Journalists sue HHS for access to Medicare Advantage data

Last year, the U.S. Department of Health and Human Services (HHS) made Medicare hospital payment data public, followed this year by individual physician payment data. Now journalists want data on the private Medicare Advantage plans and have filed suit to get it.

The nonprofit Center for Public Integrity investigative news organization, based in Washington, D.C., is behind the suit filed in the U.S. District Court in Washington under the Freedom of Information Act. In the suit, the Center complains that HHS has failed to respond to its now 1-year-old request for documents on program audits, billing data and the identities of any Medicare Advantage health plans suspected of overcharging the government. Under Federal law, HHS and the Centers for Medicare and Medicaid Services (CMS) should have responded within 20 working days with the actual requested documents, not just an acknowledgement of having received the request, and the Center wants the court to order HHS and CMS to hand over the documents.

“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 on its website.

Because insurers that offer Medicare Advantage plans to seniors must negotiate rates individually with healthcare providers, the rates they pay for healthcare services are generally considered to be somewhat higher than those paid by traditional fee-for-service Medicare. The government offsets this by paying more per beneficiary for those with Medicare Advantage plans, a practice some see as wasteful. Indeed, the Affordable Care Act mandates steep cuts to government Medicare Advantage payments to make them more equal to traditional Medicare. However, the insurance industry has so far been able to largely hold back these mandated cuts by arguing that it would hurt seniors enrolled in the popular plans.

The American Hospital Association fought the release of hospital payment data and the American Medical Association did the same for the release of individual physician payment data over concerns that the complexity of the U.S. healthcare payment system would be difficult to convey in news articles for the public, and therefore the cost data would be widely misinterpreted. The insurance industry, having watched what happened to hospitals and physicians after the release of their payment data may well have similar concerns for the release of data on Medicare Advantage.

The suit filed by the Center is available as a PDF on its website.