July 22,
2019), https://www.
davispolk.com/insights/client-update/doj-expands-opportunities-
cooperation-credit-criminal-antitrust.
``Chairman Jay Clayton Announces Change in SEC Waiver
Process,'' Davis Polk Client Memorandum (July 18, 2019),
https://www.davispolk.com/.
``Kisor v. Wilkie: Auer Deference Lives On, But in What
Form?'', Davis Polk Client Memorandum (June 27, 2019), https://
www.davispolk.com/.
``SCOTUS Expands Scope of FOIA Trade Secrets and Commercial
Information Exemption,'' Davis Polk Client Memorandum (June 26,
2019), https://www.davispolk.com/.
``Rep. Waters Proposes Changes to SEC `Bad Actor' Waiver
Process,'' Davis Polk Client Memorandum (June 26, 2019),
https://www.davispolk.com/.
``DOJ Provides Additional Guidance and Clarity Regarding Its
Evaluation of Corporate Compliance Programs,'' Davis Polk
Client Memorandum (May 7, 2019), https://www.davispolk.com/
insights/client-update/doj-provides-additional-guidance-and-
clarity-regarding-its-evaluation.
``CFTC Is Latest Entrant to Anti-Corruption Enforcement,''
Davis Polk Client Memorandum (March 11, 2019), https://
www.davispolk.com/.
``U.S. Government Fully Re-Imposes Iran Sanctions, Announces
`Unprecedented' Sanctions Effort,'' Davis Polk Client
Memorandum (November 6, 2018), https://www.davispolk.com/
insights/client-update/us-government-fully-re-imposes-iran-
sanctions-announces-unprecedented.
``Second Circuit Holds the FCPA Does Not Extend to Non-U.S.
Persons Absent U.S. Nexus,'' Davis Polk Client Memorandum
(August 31, 2018), https://www.davispolk.com/.
``SEC's Proposed Amendments to Its Whistleblower Program May
Increase Reporting of Potential Securities-Law Violations to
the SEC,'' Davis Polk Client Memorandum (July 6, 2018), https:/
/www.davispolk.com/insights/client-update/secs-proposed-
amendments-its-whistleblower-program-may-increase-reporting.
``In Amended Decision, U.S. Court of Appeals (Second Circuit)
Leaves Open the Ability to Prosecute Insider Trading Absent
Evidence of a `Meaningfully Close Personal Relationship',''
Davis Polk Client Memorandum (July 5, 2018), https://
www.davispolk.com/insights/client-update/amended-decision-us-
court-appeals-second-circuit-leaves-open-ability.
``New York's Highest Court Holds That Three-Year Statute of
Limitations Applies to Martin Act Claims,'' Davis Polk Client
Memorandum (July 2, 2018), https://www.davispolk.com/insights/
client-update/new-yorks-highest-court-holds-three-year-statute-
limitations-applies-martin.
``Supreme Court Holds that SEC Administrative Law Judges Have
Been Unconstitutionally Appointed in Decision that is Likely to
Have Far-Reaching Impact,'' Davis Polk Client Memorandum (June
25, 2018), https://www.
davispolk.com/insights/client-update/supreme-court-holds-sec-
administrative-law-judges-have-been.
``Deputy Attorney General Rosenstein Announces New Policy to
Avoid `Piling On' in Corporate Enforcement Actions,'' Davis
Polk Client Memorandum (May 11, 2018), https://
www.davispolk.com/insights/client-update/deputy-attorney-
general-rosenstein-announces-new-policy-avoid-piling.
``SEC Pursues Compliance Officers at Broker-Dealer for Aiding
and Abetting AML Violations,'' Davis Polk Client Memorandum
(April 27, 2018), https://www.davispolk.com/insights/client-
update/sec-pursues-compliance-officers-broker-dealer-aiding-
and-abetting-aml.
``Supreme Court Rules that Dodd-Frank Whistleblower Protections
Do Not Extend to Internal Reporting,'' Davis Polk Client
Memorandum (February 27, 2018), https://www.davispolk.com/
insights/client-update/supreme-court-rules-dodd-frank-
whistleblower-protections-do-not-extend.
``White Collar Update: Solicitor General Sides with Opponents,
Agrees SEC ALJs are Unconstitutionally Appointed,'' Davis Polk
Client Memorandum (December 5, 2017), https://
www.davispolk.com/.
``White Collar Update: Deputy Attorney General Rod Rosenstein
Announces New FCPA Corporate Enforcement Policy Establishing a
Category of Presumptive Declinations,'' Davis Polk Client
Memorandum, https://www.
davispolk.com/insights/client-update/white-collar-update-
deputy-attorney-general-rod-rosenstein-announces-new.
``SEC Division of Enforcement Co-Directors Stephanie Avakian
and Steven Peikin Provide Remarks on Enforcement Division's
Initiatives and Priorities,'' Davis Polk Client Memorandum
(October 30, 2017), https://www.
davispolk.com/insights/client-update/sec-division-enforcement-
co-directors-stephanie-avakian-and-steven-peikin.
``White Collar Update: Deputy Attorney General Rod Rosenstein
Delivers Address on Corporate Enforcement Policy,'' Davis Polk
Client Memorandum (October 12, 2017), https://
www.davispolk.com/insights/client-update/white-collar-update-
deputy-attorney-general-rod-rosenstein-delivers-address.
``U.S. Court of Appeals (Second Circuit) Upholds Convictions,
Eliminates Newman's `Meaningfully Close Personal Relationship'
Requirement,'' Davis Polk Client Memorandum (September 5,
2017), https://www.davispolk.com/insights/client-update/us-
court-appeals-second-circuit-upholds-convictions-eliminates-
newmans.
``The PetyaWrap Attack, Anthem Data Breach Settlement, and
NYDFS Cyber Regulations All Highlight that Companies Should
Review Their Access Controls,'' Davis Polk Client Memorandum
(June 29, 2017), https://www.
davispolk.com/insights/client-update/petyawrap-attack-anthem-
data-breach-settlement-and-nydfs-cyber-regulations-0.
``Securities Enforcement Update: Supreme Court Rules that Five-
Year Statute of Limitations Applies to SEC Disgorgement
Actions,'' Davis Polk Client Memorandum (June 6, 2017), https:/
/www.davispolk.com/insights/client-update/securities-
enforcement-update-supreme-court-rules-five-year-statute.
``Target Corp. Cyber Breach Settlement Reflects Emerging Best
Practices for Cybersecurity,'' Davis Polk Client Memorandum
(May 30, 2017), https://www.davispolk.com/insights/client-
update/target-corp-cyber-breach-settlement-reflects-emerging-
best-practices.
``Securities Enforcement Update: Supreme Court Hints at Statute
of Limitations for Disgorgement Actions, Justices Question
SEC's Authority to Seek Disgorgement Altogether,'' Davis Polk
Client Memorandum (April 26, 2017), https://www.davispolk.com/
insights/client-update/securities-enforcement-update-supreme-
court-hints-statute-limitations.
``PCAOB Cross-Border Enforcement,'' Davis Polk Client
Memorandum (March 30, 2017), https://www.davispolk.com/.
``Ninth Circuit Dodd-Frank Whistleblower Opinion,'' Davis Polk
Client Newsflash (March 8, 2017), https://www.davispolk.com/.
``White Collar Update: New DOJ Guide to Evaluation of Corporate
Compliance Programs,'' Davis Polk Client Memorandum (March 6,
2017), https://www.davispolk.com/.
``White Collar Update: Rolls-Royce Reaches Global $800 Million
Resolution in Bribery Scheme,'' Davis Polk Client Memorandum
(January 25, 2017), https://www.davispolk.com/insights/client-
update/white-collar-update-rolls-royce-reaches-global-800-
million-resolution.
``Securities Enforcement Update: Supreme Court to Decide
Statute of Limitations for SEC Disgorgement Actions,'' Davis
Polk Client Memorandum (January 19, 2017), https://
www.davispolk.com/insights/client-update/securities-
enforcement-update-supreme-court-decide-statute-limitations-
sec.
``White Collar Update: Teva to Pay $519 Million in FCPA
Resolution, a Pharmaceutical Industry Record,'' Davis Polk
Client Memorandum (January 3, 2017), https://www.davispolk.com/
insights/client-update/white-collar-update-teva-pay-519-
million-fcpa-resolution-pharmaceutical.
``White Collar Update: Odebrecht and Braskem to Pay Record FCPA
Penalty of at Least $3.5 Billion in Petrobras Fallout,'' Davis
Polk Client Memorandum (December 23, 2016), https://
www.davispolk.com/insights/client-update/white-collar-update-
odebrecht-and-braskem-pay-record-fcpa-penalty-least-35.
``SEC Announces Two Enforcement Actions Regarding Restrictive
Language in Severance Agreements,'' Davis Polk Client
Memorandum (December 22, 2016), https://www.davispolk.com/
insights/client-update/sec-announces-two-enforcement-actions-
regarding-restrictive-language.
``PCAOB Enforcement Milestone,'' Davis Polk Client Memorandum
(December 12, 2016), https://www.davispolk.com/.
``White Collar Update: Supreme Court Rejects Second Circuit's
Narrow Interpretation of Insider-Trading Law,'' Davis Polk
Client Memorandum (December 8, 2016), https://
www.davispolk.com/insights/client-update/white-collar-update-
supreme-court-rejects-second-circuits-narrow.
``Banking Regulators Float Broad Cyber Risk Approach,'' Davis
Polk Client Memorandum (October 31, 2016), https://
www.davispolk.com/.
``What's Next for PHH v. CFPB?'', Davis Polk Client Memorandum
(October 17, 2016), https://www.davispolk.com/.
``New York State Department of Financial Services Proposes New
Cybersecurity Regulations,'' Davis Polk Client Memorandum
(October 13, 2016), https://www.davispolk.com/insights/client-
update/new-york-state-department-financial-services-proposes-
new-cybersecurity-0.
``Government Contract Fraud: Understanding and Mitigating the
Risk (Chapter Co- Author),'' Davis Polk White Collar Crime:
Business and Regulatory Offenses (2016) (June 15, 2016),
https://www.davispolk.com/insights/articles-books/government-
contract-fraud-understanding-and-mitigating-risk-chapter-co.
``2nd Cir. Holds that the Federal Courts Lack Jurisdiction to
Hear Attacks Against Ongoing SEC Administrative Proceedings,''
Davis Polk Client Memorandum (June 6, 2016), https://
www.davispolk.com/insights/client-update/2nd-cir-holds-federal-
courts-lack-jurisdiction-hear-attacks-against-ongoing.
``2d Cir. Reverses $1.3B Penalty, Finding That Countrywide Did
Not Defraud Government,'' Davis Polk Client Memorandum (May 26,
2016), https://www.davispolk.com/.
``White Collar Update: DOJ Announces One-Year FCPA Self-
Reporting Pilot Program,'' Davis Polk Client Memorandum (April
19, 2016), https://www.davispolk.com/.
``White Collar Update: D.C. Circuit Reaffirms Prosecutors'
Authority over Deferred Prosecution Agreements,'' Davis Polk
Client Memorandum (April 13, 2016), https://www.davispolk.com/
insights/client-update/white-collar-update-dc-circuit-
reaffirms-prosecutors-authority-over-deferred.
``CFPB Brings First Ever Data Security Enforcement Action:
Review and Analysis,'' Davis Polk Client Memorandum (March 9,
2016), https://www.
davispolk.com/.
``Corruption in 2015: Key Takeaways,'' Davis Polk Client
Newsletter (January 27, 2016), https://www.davispolk.com/.
``White Collar Update: Supreme Court Will Decide Reach of
Insider Trading Law,'' Davis Polk Client Memorandum (January
25, 2016), https://www.
davispolk.com/.
``White Collar Update: Second Circuit Grants Jefferies Bond
Trader New Trial, Reverses Others,'' Davis Polk Client
Memorandum (December 10, 2015), https://www.davispolk.com/
insights/client-update/white-collar-update-second-circuit-
grants-jefferies-bond-trader-new-trial.
``White Collar Update: DOJ Incorporates Yates Memo into U.S.
Attorneys' Manual,'' Davis Polk Client Memorandum (December 1,
2015), https://www.
davispolk.com/insights/client-update/white-collar-update-doj-
incorporates-yates-memo-us-attorneys-manual.
``White Collar Update: The Department of Justice Retains
Compliance Counsel Expert,'' Davis Polk Client Memorandum
(November 18, 2015), https://www.davispolk.com/.
``The Department of Justice Codifies Focus on Individuals in
Corporate Cases,'' Davis Polk Client Memorandum (September 11,
2015), https://www.
davispolk.com/.
``Insider Trading Update: Department of Justice Seeks Supreme
Court Review of Second Circuit Case Deciding Reach of Insider
Trading Law,'' Davis Polk Client Memorandum (August 5, 2015),
https://www.davispolk.com/insights/client-update/insider-
trading-update-department-justice-seeks-supreme-court-review-
second.
``New York's Final `BitLicense' Rule: Overview and Changes from
the July 2014 Proposal,'' Davis Polk Client Memorandum (June 5,
2015), https://www.
davispolk.com/insights/client-update/new-yorks-final-
bitlicense-rule-overview-and-changes-july-2014-proposal-0
``Business Email Compromise Scams Pose Significant Risk,''
Davis Polk Client Memorandum (May 21, 2015), https://
www.davispolk.com/.
``SEC Announces Enforcement Action Against Restrictive Language
in Confidentiality Agreements,'' Davis Polk Client Memorandum
(April 2, 2015), https://www.davispolk.com/insights/client-
update/sec-announces-enforcement-action-against-restrictive-
language-0.
``Insider Trading: U.S. Court of Appeals (Second Circuit)
Vacates Convictions, Clarifies Requirements of Tippee
Liability,'' Davis Polk Client Memorandum (December 11, 2014),
https://www.davispolk.com/insights/client-update/insider-
trading-us-court-appeals-second-circuit-vacates-convictions.
``New York July 2014 `BitLicense' Proposal: Visual
Memorandum,'' Davis Polk Client Memorandum (July 31, 2014),
https://www.davispolk.com/insights/client-update/new-york-july-
2014-bitlicense-proposal-visual-memorandum.
``FCPA Jurisprudence: U.S. Court of Appeals (11th Circuit)
Defines `Instrumentality' Under the FCPA, Adopts Government's
View,'' Davis Polk Client Memorandum (May 21, 2014), https://
www.davispolk.com/insights/client-update/fcpa-jurisprudence-us-
court-appeals-11th-circuit-defines-instrumentality.
``DOJ and SEC Announce Filing of FCPA Enforcement Action
Against Broker-Dealer Executives,'' Davis Polk Client
Memorandum (April 29, 2014), https://www.davispolk.com/
insights/client-update/doj-and-sec-announce-filing-fcpa-
enforcement-action-against-broker-dealer.
``Can a Christian Be a Yankee's Fan,'' Modern Reformation (May
2007).
``In God We Trust,'' Houghton College Milieu Magazine (October
1989).
16. Speeches (list all formal speeches and presentations (e.g.,
PowerPoint) you have delivered during the past 5 years which are on
topics relevant to the position for which you have been nominated,
including dates):
None.
17. Qualifications (state what, in your opinion, qualifies you to
serve in the position to which you have been nominated):
Over the last 20 years I have served in senior legal and
management positions in the public and private sectors
involving certain of the legal, policy and management issues I
would face as Treasury General Counsel, including as United
States Attorney for the Eastern District of Virginia, Associate
Deputy Attorney General, a law firm partner (involving both
office and practice group management positions), and as a
General Counsel to a major trade association.
B. FUTURE EMPLOYMENT RELATIONSHIPS
1. Will you sever all connections (including participation in future
benefit arrangements) with your present employers, business firms,
associations, or organizations if you are confirmed by the Senate? If
not, provide details.
If confirmed by the Senate, I will sever all such connections.
Note that pursuant to the defined benefit plan for Davis Polk
and Wardwell, LLP partners, if I am confirmed by the Senate
once I resign from my law firm I am eligible either (a) to
receive a monthly lifetime retirement benefit in the form of a
variable annuity starting at age 59\1/2\, or (b) to roll over
the defined benefit plan. If confirmed by the Senate, I will
remain a participant in this defined benefit, unless I elect to
roll it over, but will not accrue additional benefits under
these plans after I withdraw from my law firm.
2. Do you have any plans, commitments, or agreements to pursue
outside employment, with or without compensation, during your service
with the government? If so, provide details.
No.
3. Has any person or entity made a commitment or agreement to employ
your services in any capacity after you leave government service? If
so, provide details.
No.
4. If you are confirmed by the Senate, do you expect to serve out
your full term or until the next presidential election, whichever is
applicable? If not, explain.
Yes.
C. POTENTIAL CONFLICTS OF INTEREST
1. Indicate any current and former investments, obligations,
liabilities, or other personal relationships, including spousal or
family employment, which could involve potential conflicts of interest
in the position to which you have been nominated.
In connection with the nomination process, I have consulted
with the Office of Government Ethics and the Department of
Treasury's designated agency ethics official to identify
potential conflicts of interest. Any potential conflicts of
interest will be resolved in accordance with the terms of the
ethics agreement that I have entered with the Department of
Treasury's designated agency ethics official and that has been
provided to this committee. I am not aware of any other
potential conflicts of interest.
2. Describe any business relationship, dealing, or financial
transaction which you have had during the last 10 years (prior to the
date of your nomination), whether for yourself, on behalf of a client,
or acting as an agent, that could in any way constitute or result in a
possible conflict of interest in the position to which you have been
nominated.
In connection with the nomination process, I have consulted
with the Office of Government Ethics and the Department of
Treasury's designated agency ethics official to identify
potential conflicts of interest. Any potential conflicts of
interest will be resolved in accordance with the terms of the
ethics agreement that I have entered with the Department of
Treasury's designated agency ethics official and that has been
provided to this committee. I am not aware of any other
potential conflicts of interest.
3. Describe any activity during the past 10 years (prior to the date
of your nomination) in which you have engaged for the purpose of
directly or indirectly influencing the passage, defeat, or modification
of any legislation or affecting the administration and execution of law
or public policy. Activities performed as an employee of the Federal
government need not be listed.
None.
4. Explain how you will resolve any potential conflict of interest,
including any that are disclosed by your responses to the above items.
(Provide the committee with two copies of any trust or other
agreements.)
In connection with the nomination process, I have consulted
with the Office of Government Ethics and the Department of
Treasury's designated agency ethics official to identify
potential conflicts of interest. Any potential conflicts of
interest will be resolved in accordance with the terms of the
ethics agreement that I have entered with the Department of
Treasury's designated agency ethics official and that has been
provided to this committee. I am not aware of any other
potential conflicts of interest.
5. Two copies of written opinions should be provided directly to the
committee by the designated agency ethics officer of the agency to
which you have been nominated and by the Office of Government Ethics
concerning potential conflicts of interest or any legal impediments to
your serving in this position.
Provided to the committee.
D. LEGAL AND OTHER MATTERS
1. Have you ever been the subject of a complaint or been
investigated, disciplined, or otherwise cited for a breach of ethics
for unprofessional conduct before any court, administrative agency
(e.g., an Inspector General's office), professional association,
disciplinary committee, or other ethics enforcement entity at any time?
Have you ever been interviewed regarding your own conduct as part of
any such inquiry or investigation? If so, provide details, regardless
of the outcome.
No.
2. Have you ever been investigated, arrested, charged, or held by any
Federal, State, or other law enforcement authority for a violation of
any Federal, State, county, or municipal law, regulation, or ordinance,
other than a minor traffic offense? Have you ever been interviewed
regarding your own conduct as part of any such inquiry or
investigation? If so, provide details.
No.
3. Have you ever been involved as a party in interest in any
administrative agency proceeding or civil litigation? If so, provide
details.
No.
4. Have you ever been convicted (including pleas of guilty or nolo
contendere) of any criminal violation other than a minor traffic
offense? If so, provide details.
No.
5. Please advise the committee of any additional information,
favorable or unfavorable, which you feel should be considered in
connection with your nomination.
None.
E. TESTIFYING BEFORE CONGRESS
1. If you are confirmed by the Senate, are you willing to appear and
testify before any duly constituted committee of the Congress on such
occasions as you may be reasonably requested to do so?
Yes.
2. If you are confirmed by the Senate, are you willing to provide
such information as is requested by such committees?
Yes.
______
Questions Submitted for the Record to Neil H. MacBride
Questions Submitted by Hon. Maria Cantwell
Question. I want to discuss an issue that is of serious concern--
our growing affordable housing crisis and the need to build millions
more housing units in Washington State and nationwide.
I have been working with Senator Young, along with the chairman and
Senator Portman, to expand and strengthen the Low-Income Housing Tax
Credit.
Our legislation includes several critical increases to Housing
Credit resources and improvements to the program: a 50-percent
allocation increase for the credit overall, a reduction of the current
50-percent bond threshold to 25 percent so projects can more easily
access much-needed Housing Credit equity, and important basis boosts to
help extremely low-income populations as well as high need areas
including rural and tribal communities.
This is something we have been able to make incremental progress
on, most recently last December with the enactment of the 4 percent
floor. But as we recover from the pandemic, now more than ever families
need access to more affordable housing. We have much more to do here.
I was pleased to see that the House Ways and Means reconciliation
title included $29 billion in funding for LIHTC and included many of
the eligible provisions of our bill, and I hope we can match that
historic investment in affordable housing here in this committee.
I look forward to working with you to strengthen and expand LIHTC
this Congress.
As we work towards these reforms, will you commit to do all you can
to work with myself, Senator Young, and our colleagues on expanding and
improving the Low-
Income Housing Tax Credit?
Will you work to ensure that increasing the quantity and quality of
affordable housing is a top priority for the Department of Treasury?
Answer. I am committed to increasing the quantity and quality of
affordable housing through the Low-Income Housing Tax Credit (LIHTC).
The measure that Congress enacted through leadership from you and other
members of this Committee is a critically important initiative that
will help to make the LIHTC more effective and to increase housing
affordability across the country. If I am privileged to be confirmed, I
would be honored to work with you on additional measures to strengthen
and improve the LIHTC.
Question. The American Rescue Plan provided $350 billion for State,
local, and tribal governments to address the impacts of COVID-19 and
support the economic recovery of our communities. That included more
than $4.4 billion to the State of Washington.
Our State legislature has directed more than $600 million of that
funding to go towards the removal and replacement of culverts that
block salmon passage--essentially, drainage systems that move streams
and rivers under roads, rail and other man-made infrastructure.
Salmon are a big deal for us in the Northwest. They are vital to
Washington's economy and our identity, and our Nation also has a treaty
obligation to protect tribal fishing rights. But our salmon populations
are declining, and we need to make every effort possible to restore
those salmon runs.
We know that the most significant thing we can do is to clear these
blockages that prevent salmon from returning to their native streams
and restore their habitat. Our State agencies estimate that removing
just those culverts owned by the State will increase the number of
mature salmon by at least 200,000.
But our State hasn't been able to move forward on putting $600
million in Federal funding towards these important projects because of
a lack of clarity from Treasury. The Department's guidance on State and
local funds includes eligibility for water infrastructure projects. But
the State has not gotten any assurances from Treasury that culvert
projects are included in this definition.
Will you work to address this issue and give the State of
Washington the clarity it needs to move forward with being able to use
these funds?
Answer. I understand the importance of salmon to Washington's
economy and identity. If I am privileged to be confirmed I would be
pleased to work with you on this important issue to provide clarity
around Treasury's guidance on State and local funds.
______
Questions Submitted by Hon. Catherine Cortez Masto
Question. As a former Associate Deputy Attorney General and U.S.
Attorney for the Eastern District of Virginia, you oversaw criminal
enforcement and civil litigation on behalf of the United States. You
also served as a Federal prosecutor in the U.S. Attorney's Office for
the District of Columbia.
Can you share with us how your experience will help inform and
prepare you for this new role at Treasury?
Answer. I spent 15 years as a government attorney in public
service, including in the U.S. Senate and the U.S. Department of
Justice. My decade as a Federal prosecutor focused on protecting public
safety and defending vulnerable victims, whether of domestic violence,
corporate fraud, organized crime, or terrorism. As the United States
Attorney in the Eastern District of Virginia, I targeted corporate
fraud, bank fraud and consumer fraud--with a focus on real world
victims--using all the criminal and civil tools at my office's
disposal. This included standing up the Virginia Financial Fraud Task
Force, working closely in partnership with other Federal and State
agencies (e.g., FBI, Securities Exchange Commission, Commodity Futures
Trading Commission, U.S. Postal Inspection Service, Federal Reserve and
FDIC Inspectors General Offices, Virginia Corporation Commission). I
also partnered closely with Treasury's enforcement offices to tackle
national security threats and financial crimes, including with OFAC,
FinCEN, SIGTARP, and IRS Criminal Investigative Division. Including my
work as a Senate counsel, I believe my extensive experience at the
intersection of law enforcement, national security, and financial
enforcement matters have prepared me well to serve as Treasury General
Counsel, if I am privileged to be confirmed.
Question. How will you ensure--through your role--that Treasury and
its agencies are proactive, responsive and fair in addressing
taxpayer's needs in an equitable manner?
Answer. Based on my 15 years of public services in all three
branches of government, I am firmly committed to our government working
fairly, efficiently, and responsively for the American people. That
belief will guide my work every day if I am privileged to be confirmed.
Question. In your opening statement, you noted the importance of
``promoting a more fair and equitable economy, maintaining an effective
tax system, bolstering our national security, and ensuring the
continued dynamism of the U.S. economy.'' These are important goals to
bring to the Treasury and its broad mission. Given your service and
work as a government official on law enforcement, national security,
and financial enforcement, how will you address difficult legal
questions on these matters?
Answer. While Treasury's responsibilities cover a range of issues
that generate no shortage of complex, difficult legal questions, if
confirmed I would be very fortunate to work alongside the Treasury
Legal Division's dedicated, experienced, and immensely talented lawyers
and professional staff. As the ``chief legal officer'' of Treasury, my
job would be to ensure that the Department carries out its mission in
fidelity to the law.
Question. What do you think is a particular area or issue of
emerging concern that may arise during your time in this role at
Treasury?
Answer. There are likely several emerging or priority areas which
will confront the Treasury Legal Division in the next few years,
including cryptocurrency, climate change, the Department's sanctions
review, and the implementation of anti-money laundering authorities
under the Corporate Transparency Act.
______
Questions Submitted by Hon. Elizabeth Warren
Question. We have now spoken multiple times regarding my concerns
about your previous private-sector employment and your numerous trips
through the revolving door. Given your recent work on behalf of clients
like ExxonMobil, S&P, Wells Fargo, J.P. Morgan, Morgan Stanley,
Facebook, AstraZeneca, and Cisco Systems, I have asked you to make some
commitments that will help at least reduce the speed of the revolving
door and reassure the American public that you are working for them and
not clients, past or future.
You have not made those commitments to date, so let me ask one more
time.
Will you commit to recuse yourself from working on any matters
related to your former clients--including ExxonMobil, Wells Fargo,
Morgan Stanley, AstraZeneca, and others--for 4 years if confirmed?
Answer. I have no financial interests in any of my former clients.
If I am privileged to be confirmed, I will comply with the requirements
set forth in my Ethics Agreement to terminate my outside position with
and divest my financial interest in my law firm. I have dedicated over
half my career to serving and protecting our country. I will always
seek to serve the good of our country and the good of the American
people. I have made extensive ethics commitments as requested by the
Office of Government Ethics and documented in a written agreement,
which I have signed. My Ethics Agreement and the President's Ethics
Pledge will require me, if confirmed and appointed, to recuse myself
for a period of 2 years from participating personally and substantially
in any particular matter involving specific parties in which I know
that a former employer or client identified in my Ethics Agreement is a
party or represents a party, unless I am first authorized to
participate by the appropriate ethics official. If confirmed, I agree
to extend this term of my Ethics Agreement from 2 years to 4 years. I
will ensure that I have a robust screening process in place to help
implement these recusals.
Question. Ethics law requires a 2-year recusal commitment, and
other administration officials, including Defense Secretary Lloyd
Austin, were able to commit to extending their recusal period for 4
years. But even if you commit to a 4-year recusal period, you could
still seek waivers to that recusal that would allow you to participate
in matters that directly affect the financial impacts of your former
clients.
Will you commit, if confirmed, not to seek any waivers from any
ethics recusals that prohibit you from working on matters related to
your former clients?
Answer. I have no intention to seek a waiver and no expectation
that it will be required, but if unanticipated circumstances were to
arise, I would consider available alternatives to a waiver before
seeking one and would consult very carefully with career Department
ethics officials. If I am privileged to be confirmed, I can pledge to
you I will be mindful of not only the legal requirements that govern my
conduct but also of appearances to ensure that the public has no reason
to question my impartiality. I will consult with career Department
ethics officials on these issues and require everyone who serves with
me to ensure public service is and will remain a public trust.
Question. The revolving door centers on conflicts of interest
related to what work people do before they enter government, but also
what they do after government service. For example, The New York Times
just reported this month that ``the largest U.S. accounting firms have
perfected a remarkably effective behind-the-scenes system to promote
their interests in Washington,'' with their employees ``tak[ing] senior
jobs at the Treasury Department, where they write policies that are
frequently favorable to their former corporate clients,'' after which
``the firms welcome them back with loftier titles and higher pay.''\1\
The American public deserves to know that if confirmed to this key role
at the Treasury Department, you will be working from them, not on
behalf of companies that you may be seeking employment from in the near
future.
---------------------------------------------------------------------------
\1\ The New York Times, ``How Accounting Giants Craft Favorable Tax
Rules From Inside the Government,'' Jesse Drucker and Danny Hakim,
September 19, 2021, https://www.
nytimes.com/2021/09/19/business/accounting-firms-tax-loopholes-
government.html.
Will you commit not to seek employment with or be compensated by
any company you interact with during your time in government for 4
---------------------------------------------------------------------------
years after you leave government service?
Answer. I have promised to abide by the extensive post-government
employment ethics rules required by Federal law and the Biden
administration, just as I have complied with the ethics rules
throughout my 29-year career in public service and private industry.
These statutory and administration provisions set forth comprehensive
restrictions relating to communicating back to the Federal Government
on behalf of any future employers and clients. I believe that these
existing rules are appropriate and sufficient to protect the public
interest. If confirmed, I will carry out the responsibilities of the
Treasury General Counsel honorably, and I will seek any post-government
employment in full compliance with the applicable ethics rules.
______
Questions Submitted by Hon. Mike Crapo
national debt/social security and medicare trust funds
Question. I appreciate the commitment you expressed in the hearing
to share information with the Finance Committee regarding Treasury and
the Fed's plans to prioritize payments in the event of a breach of the
national debt limit.
I am deeply concerned about the long-term stability of our
government finances and their impact on Americans' economic prospects.
At a time of significant economic uncertainty created by the COVID-19
pandemic, the Biden administration delayed by almost five months the
release of the Social Security and Medicare Trustees Reports, even as
it has advocated for unprecedented increases in Federal spending.
If confirmed as General Counsel of the Treasury Department, will
you commit to urging Secretary Yellen, the Managing Trustee of the
Social Security and Medicare Trust Funds, to release future Trust Fund
Annual Reports each year by April 1 as required by the Social Security
Act?
Answer. I deeply respect the oversight function of this Committee.
If I am privileged to be confirmed, I would very much like to work in a
collaborative way with members of the Committee to provide timely,
complete, detailed, and accurate information in line with the
traditional partnership that Treasury and the Committee have had in the
past. I would need to be fully briefed by Treasury staff to better
understand the timing issues mentioned as part of this question. If I
am privileged to be confirmed, I would very much welcome this
conversation so that we can provide satisfactory and timely information
to the Committee.
taxpayer private information/propublica
Question. On June 8, advocates at ProPublica, in the interest of a
clear political agenda, began disclosing private, legally-protected
taxpayer information and named particular individuals in an ongoing
series of articles. ProPublica claimed that it had obtained a ``vast
trove of Internal Revenue Service data on the tax returns of thousands
of the Nation's wealthiest people, covering more than 15 years.''
Section 6103 (26 U.S. Code) of the Internal Revenue Code, intended to
reinforce privacy protections for American taxpayers, provides for
confidentiality, privacy, and penalties for certain disclosure of
returns and return information.
Please describe your understanding of how section 6103 applies to
ProPublica's release of legally-protected, private taxpayer information
and identify whether, if confirmed, you feel any obligation to
investigate ProPublica's releases of private information, including
contacting authors and executives at ProPublica.
Answer. I am deeply concerned about the release of confidential
taxpayer information. Any unauthorized disclosure of confidential
government information, including as provided by 26 U.S.C. section
6103, is illegal and must be taken extremely seriously. Secretary
Yellen has said that independent investigations are underway. My
understanding from public reporting is that the matter has been
referred to the Office of the Inspector General, Treasury Inspector
General for Tax Administration, Federal Bureau of Investigation, and
the U.S. Attorney's Office for the District of Columbia, all of whom
have independent authority to investigate. If I am privileged to be
confirmed, it would be a priority of mine to make sure the Treasury
Department continues to work with relevant oversight bodies, gather all
the facts, ensure accountability and work to prevent unauthorized
access or disclosure to the fullest extent possible.
conflicts of interest
Question. If confirmed, your ethical conduct, including conduct
related to conflicts of interest, is very important particularly when
serving in such an important position such as General Counsel of the
Treasury Department.
Will you commit to recuse yourself from any decisions involving
previous clients or employers for 2 years after being confirmed, in
accordance with the Biden administration's ethics pledge?
Answer. I have no financial interests in any of my former clients.
If I am privileged to be confirmed, I will comply with the requirements
set forth in my Ethics Agreement to terminate my outside position with
and divest my financial interest in my law firm. I have dedicated over
half my career to serving and protecting our country. I will always
seek to serve the good of our country and the good of the American
people. I have made extensive ethics commitments as requested by the
Office of Government Ethics and documented in a written agreement,
which I have signed. My Ethics Agreement and the President's Ethics
Pledge will require me, if confirmed and appointed, to recuse myself
for a period of 2 years from participating personally and substantially
in any particular matter involving specific parties in which I know
that a former employer or client identified in my Ethics Agreement is a
party or represents a party, unless I am first authorized to
participate by the appropriate ethics official. If confirmed, I agree
to extend this term of my Ethics Agreement from 2 years to 4 years. I
will ensure that I have a robust screening process in place to help
implement these recusals. I have no intention to seek a waiver and no
expectation that it will be required, but if unanticipated
circumstances were to arise, I would consider available alternatives to
a waiver before seeking one and would consult very carefully with
career Treasury ethics officials.
I have committed to abide by the extensive post-government
employment ethics rules required by Federal law and the Biden
administration, just as I have complied with the applicable ethics
rules throughout my 29-year career in public service and private
industry. If confirmed, I will carry out the responsibilities of the
Treasury General Counsel honorably and will seek any post-government
employment in full compliance with the applicable ethics rules.
______
Questions Submitted by Hon. Chuck Grassley
Question. In your written testimony you note that you've worked
with the Criminal Investigation division of the IRS. Therefore, I
assume you realize how important it is that tax information provided to
the IRS is protected and is kept confidential. Since June 8th,
ProPublica has been publishing stories based on the apparent illegal
disclosure of confidential tax information. Despite my efforts as
ranking member of the Judiciary Committee and Ranking Member Crapo's
here at Finance, we've been provided very little information as to the
status of any investigations.
Do you agree that maintaining the confidentiality of taxpayer
information is very important, and that any possible breach must be
thoroughly investigated?
If confirmed, do you pledge to work with me and other Senators, to
carry out our constitutional duty of oversight, and keep us informed on
the status of any such investigation? And, would you advise Secretary
Yellen to do the same?
What is the current status of active investigations into the source
of the information ProPublica is publishing? If you are not able to
answer this question because you are not yet confirmed, will you commit
to provide me a briefing if you are confirmed?
Answer. I am deeply concerned about the release of confidential
taxpayer information. Any unauthorized disclosure of confidential
government information, including taxpayer information, is illegal and
must be taken extremely seriously. If I am privileged to be confirmed,
I pledge to work with the Finance Committee on oversight requests.
Secretary Yellen has said that independent investigations are underway.
My understanding from public reporting is that the matter has been
referred to the Office of the Inspector General, Treasury Inspector
General for Tax Administration, Federal Bureau of Investigation, and
the U.S. Attorney's Office for the District of Columbia, all of whom
have independent authority to investigate. While I am not privy to non-
public information about the current status of the investigation, if I
am privileged to be confirmed I commit to make sure the Treasury
Department continues to work with relevant oversight bodies, to gather
the facts, ensure accountability, and work to prevent unauthorized
access or disclosure to the fullest extent possible.
______
Questions Submitted by Hon. John Thune
Question. Should you be confirmed, will you agree to provide timely
and thorough responses to questions from members of the Senate Finance
Committee?
Answer. I deeply respect the oversight function of this Committee.
If I am privileged to be confirmed, I would like very much to work in a
collaborative way with the Committee to provide timely, complete,
detailed, and accurate information in line with the traditional
partnership that Treasury and the Committee have had in the past.
Question. How would you ensure the Treasury Department acts in
fidelity to the law?
Answer. Congress's authorizing statue, 31 U.S.C. section 301,
defines the Treasury General Counsel as the Department's ``chief law
officer.'' Moreover, the specific responsibilities of the Treasury
General Counsel are set forth in Treasury Order 107-04 (issued
September 29, 2020), and include providing legal advice to the
Secretary, Deputy Secretary and the other component heads related to
Treasury's statutory responsibilities; managing Treasury's position in
lawsuits; and reviewing the Department's regulatory actions. If I am
privileged to be confirmed as Treasury General Counsel, I would be
bound by the authorizing statute to ensure the Department acts in
fidelity with the laws Congress enacted and the binding case law of the
Federal courts. Having previously spent 4 years as a Senate counsel, I
am fully committed to ensuring the Department's legal positions comport
with the laws as Congress enacted.
Question. In response to the recent breach of private taxpayer
information at the Internal Revenue Service (IRS), of which that
information was leaked to ProPublica, the Treasury Department said that
the unauthorized disclosure of confidential government information is
illegal. However, it is unclear what actions the Treasury Department
and IRS have taken to provide accountability over the significant
security lapse, or what steps have been taken to prevent such an event
from happening again.
If confirmed, how would you provide accountability at Treasury in
regard to this particular breach of private taxpayer information?
If confirmed, will you commit to providing me a timely and thorough
update on this particular data breach and the measures Treasury has
taken to provide accountability?
Answer. I am deeply concerned about the release of confidential
taxpayer information. Any unauthorized disclosure of confidential
government information, including as provided by 26 U.S.C. section
6103, is illegal and must be taken extremely seriously. Secretary
Yellen has said that independent investigations are underway. My
understanding from public reporting is that the matter has been
referred to the Office of the Inspector General, Treasury Inspector
General for Tax Administration, Federal Bureau of Investigation, and
the U.S. Attorney's Office for the District of Columbia, all of whom
have independent authority to investigate. If I am privileged to be
confirmed, it would be a priority of mine to make sure the Treasury
Department continues to work with relevant oversight bodies, gather all
the facts, ensure accountability and work to prevent unauthorized
access or disclosure to the fullest extent possible.
Question. The administration has proposed requiring banks, credit
unions, and other financial institutions to report annual financial
account activity from their customers to the IRS, including certain
deposits, withdrawals, and transactions.
Given the expansive breadth of this particular proposal, what
privacy and security concerns would such an initiative present to
taxpayers? Should private taxpayer information be compromised in such a
process, how would the Treasury Department provide accountability?
Answer. My understanding is the proposed financial institution
reporting provisions advanced in the President's tax compliance agenda
will help shed light on taxpayers who evade their tax obligations. The
tax gap is concentrated at the top of the income distribution, with the
top one percent of earners with the highest incomes responsible for
nearly 30 percent of unpaid taxes which totaled over $160 billion in
tax year 2019. This inequity is closely tied to gaps in information
reporting, namely the disparity between when information is reported to
the IRS by a third-party source to facilitate verifying the accuracy of
taxpayer filings, and when it is not. My understanding is that the
proposal would simply add two additional pieces on information on the
Form 1099-INT (or successor form) that banks are already required to
file. I take the issue of private taxpayer information extremely
seriously and if I am privileged to be confirmed look forward to
working with my Treasury colleagues to ensure that privacy and security
issues are fully addressed.
______
Questions Submitted by Hon. Rob Portman
Question. Part of your responsibilities as General Counsel of the
Treasury Department will be reviewing regulations and other guidance
issued by the Department. It is my understanding that the attorneys of
the Office of Tax Policy and the IRS Office of Chief Counsel have
primary responsibility for legal analysis of tax regulatory actions;
whereas the Office of General Counsel examines their analysis and
expertise in the review of all tax regulatory actions. Furthermore,
what principles of statutory interpretation will you apply in
developing and reviewing regulations?
Answer. If I am privileged to be confirmed, I will seek to ensure
that the Department of the Treasury's approach to all Federal statutes,
including the tax laws, is guided by the traditional tools of statutory
interpretation. Those traditional tools include the text, structure,
and context of the statute, as well as any relevant precedent.
Question. The bipartisan Infrastructure Investment and Jobs Act
includes a provision which updates current information reporting
requirements under Internal Revenue Code sections 6045 and 6045A to
explicitly include cryptocurrency brokers. There is a general consensus
that there should be better and more consistent reporting on
cryptocurrency transactions, and that this would be good for holders of
cryptocurrency. This reporting requirement would standardize basic
information reporting by crypto brokers for tax purposes to help
provide certainty for everyday Americans looking to invest in these
digital assets.
During and after the passage of this act in the Senate there was
concern about who would be included in the definition of a
cryptocurrency brokers. The Treasury Department and the nonpartisan
Congressional Joint Committee on Taxation and have indicated that the
current language is clear and that the reporting requirements do not
include entities which many feared might be considered brokers,
particularly those involved with validating distributed ledger
transactions, such as miners, and certain software and hardware
providers. Senator Warner and I sought to clarify this provision with a
colloquy to address the concern. We wanted to make it clear that a
broker is defined as quote ``any person who (for consideration) is
responsible for regularly providing any service effectuating transfers
of digital assets on behalf of another person.'' The congressional
intent of the provision was that a broker would not include miners,
stakers, hardware and software sellers for digital wallets, and certain
others who play a key role in validating transactions.
Can you assure me that if the bipartisan Infrastructure Investment
and Jobs Act becomes law, the regulations promulgated by the Treasury
Department would be appropriately scoped according to congressional
intent?
Specifically, can you commit that ancillary digital asset entities
or players who do not have and cannot get information intended to be
captured by the reporting requirements for brokers, will not be
considered a broker under this provision?
Further, will you commit to working with Congress to implement any
laws and accompanying regulations under the purview of the Treasury
Department in a manner that is both timely and reflective of our
intent?
Answer. Congress's authorizing statue, 31 U.S.C. section 301,
defines the Treasury General Counsel as the Department's ``chief law
officer.'' Moreover, the specific responsibilities of the Treasury
General Counsel are set forth in Treasury Order 107-04 (issued
September 29, 2020), and include providing legal advice to the
Secretary, Deputy Secretary and the other component heads related to
Treasury's statutory responsibilities; managing Treasury's position in
lawsuits; and reviewing the Department's regulatory actions. If I am
privileged to be confirmed as Treasury General Counsel, I would be
bound by Treasury's authorizing statute to ensure the Department acts
in fidelity with the laws Congress enacted and the binding case law of
the Federal courts. Having previously spent 4 years as a Senate
counsel, I am fully committed to ensuring the Department's legal
positions are appropriately scoped according to congressional intent
and the statutory text.
Question. Section 170(h) of the Internal Revenue Code provides that
land conservation and historic preservation easement transactions can
qualify for charitable tax deductions provided certain conditions are
met. This provision was codified in 1980, and the policy was meant to
encourage land conservation and the preservation of historic buildings.
In the legislation, the IRS was directed to issue detailed regulations
so that potential donors of easements could be ``secure in the
knowledge that a contemplated contribution will qualify for a
deduction.'' Today, 40 years later, model easement agreements, sample
deeds, or other detailed regulatory guidance have not been provided by
the IRS. This guidance is needed to ensure that taxpayer have clarity
on what is needed to properly claim the deduction. Instead, attorneys
at the IRS have told the National Taxpayer Advocate that they will
issue ``guidance through litigation.'' In one recent example, the IRS
denied a charitable tax deduction because a historic building owner
installed a wheelchair ramp to comply with the Americans with
Disabilities Act (ADA). Eventually, Chief Counsel issued advice
clarifying that the installation of an ADA ramp was permissible and in
line with the congressional intent of the ADA. Thousands of taxpayers
who have donated easements on their properties are working their way
through audits, appeals, and the U.S. Tax Court. All of this generates
unnecessary expense for taxpayers and the government, and is completely
counterproductive. Straightforward regulations could clear the decks of
a large majority of tax controversy over conservation easements.
If confirmed, will you pledge to direct the Chief Counsel of the
IRS that office revisit this ``guidance through litigation'' strategy
related to conservation easements?
Will you pledge to issue sample easement agreements, model deeds,
and detailed guidance to taxpayers so that they can be secure in the
knowledge that a contemplated easement contribution will qualify for a
deduction?
Will you work with the IRS Chief Counsel to establish policies that
differentiate legitimate actors utilizing this congressionally
authorized tax incentive from those engaging in abusive transactions?
I have posed similar questions of the Treasury Secretary, Deputy
Secretary, and Assistant Secretary for Tax Policy and have received
generic answers. I would like to request yes or no answers to all three
of these specific asks.
Answer. Taxpayer certainty with regard to tax treatment in all
issues is an important goal for the system at large. While I am not
familiar with the important issue you raise, if I am privileged to be
confirmed I will confer with my Office of Tax Policy colleagues to
understand these matters. I very much appreciate the importance of
creating certainty for taxpayers on this issue and commit to work with
you once I am briefed on these issues.
Question. During COVID-19, the IRS has struggled with processing
tax forms and returns in a timely fashion as well as answering its
phones to provide assistance to taxpayers. These failures and delays
include significantly slower processing times for requests for Form
6166, Certification of U.S. Tax Residency, than before the pandemic.
U.S. investors--including pension funds--need Form 6166 to
demonstrate to foreign countries that the U.S. investor is eligible for
a lower tax rate on their investments because of the treaty between the
U.S. and the foreign country. Without a Form 6166, U.S. investors pay
foreign taxes at a higher rate than agreed to under our tax treaties
and effectively gift a portion of their investment gains to foreign
governments. It can be difficult or impossible for U.S. investors to
claim a refund of these excess taxes from foreign countries at a later
date, meaning that U.S. investors can be permanently harmed when they
do not receive a Form 6166 in a timely fashion. Some countries may
offer a tax reclaim procedure in theory but this has proven to be
unoperable and cumbersome in practice, with U.S. investors being
unsuccessful in obtaining retrospective refunds. In those cases, relief
at source is the only viable relief procedure available, stressing the
importance of receiving a Form 6166 in a timely manner so tax relief is
not permanently lost.
By some estimates, the IRS has issued approximately 40 percent of
the Forms 6166 requested by U.S. investors in 2021. For comparison, the
IRS typically has issued more than 95 percent of the Forms 6166
requested by U.S. investors by this point in a non-COVID year. In
addition, it has been difficult to get through to the IRS by phone to
determine the status of a request or resolve outstanding issues in
receiving a Form 6166. Hundreds of millions of dollars in refunds that
U.S. investors are entitled to are at stake. This includes refunds for
pension funds that help hardworking Americans fund a comfortable
retirement.
If you are confirmed, what will you do to ensure that the IRS makes
it a priority to process all forms in a timely manner including the
outstanding requests for Forms 6166 and increases telephone assistance
for taxpayers?
Specifically, what steps will you take to ensure that the 2022
issuance process, which begins on December 1, 2021, does not suffer the
same delays and other problems that have occurred during the 2021
issuance process?
Answer. I agree with the importance of timely issuance of Forms
6166 and, if I am privileged to be confirmed, commit to being fully
briefed on these important issues. In my capacity as Treasury's chief
legal officer, I will ensure that I provide my best legal advice in a
timely fashion.
Question. As you know, Treasury serves as a powerful stabilizing
force for our country. Part of that stability is preserved by
insulating Treasury from politics, which is central to the role of the
General Counsel.
Do you agree that Treasury's work to combat illicit financial
activity, impose sanctions, and conduct national security reviews
through the CFIUS process should be free from political interference?
Do you believe the same is also true for tax administration and
enforcement at the IRS?
Answer. I agree completely that the Treasury Department's important
work, including both through the CFIUS process and through the IRS's
tax administration and enforcement, should be done in a fair and even-
handed manner, keeping politics out of the process.
Question. Can you further commit to doing everything within your
power to prevent the unauthorized disclosure of taxpayer information?
Furthermore, please describe the steps the Department of the Treasury
and Internal Revenue Service are taking to prevent any further
unauthorized disclosure of taxpayer information.
Answer. I am deeply concerned about the release of confidential
taxpayer information. Any unauthorized disclosure of confidential
government information, including as provided by 26 U.S.C. section
6103, is illegal and must be taken extremely seriously. Secretary
Yellen has said that independent investigations are underway. My
understanding from public reporting is that the matter has been
referred to the Office of the Inspector General, Treasury Inspector
General for Tax Administration, Federal Bureau of Investigation, and
the U.S. Attorney's Office for the District of Columbia, all of whom
have independent authority to investigate. If I am privileged to be
confirmed, it would be a priority of mine to make sure the Treasury
Department continues to work with relevant oversight bodies, gather all
the facts, ensure accountability and work to prevent unauthorized
access or disclosure to the fullest extent possible.
______
Question Submitted by Hon. Patrick J. Toomey
pillar one implementation
Question. During the Senate Finance Committee hearing on September
22, 2021, I asked if you share the view that implementation of Pillar
One of the OECD/G20 Two-Pillar Solution would require a treaty vote in
the Senate. You responded that you would need to dig into this issue.
As you stated, your job as General Counsel would be to ``ensure the
department carries out all of its activities in compliance with law.''
Implementation requirements of the Two-Pillar Solution are a pressing
legal issue as the administration continues international discussions
regarding this agreement.
As a follow up to my question during the hearing, Mr. MacBride, do
you agree that Pillar One would need to be approved by two-thirds of
the Senate, in the same matter that all current tax treaties were
approved by the Senate?
Answer. Among other things, Pillar One will require countries to
update the international tax rules allocating taxing rights among
jurisdictions, which are currently enumerated in their bilateral tax
treaties. As a constitutional matter, such updating could occur through
several means, such as through an Article II treaty, a congressional
executive agreement, or through legislation overriding the existing
treaties. It is my understanding that Treasury has been working with
Congress on a bipartisan basis to ensure congressional support of the
Pillar One agreement. If confirmed, I would want to be briefed by my
Treasury colleagues to better understand these issues and would look
forward to discussing them further with you.
______
Questions Submitted by Hon. Tim Scott
Question. Under the Consolidated Appropriations Act of 2021, the
Secretary of the Treasury is statutorily required to testify before the
House Committee on Small Business on the operation of the COVID-19
relief programs within 120 days of the enactment of the Act. To date,
Treasury Secretary Janet Yellen has flouted U.S. law by refusing to
testify. If confirmed as the Treasury's top legal advisor, will you
advise and counsel Secretary Yellen to follow the law and testify
before Congress as legally required?
Answer. I deeply respect the oversight function of this Committee
as does Secretary Yellen. If I am privileged to be confirmed, I would
like very much to work in a collaborative way with the Committee to
provide timely, complete, detailed, and accurate information in line
with the traditional partnership that Treasury and the Committee have
had in the past.
Question. Please answer the following with a ``yes'' or ``no''
response. Do you believe that an agreement (or agreements) with foreign
governments that are intended to modify the current treatment of taxing
rights and allow residual profits to be taxed in market jurisdictions
where goods or services are used or consumed should be considered as a
treaty (or treaties) in the United States, requiring ratification by
two-thirds of the Senate?
Please further elaborate upon your ``yes'' or ``no'' answer.
Answer. Pillar One will require countries to update the
international tax rules allocating taxing rights among jurisdictions,
which are currently enumerated in their bilateral tax treaties. As a
constitutional matter, such updating could occur through several means,
such as through an Article II treaty, a congressional executive
agreement, or through legislation overriding the existing treaties. It
is my understanding that Treasury has been working with Congress on a
bipartisan basis to ensure congressional support of the Pillar One
agreement. If confirmed, I would want to be briefed by my Treasury
colleagues to better understand these issues and would look forward to
discussing them further with you.
Question. Is it your opinion that the United States Government
would lose or gain revenue from enactment of the OECD/G20 Pillar One
agreement as outlined in the July 1, 2021 ``Statement on a Two-Pillar
Solution to Address the Tax Challenges Arising From the Digitalisation
of the Economy''?
Answer. The U.S. Pillar One tax revenue modeling involves
estimating the impact of reallocating taxing rights to the U.S. from
foreign jurisdictions, from the U.S. to foreign jurisdictions, and
among U.S. MNE affiliates in foreign jurisdictions. The tax impact is
both direct and indirect (i.e., change in foreign tax credits).
In general, as a large consumer market the U.S. benefits from
reallocations of profit from foreign jurisdictions. To the extent that
the U.S. market is more profitable than other markets and depending on
the methodology for determining the relieving jurisdiction, some profit
may be reallocated to foreign markets. However, to the extent that
profit reallocations occur among foreign subsidiaries of U.S.-
parented MNEs, that reduces any impact on U.S. revenues.
In general, there are both positive and negative considerations,
and the estimates depend on the details of the Pillar One proposal.
While many of those are not final, we are confident that any revenue
impacts on the United States will be relatively small. In some
scenarios, they total in the millions rather than billions, and in some
cases are approximately zero.
Question. Please answer the following with a ``yes'' or ``no''
response. If the Biden administration sought implementation
(domestically and globally) of the OECD/G20 Pillar One agreement
referenced above, would you advise your principals at Treasury and the
White House that this agreement should be implemented through a tax
treaty requiring ratification by the Senate?
Please further elaborate upon your ``yes'' or ``no'' answer. If you
believe the agreement can be implemented through means other than a tax
treaty, please provide detail as to what action would be required, and
by which branch or body of government, and the process by which
approval would be obtained.
Answer. Please see my answer to the question above.
Question. In your opinion, what might be the effect on compliance
costs for U.S. entities subject to a GILTI calculation that shifts to a
country-by-country basis?
Answer. At this time, I have not been briefed on the issues you
raise and thus am not in a position to proffer any opinions. If I am
privileged to be confirmed, I would want to be briefed by my Treasury
colleagues to better understand these issues and would look forward to
discussing them further with you.
______
Questions Submitted by Hon. James Lankford
Question. Over the course of the last several months, we have seen
countless articles from ProPublica, a news organization that has
somehow, we're told, gotten access to thousands of taxpayers'
confidential tax data. Despite countless letters and inquiries, we have
yet to be provided any explanation of how this happened, who will be
held responsible, and what the Treasury Department and Internal Revenue
Service are doing to make sure that it stops. I understand that, if
confirmed, your role as General Counsel is separate from the Inspector
General's office. However, I am not convinced that the Treasury
Department is giving the issue the attention and haste that it
deserves.
If confirmed, how will you approach this issue once in the
building?
How will you engage with the IRS General Counsel's office to ensure
that Americans' tax data is protected?
How will you ensure that this possible breach, which jeopardizes
the privacy of thousands of Americans, is given the attention and
priority it deserves?
Answer. I am deeply concerned about the release of confidential
taxpayer information. Any unauthorized disclosure of confidential
government information, including as provided by 26 U.S.C. section
6103, is illegal and must be taken extremely seriously. Secretary
Yellen has said that independent investigations are underway. My
understanding from public reporting is that the matter has been
referred to the Office of the Inspector General, Treasury Inspector
General for Tax Administration, Federal Bureau of Investigation, and
the U.S. Attorney's Office for the District of Columbia, all of whom
have independent authority to investigate. If I am privileged to be
confirmed, it would be a priority of mine to make sure the Treasury
Department continues to work with relevant oversight bodies, gather all
the facts, ensure accountability and work to prevent unauthorized
access or disclosure to the fullest extent possible.
Question. Section 6103 of the Internal Revenue Code provides that
``returns and return information shall be confidential,'' and prohibits
any officer or employee of the Federal or State government from
disclosing such information unless authorized by the taxpayer or
provided under Federal law. Further, section 7213 states that the
unauthorized disclosure of returns or return information is unlawful
and is a felony punishable by a $5,000 fine and/or imprisonment of up
to 5 years. Section 7213(a)(3) provides that it is unlawful for someone
who receives return or return information disclosed in an unauthorized
manner to willfully print or publish this return or return information.
Given this, if confirmed, how will you engage with ProPublica
regarding their publication of private taxpayer data?
What steps will you take to stop ProPublica from publishing this
information in the future?
Answer. I am deeply concerned about the release of confidential
taxpayer information. Any unauthorized disclosure of confidential
government information, including as provided by 26 U.S.C. sections
6103 and 7213, must be taken extremely seriously.
Question. The Treasury Department's Greenbook articulates a new
financial account reporting regime. This would require financial
institutions to report data on financial accounts of individuals,
families, and businesses. This could lead to massive amounts of
taxpayer data flowing into the Internal Revenue Service.
Given the apparent vulnerability of taxpayers' private information,
as evidenced by numerous ProPublica stories, how will you ensure that
the Treasury Department and the IRS adequately protect taxpayers'
information under this proposal?
Answer. My understanding is the proposed financial institution
reporting provisions advanced in the President's tax compliance agenda
will help shed light on taxpayers who evade their tax obligations. The
tax gap is concentrated at the top of the income distribution, with the
top one percent of earners with the highest incomes responsible for
nearly 30 percent of unpaid taxes which totaled over $160 billion in
tax year 2019. This inequity is closely tied to gaps in information
reporting, namely the disparity between when information is reported to
the IRS by a third-party source to facilitate verifying the accuracy of
taxpayer filings, and when it is not. My understanding is that the
proposal would simply add two additional pieces on information on the
Form 1099-INT (or successor form) that banks are already required to
file. I take the issue of private taxpayer information extremely
seriously and if I am privileged to be confirmed look forward to
working with my Treasury colleagues to ensure that privacy and security
issues are fully addressed.
Question. Unfortunately, both recently and in the past, we've seen
inappropriate treatment of certain organizations by the IRS. Most
recently, it was in the proposed denial of tax-exempt status for a
religious nonprofit.
How will you work with the IRS General Counsel to ensure that our
tax laws are both enacted responsibly and neutrally and that they are
then carried out in the same manner?
Answer. If I am privileged to be confirmed, I would be committed to
ensuring that the Treasury Department and the IRS administer tax laws
in a fair and even-
handed manner, keeping politics out of the process.
Question. Do you believe that entities engaged in the production,
manufacturing, or sale of items listed in the Controlled Substances Act
should be exempt from this classification, or afforded other
protections and benefits, under other Federal statutes within the
purview of the U.S. Treasury Department?
Answer. I understand from public reporting that the IRS is focused
on tax compliance for the cannabis industry, which remains a Schedule 1
controlled substance under Federal law. If I am privileged to be
confirmed, I would want to be briefed by my Treasury colleagues on the
issues you raise to better understand these issues and would look
forward to discussing them further with you.
Question. The General Counsel of the U.S. Treasury Department has
the ability to review every regulation that moves through the building.
Should you be confirmed, your role requires you to follow the law as it
is written.
How will you balance that with what you believe to be congressional
intent?
Answer. Congress's authorizing statue, 31 U.S.C. section 301,
defines the Treasury General Counsel as the Department's ``chief law
officer.'' Moreover, the specific responsibilities of the Treasury
General Counsel are set forth in Treasury Order 107-04 (issued
September 29, 2020), and include providing legal advice to the
Secretary, Deputy Secretary and the other component heads related to
Treasury's statutory responsibilities; managing Treasury's position in
lawsuits; and reviewing the Department's regulatory actions. If I am
privileged to be confirmed as Treasury General Counsel, I would be
bound by the authorizing statute to ensure the Department acts in
fidelity with the laws Congress enacted and the binding case law of the
Federal courts. Having previously spent 4 years as a Senate counsel, I
am fully committed to ensuring the Department's legal positions comport
with the laws as Congress enacted.
Question. Currently, congressional Democrats are working to move
ahead with their $3.5 trillion reconciliation package, which would
contain a litany of new programs and changes to the Internal Revenue
Code. At this point in time, many of my Democrat colleagues' proposals
are moving forward without a single Senate markup and little to no
legislative history.
Given that, how will you determine congressional intent?
Answer. The U.S. Supreme Court has explained that ``[t]he starting
point in discerning congressional intent is the existing statutory
text.'' Lamie v. U.S. Trustee, 540 U.S. 526, 533 (2004). My
understanding is that in a situation where there are no other indicia
of congressional intent, the statutory text and the canons of
construction should be the endpoint as well.
Question. Next month, the OECD will meet again to work on their
ongoing project to modify international profit allocation and minimum
tax rules. While there are preliminary agreements on certain items,
details remain unfinished and several countries have yet to endorse the
current negotiations. Given that any final agreement would involve the
ceding of taxing rights, the modification of several bilateral tax
treaties, and the need for a new multilateral tax treaty, my
understanding is that any such agreement would require the advice and
consent of two-thirds of the Senate.
Do you agree that an OECD agreement will require the adoption of a
treaty, meaning \2/3\ of the Senate vote affirmatively?
Answer. Among other things, Pillar One will require countries to
update the international tax rules allocating taxing rights among
jurisdictions, which are currently enumerated in their bilateral tax
treaties. As a constitutional matter, such updating could occur through
several means, such as through an Article II treaty, a congressional
executive agreement, or through legislation overriding the existing
treaties. It is my understanding that Treasury has been working with
Congress on a bipartisan basis to ensure congressional support of the
Pillar One agreement. If confirmed, I would want to be briefed by my
Treasury colleagues to better understand these issues and would look
forward to discussing them further with you.
Question. On their April 2021 list of preferential regimes, the
OECD Forum on Harmful Tax Practices (FHTP) identified the United
States' tax treatment of foreign-derived intangible income (FDII),
found in section 250 of the Internal Revenue Code and put in place by
Congress in 2017. In addition, the FHTP identified FDII as ``in the
process of being eliminated,'' stating that ``The United States has
committed to abolish this regime.''
I find it concerning that FDII, which was created in the Tax Cuts
and Jobs Act to incentivize companies to put their IP in the United
States, was listed as a preferential regime, and I am also concerned
that the U.S. Treasury Department, representing the United States at
the OECD, would be forward enough to commit to abolishing the
provision.
Does the U.S. Treasury Department or any official of the U.S.
Treasury Department have the authority to abolish a provision of the
Internal Revenue Code?
Doesn't Congress, and only Congress, have the authority to abolish
or otherwise repeal, a provision within the Internal Revenue Code?
Answer. I am not familiar with the incident you note here, but I
agree that the only way to repeal a Federal statute is for both houses
of Congress to pass a bill.
Question. It's my understanding that there has been a top-level
agreement at the OECD on a Pillar One regime in which market countries
would be awarded the taxing rights on at least 20 percent of profit
exceeding a 10-percent margin for the biggest multinationals, and a
Pillar Two that includes a global minimum tax of at least 15 percent on
a country-by-country basis.
As you know, the U.S. was the first to enact a global minimum tax
when Congress enacted the GILTI as part of the Tax Cuts and Jobs Act.
No other country currently has a global minimum tax.
Should the OECD be successful in adopting a more detailed,
conclusive agreement this fall, you--should you be confirmed--would
have a major role in implementation of such an agreement and
corresponding legislation.
How will you keep Congress, who will have a role in enacting
corresponding domestic legislation and treaties, aware of your
implementation plan?
Please provide your expected timeline of U.S. implementation,
should an OECD agreement be met.
Do you think it is prudent to make changes to our own global
minimum tax rates before a detailed OECD agreement is met?
Would it not be more prudent to wait until an OECD agreement is
confirmed, not only because it could be difficult to reach a final
deal, but also because any resulting deal could take years to
implement?
Answer. If I am privileged to be confirmed, I am committed to
updating members of the committee on the implementation of any
agreement and corresponding legislation. I am not aware of the timeline
of U.S. implementation, should an OECD agreement be met. If confirmed,
I would advise Secretary Yellen on legal matters, not policy matters,
so would defer to the policy experts at Treasury on the timing issue
you raise.
______
Questions Submitted by Hon. Todd Young
Question. As I mentioned during our questioning period in the
hearing, I want to follow up on your views regarding the proper use of
sanctions based upon your deep experience and expertise in sanctions
law, as noted by your selection as one of ``The DC sanctions lawyers to
have on speed dial'' by Global Investigations Review and your
representation in matter such as Exxon Mobil Corporation, et al. v.
Mnuchin, et al. Please note that this series of questions asks for your
legal interpretation based upon your decades of legal experience, and
does not seek information on how or what kind of advice you would
provide if confirmed to this position.
What is your view on the legal standard and evidence necessary to
confirm ``serious human rights abuses'' in the context of our sanctions
programs?
What is your view on the legal standard and evidence necessary to
confirm corruption of foreign government officials in the context of
our sanctions programs?
How do you view Global Magnitsky sanctions implementation and
enforcement as a tool to address human rights and corruption?
In your view, does the U.S. Department of the Treasury have the
resources and authorities necessary to target serious human rights
abuses and corruption with sanctions?
What additional resources do you believe would be effective in the
Treasury's mission to address serious human rights abuses and
corruption through sanctions? Are there any current systems or
practices you believe are ineffective?
Answer. Global Magnitsky sanctions are an important tool to address
human rights and corruption. Targeted sanctions, including against
those who violate or abuse human rights and engage in corruption, are
an effective tool to discourage malign actors and promote
accountability. In 2021, the Treasury Department has applied such
sanctions in a number of contexts, including against two Chinese
Government officials in connection with serious human rights abuses
against ethnic minorities in the Xinjiang Uyghur Autonomous Region;
various Cuban authorities for their role in suppressing peaceful
protests; and corrupt actors in Paraguay. If I am privileged to be
confirmed, I will apply the same legal standard and seek the same
evidence that the Treasury Department has applied in those contexts. I
would also look forward to being briefed by my colleagues at the
Treasury Department regarding existing systems and practices. If
confirmed, I would also welcome the opportunity to collaborate with you
in ensuring that these critical efforts have the resources they need to
succeed.
Question. During your hearing, we touched briefly on President
Biden's Executive Order 14032 regarding the need for the United States
to ensure domestic markets are not being used by the Chinese military
industrial complex. Please note that this series of questions asks for
your legal interpretation based upon your decades of legal experience,
and does not seek information on how or what kind of advice you would
provide if confirmed to this position.
What additional steps can the U.S. Department of the Treasury take
to protect U.S. financial markets from the Chinese military industrial
complex?
Does Executive Order 14032 and its focus on firms that operate in
the surveillance technology sector include targeting of monetary
surveillance entities?
Answer. I share your concerns about the significant threats posed
by the military-industrial complex of the People's Republic of China
(PRC), including the use of Chinese surveillance technology outside the
PRC to facilitate repression or serious human rights abuse. If I am
privileged to be confirmed, I look forward to being briefed by my
colleagues at the Treasury Department and other Federal agencies about
whether additional legal authorities may be needed to address these
serious threats.
Question. On August 23, 2021, the International Monetary Fund (IMF)
allocated $650 billion in Special Drawing Rights (SDRs) with the
approval of the U.S. Department of the Treasury--the largest allocation
of Special Drawing Rights in history. The approved amount was just
below the level that would have required congressional consultation
under the Special Drawing Rights Act. Since this funding is distributed
to all members of the IMF, I have concerns that the new SDR allocation
could represent a bonanza and a lifeline for dictators and regimes
around the world. This creates a disconnect in Treasury's stance. On
the one hand, we are sanctioning regimes such as Iran, Venezuela,
Nicaragua, Belarus, and Burma. And now on the other hand, the U.S.
Department of the Treasury has approved millions and millions of
dollars that will go to support those very same regimes.
How are our sanctions policies compatible with Treasury's approval
of this new allocation of IMF Special Drawing Rights? Please note that
question asks for your legal interpretation based upon your decades of
legal experience, and does not seek information on how or what kind of
advice you would provide if confirmed to this position.
What steps can the Department of Treasury undertake to ensure that
SDRs do not provide a lifeline to dictators? Please note that question
asks for your legal interpretation based upon your decades of legal
experience, and does not seek information on how or what kind of advice
you would provide if confirmed to this position.
If confirmed, how would you advise Treasury conduct oversight on
the use of SDRs among IMF members?
Answer. IMF Special Drawing Rights (SDRs) are important tools in
mitigating economic stagnation in global growth, particularly as low-
income and developing countries reemerge from the COVID-19 pandemic.
Addressing the long-term global need for reserve assets through the
recent SDR allocation will help support the global recovery from the
COVID-19 crisis, which in turn will help increase demand for U.S.
exports of goods and services--creating U.S. jobs and supporting U.S.
firms.
The United States can refuse SDR transactions with any countries
that we choose, including those under U.S. sanction regimes, and the
Biden administration is working to coordinate with other countries to
do the same. Likewise, not all countries will necessarily be able to
exchange their SDRs for hard currencies. The country would need to find
a willing counterparty country to provide them with hard currency in
exchange for their SDRs, which can be difficult for certain countries.
Moreover, primary and secondary sanctions may deter IMF members from
being willing counterparties in certain SDR transactions. The United
States and other IMF members are also working with the IMF to increase
transparency in how SDRs are used. All of these are important steps
that the government can take in balancing its goals of global economic
growth with robust enforcement of its sanctions policies.
Question. As you know, Article II, Section 2 of the United States
Constitution states: [The President] shall have Power, by and with the
Advice and Consent of the Senate, to make Treaties, provided two-thirds
of the Senators present concur; . . .
On September 28, 2021, Treasury Secretary Yellen said the following
before the Senate Banking Committee: ``I believe there are a number of
ways in which Congress could implement [Pillar One], but certainly
ratification of a treaty would be one way in which Congress could
authorize. And certainly Congress has to authorize the transfer of
taxing rights that's contemplated in Pillar One.''
Based upon your training and experience as an attorney, do you
believe there is a way other than approval of a resolution of
ratification by two-thirds of the Senate for Congress to approve the
Organisation for Economic Co-operation and Development's ``Pillar One''
plan? Please answer ``yes'' or ``no.'' Note that an answer other than
``yes'' or ``no'' will be deemed unresponsive to this question. Please
also note that this question asks for your legal interpretation based
upon your decades of legal experience, and does not seek information on
how or what kind of advice you would provide if confirmed to this
position.
If your answer is ``yes,'' please explain the other way(s) Congress
could authorize Pillar One. If your answer is ``no,'' please explain
your reasoning. Please note that this question asks for your legal
interpretation based upon your decades of legal experience, and does
not seek information on how or what kind of advice you would provide if
confirmed to this position.
Answer. Among other things, Pillar One will require countries to
update the international tax rules allocating taxing rights among
jurisdictions, which are currently enumerated in their bilateral tax
treaties. As a constitutional matter, such updating could occur through
several means, such as through an Article II treaty, a congressional
executive agreement, or through legislation overriding the existing
treaties. It is my understanding that Treasury has been working with
Congress on a bipartisan basis to ensure congressional support of the
Pillar One agreement. If confirmed, I would want to be briefed by my
Treasury colleagues to better understand these issues and would look
forward to discussing them further with you.
Question. Section 321(b) of the bipartisan Economic Aid to Hard-Hit
Small Businesses, Nonprofits, and Venues Act (title III of division N
of Public Law 116-260) states:
Testimony.--Not later than the date that is 120 days after the
date of enactment of this Act, and not less than twice each
year thereafter until the date that is 2 years after the date
of enactment of this Act, the Administrator and the Secretary
of the Treasury shall testify before the committee on Small
Business and Entrepreneurship of the Senate and the Committee
on Small Business of the House of Representatives regarding
implementation of this Act and the amendments made by this Act.
Based upon your training and experience as an attorney, what is
your interpretation of the meaning of ``the Secretary of the Treasury''
in the legislation cited above? Please note that this question asks for
your legal interpretation based upon your decades of legal experience,
and does not seek information on how or what kind of advice you would
provide if confirmed to this position.
Based upon your training and experience as an attorney, do you
believe that section 321(b) of the Economic Aid to Hard-Hit Small
Businesses, Nonprofits, and Venues Act, cited above, requires the
Secretary of the Treasury to appear personally before the Senate
Committee on Small Business and Entrepreneurship Act? Please answer
``yes'' or ``no.'' Note that an answer other than ``yes'' or ``no''
will be deemed unresponsive to this question. Please also note that
this question asks for your legal interpretation based upon your
decades of legal experience, and does not seek information on how or
what kind of advice you would provide if confirmed to this position.
If your answer is ``yes,'' if confirmed, will you commit to
advising Secretary Yellen that the law requires her to appear
personally before the Senate Committee on Small Business and
Entrepreneurship? Please answer ``yes'' or ``no.'' Note that an answer
other than ``yes'' or ``no'' will be deemed unresponsive to this
question.
If your answer is ``no,'' please explain your reasoning and please
reference other examples found in the law where requirements for the
Secretary of the Treasury to testify before a congressional committee
have been interpreted to authorize officials other than the Secretary
of the Treasury (when such Secretary has been duly confirmed and is
currently serving) to testify in his or her place.
Answer. I deeply respect the oversight function of this committee
as does Secretary Yellen. If I am privileged to be confirmed, I would
like very much to work in a collaborative way with the committee to
provide timely, complete, detailed, and accurate information in line
with the traditional partnership that Treasury and the committee have
had in the past.
______
Prepared Statement of Hon. Ron Wyden, a U.S. Senator From Oregon
The Finance Committee meets this morning to discuss two nominations
for key roles in the Biden administration--jobs that both deal with
sound management and good government within major Federal agencies.
Christi Grimm is the President's nominee to serve as the Inspector
General for the Department of Health and Human Services. And Neil
MacBride is the President's nominee to serve as General Counsel of the
Treasury Department.
Christi Grimm brings to her nomination more than 2 decades of
experience within the HHS Office of the Inspector General--an office
she first joined in 1999. She's held a variety of roles over the years,
but she currently serves as Principal Deputy Inspector General, and
she's been performing the role of the IG for more than a year.
Ms. Grimm knows the office inside and out. She knows the importance
of working with the Congress and this committee in particular. She's
got a proven commitment to maintaining and strengthening the integrity
of America's health-care programs.
I appreciate that she is willing to take on the top job as
Inspector General during such a challenging time. Setting every other
issue aside, studying the Nation's response to the pandemic would keep
the IG and its staff of more than 1,500 busy through the end of the
decade. The pandemic response, however, is just one of many challenges
ahead for the HHS Inspector General. This committee takes its oversight
role very seriously, so we look forward to continuing to work closely
with Ms. Grimm, if and when she's confirmed.
Neil MacBride also brings decades of experience to his nomination.
Currently in private practice, Mr. MacBride previously served during
the Obama administration as Associate Deputy Attorney General for
Criminal Enforcement and as the U.S. Attorney for the Eastern District
of Virginia. He also served as Chief Counsel to then-Senator Biden on
the Judiciary Committee, which means he knows his way around these
parts of the Dirksen office building.
If and when he's confirmed, Mr. MacBride will join a Treasury
Department that's working hard to build back better from the economic
crash that wiped out tens of millions of jobs during the early stages
of the pandemic.
Democrats in Congress are working hard with Secretary Yellen and
her team on policies that will create high-wage, high-skill jobs, make
it easier to support a family, build more affordable housing, and
ensure that mega-corporations and the ultra-wealthy pay a fair share.
Members of this committee will count on Mr. MacBride to support those
efforts.
As I mentioned, the Finance Committee is committed to oversight. I
spoke with Mr. MacBride about those issues during a recent meeting,
particularly certain abuses by the previous administration. I was
pleased to have his commitment to work with the committee on oversight
going forward.
Bottom line, these are two highly qualified nominees. I want to
thank them for their willingness to serve in challenging roles at a
time when the HHS IG and the Treasury Department are working nights and
weekends due to the pandemic. I'm looking forward to Q&A.
______
United States Senate
Washington, DC 20510-4607
September 20, 2021
Dear Chairman Wyden and Ranking Member Crapo:
I write to you in support of Principal Deputy Inspector General Christi
Grimm for confirmation as the Inspector General for the Department of
Health and Human Services (HHS). Ms. Grimm has served as the Acting
Inspector General at HHS since January of 2020. During this time, and
throughout her career, she has demonstrated the attributes and skills
necessary to serve as the Inspector General through her consistent
commitment to leadership, strong work ethic, and personal integrity.
As the Principal Deputy Inspector General, Ms. Grimm has combated
health care fraud, waste, and abuse and has improved the efficiency and
efficacy of HHS programs. She leads an independent and objective
organization of more than 1,600 auditors, evaluators, investigators,
lawyers, and management professionals who carry out the Office of the
Inspector General's (OIG) mission of protecting the integrity of HHS
programs as well as the health and welfare of program beneficiaries.
She ensures the effective use of OIG's approximately $411 million
budget to oversee $1.6 trillion in HHS expenditures. She also oversees
OIG's administration of $290 million in grants to states for the
purposes of Medicaid fraud control. Now, more than ever, as we continue
to address and recover from the pandemic, we need strong leadership and
committed staff throughout HHS to protect the programs essential to the
health and well-being of all Americans.
Ms. Grimm knows that independence and objectivity are essential to the
work of an Inspector General, and work produced under her leadership
has reflected these qualities. Ms. Grimm is an experienced and highly
accomplished manager, as evidenced by HHS OIG's most recent Federal
Employee Viewpoint Survey results identifying her office as one of the
best places to work in government, with an employee engagement score of
86.9 percent. Ms. Grimm has a demonstrated commitment to public service
and has proven herself to be an invaluable asset to the work of the HHS
OIG. I support Ms. Grimm's nomination for Inspector General for HHS,
and I trust that this Committee will give her due consideration.
I ask that this letter of support be made part of the Committee's
official record.
Sincerely,
Tim Kaine
United States Senator
______
21 September 2021
The Honorable Ron Wyden The Honorable Mike Crapo
Chairman Ranking Member
U.S. Senate U.S. Senate
Committee on Finance Committee on Finance
Washington, DC 20510 Washington, DC 20510
Dear Chairman Wyden and Ranking Member Crapo:
We write in bipartisan support of the nomination of Neil H. MacBride to
be General Counsel for the Department of the Treasury. Each of us has
served as Treasury General Counsel, in Democratic and Republican
administrations reaching back to 1977. We all believe Neil to be a
superb choice to serve as General Counsel and as a senior advisor to
Secretary Yellen.
Neil's prior public service and his work in the private sector
demonstrate that he is particularly well-suited to serve as General
Counsel. Neil has extensive experience in many subject matters central
to the Treasury Department's work, and he possesses deep insight into
how those matters affect our Nation's position in the world. Neil's
experience in the public sector--as United States Attorney for the
Eastern District of Virginia, Associate Deputy Attorney General, and as
Chief Counsel and Staff Director for the Senate Committee on the
Judiciary--has centered on complex legal judgments involving public
policy, government litigation, enforcement of the law and national
security. In the course of his public service, Neil addressed the
significant legal issues of the day, and we are confident he will bring
to the role of Treasury General Counsel the same sound judgment,
integrity and temperament.
As former occupants of the Treasury General Counsel position, we
believe that Neil's experience will position him to provide seasoned
and expert advice, with the highest adherence to the rule of law, on
the array of issues for which the Treasury is responsible. Being
respectful of the important role the Senate plays in the confirmation
of the President's nominees, we urge the Committee and the Senate to
approve Neil's nomination to be General Counsel for the Department of
the Treasury.
Sincerely,
Brian Callanan Brent J. McIntosh
2019-2021 2017-2019
Christopher J. Meade George W. Madison
2013-2015 2009-2012
Robert F. Hoyt Arnold I Havens
2006-2009 2003-2006
David Aufhauser Neal S. Wolin
2001-2003 1999-2001
Edward Knight Edith E. Holiday
1994-1999 1989-1990
Robert M. Kimmitt Peter J. Wallison
1985-1987 1981-1985
Robert H. Mundheim
1977-1980
______
September 21, 2021
The Honorable Ron Wyden The Honorable Mike Crapo
Chairman Ranking Member
U.S. Senate U.S. Senate
Committee on Finance Committee on Finance
221 Dirksen Senate Office Building 239 Dirksen Senate Office Building
Washington, DC 20510 Washington, DC 20510
Re: Confirmation of Neil H. MacBride for General Counsel of the
Treasury Department
Dear Chairman Wyden and Ranking Member Crapo:
We are 149 former U.S. Department of Justice officials of both
parties who served in every Administration over the last five decades.
We write today in strong and enthusiastic support of the nomination of
former U.S. Attorney Neil H. MacBride as General Counsel for the U.S.
Department of the Treasury.
As former senior Justice Department officials, we are well
positioned to evaluate the qualifications of one of our own to serve as
the senior legal adviser to the Treasury Secretary and senior staff and
as the leader of the Treasury Department's Legal Division. Many of us
served alongside Neil, know him personally, and can vouch for his
outstanding reputation--both as an extraordinarily effective lawyer and
manager and as a person of the highest integrity.
Neil is an exceptional lawyer and public servant. He has a keen and
analytical mind, a tireless work ethic and excellent judgment, and his
record of achievement demonstrates those traits. He graduated from
Houghton College, magna cum laude, and earned his J.D. from the
University of Virginia. He then served as a law clerk for Judge Henry
Coke Morgan, Jr. of the United States District Court for the Eastern
District of Virginia. After his clerkship and a few years in private
practice, Neil joined the Justice Department in 1997 as an Assistant
U.S. Attorney for the District of Columbia under then-United States
Attorney Eric Holder, where he was lead prosecutor on more than 50
grand jury investigations and 25 jury trials and also co-authored the
U.S. Attorney's Office training manual. For his exceptional service,
Neil received two Justice Department Special Achievement Awards.
Neil left the Justice Department in 2001 and joined the Senate
Judiciary Committee staff for then-Senator Joe Biden. He served for
four years as Chief Counsel to Senator Biden on the Judiciary Crime
Subcommittee and worked in the critical areas of national security,
intelligence, civil rights, constitutional law, corporate fraud,
environmental crimes, violence against women, assistance to state and
local law enforcement, and criminal justice reform; he also assisted
Senator Biden in enacting key legislation, including criminal
provisions of the Sarbanes-Oxley Accounting Reform Act and the
reauthorization of the Violence Against Women Act, and advised him on
federal court nominations including to the United States Supreme Court.
In 2008, Neil served on the Obama-Biden Transition Team and later
was appointed as an Associate Deputy Attorney General where he served
as a member of Attorney General Holder's senior leadership team. In
2009, President Obama nominated, and the Senate unanimously confirmed,
Neil as the United States Attorney for the Eastern District of
Virginia. As that district's chief law enforcement officer, Neil was
responsible for overseeing all criminal and civil matters in one of the
most significant U.S. Attorneys' Offices in the nation. During his four
years in that position, he led and managed an office of over 300
attorneys and professional staff, oversaw the enforcement of matters
across Virginia and the world, defended federal agencies and laws from
legal challenges, and handled a number of the most challenging and
high-profile prosecutions in the country. Under Neil's leadership, his
office stood up the Virginia Financial and Securities Fraud Task Force,
working with their federal and state enforcement and regulatory
partners to target bank and consumer frauds, securing important
convictions against banks and CEOs.
Neil's lengthy tenure as a government attorney demonstrates his
commitment to public service. He served our nation for 15 years, over
half his career as a lawyer, and in all three branches of government.
It has been a remarkable tour of duty that reflects Neil's deep
devotion to public service and his constant willingness to answer the
call of duty, as seen most recently in his service on the 2020 Biden-
Harris Transition Team.
Neil's record also demonstrates his integrity and independence. As
a federal prosecutor, Neil aggressively investigated large corporations
and corporate officers, prosecuted government officials and public-
corruption cases, and pursued fraudsters of all types, without fear or
favor. In the process, he earned the deep respect of the Bench and
defense bar for his fair and even-handed exercise of prosecutorial
discretion, for his constant focus on civil liberties and the rights of
the accused in the criminal justice system, and for his insistence that
his office always take the high--and fair--road in every decision it
makes and in every prosecution it brings. Also, with his warm and
caring personality, he also earned the affection of his colleagues in
the U.S. Attorney's Office and of many throughout the Justice
Department who--like us--were fortunate to work alongside Neil in the
cause of justice.
In sum, Neil epitomizes the ideal qualities of a public servant--
honesty, decency, humility, sound judgment and devotion to duty and the
nation--and we have no doubt that he will serve with the greatest
distinction as General Counsel of the Treasury Department. We are
therefore honored to offer our unqualified support for his nomination,
and we respectfully request that you support his confirmation.
Kent Alexander Robert Balfe
United States Attorney United States Attorney
Northern District of Georgia (1994-
97) Western District of Arkansas (2004-
09)
Malcolm Bales Brian A. Benczkowski
United States Attorney Assistant Attorney General
Eastern District of Texas (2009-16) Criminal Division (2018-20)
Alan Bersin Mark Calloway
United States Attorney United States Attorney
Southern District of California
(1993-98) Western District of North Carolina
(1994-2001)
Daniel G. Bogden J.A. Canales
United States Attorney United States Attorney
District of Nevada (2001-07, 2009-
17) Southern District of Texas (1977-
80)
Dana J. Boente Robert Capers
United States Attorney United States Attorney
Eastern District of Virginia (2008-
09, 2013-18) Eastern District of New York (2016-
17)
James S. Brady Don Casayoux
United States Attorney United States Attorney
Western District of Michigan (1977-
81) Middle District of Louisiana (2010-
13)
Lanny A. Breuer Paul K. Charlton
Assistant Attorney General United States Attorney
Criminal Division (2009-13) District of Arizona (2001-06)
Greg Brower Robert J. Cleary
United States Attorney United States Attorney
District of Nevada (2008-09) District of New Jersey (1999-2002)
United States Attorney
Southern District of Illinois
(2002)
Kenyen Brown Sanford Coats
United States Attorney United States Attorney
Southern District of Alabama (2009-
17) Western District of Oklahoma (2009-
16)
John Brownlee Tristram J. Coffin
United States Attorney United States Attorney
Western District of Virginia (2001-
08) District of Vermont (2009-15)
Dan Bryant Donna Bucella
Assistant Attorney General United States Attorney
Office of Legal Policy (2003-05) Middle District of Florida (1999-
2001)
James M. Cole Paul Coggins
Deputy Attorney General (2010-15) United States Attorney
Northern District of Texas (1993-
2001)
Richard Cullen Vincent H. Cohen, Jr.
United States Attorney United States Attorney
Eastern District of Virginia (1991-
93) District of Columbia (2015)
William B. Cummings Conner Eldridge
United States Attorney United States Attorney
Eastern District of Virginia (1975-
79) Western District of Arkansas (2010-
15)
Kelly Currie Zach Fardon
United States Attorney United States Attorney
Eastern District of New York (2015) Northern District of Illinois
(2013-17)
Gregory Davis David Fein
United States Attorney United States Attorney
Southern District of Mississippi
(2012-17) District of Connecticut (2010-13)
Steven M. Dettelbach Wifredo Ferrer
United States Attorney United States Attorney
Northern District of Ohio (2009-16) District of Florida (2010-17)
Carol DiBattiste Mark Filip
United States Attorney Deputy Attorney General(2008-09)
Southern District of Florida (1991-
93) Attorney General (2009)
Tammy Dickinson Stephanie A. Finley
United States Attorney United States Attorney
Western District of Missouri (2013-
17) Western District of Louisiana
(2010-17)
Christopher Droney Alice S. Fisher
United States Attorney Assistant Attorney General
District of Connecticut (1993-97) Criminal Division (2005-08)
Jenny A. Durkan Paul J. Fishman
United States Attorney United States Attorney
Western District of Washington
(2009-16) District of New Jersey (2009-17)
Terry Flynn Robert B. Fiske, Jr.
United States Attorney United States Attorney
Western District of New York (2006-
09) Southern District of New York
(1976-80)
Matt Friedrich Patrick J. Fitzgerald
Assistant Attorney General United States Attorney
Criminal Division (2008-09) Northern District of Illinois
(2001-12)
Deborah R. Gilg Hal Hardin
United States Attorney United States Attorney
District of Nebraska (2009-17) Middle District of Tennessee (1977-
81)
Benjamin Glassman Nancy Harr
United States Attorney United States Attorney
Southern District of Ohio (2016-19) Eastern District of Tennessee
(2016-17)
Wendy Goggin Richard S. Hartunian
United States Attorney United States Attorney
Middle District of Tennessee (1998-
2000) Northern District of New York
(2010-17)
Jonathan L. Goldstein Tim Heaphy
United States Attorney United States Attorney
District of New Jersey (1974-77) Western District of Virginia (2009-
15)
Booth Goodwin Rodger A. Heaton
United States Attorney United States Attorney
Southern District of West Virginia
(2010-15) Central District of Illinois (2005-
09)
Walt Green Thomas B. Heffelfinger
United States Attorney United States Attorney
Middle District of Louisiana (2014-
17) District of Minnesota (1991-93,
2001-06)
Barry R. Grissom Karen P. Hewitt
United States Attorney United States Attorney
District of Kansas (2010-16) Southern District of California
(2007-10)
Melinda Haag David J. Hickton
United States Attorney United States Attorney
Northern District of California
(2010-15) Western District of Pennsylvania
(2010-16)
Dwight Holton Faith S. Hochberg
United States Attorney United States Attorney
District of Oregon (2010-11) District of New Jersey (1994-99)
John Horn Eric H. Holder, Jr.
United States Attorney United States Attorney
Northern District of Georgia (2015-
17) District of Columbia (1993-97)
Deputy Attorney General (1997-2001)
Attorney General (2009-15)
Robert K. Hur Nicholas A. Klinefeldt
United States Attorney United States Attorney
District of Maryland (2018-21) Southern District of Iowa (2009-15)
David C. Iglesias Kathryn Landreth
United States Attorney United States Attorney
District of New Mexico (2001-07) District of Nevada (1993-2001)
Marcos Daniel Jimenez Jim Letten
United States Attorney United States Attorney
Southern District of Florida (2002-
05) Eastern District of Louisiana
(2001-12)
Brendan V. Johnson James A. Lewis
United States Attorney United States Attorney
District of South Dakota (2009-15) Central District of Illinois (2010-
16)
Doug Jones Jessie K. Liu
United States Attorney United States Attorney
Northern District of Alabama (1997-
2001) District of Columbia (2017-20)
Todd Jones Karen Loeffler
United States Attorney United States Attorney
District of Minnesota (1998-2001,
2009-13) District of Alaska (2009-17)
John P. Kacavas Loretta E. Lynch
United States Attorney United States Attorney
District of New Hampshire (2009-15) Eastern District of New York (1999,
2010-15)
Attorney General (2015-17)
David N. Kelley Ronald C. Machen
United States Attorney United States Attorney
Southern District of New York
(2003-05) District of Columbia (2010-15)
William C. Killian Kenneth Magidson
United States Attorney United States Attorney
Eastern District of Tennessee
(2010-15) Southern District of Texas (2011-
17)
Damon Marinez Jerry Martin
United States Attorney United States Attorney
District of New Mexico (2014-17) Middle District of Tennessee (2010-
13)
Jay P. McCloskey Peter Nehonra
United States Attorney United States Attorney
District of Maine (1993-2001) District of Rhode Island (2009-17)
Mike McKay William N. Nettles
United States Attorney United States Attorney
Western District of Washington
(1989-93) District of South Carolina (2010-
16)
Paul J. McNulty Thomas P. O'Brien
United States Attorney United States Attorney
Eastern District of Virginia (2001-
05) Central District of California
(2007-09)
Deputy Attorney General (2006-07)
Barbara McQuade Charles Oberly
United States Attorney United States Attorney
Eastern District of Michigan (2010-
17) District of Delaware (2010-17)
Zane Memeger David W. Ogden
United States Attorney Assistant Attorney General
Eastern District of Pennsylvania
(2010-16) Civil Division (1999-2001)
Deputy Attorney General (2009-10)
Eric Miller Wendy Olson
United States Attorney United States Attorney
District of Vermont (2015-17) District of Idaho (2010-17)
Greg Miller Carmen M. Ortiz
United States Attorney United States Attorney
Northern District of Florida (2002-
08) District of Massachusetts (2009-17)
Tom Monaghan Thomas J. Perrelli
United States Attorney Associate Attorney General (2009-
2013)
District of Nebraska (1993-2001)
Michael B. Mukasey Richard J. Pocker
Attorney General (2007-09) United States Attorney
District of Nevada (1989-90)
Florence Nakakuni Timothy Purdon
United States Attorney United States Attorney
District of Hawaii (2009-17) District of North Dakota (2010-15)
Ripley Rand Richard Rossman
United States Attorney United States Attorney
Middle District of North Carolina
(2011-17) Eastern District of Michigan (1980-
81)
Ira H. Raphaelson Patrick J. Rowan
United States Attorney Assistant Attorney General
Northern District of Illinois
(1991-93) National Security Division (2008-
09)
Carole Rendon Sarah R. Saldana
United States Attorney United States Attorney
Northern District of Ohio (2016-17) Northern District of Texas (2011-
14)
James H. Reynolds Scott N. Schools
United States Attorney United States Attorney
Northern District of Iowa (1976-82) District of South Carolina (2001)
United States Attorney
Northern District of California
(2007-08)
John C. Richter McGregor W. Scott
Assistant Attorney General United States Attorney
Criminal Division (2005) Eastern District of California
(2003-09, 2017-21)
United States Attorney
Western District of Oklahoma (2005-
09)
Jose Rivera Ronald W. Sharpe
United States Attorney United States Attorney
District of Arizona (1998-2001) District of the Virgin Islands
(2009-17)
Stephen Robinson Gregory Sleet
United States Attorney United States Attorney
District of Connecticut (1998-2001) District of Delaware (1993-98)
Richard B. Roper Edward L. Stanton III
United States Attorney United States Attorney
Northern District of Texas (2004-
09) Western District of Tennessee
(2010-17)
Chuck Rosenberg Donald K. Stern
United States Attorney United States Attorney
Southern District of Texas (2005-
06) District of Massachusetts (1993-
2001)
United States Attorney
Eastern District of Virginia (2006-
08)
DEA Administrator (2015-17)
Carter Stewart Charles J. Stevens
United States Attorney United States Attorney
Southern District of Ohio (2009-16) Eastern District of California
(1993-97)
Edward J. Tarver Joyce White Vance
United States Attorney United States Attorney
Southern District of Georgia (2009-
17) Northern District of Alabama (2009-
17)
Jeffrey A. Taylor John W. Vaudreuil
United States Attorney United States Attorney
District of Columbia (2006-09) Western District of Wisconsin
(2010-17)
Ronald J. Tenpas Gregory A. Vega
United States Attorney United States Attorney
Southern District of Illinois
(2003-05) Southern District of California
(1999-2001)
Assistant Attorney General
Environment and Natural Resources
Division (2007-09)
G. Zachary Terwilliger Benjamin B. Wagner
United States Attorney United States Attorney
Eastern District of Virginia (2018-
21) Eastern District of California
(2009-16)
Larry Thompson Ken Wainstein
United States Attorney United States Attorney
Northern District of Georgia (1982-
86) District of Columbia (2004-06)
Deputy Attorney General (2001-03) Assistant Attorney General
National Security Division (2006-
08)
R.E. Thompson Thomas G. Walker
United States Attorney United States Attorney
District of New Mexico (1978-82) Eastern District of North Carolina
(2011-16)
Anne Tompkins John Walsh
United States Attorney United States Attorney
Western District of North Carolina
(2010-15) District of Colorado (2010-16)
Stan Twardy, Jr. Atlee W. Wampler, III
United States Attorney United States Attorney
District of Connecticut (1985-91) Southern District of Florida (1980-
82)
Mary Jo White Debra Wong Yang
United States Attorney United States Attorney
Southern District of New York
(1993-2002) Central District of California
(2002-06)
Joe D. Whitley William F. Weld
United States Attorney United States Attorney
Middle District of Georgia (1981-
87) District of Massachusetts (1981-86)
United States Attorney Assistant Attorney General Criminal
Division (1986-88)
Northern District of Georgia (1990-
93)
William D. Wilmoth Sally Q. Yates
United States Attorney United States Attorney
Northern District of West Virginia
(1993-99) Northern District of Georgia (2010-
15)
Deputy Attorney General (2015-17)
Attorney General (2017)
Stephanie Yonekura
United States Attorney
Central District of California
(2014-15)
______
Communication
----------
Statement of Charles N. W. Keckler, Formerly Senior Advisor to the
Secretary, Department of Health and Human Services
Re: Hearing to Consider the Nominations of Christi A. Grimm, to be
Inspector General, Department of Health and Human Services; and Neil H.
MacBride, to be General Counsel, Department of the Treasury.
Date: Wednesday, September 22, 2021
To the Committee:
From May 1, 2017 until January 20, 2021, I was a member of the non-
career senior executive service assigned to the Immediate Office of the
Secretary of Health and Human Services, and during that time,
interacted extensively with Ms. Christi Grimm, whose nomination is
under consideration by the Committee. In July 2019, I was designated as
Senior Advisor to the Secretary for inter alia, the Office of Inspector
General (OIG), and was thus the Departmental liaison to the OIG during
the period in which Ms. Grimm became its leader in January 2020 and
over the course of the first year of her leadership, meeting with her
generally on a biweekly or more frequent basis. This statement for the
record represents my personal and unsolicited views in strong support
for the confirmation of this outstanding public servant as Inspector
General.
While I have confidence that Ms. Grimm will ultimately be confirmed, I
write to urge a bipartisan and ideally unanimous vote by the Committee
and the Senate for this position and this nominee. A strong vote of
support provides important value for officials throughout their tenure,
as I can attest, having been twice confirmed by the Senate myself. The
HHS OIG has crucial responsibilities of stewardship over hundreds of
billions of taxpayer dollars, and empowering her in this way will, in
my estimation, likely have a meaningful effect in helping her do her
job. This translates into greater government accountability, and given
the scope of her responsibilities, and the massive spending which has
occurred and is still occurring within her oversight purview, any help
you give now to strengthen the hand of the IG at HHS will yield cost
savings and better Congressional oversight in the future.
Christi Grimm well deserves your trust. She became leader of the OIG
just as the pandemic was beginning and unprecedented challenges for the
nation, Department, and OIG were right around the corner. Tested, she
rose to the occasion by finding ways new ways her talented staff could
contribute positively to the response. As the line staff went remote in
the Spring and Summer, I would sometimes walk over to the OIG offices
and find Ms. Grimm--a new mother with more reason than most to work
remotely--holding down the fort, alone. Put under incredible pressure
from the highest levels early in her tenure, she remained resolutely
professional. All too many people in her position would have buckled
and blamed their subordinates, or else reacted with anger and rancor.
She did neither of these things: although ready to listen to and learn
from legitimate concerns, she chose to take the heat on herself and
maintain a firm defense of the integrity and independence of the OIG's
work.
The OIG under Ms. Grimm's leadership worked innovatively and
productively with the Department during 2020 on several key projects,
despite the increased workload of the pandemic. Showing a sophisticated
understanding of the value of deregulation, her team was crucial in
helping reform the Anti-Kickback regulations to lighten the burden of
these rules on the public while maintaining needed oversight. The OIG
also aided us in developing new waivers for telemedicine during the
pandemic, providing important warnings from their wealth of law
enforcement experience, and guiding rather than obstructing our
reforms. Ms. Grimm was also active in promoting advanced technologies
for the OIG; in my review of the existing artificial intelligence
projects in the Department, it became apparent that the OIG's AI
strategy was among the most sophisticated among all the domestic
agencies, and it provided a key inspiration and template for the
Departmental strategy and our interagency discussions. At the same time
that she looked for ways to partner with the Department to help foster
good government, she always stayed true to her statutory independence
and dual reporting responsibilities, and was a fierce pursuer of the
miscreants who produce bad government--no matter who they were.
Should Ms. Grimm be confirmed, I have no doubt all members of the
Senate will find in her a strong and vigilant partner in oversight over
the current Administration. With that understanding, I can therefore
comfortably urge all members of the Committee to stand behind her in
voting favorably on her nomination.
[all]
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