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How the Ciox case changed medical record requests

Laura F. Fryan ( is a Partner and Nicole Thorn ( is an attorney in the Akron, Ohio, office of Brouse McDowell.

In January 2020, the United States District Court for the District of Columbia handed down a ruling that completely changed the way healthcare providers could charge for medical records in certain instances, overruling longstanding guidance from the U.S. Department of Health & Human Services (HHS). Shortly afterward, the pandemic rocked the United States, and the impact of Ciox Health, LLC, v. Alex Azar[1] garnered very little attention. In reality, Ciox makes a substantial difference for healthcare providers and third-party record fulfillment vendors. It also highlights the nuances of state law in making decisions regarding how much to charge for medical record requests.

Ciox Health LLC is a national medical records provider that maintains, retrieves, and produces individuals’ protected health information (PHI). In March 2017, HHS notified CHI Health St. Francis of a patient complaint alleging that Ciox had charged an excessive fee for forwarding her electronic medical records to a law firm. HHS warned St. Francis that, as a result of Ciox’s actions, St. Francis may have violated the Privacy Rule, but the agency took no further action. On November 16, 2018, HHS advised Ciox that it had received another complaint. HHS demanded Ciox produce records to aid in HHS’s investigation. HHS later rescinded its record request, but Ciox filed suit against HHS claiming that it did not have the authority to expand what is known as the patient rate and its scope under the Health Information Technology for Economic and Clinical Health (HITECH) Act, the Omnibus Rule, and guidance from HHS in 2016.

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