A 30+ Year Injunction Vacated, the ACA To Thank

On May 31, the 11th Circuit Court of Appeals vacated a 30+ year injunction that prevented disclosure of Medicare claims data.  It did so in the name of the public's interest in increased transparency and the ACA's efforts to facilitate it. 

In 1979, a district court in Florida issued a permanent injunction against HHS (then the U.S. Department of Health, Education & Welfare) barring the department from releasing lists identifying physicians who received a certain level of Medicare reimbursements. Even though HHS had made such a disclosure two years prior and had amended its regulation to specifically allow such disclosures, the Florida court invoked an exemption from the the Freedom of Information Act and the Privacy Act to enjoin HHS from individually identifying how much specific physicians receive in Medicare payments. 

However, two years ago the court reopened the case.  When doing so, it allowed two key parties to intervene -- Real Time Medical Data, LLC, a company that uses Medicare claims data to assist hospitals with marketing and strategic planning, and Dow Jones and Company, Inc., which publishes The Wall Street Journal.  Both companies arguments pointed to changing times with regards to transparency.

Real Time Medical Data argued that since the 1979 ruling, there has been a shift in balance between physician privacy interests and the public interest in disclosure of Medicare reimbursement amounts.  To bolster that argument, it noted that a specific ACA-created program expressly permits disclosures of Medicare Part B (physician insurance) to qualified entities to generate provider performance reports. Qualified entities are companies, not unlike Real Time, who have been approved by The Centers for Medicare & Medicaid Services (CMS) to collect claims data for evaluating quality performance of providers and suppliers. 

Dow Jones made similar arguments, noting Medicare claims data could be invaluable in identifying fraudulent conduct of physicians and physician groups.

Although the court does not anticipate an immediate release of Medicare claims data after this ruling, it's cases like this one that are steps in the right direction -- toward a more transparent and palpable healthcare system.