Florida Medical Ass'n v. DEPT. OF HEALTH, ED., ETC.
| Decision Date | 22 October 1979 |
| Docket Number | No. 78-178-Civ-J-S.,78-178-Civ-J-S. |
| Citation | 479 F. Supp. 1291 |
| Parties | FLORIDA MEDICAL ASSOCIATION, INC., a Florida Corporation, on behalf of its members, Louis C. Murray, M.D., Jack McCris, M.D., Jere Annis, M.D., O. William Davenport, M.D., Robert E. Windom, M.D., and Charles H. Berchert, M.D., on behalf of themselves and all others similarly situated, Plaintiffs, and American Medical Association, on behalf of its members, and Robert B. Hunter, M.D., Frank J. Jirka, Jr., M.D., Lowell H. Steen, M.D., Harold Gurgone, Walter E. Schrange, Plaintiffs (Intervenors), and Broward County Medical Society, Amicus Curiae, v. DEPARTMENT OF HEALTH, EDUCATION & WELFARE, Patricia R. Harris, Secretary of Health, Education & Welfare, Blue Shield of Florida, Inc., a Florida Corporation, and Group Health, Inc., a Florida Corporation, Defendants. |
| Court | U.S. District Court — Middle District of Florida |
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William H. Adams, III, Peter L. Dearing, Stephen D. Lobrano, Jacksonville, Fla., for Florida Medical Assoc.
Newton N. Minow, Jack R. Bierig, Bernard D. Hirsh, B. J. Anderson, Chicago, Ill., for American Medical Assoc.
William DeF. Thompson, Fort Lauderdale, Fla., for amicus curiae.
John Power, Sr., Vice President Group Health, Inc., Coral Gables, Fla., for Group Health, Inc.
John Slye, Jacksonville, Fla., for Blue Shield of Florida.
Steve J. Cohen, Miami, Fla., for Broward County Medical Society.
Ernst D. Mueller, Asst. U. S. Atty., Jacksonville, Fla., for HEW.
Barbara Allen Babcock, Leonard Schaitman, Linda Cole, Terrence Jackson, Dept. of Justice, Washington, D. C., Henry R. Goldberg, Vicki Schulkin, Dept. of Health, Ed. & Welfare, Washington, D. C., for defendants.
This case presents the question whether the Secretary (`the Secretary') of the United States Department of Health, Education & Welfare (`HEW') may disclose information concerning the annual amounts of reimbursements paid to Medicare providers in a way that would individually identify at least some of those providers. This question carries with it a clash of two basic rights: (1) the right of citizens to have free access to knowledge about the operations of their government, and (2) their right to be free from unwarranted intrusions by the government into their personal lives and private affairs.
Plaintiff, Florida Medical Association (`FMA') is a voluntary, nonprofit professional association incorporated in the State of Florida. FMA's members are physicians licensed to practice medicine in Florida. FMA has more than 14,000 members who represent approximately 97% of practicing, licensed physicians in the State of Florida. The individual plaintiffs, Louis C. Murray, M.D., Jack McCris, M. D., Jere Annis, M. D., O. William Davenport, M. D., Robert E. Windom, M. D., and Charles E. Berchert, M. D., are physicians residing in the State of Florida and licensed to practice medicine in Florida. Defendant HEW, is an agency of the Executive Branch of the United States government. Defendant, Patricia R. Harris, is the current Secretary of HEW, and was automatically substituted pursuant to Fed.R.Civ.P. 25(d)(1) for Joseph A. Califano, Jr., the former Secretary of HEW. Defendants, Blue Shield of Florida, Inc., (`Blue Shield') and Group Health, Inc., (`Group Health') are Florida corporations licensed to do business in Florida as health insurers. Blue Shield has its principal place of business in Jacksonville, Florida. Broward County Medical Society (`BCMS') is a professional association of physicians practicing in Broward County, Florida, and has been permitted to appear as Amicus Curiae on behalf of plaintiffs in this case.
On April 28, 1978, a temporary restraining order was issued, which was extended on May 8, 1978. By agreement of the parties, the temporary restraining order remained in effect until the Court's ruling in this case or June 6, 1978, whichever occurred first. Plaintiffs' preliminary injunction motion was referred to, and heard by, the Magistrate who issued findings and recommendation on May 8, 1978. The parties filed written objections to those findings and recommendation, and the Court heard arguments concerning those objections on May 16, 1978. Additionally, the defendants and plaintiffs have filed cross-motions for summary judgment which are before the Court. Finally, the parties stipulated that the Court should consolidate its ruling on the merits in this case with its consideration of plaintiffs' preliminary injunction motion, pursuant to Fed.R.Civ.P. 65(a)(2). That stipulation provided that the Court, in ruling on the merits in this case, may consider all the evidence admitted at the hearing on plaintiffs' preliminary injunction motion before the Magistrate, as well as all of the pleadings and other documents in the record in this case.
Meanwhile, on June 12, 1978, the American Medical Association (`AMA'), on behalf of its members, and three individual physicians, as well as two individual patients, were all allowed to intervene as plaintiffs in this case against HEW and the Secretary. The AMA and the individual plaintiffs had ten days earlier commenced an action virtually identical to this one in the United States District Court for the Northern District of Illinois. A temporary restraining order against the Secretary had been issued on June 5, 1978, by the Northern District of Illinois, and extended on June 12, on the condition that the AMA and the individual plaintiffs "explore appearing in this case." The AMA is a national, voluntary professional association whose membership exceeds 200,000 licensed physicians in all 50 states, four territories, and the District of Columbia.
After the intervention of the AMA and the individual plaintiffs, the Court recertified this case as a class action, redefining the class in view of the additional plaintiffs who had been permitted to intervene. The recertified class is all physicians licensed to practice in Florida (including those who are members of the FMA and those who are not, and including those who are members of the AMA and those who are not) and all other members of the AMA who are not Florida physicians, if (1) they are providers of Medicare services within the meaning of the Medicare Act, and (2) they would be individually identified by the Secretary in a disclosure of annual Medicare reimbursement amounts. Florida Med. Ass'n v. HEW, 454 F.Supp. 326, 329 n. 4 (M.D.Fla. 1978), vac'd on other grounds 601 F.2d 199 (5th Cir. 1979).
Although by consent of the original parties, the temporary restraining order in this case had been extended through June 19, 1978, once the AMA and the new individual plaintiffs had intervened in this case, the Court issued a temporary restraining order on their behalf, which was extended for an additional ten days. In the interim, the Secretary had obtained extensions of time in which to file an additional memorandum of law. Faced with the likelihood that its limited subject matter jurisdiction might vanish by the Secretary's unrestrained disclosure of the information that he proposed to release, the Court, while waiting for the Secretary's memorandum of law, issued what it termed `an Ancillary Writ of Injunction' which the Court believed was derived from its ancillary jurisdiction attendant to the Court's original subject matter jurisdiction over this case, and from the Court's all writs jurisdiction under 28 U.S.C. § 1651(a). Since that time, however, the Fifth Circuit Court of Appeals has determined that the ancillary and all writs jurisdiction of the Court to fashion equitable, injunctive relief, is curtailed by the provisions and requirements for issuing temporary restraining orders and preliminary injunctions under Fed.R.Civ.P. 65. Florida Med. Ass'n v. HEW, 601 F.2d 199, 203 (5th Cir. 1979), vac'g 454 F.Supp. 326 (M.D.Fla.1978).
The federal program of health insurance for eligible aged and disabled persons is known as `Medicare'. 42 U.S.C. § 1395 et seq. The HEW Secretary is responsible for administering the Medicare program. Part A of the program1 provides hospital and medical care insurance for eligible beneficiaries.2 Part B3 furnishes voluntary supplemental medical insurance by reimbursing from federal funds up to 80% of the reasonable costs (reduced by an annual $60.00 deductible amount) of "providers of services"4 and other individuals supplying medical and health care services. The reimbursements are channeled from HEW through contracts with health insurance carriers (including the physical intermediaries under Part A of the program),5 such as defendants Blue Shield and Group Health.
Enrolled beneficiaries can submit two kinds of claims for reimbursement of reasonable health care costs: assigned and unassigned. Assigned claims are transferred to the provider or other individual (such as a physician) who renders health services. The provider or physician submits the claim for reimbursement of reasonable costs to a carrier; and, in accordance with the contract between the carrier and HEW, 80% of the reasonable costs are paid directly to the provider or physician. Unassigned claims are submitted by the patient to the carrier for reimbursement of 80% of the reasonable costs; but the patient must pay the physician or provider directly for the entire amount charged. The effect of the distinction between assigned and unassigned claims is that while a physician or provider is guaranteed payment for services under assigned claims, remuneration is limited to 80% of the reasonable costs; but, without the security of remuneration from federal funds, a physician or provider can require the full amount of charges under unassigned claims, although the patient is limited to reimbursement from the government of reasonable costs6 only.
All claims submitted, whether assigned or unassigned, include the names of the physicians...
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