The American healthcare system may have its flaws, but at least we used to have access to information about what those flaws were. In March 2016, the Supreme Court handed down a ruling that could detrimentally impact our ability to see comprehensive data about the healthcare sector as a whole.
Supreme Court Sides with Liberty Mutual
Federal programs like Medicare require participating providers to submit claim information to a national database. It was previously the case in 18 states around the country that private insurers and healthcare providers had to submit that information as well. Thanks to a lawsuit filed by Liberty Mutual, that is no longer the case in any state.
Liberty Mutual argued that as a nationwide company, it shouldn’t be required to adhere to different disclosure laws in different states. The company is a self-insurer, meaning that it pays out-of-pocket for its employees’ healthcare claims.
The Supreme Court ultimately sided with the Liberty Mutual, aided by the precedent of a 1974 law that applied to self-insuring companies. That law, the Employee Retirement Income Security Act of 1974 (ERISA), does not require self-insurers to disclose that data.
How This Ruling Impacts Nationwide Data Collection
Without data from self insurers and private healthcare companies, it may be very difficult to have a clear picture of healthcare spending and overall trends in the industry.
This ruling provides a gateway for other companies to refuse to submit their healthcare data to national disclosure systems.
Healthcare data can be used to see where inappropriately high reimbursements are being given, and it helps regulators flag doctors and other healthcare providers who consistently submit suspicious claims.
Whistleblower Attorney James Young expresses similar concerns about this ruling. “It is disappointing to see one of the advantages in the Affordable Care Act being largely washed away by the Supreme Court in this ruling,” Young explains.
“The Affordable Care Act promised improvements in health care delivery and efficacy through the use of analytics of large data sets. Perhaps Congress will pass laws or agencies will pass rules to offset the situation but for now we are stuck relying on Medicare data which has serious demographic limitations.”