Physician-specific Medicare Claim Data Could Be Released

Physicians’ claims payments by Medicare may become public record thanks to a Florida Federal District Judge’s vacating a 34-year-old injunction against releasing the information.

The injunction prevented information regarding how much Medicare money physicians received from being released after the Department of Health and Human Services’ (HHS) predecessor, Health, Education, and Welfare (HEW) released 1975 and 1977 data. Judge Marcia Morales Howard ruled May 31st that the Privacy Act-based argument under which the injunction was enacted was no longer in consumers interest.  Plaintiff in the case was Dow Jones’ Wall Street Journal, which had published a series of articles about Medicare fraud but could not name specific physicians because of the injunction.

Recently, CMS released the payments made to hospitals by procedure by state, revealing significant disparity.

While physicians and other providers lack enthusiasm for release of the data, feeling it would be misunderstood and misused by the public, advocates and others say access to the data allows consumers to compare physicians’ and other providers’ on quality, cost, and wasteful care. The Affordable Care Act—or Obamacare—and the Centers for Medicare and Medicaid rely heavily on this information to achieve successful implementation.

Health IT Strategist said, proponents of releasing the data argue it could help identify patterns of waste and fraud and help patients and insurance companies find doctors who deliver the most efficient and highest quality care. But medical groups have successfully fought to keep the payment information secret, saying it would violate physicians’ privacy rights to disclose their Medicare claims data.

Howard said in her decision that the injunction was “outdated and overly broad” as a result of judicial rulings on the federal Privacy Act since 1979. “It is evident that the Privacy Act no longer authorizes any of the injunctive relief granted in the 1979 FMA injunction, much less the permanent ongoing prospective relief at issue here,” she wrote.

The American Medical Association’s AMedNews said physicians’ Medicare data will not become available immediately. Media outlets and other interested parties will need to make Freedom of Information Act requests to access the data, and HHS still will have the option to deny the requests. The ruling does not invalidate the HHS policy aimed at protecting physician privacy rights. That policy states that “the public interest in the individually identified payment amounts is not sufficient to compel disclosure in view of the privacy interests of the physicians found compelling by the courts.”

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