In business, ROI often is shorthand for return on investment, but in healthcare, it also can mean release of information.
Manhattan lawyer Lowell Sidney got a shock when the mail delivered a weighty package containing 1,758 pages of his 71-year-old client's medical records for which ROI costs were $2,693.68, including shipping and handling.
The charges were based on a payment rate of $1.50 a page, the suit alleges.
That's double the $0.75 per page rate limit set by New York and a violation of state law, Sidney said. And at those prices, Sidney said the goods were thoroughly scrutinized.
“They charged me not only for the HIPAA authorization,” his client had signed, “but the cover letter that I sent them,” Sidney said.
Sidney said he paid the tab, then filed a class-action suit against Columbia Presbyterian Medical Center and IOD Inc., of Green Bay, Wis., a document management vendor that provided release of information services for the New York City hospital.
The suit claims through the plaintiffs' “wrongful and unlawful conduct” they've received “substantial profits and windfalls” and have been “unjustly enriched at the expense of plaintiff and members of her class.”
This isn't a malpractice case, Sydney stressed, at least not against the hospital, part of the New York Presbyterian Healthcare System. He said clinicians provided “top notch” care to his client, Vicky Ortiz, after she arrived there by ambulance from a rehab center where she was mistreated, according to Sidney.
“The only allegation is that the administrators and the vendor they chose are running -- I don't know what it is," Sydney said. "It's extortion. They have a monopoly on the medical records. If I don't pay, I don't get the medical records.”
The complaint alleges thousands of individuals have been similarly overcharged for copies of their records.
“I predict I will be adding many more defendants to this list,” Sidney said. After news of the suit had broken in the New York newspapers, "an attorney called me yesterday and said he paid $2.25 a page,” Sidney said. “I think it's rampant in the industry.”
And in fact, a recent JAMA article discussed the financial and convenience barriers to obtaining medical records.
Sidney might be right.
The Office for Civil Rights at HHS last year issued guidance to providers suggesting that a flat fee of $6.50 for digital records, no matter their size, is appropriate.
“Most hospitals have outsourced their release of information to third parties,” said Kathy Downing, senior director for information governance to the American Health Information Management Association, a professional organization for medical records workers and managers. “Third parties are unhappy about this (OCR) guidance because they make their money by charging as much as they can to attorneys and third-party requesters.
But, Downing said, “A person has a right to direct their information to another person. They shouldn't be charged more because they want the information to go to an attorney.”
Columbia Presbyterian and IOD, which merged in 2016 with three other companies to become Ciox, based in Alpharetta, Ga., did not respond to requests for comment at deadline.