Tom Krause, NOSSCR Litigation Director

Almost anyone requesting medical records regularly has heard of Ciox Health, MRO, Smart Corp., MedSouth, or any of a dozen other copy services for health care providers. Often, the copy service charges (or, at least, tries to charge) outrageous fees for the records. Often, too, the excessive charges violate state or federal law and the copy service fails to provide the records timely and without prepayment.

It is time for a change. On March 25, 2024, NOSSCR filed a complaint against CIOX Health with the U.S. Department of Health and Human Services’ Office of Civil Rights, seeking to change some of these problems.

NOSSCR specifically claimed that CIOX Health’s practice was to require prepayment of fees, delaying the records and causing a considerable amount of wasted time on behalf of those requesting records. Also, federal law limits CIOX Health to “reasonable fees.” We contend any fee above what the state allows them to charge is “unreasonable.” Moreover, CIOX makes it difficult to correct their mistakes.

Systemic violations include:

a. Ciox Health has willfully neglected to provide requested PHI/medical records prior to payment, in violation of 45 C.F.R. § 164.524(b)(2);

b. Ciox Health has willfully neglected to provide adequate notice of the reason for failing to provide the requested PHI/medical records in violation of 45 C.F.R. § 164.524(d)(2)(i);

c. Ciox Health has willfully neglected to provide adequate notice of the individual’s review rights and/or how the individual may complain to the covered entity, in violation of 45 C.F.R. § 164.524(d)(2)(ii-iii); and

d. Ciox Health has willfully neglected to charge fees that are “reasonable,” including an excessive “basic fee,” “retrieval fee,” “per page copy fee,” “electronic data archive fee,” and charges in excess of that allowed by state law, in violation of 45 C.F.R. § 164.524(c)(4).

We could only do this with the assistance of NOSSCR members Beth Bates of West Tennessee Legal Services (and legal secretary Diana Wray) and Andrew Sindler of Severna Park, Maryland.

We continue to develop the evidence in this case. If you are interested in providing an Affidavit or Declaration and documentation (such as requests, invoices, and the like), PLEASE contact tom.krause@nosscr.org.