Navy Inspectors General: Investigations of Complaints and Inspection
Practices Need Strengthening (Letter Report, 08/24/94, GAO/AIMD-94-128).

This report responds to congressional concerns about two primary
responsibilities of the Navy's Inspector General (IG)
organization--resolving complaints received from various sources and
inspecting Navy units. The perceived integrity, timeliness, and quality
of the complaint process is critical to its success. If persons have
doubts about the credibility or effectiveness of the complaint process,
they may not report instances of waste or mismanagement. As a result,
Congress, the Defense Department (DOD), and the public cannot be sure
that allegations are properly examined to minimize waste, mismanagement,
and improper activities within the Navy. Navy IG inspections are
important because they help to ensure the readiness, effectiveness, and
efficiency of Navy commands and provide an assessment of the quantity,
quality, and management of resources. The Navy IG needs to ensure that
established inspection procedures are adhered to and complaint results
are used in planning inspections. The Navy IG could also better inform
Congress and DOD by more widely distributing inspection results. Also,
the Navy IG could benefit from a comprehensive external review by the
DOD IG.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  AIMD-94-128
     TITLE:  Navy Inspectors General: Investigations of Complaints and 
             Inspection Practices Need Strengthening
      DATE:  08/24/94
   SUBJECT:  Inspectors General
             Internal controls
             Investigations by federal agencies
             Naval personnel
             Human resources training
             Reporting requirements
             Noncompliance
             Cost effectiveness analysis
             Auditing standards

             
**************************************************************************
* This file contains an ASCII representation of the text of a GAO        *
* report.  Delineations within the text indicating chapter titles,       *
* headings, and bullets are preserved.  Major divisions and subdivisions *
* of the text, such as Chapters, Sections, and Appendixes, are           *
* identified by double and single lines.  The numbers on the right end   *
* of these lines indicate the position of each of the subsections in the *
* document outline.  These numbers do NOT correspond with the page       *
* numbers of the printed product.                                        *
*                                                                        *
* No attempt has been made to display graphic images, although figure    *
* captions are reproduced. Tables are included, but may not resemble     *
* those in the printed version.                                          *
*                                                                        *
* A printed copy of this report may be obtained from the GAO Document    *
* Distribution Facility by calling (202) 512-6000, by faxing your        *
* request to (301) 258-4066, or by writing to P.O. Box 6015,             *
* Gaithersburg, MD 20884-6015. We are unable to accept electronic orders *
* for printed documents at this time.                                    *
**************************************************************************


Cover
================================================================ COVER


Report to the Chairman, Subcommittee on Readiness, Committee on Armed
Services, House of Representatives

August 1994

NAVY INSPECTORS GENERAL -
INVESTIGATIONS OF COMPLAINTS AND
INSPECTION PRACTICES NEED
STRENGTHENING

GAO/AIMD-94-128

Navy Inspectors General


Abbreviations
=============================================================== ABBREV

  DOD - Department of Defense
  IG - Inspector GeneralB-254934

Letter
=============================================================== LETTER


B-254934

August 24, 1994

The Honorable Earl Hutto
Chairman, Subcommittee on Readiness
Committee on Armed Services
House of Representatives

Dear Mr.  Chairman: 

This report responds to your request that we examine a number of
issues regarding the Department of the Navy Inspector General (IG)
organization.  The Navy IG organization is comprised of a statutory
IG office within the Office of the Secretary of the Navy and
administratively established IG offices at the various command levels
within the Navy.  The Navy IG organization differs in a number of
ways from IGs created under the Inspector General Act of 1978.  For
example, Navy IGs do not have subpoena powers or the audit functions
granted to the IGs by the Act. 

Your concerns related to two primary responsibilities of the Navy IG
organization:  resolving complaints received from various sources and
performing inspections of Navy units.  Specifically, you requested
that we review individual complaints investigated by the Navy IG
organization to determine if (1) the staff who investigated
complaints were independent, (2) investigative work was complete, (3)
documentation of investigative work was complete, (4) investigations
were handled in a timely manner, and (5) complainant confidentiality
was maintained.  You also asked us to review concerns about Navy IG
organization inspections to determine whether (1) inspections were
being performed in accordance with established procedures, (2)
inspections covered economy, efficiency, and effectiveness issues and
inspection reports were broadly disseminated, and (3) the Department
of Defense Inspector General (DOD IG) performed any oversight of Navy
IG inspection activities. 


   RESULTS IN BRIEF
------------------------------------------------------------ Letter :1

Our review of 98 individual complaint investigations and selected
inspection activities found that the Navy investigation and
inspection practices need to be strengthened.  We also determined
that while the Navy IG inspections addressed significant economy,
efficiency, and effectiveness issues, a review of the Navy statutory
IG by the DOD IG could result in constructive suggestions for
achieving more efficient use of inspection funds and personnel. 

We found weaknesses in how the Navy IG units we reviewed investigated
individual complaints of waste, mismanagement, or improper actions by
Navy personnel.  Our detailed review of 98 randomly selected cases
showed that 89 cases had at least one of the following weaknesses: 
(1) the complaint investigator was not independent, (2) the
investigative work was not complete, (3) investigative documentation
was not complete or was missing from the files, (4) the investigation
was not timely, and/or (5) complainant confidentiality procedures
were not followed.  As a result, the Congress, DOD, and the public
cannot be sure that the Navy IG organization is properly
investigating allegations of waste, mismanagement, or improper
actions by Navy personnel.  To strengthen its investigations, the
Navy statutory IG is developing a detailed investigation manual for
investigators, and incorporating specific investigation procedural
requirements into a planned IG training course. 

We also found that Navy IG inspection activities have weaknesses. 
The Navy statutory IG did not inspect several major commands within
the Navy's established 3-year cycle.  Further, the IGs of these major
commands did not identify trends in inspection results.  As a result,
systemic weaknesses may not have been identified. 

The Navy IG has addressed significant economy, efficiency, and
effectiveness issues.  For example, an IG report on a major Navy
command stated that savings of over $100 million could be achieved if
a command's program for cost reduction and productivity improvement
was expanded to all of its units.  However, except for the selected
summaries that were part of the semiannual DOD IG report to the
Congress, the Navy statutory IG did not routinely distribute
information regarding its significant results outside the Navy.  This
information could be useful to decisionmakers, such as the Congress
and DOD officials, in fulfilling their oversight and policy
responsibilities. 

Also, the DOD IG has not conducted a comprehensive oversight review
of the Navy statutory IG inspection activities.  An independent
review of the Navy statutory IG by an external organization could
offer constructive suggestions for achieving more efficient use of
resources. 


   BACKGROUND
------------------------------------------------------------ Letter :2

The Office of the Naval Inspector General was created by statute in
1948.  Under current law, this Office is a component of the Office of
the Secretary of the Navy and, "when directed, shall inquire into and
report on any matter that affects the discipline or military
efficiency of the Department of the Navy." The Office is currently
under the command of a Vice Admiral. 

Within the Navy's decentralized chain of command, unit commanders
also have staff who perform IG investigative and inspection functions
and serve as their confidential representatives.  According to Navy
cost and personnel data, which we did not verify, the Navy IG
organization had operating costs of about $20.3 million and involved
about 209 full-time staff in conducting investigations and
inspections during fiscal year 1993.  Most commands also have staff
who perform IG functions on a part-time basis, including the
investigation of complaints.  For example, an IG official at one
major Navy command spent 20 percent of time on IG functions, with the
remaining time devoted to the command's personnel activities. 

The complaint investigation function relies heavily on a
decentralized IG investigation system.  After analyzing the
seriousness of Navy-related complaints, the DOD IG refers most of
these allegations to the Navy statutory IG who, in turn, refers most
allegations to Navy commands.  IGs at the commands can either conduct
the investigation or task another unit in the command to perform the
investigation, subject to supervision by the command IG. 

While Navy regulations provide that the Navy statutory IG serves as
an overall coordinator and monitor of the IG investigation and
inspection functions, command level IGs report directly to their unit
commanders and not to the Navy statutory IG.  However, the Navy
statutory IG is responsible for periodically assessing the
investigation and inspection functions of the command level IGs to
determine compliance with basic Navy policies and procedures
pertaining to complaint investigations and inspections.  The command
level IGs, in turn, are to assess the investigation and inspection
activities of their immediate subordinate commands. 

While sharing general responsibility for helping to improve Navy
operations, the Navy IGs differ from the DOD and civilian agency IGs
created under the Inspector General Act of 1978.  The DOD and
civilian agency IGs are organizationally centralized, while the Navy
IG organization is decentralized.  In addition, the DOD and civilian
agency IGs have statutory authorities (such as subpoena powers) and
statutory responsibilities (such as performing, or deciding if an
independent external auditor should conduct, financial statement
audits under the Chief Financial Officers Act of 1990) that do not
apply to the Navy or other military IGs.  Also, the DOD and civilian
agency IGs must conduct their audits in accordance with government
auditing standards, while the Navy and other military IGs are not
required to follow these standards. 


   SCOPE AND METHODOLOGY
------------------------------------------------------------ Letter :3

To review investigation and inspection issues, we visited the Navy
statutory IG and the command level IGs of the Atlantic Fleet, Pacific
Fleet, and Naval Supply Command.  To address investigation issues, we
used DOD and Navy investigation criteria to assess a random sample of
98 complaint cases that were closed during fiscal year 1992 by these
4 commands.\1

Our objective was to assess if the 98 individual investigations were
conducted in accordance with applicable requirements.  Consistent
with the request, we divided our assessment into five categories (1)
investigator independence, (2) completeness of investigative work,
(3) documenting investigative work in the complaint file, (4)
investigative timeliness, and (5) maintaining complainant
confidentiality when requested. 

We reviewed investigative records and, where we had questions,
discussed cases with investigative personnel assigned to the
locations where we did our work.  However, we did not attempt to
pursue issues not resolved by an investigator or determine whether
the conclusions reached by investigative staff should have been
different.  Therefore, we do not question the result of any
investigation.  In addition, we were not able to establish the number
of Navy-wide complaints because the Navy statutory IG does not track
cases at all commands levels.  As a result, our sample of 98 cases
cannot be projected to all Navy IG investigations. 

To address inspection issues, we reviewed inspection reports and
procedures at these commands and observed two of their inspections. 
We conducted our field work from January 1993 through March 1994, in
accordance with generally accepted government auditing standards. 
Appendix I provides further details on our scope and methodology. 


--------------------
\1 Cases closed during fiscal year 1992 were the most recent universe
of completed investigations as of the beginning of our fieldwork. 


   COMPLAINT INVESTIGATION PROCESS
   HAS WEAKNESSES
------------------------------------------------------------ Letter :4

Eighty-nine of the 98 randomly selected Navy IG investigations that
we reviewed had at least one of the weaknesses listed in table 1. 



                           Table 1
           
                 Weaknesses in the Complaint
                    Investigation Process

Weakness                                              Number
--------------------------------------------------  --------
Investigator not independent                              19
Investigative work not complete                           34
Case documentation incomplete                             47
Investigation not timely                                  72
Confidentiality procedures not followed                    2
------------------------------------------------------------

      INVESTIGATORS NOT
      INDEPENDENT
---------------------------------------------------------- Letter :4.1

For 19 of our 98 sampled cases, the complaint investigators were not
independent because they were closely associated with the people
involved in the complaint, subordinate to the accused, and/or part of
the office or command identified or involved in the complaint.  DOD
instructions require that complaints be investigated by officials
independent of the specific unit, office, or staff element specified
in the complaint.  Also, an applicable Navy independence standard
states that the individual or organization performing the inquiry
must be free, in fact and in appearance, from official, personal,
professional, and financial impairments to independence, and
examiners must have sufficient seniority in the matter under inquiry. 
The following examples illustrate independence issues. 

  The DOD IG referred a complaint, alleging that government funds
     were being wasted at a Navy facility, to the Navy statutory IG. 
     The DOD IG did not accept the initial Navy IG report, which did
     not substantiate the allegation, because the investigation had
     been conducted by staff from the organization alleged to have
     wasted funds.  Also, the investigators reported to some of the
     individuals involved with the complaint.  A second investigation
     by independent Navy officials from another Navy unit
     substantiated the allegation. 

  A complaint alleged that a unit commander was improperly using
     government funds for personal reasons.  The Navy IG
     investigation was conducted personally by a subordinate who
     reported to the accused.  The report stated that the commander's
     secretary had erred and was counseled on complying with
     established procedures.  Reimbursement to the government was
     made by the unit commander. 


      INVESTIGATIVE WORK WAS NOT
      COMPLETE
---------------------------------------------------------- Letter :4.2

Investigative work in 34 of the 98 investigations was not complete.\2
DOD and Navy instructions require investigations to be complete, with
investigation reports leaving no unanswered questions and not being
open to question or misinterpretation.  In addition, the DOD IG
developed guidelines for assessing and reporting on the quality of
completed investigations.  These guidelines include:  (1) Were all
the allegations in the basic complaint addressed?  (2) Were all key
witnesses and subjects interviewed?  (3) Were all relevant questions
asked?  (4) Did the investigator collect and review all pertinent
documentation needed to support the findings and conclusions?  and
(5) Were legal opinions or technical expertise solicited when
appropriate?  We used these guidelines to assess whether
investigative work met the completeness standard.  The following
examples illustrate the concerns we have about incomplete
investigations. 

  A complainant alleged that a $2.8 million contract for lawn
     maintenance was awarded "at the whim" of a base commander.  The
     investigator concluded that the allegation was not substantiated
     based solely on information obtained during a telephone
     conversation with a manager who was not assigned to the base. 
     We discussed this case with responsible Navy investigative staff
     who agreed that additional work should have been done to assess
     the validity of the allegation. 

  An officer and an enlisted person were alleged to be violating the
     Navy's policy against fraternization.  The investigator
     interviewed the officer and enlisted person and reported that
     the allegation was unsubstantiated.  However, the investigator
     did not obtain evidence to corroborate the statements of the
     subjects of the investigation.  We discussed this case with a
     legal officer in the unit who told us that additional evidence
     should have been obtained to support the investigator's
     conclusion. 


--------------------
\2 Some of these 34 investigations involved multiple allegations. 
While each of the 34 investigations had at least one allegation that
was incompletely investigated, we do not conclude that all of the
investigative work in these cases was incomplete.  In addition, we
did not attempt to pursue issues not resolved by the investigator, or
determine whether the conclusions reached by the investigative staff
should have been different.  Accordingly, we do not question the
results of the 34 cases. 


      INVESTIGATIVE FILES LACKED
      SUFFICIENT DOCUMENTATION
---------------------------------------------------------- Letter :4.3

For 47 of our sample cases, the files provided to us by the Navy did
not contain sufficient documentary evidence to fully support
investigator findings and conclusions.  DOD instructions require
investigation files to contain documentary evidence that fully
supports investigators' findings and conclusions.  Also, the
investigator's file is to include the identities of all witnesses,
the information provided during interviews, and the report.  Because
the report is frequently the only document that DOD and Navy IG
reviewers have for use in evaluating the quality of the investigative
effort, Navy guidance requires that the report present sufficiently
detailed information on investigative findings and conclusions. 

The following example illustrates the problems we found.  An
investigator reported that no evidence was found to substantiate an
allegation of discrimination and harassment.  While the examiner's
report stated that the complainant and 39 other people were
interviewed, the investigation files did not contain documentation
showing the identities of, and information provided by, the 40
individuals who were interviewed. 


      INVESTIGATIONS NOT TIMELY
---------------------------------------------------------- Letter :4.4

Of the 98 investigations we reviewed, 72 took over 90 days to
complete, including 39 that exceeded 180 days.  The average time to
complete a case was 176 days.  Although extensions may be granted for
unusual circumstances, DOD guidance states that Navy IG
investigations are to be examined and completion reports of the
results submitted within 90 days from the date the complaint was
transmitted for action.  The following is an example of a case that
was not completed in a timely manner.  A complaint about a Navy
officer's obligation to provide adequate monetary support to a spouse
took 376 calendar days from opening to closing.  According to the
reviewing official, the investigation was inadequate because the
investigator did not thoroughly address all relevant aspects of the
allegation in the submitted completion report.  Of the 376 days, 216
days of the time were attributed to resolution of the reviewer's
concerns. 


      PROCEDURES TO PROTECT
      COMPLAINANT CONFIDENTIALITY
      WERE NOT FOLLOWED
---------------------------------------------------------- Letter :4.5

Complainants requested confidentiality in 3 of the 98 sampled cases. 
In two of these cases, procedures to protect the confidentiality of
the complainants were not followed.  DOD instructions require that
administrative controls and procedures be established to provide
maximum protection for any complainant who requests confidentiality. 
Navy requirements also state that confidentiality is a consideration
used to encourage full disclosure of information without fear of
reprisal.  Navy instructions permit the Navy statutory IG to release
the identity of the complainant to the Navy investigator if it is
required to conduct the investigation.  In those cases where the Navy
statutory IG releases the name, the identity of the complainant shall
be protected to the utmost of the investigator's capabilities. 

Based on our review of the following two cases, procedures to protect
complainant confidentiality were not followed. 

  A complainant requested anonymity and wanted to be contacted before
     any identifying information was released.  However, the
     complainant's name was provided, without following established
     procedures, to persons who were not conducting the
     investigation.  In addition, after reviewing the examination
     completion report, an IG reviewer wrote in the file that the
     complaint was "apparently malicious" and suggested that the
     complainant's supervisor be contacted.  There was no
     documentation in the case file that indicated whether or not the
     supervisor was contacted. 

  A complainant, who was employed at a Navy-provided child care
     center, requested confidentiality in making allegations of child
     abuse and harassment at the center.  A Navy IG official
     determined that there was no need to maintain the complainant's
     confidentiality because the complainant was terminated from the
     child care center.  Without following the required procedures,
     the Navy IG official then released the complainant's name to the
     Navy investigator who was going to conduct the inquiry. 

In addition, as part of our observation of an IG inspection of a
subordinate command, we reviewed the case file of an anonymous
complaint\3 that was investigated by the command.  The investigator's
notes showed that 19 of 23 witnesses were asked to speculate as to
the identity of the anonymous complainant.  In reporting the
investigation results to the commanding officer, the investigator
stated that a majority of the interviewees suspected a person in the
unit as being the complainant.  The investigator recommended that the
suspected complainant be counseled and, if no improvement was made,
be terminated. 


--------------------
\3 This complaint was not part of our 98 sampled cases. 


      NAVY TAKING CORRECTIVE
      ACTIONS
---------------------------------------------------------- Letter :4.6

Navy statutory and command level IG officials told us that a primary
reason for the problems we found was lack of detailed guidance and
training.  The Navy statutory IG had not issued a manual that
detailed the procedures on how to conduct investigations.  An IG
official from a major command told us the command's biggest problem
was that staff assigned to investigate complaints lacked
investigative training, and a 3-day Navy IG training course did not
cover how to conduct an investigation. 

While our review was in process, the Navy statutory IG developed a
detailed interim investigations manual as well as plans for providing
periodic training to IG officials on the manual's procedures.  Navy
IG officials told us that their intent was to establish procedures
that will be consistently applied in conducting investigations and to
provide comprehensive guidance to ensure that all required standards
are met.  The interim manual

  emphasizes that special care be taken to ensure that there is no
     real or apparent lack of impartiality on the part of the
     investigating unit,

  stresses the need to perform a complete inquiry, including
     obtaining sufficient corroborating evidence, in a timely manner,
     and

  calls for sufficient information to be obtained to permit
     responsible officials to hold, where appropriate, subordinates
     accountable for their actions and to correct systemic problems. 

The issuance of the manual in final format and the related planned
training could be especially beneficial to staff who do not perform
complaint investigations on a full-time basis.  Because
investigations can be frequently assigned to staff as a collateral
duty, we believe that the expectations and criteria for conducting
quality investigations need to be emphasized.  This could be done by
requiring that individuals who investigate complaints, and their
immediate supervisors, certify that they are aware of the
requirements to be independent and to perform investigations in
accordance with DOD and Navy requirements.  These actions, coupled
with periodic DOD IG quality assurance reviews, could help improve
complaint investigations. 


   INSPECTION ACTIVITIES HAD
   WEAKNESSES
------------------------------------------------------------ Letter :5

We also found weaknesses during our review of the Navy IG inspection
activities.  First, the Navy statutory IG did not adhere to
established Navy procedures in meeting periodic inspection
requirements.  Also, Navy Atlantic and Pacific Fleet IGs did not
review inspection reports to identify trends that may indicate
systemic weaknesses and use complaint reports in planning
inspections.  In addition, while Navy IG inspections addressed
significant economy, efficiency, and effectiveness issues, this
information was not always made available to the Congress and DOD
decisionmakers who oversee major Navy programs and activities. 
Although selected summaries of inspection reports were submitted as
part of the semiannual DOD IG report to the Congress, the Navy
statutory IG has not routinely distributed information on inspections
performed or the significant results outside the Navy.  Lastly, the
DOD IG has not conducted a comprehensive review of the Navy's
inspection activities. 


      PERIODIC INSPECTIONS AND
      TREND ANALYSIS NOT ROUTINELY
      CONDUCTED
---------------------------------------------------------- Letter :5.1

The Navy statutory IG has established a 3-year cycle for inspecting
major commands.  However, two of these commands, the Atlantic and
Pacific Fleets, have not been inspected since 1980 and 1982,
respectively.  These two fleets, with a fiscal year 1993 budget of
about $10 billion, provide the ships, submarines, and aircraft needed
to ensure control of the sea and air in the Atlantic, Pacific, and
Indian Oceans and the Mediterranean Sea--areas vital to our national
interests.  Together, they comprise about 535 ships, 3,700 aircraft,
and almost 500,000 personnel.  Navy statutory IG officials stated
that these two fleets have not been inspected for over a decade
because of other priorities, but said they would do so at the next
change of command.  While we recognize that the two fleets are
subjected to periodic reviews by fleet personnel, the Navy statutory
IG's comprehensive assessment would be independent of the inspections
performed by fleet personnel. 

During our visits to the two fleet commands, IG officials told us
that they were not reporting patterns of problems found in lower
units.  Trend analyses of such patterns could provide management with
indicators of how a unit is performing its mission over time and
identify similar problems among other units and commands that
indicate opportunities for improvement and inadequate policies and
procedures on a broad scale. 

The Navy statutory IG has recognized the benefits that could result
from trend analyses.  For example, during an inspection, the Navy
statutory IG found that data was not being analyzed for emerging
trends or problems that may affect other Navy units.  The Navy
statutory IG stated that analysis of information in the records of
the unit being inspected could indicate medical, personnel, or morale
problems that would be of interest to other Navy units.  Similarly,
the two fleet IGs do not use complaint results and trend analyses in
planning inspections.  A pattern in substantiated cases could
indicate internal control problems that should be the subject of a
more detailed examination. 


      SIGNIFICANT ISSUES DISCUSSED
      BUT DISSEMINATION LIMITED
---------------------------------------------------------- Letter :5.2

Inspections by the Navy statutory and higher-level command IGs
addressed significant economy, effectiveness, and efficiency issues. 
Their reports contain much worthwhile information for decisionmakers
concerned with the efficient use of DOD resources and were typically
distributed to about 20 Navy components.  Copies were also furnished
to Navy commands who need to take action on recommendations contained
in the report.  However, cognizant DOD management officials or other
key decisionmakers were not routinely provided reports of significant
results of inspections. 

The following examples illustrate the types of significant issues
discussed in IG reports. 

  A report on the Naval Facilities Engineering Command discussed how
     savings in excess of $100 million could be achieved if a Command
     program for cost reduction and productivity improvement was
     expanded to all of its units. 

  A report on the Naval Sea Systems Command found that the Command's
     1991 fiscal year $353 million information technology budget
     submission was based on a procedure that resulted in a multitude
     of errors, weaknesses, and problems that were indicative of a
     lack of fundamental command-wide control and oversight.  The
     report also criticized the Navy's manual accounting for certain
     shipbuilding and conversion appropriation accounts.  Manual
     accounting records can increase the potential for errors and do
     not readily permit integration with automated accounting records
     for financial reporting. 

  A report on the Naval Reserve Force Command said that a training
     program designed to improve and standardize training for the
     Naval Surface Reserve Force was poorly managed, ineffective,
     inefficient, and not based on training requirements. 

  A report said that a maintenance activity was considered
     unsatisfactory because of large excess inventories, checks being
     issued without obtaining required signatures, and a lack of
     formal procedures to ensure personnel were properly trained in
     using a computerized maintenance management system. 

  An inspection of a patrol wing found that over half of the enlisted
     aircrews arriving at the wing's squadrons had not completed
     their required training.  The IG recommended establishing an
     appropriate policy to correct this problem. 

In general, the results of Navy inspections would be useful to DOD
officials and other key decisionmakers.  While summaries of selected
Navy inspections were included in the DOD IG Semiannual Report to the
Congress, distribution of inspection reports outside the Navy was not
routinely made.  For example, a DOD IG Semiannual Report to the
Congress summarized certain results of a 1992 inspection report on
the Military Sealift Command.  The summary did not include an
inspection finding that unauthorized persons, who were not in the
Navy, were taking cash from ships used by the Command.  The
inspection report recommended that the Navy coordinate with the Joint
Chiefs of Staff, the Secretary of Defense, and the Secretary of State
to improve security measures for the Command's ships.  Unless copies
of the complete inspection report are provided to appropriate DOD
policy officials, they may not be in a position to initiate prompt
remedial measures.  Also, the Congress could benefit from a
semiannual list that summarizes inspections completed by the Navy
statutory and command level IGs. 


      DOD IG OVERSIGHT COULD
      BENEFIT NAVY IG INSPECTIONS
---------------------------------------------------------- Letter :5.3

The DOD IG provides policy guidance and oversees the operations of
internal audit and internal review functions within DOD.  In doing
so, the DOD IG has periodically reviewed the Navy IG's complaint
investigation process, but has not reviewed its inspection
activities.  Comprehensive reviews by an outside organization can
provide perspectives and suggestions that result in improved
operations and performance.  Outside reviews also provide a measure
of accountability in ensuring compliance with established regulations
or policies.  For example, in the case of the Navy statutory IG, a
review of inspection activities by the DOD IG could have helped to
identify delays in the Navy IG's inspection of the two major fleets,
determine the underlying cause of the delay, and develop
recommendations to resolve it. 

According to the DOD IG, it has not reviewed the inspection
activities of the Navy statutory IG or the other military IGs because
of resource constraints and other higher priorities.  As discussed
earlier, Navy IG inspections have addressed significant economy,
efficiency, and effectiveness issues, and Navy inspection reports
contain much worthwhile information for decisionmakers concerned with
the efficient use of DOD resources.  Due to the significance of the
issues addressed by inspections, it is important that steps be taken
within DOD to ensure that Navy IG inspections are performed as
effectively as possible. 


   CONCLUSIONS
------------------------------------------------------------ Letter :6

The perceived integrity, timeliness, and quality of the complaint
process is critical to its success.  If individuals have doubts about
the credibility or effectiveness of the complaint process, they may
not bother to report instances of waste or mismanagement.  As a
result, the Congress, DOD, and the public cannot be sure that
allegations are properly examined to minimize waste, mismanagement,
and improper activities within the Navy. 

Navy IG inspections are important because they help to ensure the
readiness, effectiveness, and efficiency of Navy commands and provide
an assessment of the quantity, quality, and management of available
resources.  The Navy statutory IG needs to ensure that established
inspection procedures are adhered to and complaint results are used
in planning inspections.  The Navy statutory IG could also better
inform the Congress and key DOD decisionmakers by providing a wider
distribution of inspection results.  Also, the Navy statutory IG,
like the commands it inspects, could benefit from a comprehensive
external review by the DOD IG. 


   RECOMMENDATIONS
------------------------------------------------------------ Letter :7

To strengthen the complaint and inspection activities of the Navy IG
organization, we recommend that the Secretary of the Navy direct the
Navy statutory IG to: 

  Establish a requirement that all individuals who investigate
     complaints, and their immediate supervisors, certify that they
     are aware of the requirements to maintain independence and to
     perform their investigations in accordance with DOD and Navy
     directives. 

  Effectively implement the planned Navy IG complaint corrective
     actions, particularly development of an investigations manual
     and the related training for IG staffs. 

  Establish an IG quality assurance review process to ensure that
     complaint procedures are being followed and that complaint and
     inspection trends are used in planning inspections. 

  Provide copies of Navy statutory IG reports to the cognizant
     Assistant Secretaries of Defense who have policy responsibility
     for the matters discussed in the report and send a semiannual
     list to cognizant congressional committees that summarizes
     inspections completed by the statutory and command level IGs. 

We also recommend that the DOD IG perform, on a periodic basis, a
comprehensive oversight review of the Navy statutory IG inspection
activities. 


---------------------------------------------------------- Letter :7.1

As agreed with your office, we did not obtain agency comments on a
draft of this report.  However, at the end of our fieldwork, we
discussed the results of our work with DOD and Navy IG officials and
have incorporated their views where appropriate.  As arranged with
your office, unless you publicly release the report's contents
earlier, we plan no further distribution until 30 days after the date
of this letter.  At that time, we will send copies of the report to
appropriate congressional committees, the Secretary of Defense, and
other interested parties. 

Please contact me at (202) 512-9489 or Joseph H.  Potter, Assistant
Director, at (202) 512-5198 if you or your staff have any questions
about this report. 

Sincerely yours,

David L.  Clark
Director, Legislative Reviews
 and Audit Oversight


SCOPE AND METHODOLOGY
=========================================================== Appendix I

To evaluate the complaint and inspection issues, we reviewed previous
DOD studies, DOD and Navy policy and procedural guidance, our prior
reports,\1 and a 1980 task force study on the inspection,
investigation, and audit components of DOD. 

To assess how the Navy handled complaint investigations, we used DOD
criteria as supplemented by Navy instructions.  In May 1982, the
Secretary of Defense set general operating procedures and standards
for investigating complaints in DOD Directive 7050.1, which was
updated in March 1987.  Among other things, the directive and
implementing Navy guidance requires that standards of investigator
independence, investigation completeness, documentation sufficiency,
timeliness, and complainant confidentiality be achieved during the
course of an investigation.  To assess whether investigations were
complete, we also used DOD IG guidelines developed for performing
quality assurance reviews of DOD agencies and service commands to
ensure that investigations are conducted properly. 

To address the investigation issues, we randomly selected 88
individual cases that were closed during fiscal year 1992 by the
Atlantic Fleet, Pacific Fleet, and the Naval Supply Command IGs.  We
also selected a sample of 10 senior official cases examined by the
Navy statutory IG.  Since the Navy statutory IG does not track cases
at all command levels, we were not able to establish the universe of
complaints.  However, the 4 commands that we sampled closed 624 cases
in fiscal year 1992. 

Using DOD and Navy criteria and guidelines, we reviewed each of the
sampled cases--concentrating on evaluating investigator independence,
the completeness of the investigation, the sufficiency of
documentation to support findings and conclusions, investigation
timeliness, and complainant confidentiality.  Our work was limited to
the review of the investigators' case files and related documentation
provided to us by Navy personnel. 

In addition, we discussed selected cases with a DOD IG official who
has experience in conducting periodic quality assurance reviews of
cases at major service commands.  Our sample is not projectable to
the universe of cases, but can provide a good indicator of how well
complaints were handled in the units we reviewed. 

To address the inspection issues, we reviewed inspection reports and
procedures at the Navy statutory IG, the Atlantic and Pacific Fleet
IGs, the Naval Supply Command IG, and three major subordinate fleet
command IGs.  We also reviewed DOD semiannual reports covering April
1990 through September 1993, which included discussions of selected
Navy IG reports.  To gain an understanding of the approach and manner
in which inspections were conducted, we observed inspections
conducted by the Atlantic Fleet and Naval Supply Command IGs.  During
our review, we also provided the Navy statutory IG with our comments
on a draft revision of inspection guidance.\2


--------------------
\1 DOD Fraud Hotline:  Generally Effective But Some Changes Needed
(GAO/AFMD-86-9, Mar.  21, 1986) and Special Report:  DOD Hotline
Referrals (GAO/OSI-93-6BR, Apr.  9, 1993). 

\2 Observations and Suggestions on Navy IG Draft Revision of
Inspection Instruction (GAO/AIMD-93-66R, Sept.  30, 1993). 


MAJOR CONTRIBUTORS TO THIS REPORT
========================================================== Appendix II


   ACCOUNTING AND INFORMATION
   MANAGEMENT DIVISION,
   WASHINGTON, D.C. 
-------------------------------------------------------- Appendix II:1

Joseph H.  Potter
Jerry F.  Wilburn


   LOS ANGELES REGIONAL OFFICE
-------------------------------------------------------- Appendix II:2

Phillip Abbinante
Charles E.  Payton


   NORFOLK REGIONAL OFFICE
-------------------------------------------------------- Appendix II:3

Sandra F.  Bell
Cora M.  Bowman
Daniel A.  Omahen
Joseph J.  Watkins


   PHILADELPHIA REGIONAL OFFICE
-------------------------------------------------------- Appendix II:4

Shahied A.  Dawan
David B.  Pasquarello
Douglas W.  Sanner

