Ciox Health v. Azar (2020) & Medical Record Copying Fee Schedules Explained
Why the federal court ruling in Ciox Health, LLC v. Azar, 435 F. Supp. 3d 30 (D.D.C. 2020) eliminated the $6.50 HITECH fee cap for third-party law firm requests—and how state statutory fee schedules vs. direct patient requests work today.
Quick-Reference Facts: Ciox v. Azar & Record Fee Schedules
- Case Citation
- Ciox Health, LLC v. Azar, 435 F. Supp. 3d 30 (D.D.C. Jan. 23, 2020) (Judge Amit P. Mehta).
- HHS OCR Notice
- HHS Office for Civil Rights 'Important Notice Regarding Individuals' Right of Access to Health Records' (Jan. 28, 2020).
- What Was Vacated
- (1) The 2016 HHS guidance extending the HIPAA 'Patient Rate' (45 CFR § 164.524(c)(4)) to third-party directives, and (2) the expansion of the HITECH third-party directive rule beyond records kept in an EHR.
- What Remains Valid Law
- The HIPAA Patient Rate (reasonable cost-based labor fee or optional $6.50 flat-fee election, with $0 search fees) STILL applies whenever records are requested by and provided directly to the individual patient.
Medical Record Copying Fee Rules After Ciox Health, LLC v. Azar (2020)
| Scenario | Who Receives the Delivery? | Governing Fee Law Post-2020 | Are Search / Clerical Fees Allowed? |
|---|---|---|---|
| Patient Direct Access Request | Delivered directly to the patient's email, portal, or home address | Federal HIPAA Patient Rate (45 CFR § 164.524(c)(4)) — Cost-based labor only (or optional $6.50 flat election) | NO — Prohibited by 45 CFR § 164.524(c)(4) |
| Third-Party Directive (EHR Only) | Patient directs provider to send EHR records to a law firm | State Statutory Copying Fee Schedule (Ciox v. Azar vacated the federal Patient Rate for 3rd parties) | Yes, up to the State Statutory Search Fee Cap |
| Third-Party HIPAA Authorization (45 CFR § 164.508) | Law firm, insurer, or retrieval vendor submits signed HIPAA release | State Statutory Copying Fee Schedule | Yes, up to the State Statutory Search Fee Cap |
Why Outdated 'HITECH $6.50' Letters Get Rejected by Hospitals and Ciox/MRO Today
Between 2016 and January 2020, personal injury attorneys across the country sent 'HITECH Third-Party Directive' letters signed by their clients demanding that hospitals and Ciox Health send electronic PDFs to the law firm for $6.50. On January 23, 2020, in Ciox Health, LLC v. Azar, 435 F. Supp. 3d 30 (D.D.C. 2020), the U.S. District Court for the District of Columbia ruled that HHS exceeded its statutory authority in 2016 when it extended the HIPAA 'Patient Rate' cap to third-party directives. Five days later, on January 28, 2020, HHS OCR formally announced that the cost-based fee limitation in 45 CFR § 164.524(c)(4) applies ONLY when an individual requests access for themselves. Consequently, when records are sent to a law firm, state statutory copying fee caps govern.
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