Shteynshlyuger v. Centers for Medicare and Medicaid Services

CourtDistrict Court, District of Columbia
DecidedSeptember 30, 2023
DocketCivil Action No. 2020-2982
StatusPublished

This text of Shteynshlyuger v. Centers for Medicare and Medicaid Services (Shteynshlyuger v. Centers for Medicare and Medicaid Services) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shteynshlyuger v. Centers for Medicare and Medicaid Services, (D.D.C. 2023).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

ALEX SHTEYNLYUGER,

Plaintiff,

v. Civil Action No. 20-2982 (RDM) CENTERS FOR MEDICARE AND MEDICAID SERVICES, et al.,

Defendants.

MEMORANDUM OPINION AND ORDER

Plaintiff Alex Shteynlyuger, a “licensed physician and a specialist in health economics,”

Dkt. 1 at 2 (Compl. ¶ 2), submitted eight requests for records to the Centers for Medicare and

Medicaid Services (“CMS” or “the agency”) between April 2020 and July 2020. Dkt. 28-3 at 2

(Gilmore Decl. ¶ 5). Unsatisfied with the agency’s responses as of October 16, 2020, Plaintiff

filed this suit under the Freedom of Information Act (“FOIA”), 5 U.S.C. § 552(a)(4)(B).

Now before the Court are the parties’ cross-motions for summary judgment. See Dkt. 28,

31. At issue is the adequacy of the search CMS conducted in response to Plaintiff’s FOIA

requests, and its decisions to withhold certain records pursuant to FOIA Exemptions 4, 5, and 6.

For the reasons that follow, the Court will DENY CMS’s motion for summary judgment and will

GRANT in part and DENY in part Plaintiff’s motion for summary judgment.

I. BACKGROUND

A. Factual Background

Plaintiff submitted eight FOIA requests to CMS in 2020. Dkt. 28-3 at 2 (Gilmore Decl.

¶ 5). CMS is a federal agency within the U.S. Department of Health and Human Services that,

1 among many other duties, is responsible for enforcing the “administrative simplification

standards from the Health Insurance Portability and Accountability Act of 1996” (“HIPAA”).

Id. (Gilmore Decl. ¶ 6). “The Administrative Simplification process aims to save time and

money by streamlining communication around billing and insurance related tasks. All HIPAA

covered entities (which include health care providers that transmit transactions electronically,

health plans, and clearinghouses) must comply with the Administration Simplification process.”

Id. at 6–7 (Gilmore Decl. ¶ 20).

Plaintiff’s FOIA requests seek records “pertaining to the enforcement of HIPAA’s

administrative simplification requirements . . . including [those pertaining to] electronic

transactions, such as . . . [electronic funds transfer (“EFT”)] transactions.” Dkt. 1 at 1 (Compl.

¶ 1). Specifically, the requests seek all records relating to several FAQs discussing EFTs, Dkt.

28-3 at 4 (Gilmore Decl. ¶ 14), complaints involving certain specific HIPAA covered entities, id.

at 26 (Gilmore Decl. ¶ 65), “the CMS investigation of covered entities, including health plans,

clearinghouses, and business associates charging fees to conduct standard transactions,” id. at 35

(Gilmore Decl. ¶ 85), “[c]ommunications to and from the US Congress . . . related to fees to

conduct standard transactions (EFT, ERA), and use of virtual credit cards or payment cards,” id.

at 20 (Gilmore Decl. ¶ 48), “standards for healthcare attachment transactions and electronic

signatures,” id. at 42 (Gilmore Decl. ¶ 108), and finally, “price setting, cost reimbursement, fee

schedule allowable amount setting for Medicare reimbursement, APC code

selection, . . . comparative clinical effectiveness research (CER) or analysis, cost-effective[ne]ss

analysis, effect on cost of care for BPH; [and] . . . determination of maximum lifetime

reimbursement quantity that involve” certain therapies or treatments, id. at 39 (Gilmore Decl.

¶ 97).

2 In response to these requests, CMS conducted eight searches, which the Court

summarizes in some detail due to the nature of the parties’ arguments regarding the adequacy of

those searches.

1. April 13, 2020 FOIA request

On April 13, 2020, Plaintiff submitted his first FOIA request to CMS, seeking “all

records” from January 1, 2015 to April 10, 2020 regarding “CMS EFT FAQ FAQ22297 (FAQ

22297), CMS FAQ22285 (FAQ 22285), CMS FAQ22281 (FAQ 22281), CMS FAQ22297 (FAQ

22297)” (the “April 13 FOIA request”). Dkt. 28-5 at 1. In that request, Plaintiff stated that the

“[O]ffice of the CMS Administrator,” the “Office of Strategic Operations and Regulatory

Affairs” (“OSORA”), and the “Office of Information Technology[’s] Program Management and

National Standards Group [(“PMNSG”)] may have responsive records,” but noted that

“additional offices may have responsive records as well.” Dkt. 28-5 at 1–2. Plaintiff also stated

that certain CMS employees he listed “have intimate knowledge of the responsive documents”

and thus were likely custodians of responsive records. Id. at 2.

After reviewing Plaintiff’s April 13 FOIA request, CMS “sent . . . [the] request to two

different entities:” to OSORA and PMNSG (which due to a reorganization within CMS, became

NSG on June 23, 2020). Dkt. 28-3 at 6–7 (Gilmore Decl. ¶¶ 19, 21). OSORA was tasked with

conducting an automated search for records because “Plaintiff sought EFT

FAQ . . . information . . . as well as correspondence to CMS about these FAQ[s],” and “CMS’s

correspondence unit . . . is under OSORA.” Id. at 9 (Gilmore Decl. ¶ 24). OSORA searched its

Strategic Work Information Folder Transfer System (“SWIFT”) database, which “contains

copies of incoming correspondence to the CMS Administrator and leadership.” Id. (Gilmore

Decl. ¶ 25). The search terms used in OSROA’s search of its SWIFT system were “EFT,”

3 “FAQ,” “22297,” “22285,” and “22281.” Id. OSORA also searched the SWIFT system “using

the names of the CMS Administrator and leadership because Plaintiff’s April 13 FOIA request

provided names of custodians some of whom were in the NSG and OSORA Offices.” Id. at 9–

10 (Gilmore Decl. ¶ 26). Those search terms were “Slavitt,” “Verma,” “Tavenner,” “CIO,” and

“CMS Principal Deputy Administrator.” Id.

The April 13 FOIA request was also sent to NSG “because Plaintiff sought information

on EFT transactions which are covered by the Administrative Simplification process of HIPAA,”

and NSG “is the entity [that] develops regulations and policies to implement and support the

Administrative Simplification process,” including “sub-regulatory guidance about EFT

transactions.” Id. at 6–7 (Gilmore Decl. ¶ 20). CMS contends that “it was logical to believe that

if responsive records existed, the NSG would be the appropriate entity to have records that could

be responsive to Plaintiff’s April 13 FOIA [r]equest.” Id. at 8 (Gilmore Decl. ¶ 22).

NSG “initiated an automated search in the ASETT system with the timeframe [of]

January 1, 2015 through April 10, 2020.” Id. (Gilmore Decl. ¶ 23). The ASETT system, or

Administrative Simplification Enforcement and Testing Tool system, “is a web-based

application which enables individuals or organizations to file a complaint against a HIPAA

covered entity for potential non-compliance” and it “allows all HIPAA related transactions to be

checked consistently for compliance, syntax and business rules.” Id. at 7 (Gilmore Decl. ¶ 21).

NSG’s search of the ASETT system used the keywords “EFT,” “FAQ,” “22297,” “22285,” and

“22281.” Id. at 8 (Gilmore Decl. ¶ 23).

In addition, because NSG was previously a “subsidiary” of the Office of Information

Technology (“OIT”), “OIT also searched records related to its employees, including employees

of NSG” that were mentioned in Plaintiff’s FOIA request. Id. at 10 (Gilmore Decl. ¶ 27). The

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