What GAO Found The Department of Veterans Affairs (VA) provides health care services to over 9 million enrolled veterans, and thousands of military service members transition to its care each year. Mental health conditions are a persistent issue for veterans, and many veterans also live with chronic pain. These conditions are often treated with medications that must be managed carefully. For example, opioids can be prescribed for pain, but these carry the risk of addiction and overdose. VA has implemented four key GAO recommendations to strengthen its oversight of mental health treatment plans and to help ensure its providers follow strategies for mitigating the risk of opioids. Mental health treatment plans. Veterans with mental health conditions may be offered various treatment options, including medication or therapy, or a combination of both. The Veterans Health Administration (VHA) requires specialty providers, such as psychiatrists, to document in mental health treatment plans that evidence-based treatment options were considered. In June 2019, GAO found VHA did not have guidance for these requirements nor monitor whether the providers followed them. VA concurred with GAO’s two recommendations to address these issues and, in 2020, implemented both. For example, VA initiated reviews of selected charts biannually to ensure providers meet mental health treatment planning expectations. Opioid safety risk mitigation strategies. In response to concerns about opioid use, VA launched its Opioid Safety Initiative in 2013 to help ensure veterans are prescribed and use opioids in a safe and effective manner. As part of this initiative, VHA developed risk mitigation strategies for providers to follow when prescribing opioids to veterans, such as conducting urine drug screening. In May 2018, GAO found VHA providers at selected medical facilities did not consistently follow some risk mitigation strategies. Further, not all facilities had access to trained providers to educate other providers in ensuring opioid safety. GAO made two recommendations to address these issues. VA concurred and, in 2019 and 2020, implemented each recommendation. For example, VA created a planning tool that gives providers information on risk mitigation strategies, such as the patient’s last urine screening. VA has not addressed GAO’s recommendation to the Department of Defense-VA Joint Executive Committee to assess the effectiveness of mental health services for transitioning service members and veterans. This Committee oversees the two departments’ coordination for health care and benefits, including programs that may assist service members and veterans during the transition. In 2024, GAO found that the Committee had identified a number of mental health touchpoints for transitioning service members. However, the Committee had not assessed the effectiveness of the departments’ efforts in facilitating access to such mental health touchpoints and made a recommendation that it do so. VA concurred with this recommendation, but as of November 2025, this recommendation has not yet been implemented. Why GAO Did This Study Effective medication management is of the utmost importance to ensure U.S. veterans receive safe and comprehensive treatment as part of their health care. This is particularly important for the growing number of veterans receiving treatment for mental health conditions and for vulnerable populations, such as those transitioning out of the military. Concerns have been raised about the adverse effects of polypharmacy among veterans, which is the use of more than one medication. For example, research suggests that prescribing both benzodiazepines—a type of medication used to treat anxiety or post-traumatic stress disorder—and opioids to treat chronic pain can increase veterans’ risk of death from suicide. GAO has reported on opportunities for VA to enhance its oversight of various issues related to medication management for veterans, including those with mental health conditions and those transitioning out of the military. This statement describes a selection of this work, including recommendations GAO has made related to (1) mental health treatment plans, (2) opioid safety, and (3) access to mental health services for transitioning service members and veterans. This statement is based primarily on three GAO reports issued between May 2018 and July 2024 (GAO-18-380, GAO-19-465, and GAO-24-106189). GAO also reviewed available research related to VA prescribing practices and steps the agency has taken to address five selected recommendations GAO made across these reports. For more information, contact Alyssa M. Hundrup at hundrupa@gao.gov.

What GAO Found Preliminary results from GAO's ongoing covert testing suggest fraud risks in the advance premium tax credit (APTC) persist. The federal Marketplace approved coverage for nearly all of GAO's fictitious applicants in plan years 2024 and 2025, generally consistent with similar GAO testing in plan years 2014 through 2016. GAO's covert testing is illustrative and cannot be generalized to the enrollee population. Plan year 2024. The federal Marketplace approved subsidized coverage for all four of GAO's fictitious applicants submitted in October 2024. In total, the Centers for Medicare & Medicaid Services (CMS) paid about $2,350 per month in APTC in November and December for these fictitious enrollees. For some, the federal Marketplace requested documentation to support Social Security numbers (SSN), citizenship, and reported income. GAO did not provide documentation yet received coverage. Plan year 2025. Of 20 fictitious applicants, 18 remain actively covered as of September 2025. APTC for these 18 enrollees totals over $10,000 per month. GAO continues to monitor the enrollments as part of its ongoing work. More broadly, GAO's preliminary analyses identified vulnerabilities related to potential SSN misuse and likely unauthorized enrollment changes in federal Marketplace data for plan years 2023 and 2024. Such issues can contribute to APTC that is not reconciled through enrollees' tax filings to determine the amount of premium tax credit for which enrollees were ultimately eligible. GAO's preliminary analysis of data from tax year 2023 could not identify evidence of reconciliation for over $21 billion in APTC for enrollees who provided SSNs to the federal Marketplace for plan year 2023. Unreconciled APTC may not necessarily represent overpayments, as enrollees who did not reconcile may have been eligible for the subsidy. However, it may include overpayments for enrollees who were not eligible for APTC. Overused SSNs. GAO's preliminary analyses identified over 29,000 SSNs in plan year 2023 and nearly 68,000 SSNs in plan year 2024 used to receive more than one year's worth of insurance coverage with APTC in a single plan year. CMS officials explained that the federal Marketplace does not prohibit multiple enrollments per SSN to help ensure that the actual SSN-holder can enroll in insurance coverage in cases of identity theft or data entry errors. GAO's preliminary analyses also identified at least 30,000 applications in plan year 2023 and at least 160,000 applications in plan year 2024 that had likely unauthorized changes by agents or brokers. This can result in consumer harm, including loss of access to medications. In July 2024, CMS implemented a new control to prevent such changes, which GAO is reviewing in its ongoing work. GAO preliminarily identified weaknesses in CMS’s APTC fraud risk management as compared to leading practices. Specifically, CMS has not updated its fraud risk assessment since 2018 despite changes in the program and its controls. Further, CMS’s 2018 assessment may not fully align with leading practices, like identifying inherent fraud risks. Finally, CMS did not use its 2018 assessment to develop an antifraud strategy. Together, these weaknesses appear to hinder CMS’s ability to effectively and proactively manage fraud risks in APTC. Why GAO Did This Study The Patient Protection and Affordable Care Act provides premium tax credits to help eligible individuals pay for health insurance. The federal government can pay this credit directly to health insurance issuers as APTC. CMS estimated that it paid nearly $124 billion in APTC for about 19.5 million enrollees in plan year 2024. Consumers can enroll in insurance through the federal Marketplace independently or with assistance from an agent or broker. Recent indictments highlight concerns about agent and broker practices in the federal Marketplace. Further, CMS reported that it received roughly 275,000 complaints in 2024 that consumers were enrolled or had insurance plans changed in the federal Marketplace without their consent. GAO was asked to review issues related to fraud risk management in APTC. This report discusses preliminary results of ongoing GAO work related to (1) covert testing and (2) data analyses of enrollment controls in the federal Marketplace, as well as (3) CMS's APTC fraud risk assessment and antifraud strategy. To perform this work, GAO created 20 fictitious identities and submitted applications for health care coverage in the federal Marketplace for plan years 2024 and 2025. The results, while illustrative, cannot be generalized to the full enrollment population. Additionally, GAO analyzed federal Marketplace enrollment data for plan years 2023 and 2024 and compared these data to federal death data and tax data. Finally, GAO assessed documentation related to CMS's fraud risk management activities against relevant leading practices.

What GAO Found Property technology encompasses a wide range of digital tools used in real estate and is used in nearly every phase of the homebuying process. Selected Property Technology Products Used in Homebuying These products can simplify homebuying and reduce costs for homebuyers but also pose risks, particularly related to artificial intelligence (AI). Online real estate platforms offer consumers one-stop shopping but may raise privacy concerns by collecting sensitive consumer data. Chatbots or advertising algorithms also may violate fair housing laws by steering consumers in protected classes toward certain listings, according to studies GAO reviewed and interviews with federal entities, selected companies, and other stakeholders. Fair lending and other consumer protection laws and regulations may apply to property technology products. With the exception of the Federal Housing Finance Agency (FHFA), agency oversight generally has not focused specifically on the products. FHFA—which examines Fannie Mae and Freddie Mac (enterprises)—has conducted examinations specifically focused on products such as automated mortgage underwriting systems and automated valuation models. The Consumer Financial Protection Bureau’s (CFPB) examinations of mortgage lenders could involve lenders’ use of technology but were not product-focused. The other three agencies in GAO’s review generally have not conducted product-specific oversight. In 2025, FHFA began implementing new priorities and responding to executive orders directing changes to certain policies and programs. FHFA made changes to its fair lending oversight program, including changing its examination approach, waiving components of its fair lending rule, and rescinding related guidance. Although the enterprises remain subject to fair lending and other consumer protection laws, FHFA has not communicated its revised compliance requirements or supervisory expectations. Given the extent of FHFA’s changes, providing additional written direction for the enterprises on the changes would help ensure the enterprises clearly understand FHFA’s compliance requirements and its supervisory expectations. This would help to ensure that the enterprises appropriately carry out requirements, which are intended to help promote sustainable housing opportunities for underserved communities. Why GAO Did This Study Property technology products have transformed homebuying. But their use of AI has raised questions about potential effects on homebuyers and the housing market, particularly regarding compliance with fair housing and other consumer protection laws. GAO was asked to review issues related to use and oversight of property technology products in the homebuying process. This report examines (1) the use of selected products, (2) their potential benefits and risks, and (3) agency oversight of compliance with fair lending and relevant consumer protection laws for the products. GAO focused on online real estate platforms, automated valuation models and underwriting systems, and electronic closing products, selected for their use at different stages of the homebuying process and potential risks they may pose to homebuyers. GAO conducted a literature review, reviewed industry and government reports, and examined relevant federal laws, regulations, and guidance. GAO also interviewed officials of five federal agencies—CFPB, Department of Housing and Urban Development, FHFA, Federal Trade Commission, and Department of Veterans Affairs—Fannie Mae and Freddie Mac; selected companies; and other stakeholders, chosen in part for their expertise and diverse characteristics.