A U.S. District Court has ordered HHS to turn over detailed Medicare physician claims that can be used to determine the specific amount Medicare reimburses individual providers.
In a 23-page opinion, the U.S. District Court for the District of Columbia ruled that HHS must honor an 18-month-old Freedom of Information Act request made by Consumers Checkbook/the Center for the Study of Services to turn over its 2004 claims data for Illinois, Maryland, Virginia, Washington, D.C., and Washington state. Additionally, the court said that HHS is prohibited from charging what the agency estimated would be close to $20,000 in fees because the requested information would contribute to the publics understanding of the operations of CMS and the Medicare program.
The Medicare physicians claim data can be compared against the CMS publicly available Medicare fee schedule to determine whether Medicare is paying providers who may not be qualified to perform certain procedures or who have exhibited poor quality-of-care practices.
The decision could open the floodgates for similar requests made from other groups. A CMS spokeswoman said that the agency is still reviewing the decision and has not decided whether it will appeal the order. -- by Matthew DoBias