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Based on the historical foundations of American higher education, there are a number of references in the literature to important milestones relating to institutional quality and accountability, particularly with regard to program review, evaluation, assessment and accreditation. And even though accreditation did not exist as we know it in higher education’s earliest history, it is still possible to identify those developments that were precursors to contemporary practices in accreditation and assessment. Through the use of appropriate citation of researchers and writers on the issues of institutional quality and accountability, this article critically discusses how these early developments influenced the growth of accreditation and quality assurance as they are conceptualized and practiced today. This essay also discusses why there has never been complete government control over higher education and accreditation in the United States of America, even though recent developments around the Reauthorization of Higher Education Amendments tend to lean more and more in such a direction.