Consumers' Checkbook Loses Appeal in Medicare Data Case

By Admin on February 02, 2009 | Last updated on March 21, 2019

In a blow to a consumer group and its efforts to make physicians Medicare claims information more transparent, a federal court of appeals has ruled that a consumer group is not entitled to access to a set of records on Medicare claims from the government that it had requested. The AP reported that the case was seen as "an important battle in the effort to remake the nation's health care system to provide higher quality service and waste less" and was "being closely watched by employers, insurers and consumer advocates".

The lawsuit was brought by Consumers' Checkbook, Center for the Study of Services (CSS), which is a nonprofit consumer organization that analyzes the quality and prices of local service firms and stores, such as auto repair shops, plumbers, dentists, banks, and insurance companies. It sued under a federal law known as the Freedom of Information Act and asked for records for all Medicare claims submitted to the United States Department of Health and Human Services by physicians in several areas during 2004. Consumers' Checkbook wanted this information so that they could analyze physicians' performance and rate individual doctors, as it does with other providers of services.

Although Consumers' Checkbook succeeded in lower court getting an order to release the records, late Friday an appellate court concluded that the records at issue could not be obtained because "physicians have a substantial privacy interest in the total payments they receive from Medicare for covered services." The court rejected Consumers' Checkbook's claims that the public's interest in the documents justified their release. It simply didn't buy into the group's claims that the release of documents would help in assessing the efficiency and quality of services provided under Medicare or that it would help detect possible fraud and waste in the industry.

In the end, the court said that the information Consumers' Checkbook wanted simply did not serve any qualifying "public interest" in disclosure, much less one that could outweigh physicians' own "substantial privacy interest".

AP: Appeals court rejects disclosure of Medicare data
U.S. Court of Appeals for the D.C. Circuit's Opinion (FindLaw)
Must HHS release physician-specific Medicare data to public? (Contemporary OB/Gyn)
HHS forced to release physician Medicare data (FierceHealthcare.com)