As the FOIA Turns: Access to Physician Specific Medicare Payment Data

A lot has happened in health care since 1979 but one thing has been constant: Freedom of Information Act requests to the Centers for Medicare & Medicaid Services  for individual physician identified Medicare payment data have been denied. A 1979 United States Middle District of Florida injunction prohibiting the release of Medicare data that would identify specific physicians in the name of protection of physician privacy interests  (under the Privacy Act of 1974 and in response to Florida Medical Association, Inc. v. Dep't of HEW) was lifted in May of last year by Judge Marcia Morales Howard. As the Department of Health and Human Services' (and its predecessor agencies') position had always been that the departmental policy was in response to the FMA decision, a very longstanding injunction was ripe to be lifted.

The Dow Jones Company, parent of the Wall Street Journal,  along with the Center for Public Interest had fought for this access for years  as part of a campaign to promote the use of the data to expose fraud and abuse. 

The Centers for Medicare & Medicaid Services then sought public comment on the scope of data release, receiving numerous comments.  The American Medical Association, perhaps bowing to the now inevitable, focused on the "reliable and effective use of this information." This appears to have meant that the data should not be posted on along with other newly transparent health system data for for the public and the media to view via the internet.

On January 15 of this year came the news that CMS will, in a few months,  begin to respond to FOIA requests for Medicare physican payment data on an ad hoc basis using a balancing test focused on Medicare beneficiary privacy interests. Aggregated data will also begin to be made available.

Let the FOIA requests commence. We won't know what CMS has in mind until the Medicare payment data requests of long-gone journalists are renewed and the newly ad hoc responses are received.

x-posted at Prawfsblawg:


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