[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

                               __________






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            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.
---------------------------------------------------------------------------
    \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 
---------------------------------------------------------------------------
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 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    \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 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    \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, 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \19\ https://www.oig.hhs.gov/oei/reports/OEI-01-20-00220.asp.

    3.  Ongoing audit of the Indian Health Service's newly implemented 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    \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 
---------------------------------------------------------------------------
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\
---------------------------------------------------------------------------
    \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, 
---------------------------------------------------------------------------
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.
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    \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]