Physicians' Medicare claims data could be made public after court ruling

June 4, 2013

A federal judge's decision last week that could result in individual doctors' Medicare claims data being made public - though the ruling does provide doctors with a degree of protection.

Doctors who fear big government intrusion into the practice of medicine may have just gotten something else to worry about.

A federal judge made a decision last week that could result in individual doctors' Medicare claims data being made public.

U.S. District Judge Marcia Morales Howard on Friday lifted a 1979 injunction that had barred public access to a confidential database of Medicare claims data. The American Medical Association (AMA), which opposes lifting the ban on the grounds of physician privacy, may appeal the ruling.

The AMA's leadership is meeting next week and is expected to discuss its next steps in the case, AMA spokesman Robert Mills said. Mills declined comment beyond a two-sentence statement that the AMA released on Friday.

"Medicine has stood its ground during the last 34 years to defend an injunction that favored individual rights and protected innocent physicians from becoming targets of suspicion," AMA President-elect Ardis Dee Hoven, MD, said in the statement. "The American Medical Association is considering its options on how best to continue to defend the personal privacy interests of all physicians."

Dow Jones & Co., which owns the Wall Street Journal, challenged the 1979 injunction, putting it in opposition to the AMA's position on the case.

Regardless of the AMA's decision on an appeal, the ruling does provide doctors with a degree of protection related to their Medicare claims data. To gain access to a physician's data, news organizations would have to file a Freedom of Information Act request with the federal government. Even then, the government could decide to deny those requests on a case-by-case basis, the Wall Street Journal reported.

It's unclear whether members of the non-news-media public would be able to obtain access to the data under any circumstances. A call to the Centers for Medicare & Medicaid Services (CMS) was not returned.

Dow Jones challenged the 1979 injunction after the Journal ran a series of articles a few years ago that uncovered tens of millions of dollars in fraud and abuse by physicians and other Medicare providers, Reuters reported. Those articles were unable to name any specific providers, due to the 1979 injunction's limitations on the release of individual physician Medicare data.

The American College of Physicians (ACP) declined to make a specific comment on the ruling or its implications for physicians. "Because ACP is reviewing the decision, we won't have reaction until we finish our analysis," a spokesman said. A spokeswoman for the American Academy of Family Physicians also declined comment on the case.

 

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