New President, Let’s Talk Compliance and the Affordable Care Act!

photo of the white house

New Administration

The results are in and we have a new President-elect. Both candidates were faced with addressing a critical issue – healthcare and its costs. Although there are different approaches to what that could mean, the simple fact still holds true – change is coming to healthcare, once again.

But what kind of changes and what the impact will be remains to unfold. One thing is certain though, compliance is here to stay and no matter what Congress chooses to do with the Affordable Care Act (ACA), it would be hard pressed to go backwards when it comes to the “teeth” in the law that surrounds compliance and best practice for a safe healthcare environment.

Back to the Beginning

To underscore what compliance will likely look like under a new administration, it would be prudent to go to the origins of compliance in healthcare. There are so many laws that set the stage for a compliant healthcare organization. These laws address fairness, the avoidance of kick-backs or referrals for a fee, as well as, making sure that the right and qualified people who practice medicine or related services in healthcare remain continuously qualified, licensed and in good standing.

The SSA Section 1128, et. al., and False Claims Act provisions were put into place irregardless and prior to the passage of the ACA. They provide the bedrock for a healthcare environment that is free from undue influence and provides rules surrounding the avoidance of fraud and abuse. These remain unchanged by any repeal or replacement of the ACA.

In fact the OIG for HHS has been tasked with ferreting out fraud and abuse for decades. In the early 1990’s the OIG developed the List of Excluded Individual and Entities (LEIE). The purpose of the LEIE was and is to make it easy for healthcare compliance and HR departments to search for and against a federal list of persons or entities that are excluded, and thus no federal healthcare dollars (Medicare, Medicaid, TriCare or CHIPS) payments can be made to reimburse the company for those services or items billed.


Good governance and compliance is a mainstay. It will and has survived decades of Republican or Democrat Presidents and even Congress shifts in makeup. So, although parts of the ACA regarding insurance mandates, coverage and funding may be subject to debate and modification with the incoming administration, compliance and exclusion monitoring is here to stay.

Written by Michael Rosen, ESQ
ProviderTrust Co-Founder,

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
Connect with Michael on Linkedin

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