Legal Advocacy
AARP Asks Court to Order Release of Medicare Data
AARP has filed a “friend of the court” brief in a case that challenges the U.S. Department of Health and Human Services’ refusal to make Medicare data publicly available.
The disputeIn March 2006, a consumer rights organization (Consumers’ Checkbook Center for the Study of Services) requested information from the Centers for Medicare and Medicaid Services (CMS), the division of the U.S. Department of Health and Human Services that oversees the nation’s two largest public heath programs. Consumers’ Checkbook was seeking records of all Medicare claims submitted by physicians in 2004 from a database maintained by CMS for five localities (Washington DC, Illinois, Maryland, Virginia, and Washington State).
CMS denied the Freedom of Information Act (FOIA) request, citing concerns about physician confidentiality because release of the information would allow the public to calculate some of the annual billings and receipts of participating physicians. Consumers’ Checkbook sued and a court ruled in its favor. The Court ruled that CMS had erroneously read narrow exceptions to FOIA’s general open-book policies regarding governmental records. The exceptions allowing government agencies to withhold information were designed to cover personnel and medical files and other strictly personal information.
The court ruled that here, the disclosure of information that Consumers’ Checkbook sought was not personal, but rather business information, and its release was in the public interest. Allowing the public a better understanding of the Medicare system would serve the core purpose of FOIA – that is, to enable public understanding of the operations or activities of government. Thus, the court ruled, the FOIA exceptions invoked did not apply. The agency appealed, and Consumers’ Checkbook v. U.S. Department of Health and Human Services is now before the U.S. Court of Appeals for the District of Columbia.
AARP’s briefAARP Foundation Litigation attorneys filed AARP’s brief, which emphasizes the importance in disclosure of Medicare claims data for individuals, providers, and for the government. The brief argues that transparency of health care quality and cost information is a necessary strategy to achieve high quality care because it allows patients to make choices among providers, allows meaningful feedback to providers whose quality of care falls short, provides a built-in incentive for providers to do the best job they possibly can, and by opening records to public review helps ensure the integrity of the billings and claims process.
AARP’s brief notes that transparency is particularly needed because the current state of publicly reported health care quality and cost information is inadequate with regard to physician-level data in the Medicare program, which has lagged behind private efforts to make physician-specific health care information more transparent.
The issue is important to AARP members because Medicare is the federal health insurance program for older Americans. It is also this country’s largest health insurance program, currently serving more than 43 million beneficiaries and processing more than one billion claims per year. Older people are especially vulnerable to the effects of poor care, both because the complexity and multiplicity of health issues tends to increase with age and because they are disproportionately more affected by secondary health issues (such as infections) if they do have to enter into a hospital or other institutional setting because substandard care has complicated their underlying conditions.
Contact persons:Stacy Canan
scanan@aarp.org Bruce Vignery bvignery@aarp.org (202) 434-2060 July 1, 2008