History Corner: Those Huge Free CMS Physician Payment Datasets - Where Did They Come From?
At Data.cms.gov, one of many data sets is complete 2013-2023 data on claims paid by Medicare Part B, by provider and by CPT code. "Provider" includes physicians, as well as independent labs. (Hospital labs are not included.)
Find the data here:
https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service
It's a little tricky at first to search and filter and download the data, but it just takes a little time and practice with the filter and download menus.
Where Did This Come From?
I "lived through this" - working in policy consulting since 2008, and especially, during the active years of court cases around 2010-2013.
I asked Chat GPT to write a history essay. It may not be perfect in detail, but gives you a good entry point.
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AI CORNER
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Here is a consolidated article based on your notes and prior research:
From Secrecy to Sunshine: The Legal Journey Behind CMS’s Physician Payment Data Releases (2013–2023)
In 2014, the Centers for Medicare & Medicaid Services (CMS) made a historic move: it released a massive public dataset detailing what individual physicians and other healthcare providers were paid by Medicare, broken down by CPT code, number of services, and total reimbursements. The data, covering payments for services rendered in 2012, marked a turning point in federal transparency. But the road to that moment spanned more than three decades of legal battles, privacy concerns, and shifting public policy.
The 1979 Injunction: A Curtain of Confidentiality
The story begins in the late 1970s, when the Department of Health, Education, and Welfare (now HHS) planned to release names and Medicare reimbursement amounts for physicians earning over $100,000. The Florida Medical Association (FMA), joined by the American Medical Association (AMA) and several individual physicians, sued to block the release.
In 1979, a federal court agreed with the physicians and issued a permanent injunction (Florida Medical Ass’n v. HEW, 479 F. Supp. 1291), citing FOIA Exemption 6, which protects personal privacy. The ruling barred HHS from disclosing any lists of Medicare reimbursement amounts that would identify physicians. For more than 30 years, this injunction sealed physician-level Medicare payment data from public view.
Early Challenges and the FOIA Push (2003–2011)
In 2003, Real Time Medical Data (RTMD), a private analytics firm, requested Medicare claims under the Freedom of Information Act (FOIA). HHS released limited data but withheld anything that could identify individual physicians, citing the 1979 injunction. A subsequent appeal by RTMD was rejected by the Eleventh Circuit Court, which upheld the injunction but suggested that the proper route was to challenge the injunction directly in the issuing court.
At the same time, the landscape was changing. Medicare was growing rapidly—both in cost and complexity—and concerns about fraud, waste, and provider overbilling were intensifying. Meanwhile, CMS was expanding its Health Data Initiative, releasing large datasets on hospital charges and quality measures. In this environment, the case for transparency gained traction.
Dow Jones and WSJ Enter the Fray
In 2011, Dow Jones & Company, parent of The Wall Street Journal, formally intervened in the 1979 case. Alongside RTMD, they argued that the injunction was outdated and inequitable. HHS also reversed its position and joined the effort to vacate the injunction, citing evolving FOIA case law and public interest arguments.
Dow Jones emphasized that Medicare had grown twenty-fold since 1979 and now represented a significant portion of the federal budget. They submitted expert declarations—such as that of Harvard’s Malcolm Sparrow—highlighting the public value of the data in uncovering Medicare fraud.
The Legal Turning Point: Injunction Vacated in 2013
On May 31, 2013, the U.S. District Court for the Middle District of Florida vacated the 1979 injunction. The court ruled that:
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The Privacy Act does not support long-term prospective injunctions against government agencies,
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Injunctive relief under the Act only applies in narrow circumstances (e.g., denying access to one’s own records),
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And broad “reverse FOIA” restrictions could harm the public interest.
The ruling didn’t mandate data release—but it removed the legal barrier. CMS was now free to decide whether to release physician-level payment data under FOIA standards.
CMS Requests Comments—and Signals Intent
In August 2013, CMS posted a Request for Public Comments, seeking input on how to balance physician privacy with public interest. The notice asked whether individual payment data should be released, how it might improve healthcare delivery, and what formats would best serve researchers and stakeholders. CMS emphasized its alignment with the Obama administration’s data transparency agenda and its goal to reduce waste and abuse.
The First Release: April 2014
On April 9, 2014, CMS released physician-level Medicare payment data for calendar year 2012. The dataset included over 880,000 individual providers, listing:
The dataset covered physicians, nurse practitioners, podiatrists, and independent labs.
WSJ Leads the Media Response
The Wall Street Journal was the first major news outlet to fully capitalize on the release. It built a searchable interactive database that allowed the public to look up any physician by name or NPI, view their most common procedures, and compare billing patterns.
The WSJ's investigative coverage spotlighted top billers, regional anomalies, and specialties with unusually high payments (e.g., ophthalmology and oncology). Its reporting series included:
Impact and Backlash
The release was praised by watchdogs, policymakers, and health economists for its potential to:
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Uncover fraud and overutilization
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Encourage provider accountability
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Inform research on spending patterns
But the medical community pushed back. The AMA and other groups warned that the data lacked nuance. Gross payments didn’t reflect provider costs, group practice billing, or medically necessary high volumes. There were concerns about reputational harm and patient confusion.
A New Era of Data Transparency (2014–2023)
Despite the controversy, CMS affirmed its intent to release physician-level data annually. Each year since 2014, CMS has published updated datasets, now covering services from 2013 through 2023. These releases are hosted at data.cms.gov and have become essential tools for:
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Journalists
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Academic researchers
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Policy analysts
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Healthcare watchdogs
The data has been used to flag inappropriate billing, compare specialties, and inform healthcare reform discussions.
Each year's data appears about 18 months after the close of the year. At least in part, because physicians have one year to submit final claims as each year closes in December.
Conclusion
The release of Medicare physician payment data was not a one-time event—it was the product of a 35-year legal journey that pitted privacy against transparency. Thanks to media pressure, shifting FOIA jurisprudence, and CMS’s evolving role in healthcare stewardship, the 2014 release marked the beginning of an ongoing transformation in how government healthcare data is shared.
Today, what was once legally forbidden is a public resource. The result is a new era in which anyone—from a patient to a policymaker—can explore how billions in Medicare funds are spent, one CPT code at a time.
