Federal courts are preparing to decide whether private organizations can profit from copyrighting information that the government requires hospitals and insurers to use. PatientRightsAdvocate.org is suing the American Medical Association (AMA) and American Hospital Association (AHA) for the right to publish their billing code manuals online, arguing that gatekeeping access to legally mandated standards violates copyright law and constitutes trademark misuse.

The case hinges on a fundamental tension in intellectual property law: when does copyright protection end and public access begin? The AMA's Current Procedural Terminology (CPT) codes and the AHA's UB-04 manual are the backbone of how doctors and hospitals get paid within the nation's multi-trillion dollar healthcare system. Yet these standards are mandated under the Health Insurance Portability and Accountability Act (HIPAA) and programs like Medicare and Medicaid, raising questions about whether private organizations should be able to charge for access to information the government requires.

Why Does This Copyright Battle Matter?

The lawsuit touches on issues that extend far beyond medical billing. The intersection of intellectual property law and government regulation has rarely been tested in federal court with this level of clarity.

"You rarely get to see this interaction be dealt with in the court. So I would hope that this case is an opportunity to flush out the problems that arise," said Charles Duan.

Charles Duan, Assistant Law Professor at American University

PatientRightsAdvocate.org founder and chairman Cynthia Fisher framed the core issue this way:

"Nobody should have to pay a private gatekeeper to access binding legal standards. It would be as if the IRS required all taxpayers to purchase an official instruction manual every year from a private organization just to know how to fill out their tax forms," Fisher said.

Cynthia Fisher, Founder and Chairman at PatientRightsAdvocate.org

PatientRightsAdvocate.org is seeking declaratory judgment in separate lawsuits in the US District Court for the Northern District of Illinois, arguing that the medical groups' copyrights are invalid because the information is mandated under HIPAA and Medicare and Medicaid programs. They also contend that making the manuals freely available constitutes fair use, and that the AMA and AHA have misused their trademarks.

What Are the Legal Arguments on Both Sides?

The AMA and AHA argue that government adoption does not invalidate their intellectual property rights. They contend that they invest significant resources in developing and revising the codes each year, and that copyright protections ensure they can continue this work.

"We will vigorously defend the AMA's intellectual property rights to ensure the continued access physicians and patients rely on," an AMA spokesperson stated.

AMA Spokesperson

The two sides disagree fundamentally on what copyright should protect in this context. Industry groups say intellectual property protections are necessary to protect investments that produce the standards government relies on, while public advocates say they're illegally profiting from the law.

How Have Courts Handled Similar Cases?

The legal landscape is inconsistent. Courts have treated similar cases "often in ways that honestly are kind of inconsistent with each other," according to Duan. Here's what precedent shows:

• US Supreme Court (2020): Concluded that non-binding annotations to Georgia's public code were not copyrightable, weighing several factors about the government's involvement in their authorship and incorporation into law.
• Ninth Circuit (1997): Ruled that the AMA's copyright for its CPT codes wasn't invalidated after the federal government mandated their use in Medicaid, though it did agree that a contract provision prohibiting the government from using other codes constituted misuse.
• Fifth Circuit (2002): Ruled in Veeck v. S. Bldg. Code Cong. Int'l, Inc. that privately developed building standards adopted by the government weren't copyrightable, although the authors retained copyrights to the model codes.
• DC Circuit and Third Circuit (recent): The American Society for Testing and Materials lost one case at the DC Circuit and a preliminary motion at the Third Circuit over other organizations' publication of industry standards incorporated into law.

The inconsistency reflects a deeper problem: courts have not figured out how to separate the value of copyright protection from the value of standardization itself. Duan pointed to the AMA's $267.5 million in profits reported in 2025 from books and digital content, which includes but is not limited to CPT products. "That's not the value of their copyright. That's the value of the standardization," he explained.

Which Arguments Are Most Likely to Succeed?

James Gourley, partner at intellectual property firm Carstens, Allen & Gourley, said the court is most likely to accept the fair use argument.

"Invalidating copyrights is a little bit more extreme," noted Gourley, who won a case at the Fifth Circuit representing a Texas firm that reproduced safety standards from a Canadian nonprofit.

James Gourley, Partner at Carstens, Allen & Gourley

The AMA and AHA argue that making the manuals free would harm the revenue necessary to produce them. Legal experts say this argument is unlikely to sway the court. Courts have dismissed similar arguments as theoretical in cases where plaintiffs were unable to back them up with concrete evidence. "The model code drafters were not able to show any evidence of reduced sales or anything like that," Gourley explained.

Bernard Chao, co-director of University of Denver's IP and Technology Law Program, noted that the groups' other revenue streams undercut their theory of market harm.

"There's ways to make money that build upon the raw information that I would say is purely functional and necessary to interact with the government," Chao said.

Bernard Chao, Co-Director of IP and Technology Law Program at University of Denver

Steps Courts May Take to Reach a Middle Ground

Legal experts suggest the court could find a compromise that partially favors each side:

• Core Material Release: Allow PatientRightsAdvocate.org to publish the essential billing codes and instructions necessary to comply with government requirements and understand public pricing information.
• Supplementary Content Restriction: Block publication of extra guidance, commentary, or materials not completely necessary to satisfy the transparency mission, preserving some revenue streams for the AMA and AHA.
• Fair Use Determination: Rule that posting the codes online constitutes fair use under copyright law, even if the underlying copyrights remain technically valid.

Chao noted that "there may be material in the manuals not completely necessary to satisfy PRA's mission. The court could block PRA from posting extra guidance, for example, even if they win on the core material. To me that seems like that may be a distinction".

Chao

What Does This Reveal About Copyright in the Digital Age?

The case raises a fundamental question about what copyright is meant to protect. According to Duan, copyright is meant to protect the added value of a particular work in a competitive market, not the underlying idea itself. He used the Harry Potter book series as an example of healthy copyright competition.

"There are lots and lots of people who are writing books about magical boys who go to fancy schools, and that competition is what makes sure everybody tries their best to write the best story," Duan said.

Charles Duan, Assistant Law Professor at American University

The medical billing code case tests whether this principle applies when the government mandates a standard. If the court rules in favor of PatientRightsAdvocate.org, it could establish precedent that government-adopted standards cannot be copyrighted, even if they were privately developed. If it rules for the AMA and AHA, it reinforces the idea that private organizations can maintain copyright control over standards the government requires, as long as they can demonstrate ongoing investment in their development.

The outcome will likely influence how courts approach similar disputes involving intellectual property and government-mandated standards. The tension between private intellectual property rights and public access to information that shapes government policy remains unresolved, and this case offers federal courts a rare opportunity to clarify the boundaries.