Special Report: 4 ways Trump's win could affect the fight against healthcare fraud

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With Donald Trump’s surprise victory in the presidential election, along with a Republican-controlled House and Senate, it appears the Affordable Care Act’s days are numbered.

Republicans have been trying for six years to tear down President Barack Obama’s signature healthcare law, but it's still unclear how the ACA will be altered or repealed moving forward. Last week, Trump indicated he is willing to retain some parts of the ACA. Meanwhile, Republicans appear unable to agree on the best approach to dismantling the law.

President-elect Donald Trump
President-elect Donald Trump

The most obvious and important impact of any major health policy change is what it will do to those who are currently insured through ACA exchange plans and Medicaid expansion. But in the background, there is some uncertainty about what impact an ACA repeal--as well as a drastically different administration--could have on healthcare fraud enforcement and prevention efforts.

A number of provisions within the ACA significantly altered the government’s antifraud efforts, not the least of which was allocating $350 million to the Health Care Fraud Abuse Control (HCFAC) program over a 10-year period from fiscal years 2011 through 2020.

But the law also incorporated significant policy and administrative changes, including better pre-enrollment screening for providers, fingerprint-based background checks, requirements for healthcare companies to have more robust compliance programs, and new regulations that force providers to return overpayments within 60 days. The ACA also gave the Secretary of the Department of Health and Human Services greater authority to withhold payments to businesses investigated for fraud and issue a moratorium on new providers entering certain service areas in parts of the country where there are high rates of improper billing.  

The healthcare law also pushed fraud enforcement into the 21st century by opening up pathways to allow various federal agencies to share data, and giving the Department of Justice (DOJ) and the Office of Inspector General access to Medicare and Medicaid claims data, making it easier to identity and prosecute fraud.  

Dennis Jay

Fraud prevention is typically a bipartisan issue—both sides of the aisle can agree that cutting down on wasteful or improper spending benefits taxpayers. Still, the prospect of a repeal has left some nervous about the future of fraud enforcement, particularly after Trump’s surprise victory.

Hillary Clinton "obviously knows government and governance; she knows how to run things,” says Dennis Jay, executive director of the Coalition Against Insurance Fraud.

“We have no idea with Trump. We have no idea what people he’s going to be bringing in. He doesn’t have a long history of having a ton of aides or really smart people that know how government functions, so I think across government, there is that anxiety right now.”

The full impact on fraud programs won’t be known until Trump is officially inaugurated and begins restructuring the ACA, but click through the pages below for four ways that changes to the law and the administration could impact antifraud efforts.

Special Report: 4 ways Trump's win could affect the fight against healthcare fraud