Camperlengo v. Blum, 56 N.Y.2d 254 (1982)
The physician-patient privilege does not provide absolute protection to a doctor’s treatment records of Medicaid patients when those records are subpoenaed by the State Department of Social Services during a billing practices investigation.
Summary
This case addresses the conflict between physician-patient privilege and the state’s need to investigate potential Medicaid fraud. A psychiatrist, Camperlengo, faced a subpoena for patient records due to unusual billing patterns. He argued the records were protected by physician-patient privilege. The court held that while the privilege exists, it is abrogated to the extent necessary for effective Medicaid oversight. This exception is narrowly tailored to ensure funds are properly used and patient confidentiality is maintained as much as possible. The ruling balances patient privacy with the public interest in preventing Medicaid fraud, allowing access to records directly relevant to administering the program.
Facts
A psychiatrist, Camperlengo, treated Medicaid recipients. The State Department of Social Services noticed consecutive billing dates for some patients, which they considered unusual. The Department requested access to the psychiatrist’s records to check for unnecessary treatment or fraudulent billing. The psychiatrist’s initial cooperation was insufficient, leading the Department to issue a subpoena duces tecum for records of 35 Medicaid patients. The subpoena sought treatment plans, evaluations, diagnostic records, and payment records from third parties.
Procedural History
The psychiatrist moved to quash the subpoena in the Supreme Court. The Supreme Court denied the motion. The Appellate Division affirmed the Supreme Court’s decision.
Issue(s)
Whether the physician-patient privilege under CPLR 4504(a) protects a psychiatrist’s treatment records of Medicaid patients from a subpoena issued by the State Department of Social Services during an investigation of billing practices.
Holding
No, because the Federal and State record-keeping and reporting requirements of the Medicaid program demonstrate a clear intention to abrogate the physician-patient privilege to the extent necessary to ensure proper application of Medicaid funds.
Court’s Reasoning
The court acknowledged the physician-patient privilege, a statutory creation designed to protect patient confidentiality and encourage open communication with doctors. The court stated, “to protect those who are required to consult physicians from the disclosure of secrets imparted to them; to protect the relationship of patient and physician and to prevent physicians from disclosing information which might result in humiliation, embarrassment, or disgrace to patients”. However, the court also noted that the legislature has, in some instances, abrogated this privilege to effectuate other public policies, such as preventing child abuse or treating narcotic addiction.
The court then examined the Medicaid program, which uses public funds and requires accountability. Federal regulations (42 U.S.C. § 1396a(a)(27)) mandate that states participating in Medicaid have agreements with service providers to keep records fully disclosing the services provided and to furnish the state agency with information regarding payments claimed. New York regulations (18 NYCRR 540.7(a)(8)) also require providers to keep such information available for at least six years after payment.
While there is no explicit statutory exception to the physician-patient privilege for Medicaid records, the court found that the federal and state record-keeping requirements demonstrate a clear intention to abrogate the privilege to the extent necessary for effective Medicaid oversight. The court emphasized that this exception is limited to ensuring Medicaid funds are properly applied. Confidentiality is maintained through restrictions on the use of the information, limiting its use to purposes directly connected with administering the Medicaid program. As the court explained, “the public must be assured that the funds which have been set aside for this worthy purpose will not be fraudulently diverted into the hands of an untrustworthy provider of services”.