The Federal Court of Appeals in the Eleventh Circuit has vacated a lower court decision holding that a private company had a right to access Medicare claims data to hospitals through the Freedom of Information Act (FOIA). The appellate decision, handed down in December, has a significant impact on what Medicare data can be obtained by the public and then be used in a commercial manner, including the possibility of identification of reimbursement amounts to physicians.

The plaintiffs/appellees in the case--Jennifer D. Alley and Real Time Medical Data LLC, wanted to compel the United States Department of Health and Human Services (HHS) to disclose certain records under FOIA. HHS had argued that complying with the FOIA request violated an injunction issued in a much older case, Florida Medical Ass'n v. Department of Health Education & Welfare, 479 F. Supp. 1291 (M.D.F.L. 1979).

The appellate case, Alley v. United States HHS, 2009 U.S. App. LEXIS 27801 (11th Cir. 2009), stems from the District Court decision in Alley v. United States HHS, 2008 U.S. Dist. LEXIS 106884 (N.D. AL 2008).

As background, the Florida Medical case involved disclosure of information from the precursor to HHS-the Department of Health, Education and Welfare (HEW). In 1977, HEW had made public a list of the physicians and groups receiving large reimbursements from Medicare. This information was publicized in the media, despite inaccuracies found later. Nonetheless, HEW had directed continued publication of information from subsequent years. This information included the names of physicians and providers, their addresses, the net total amount of Medicare reimbursement paid and the net total amount of Medicare reimbursements paid to beneficiaries. While HEW did attempt to rectify the previous inaccuracies, in 1977 the Florida Medical Association and six individual physicians brought a class action suit to enjoin the scheduled disclosures. The AMA intervened as a plaintiff, which expanded the class of plaintiffs to include all physicians licensed to practice in Florida and all members of the AMA, if they were providers of Medicare services and would be individually identified by the HEW disclosure.

The plaintiffs in the Florida Medical case claimed that the disclosures would violate a federal privacy act, 5 U.S.C. 552a, and also fell under various FOIA exemptions including Exemption 6, which protects "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy." In balancing the private and public interests within the case, the Florida Medical court ultimately decided that no legitimate public interest would be advanced by knowing the identity of the providers and the amounts involved. Therefore, disclosure of the information was prohibited by the privacy act and FOIA exemptions. The injunction stated that any such disclosure of Medicare reimbursement for "any years" was prohibited.

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