Austin Court of Appeals holds Medicaid claim information is not protected and potentially subject to disclosure under Public Information Act

 

Ken Paxton, Attorney General of the State of Texas v. Texas Health and Human Services Commission 03-15-00652-CV (Tex.App. – Austin, December 14, 2017)

This is a Public Information Act (“PIA”) lawsuit where the Austin Court of Appeals reversed the granting of a summary judgment in favor of the Commission and remanded the matter back to the trial court.

Texas Health and Human Services Commission (“HHSC”) received a PIA request for healthcare-service providers’ Medicaid claims for reimbursement.  HHSC asserted the names of, or any information concerning, persons applying for or receiving Medicaid assistance is confidential. The AG issued an opinion the information must be released because it does not identify the individuals from whose claims the information is derived and, thus, is not “any information concerning” Medicaid applicants or recipients.  After opposing summary judgments, the trial court ruled for HHSC that the information was excepted from disclosure. The AG appealed.

HHSC is charged with supervising the administration and operation of the Texas Medicaid program.  The specific Medicaid-claim information requested was “date of service; procedure code; claim status; billed amount; paid amount; provider name and ID; provider codes; and billing entity.” The AG agreed the claim numbers were protected, but the remainder of the information must be released. Tex. Hum. Res. Code § 12.003 states the names and “any information concerning persons applying for or receiving [Medicaid] assistance” are confidential. The statutory construction in this case centered on the phrase “any information concerning” Medicaid recipients. HHSC asserts that since the claim payment information is derived from individual patient treatments, it qualifies as “any information concerning” the recipient. However, the panel disagreed. The fact the information requested is necessarily taken from individuals’ Medicaid files is not dispositive. The court analyzed the sentence structure, but held the requirement it read the statute liberally to promote disclosure should win out.  Section 12.003, therefore, expresses an intent to shield only that information in Medicaid records that names or refers to Medicaid applicants or recipients—i.e., identifies the applicants or recipients, discloses their personal information, or could be used to identify them. However, the court held the AG did not negate the fact the information could be used to derive the identity of a recipient. Therefore, it remanded the case.

Jusice Bourland dissented noting the phrase “any information concerning” is broad and the principles of statutory construction as well as the plain meaning favor a board reading. Courts should not ignore the plain language of the text in favor of liberal PIA construction. Her dissent can be found here.

If you would like to read the majority opinion click here. Panel consists of Chief Justices Rose, Pemberton, and Bourland. Memorandum Opinion by Justice Rose. To see the attorneys listed for the Appellants and Appellee click here.