Federal Agency Challenges Court Ruling on Medicare Claims Data

HHS has appealed a court decision that would require the agency to release Medicare physician claims data to a consumer organization that wants to make it available in an online database.

In late August, Consumers' Checkbook/Center for the Study of Services, won a freedom-of-information lawsuit against HHS that would have required the agency to release data about every physician claim paid by Medicare by Oct. 22. HHS appealed the decision on Oct. 19, sending the case to the U.S. Court of Appeals for the District of Columbia for a decision. The agency has said it would not release the data unless the court rules in favor of Consumers' Checkbook, and it is not clear when the appeals court will hear the case.

HHS is "fully committed to making available as much Medicare data as allowable by law," said Kevin Schweers, an HHS spokesperson in a prepared statement.

However, he added, HHS is caught between two court cases and two differing opinions -- the current case involving Consumers' Checkbook and a 1979 case in which the U.S. District Court for the Middle District of Florida ruled that the public concern was not advanced by revealing the identity of individual providers and their Medicare payments. Schweers said that HHS is working with the Justice Department to resolve the conflicting opinions.

Consumers' Checkbook wants to post the Medicare information in an online database that would allow patients to check the number and types of major procedures performed by physicians paid by Medicare. With this information, patients can gauge the experience level of individual physicians for various procedures, said Robert Krughoff, president of Consumers' Checkbook. He stressed that the information would identify only Medicare physicians, not patients -- an important consideration.

"It does not include any information that would make patients identifiable," Krughoff said.

Krughoff said that the appeal will "waste a lot of time and energy," and he told AAFP News Now that he thinks Consumers' Checkbook will win on appeal. Krughoff also said the appeal is "inconsistent with what HHS has been saying about its commitment to consumer information and transparency."