Policy: Law

Center for Public Integrity sues in an effort to make Medicare Advantage files public

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Health Care,Medicare and Medicaid,Entitlements,Center for Public Integrity,Law,Transparency,FOIA

This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.

The Center for Public Integrity has sued the U.S. Department of Health and Human Services, seeking a wide range of records concerning oversight of Medicare Advantage health insurance plans for senior citizens.

The suit, filed today in U.S. District Court in Washington under the Freedom of Information Act, argues that officials have yet to release any documents sought by the Center for more than a year. Federal law generally requires a response within 20 working days.

"The information about Medicare Advantage that we are asking for should be readily available to the taxpaying public. There's no excuse for  ignoring our request," said Bill Buzenberg, the Center's Executive Director.

Medicare Advantage, a privately-run alternative to standard Medicare, has enrolled nearly 16 million elderly and disabled persons at an annual cost expected to top $150 billion. The plans have been popular with seniors because they often provide extra benefits, such as eyeglasses and dental care, and can cost patients less than standard Medicare.

But the industry also has been a frequent target of government auditors and other critics who argue that federal officials overpay the plans by billions of dollars every year.

As part of a Center investigation into the billing issue, senior reporter Fred Schulte requested records from the Centers of Medicare and Medicaid Services (CMS), an arm of HHS, in a May 21, 2013, letter. The letter asked for copies of program audits, billing data and the identities of any health plans suspected of overcharging the government. The Center did not request the names of patients. The results of the investigation will be published next month.

On June 7, 2013, Michael Marquis, who directs the CMS Freedom of Information division, acknowledged receiving the request. But since then, the agency has produced no materials. "Plaintiffs have a statutory right to the requested records, and there is no legal basis for Defendant’s failure to make them available," the lawsuit states.

It is the second time the Center for Public Integrity has sued the Medicare agency to compel disclosure of billing data and other records. In a 2009 case, the Center, in partnership with The Wall Street Journal, sued to obtain Medicare billing records for thousands of doctors and hospitals. The records were used in a number of articles, including the 2012 series Cracking the Codes, which disclosed how thousands of doctors had steadily billed higher fees for office visits and other routine medical services, adding at least $11 billion dollars to Medicare costs. CMS has since made public physician billing records prompting media outlets to report similar stories.

Copyright 2014 The Center for Public Integrity

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