142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Compliance Programs after The Affordable Care Act

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Angela Mattie, MPH, JD , School of Business,Dept. Healthcare Management & Organizational Leadership, Quinnipiac University, East Haven, CT
Teresa Tai, Ph.D. , Quinnipiac University, Hamden, CT
Many view The Patient Protection and Affordability Care Act (“Act”) as legislation that primarily expanded insurance coverage for the uninsured.   The major provisions of this “Act” do focus on insurance expansion, however, the reform provisions of this “Act” include revisions and requirements for healthcare organizations’ compliance programs and activities.   These provision while receiving little or no media attention or health policy discussions are a Congressional attempt to weed out the billions of dollars of waste in our healthcare system.  Some experts indicate that this waste accounts for 100 billion of dollars lost each year to fraud and abuse in our healthcare system.

Historically, The Department of Health and Human Services, Office of Inspector General has published guidance to individual sectors of the healthcare field.   This guidance provided the framework for voluntary compliance programs for the healthcare industry.   The “Act” requires, for the first time, mandatory compliance programs to mitigate healthcare fraud and abuse.

This presentation will discuss and describe these provisions embedded in the Affordable Care Act.   The authors will also analyze the impact on the healthcare system and healthcare organizations.  The paper concludes with specific recommendations to the field for implementation of the compliance requirements of this “Act.”  Also, discussed are the gaps in requirements that remain for compliance-related mandates and recommendations for potential Congressional action.

Learning Areas:

Administration, management, leadership
Ethics, professional and legal requirements
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe and discuss compliance program mandates part of The Affordable Care Act; Analyze impact of these mandates on healthcare facilities; Identify steps to implement changes.

Keyword(s): Health Care Reform, Health Care Delivery

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: n/a

Qualified on the content I am responsible for because: I have experience in graduate course design and teaching in this area, publications related to this area, and professional experience encompassing this area. I co-founded and implemented a graduate compliance certificate program at Quinnipiac University and have served in professional positions related to healthcare quality and compliance. In addition, I have been a frequent presentor at APHA and other venues, a Robert Wood Johnson Health Policy Fellow and serve as a department chair.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.