Ban On Disclosure Of Information On Medicare Reimbursements Lifted

June 7th, 2013 by Qui Tam

In the 1970’s, the Florida Medical Association and individual physicians filed suit objecting to the release of a list by the U.S. Department of Health and Human Services identifying physicians or practices which received annual payments of $100,000 or more in Medicare reimbursements.  On October 22, 1979, a federal district court judge found that the doctors’ privacy interests outweighed the public’s interest in disclosure and prohibited the Department from revealing “any …. annual Medicare reimbursement amounts, for any years, in a manner that would personally and individually identify the providers.”  

Dow Jones, the publisher of the Wall Street Journal, challenged this ban in 2009 and sought access to the information stating that it had “essentially limitless potential to help expose fraud, waste, and abuse in the Medicare system.  Dow Jones’ suit was settled in January of 2010 under terms which allowed Dow Jones and the non-profit Center for Public Integrity to purchase a portion of the file containing all billings for a randomly selected 5% of Medicare recipients. A series of articles later appeared in the Wall Street Journal reporting on possible fraud and waste by Medicare providers. 

Dow Jones and another company, Real Time Medical Data – which uses Medicare data to help hospitals with marketing and strategic planning – subsequently moved to intervene in the Florida case.  Dow Jones argued that the 1979 injunction interfered with its ability to report on Medicare while Real Time Medical Data claimed that the public had an interest in the information given the billions of dollars which are spent in connection with Medicare.  According to Dow Jones and Real Time Medical Data, access to the reimbursement data could help expose Medicare fraud.  Dow Jones also argued that, “….the privacy interests of physicians no longer clearly outweigh the compelling public interest in monitoring a program that now consumes one out of every eight federal dollars.”  The court agreed and the 33 year old injunction has now been lifted.

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