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Hollabaugh v. MRO Corporation, No. 27, September Term, 2024.","paragraph_id":"para_1"},{"text":"CONFIDENTIALITY OF MEDICAL RECORDS ACT – STATUTORY","paragraph_id":"para_2"},{"text":"STANDING – MOTION TO DISMISS","paragraph_id":"para_3"},{"text":"The Confidentiality of Medical Records Act provides that a “health care provider or any","paragraph_id":"para_4"},{"text":"other person who knowingly violates any provision” of the Act is “liable for actual","paragraph_id":"para_5"},{"text":"damages.” Although the petitioner and cross-respondent was not the party who made the","paragraph_id":"para_6"},{"text":"request or paid the fee to the provider, she alleged in her complaint that she reimbursed her","paragraph_id":"para_7"},{"text":"attorney in full for the payment made. At the motion to dismiss stage, the petitioner’s","paragraph_id":"para_8"},{"text":"allegations created a reasonable inference of facts sufficient to support her standing.","paragraph_id":"para_9"},{"text":"CONFIDENTIALITY OF MEDICAL RECORDS ACT – STATUTORY","paragraph_id":"para_10"},{"text":"INTERPRETATION – FEE FOR RETRIEVAL AND PREPARATION","paragraph_id":"para_11"},{"text":"The Confidentiality of Medical Records Act seeks to protect the privacy of patients and","paragraph_id":"para_12"},{"text":"maintain the confidentiality of medical records by establishing rules for health care","paragraph_id":"para_13"},{"text":"providers’ maintenance and disclosure of those records. As part of that statutory scheme,","paragraph_id":"para_14"},{"text":"the Act establishes that the providers may charge a reasonable cost-based fee to certain","paragraph_id":"para_15"},{"text":"persons for copying and providing information requested, and it authorizes and caps certain","paragraph_id":"para_16"},{"text":"types of fees, including “a preparation fee not to exceed $22.88 for medical record retrieval","paragraph_id":"para_17"},{"text":"and preparation.” The plain meaning and statutory context of that provision confirm that","paragraph_id":"para_18"},{"text":"health care providers may not charge a preparation fee for a search that does not result in","paragraph_id":"para_19"},{"text":"copying and providing the information requested.","paragraph_id":"para_20"},{"text":"Circuit Court for Baltimore County","paragraph_id":"para_21"},{"text":"Case No. C-03-CV-22-003166","paragraph_id":"para_22"},{"text":"Argued: April 7, 2025","paragraph_id":"para_23"},{"text":"IN THE SUPREME COURT","paragraph_id":"para_24"},{"text":"OF MARYLAND","paragraph_id":"para_25"},{"text":"No. 27","paragraph_id":"para_26"},{"text":"September Term, 2024","paragraph_id":"para_27"},{"text":"______________________________________","paragraph_id":"para_28"},{"text":"JANICE HOLLABAUGH","paragraph_id":"para_29"},{"text":"v.","paragraph_id":"para_30"},{"text":"MRO CORPORATION","paragraph_id":"para_31"},{"text":"______________________________________","paragraph_id":"para_32"},{"text":"Fader, C.J.,","paragraph_id":"para_33"},{"text":"Watts,","paragraph_id":"para_34"},{"text":"Booth,","paragraph_id":"para_35"},{"text":"Biran,","paragraph_id":"para_36"},{"text":"Gould,","paragraph_id":"para_37"},{"text":"Eaves,","paragraph_id":"para_38"},{"text":"Killough,","paragraph_id":"para_39"},{"text":"JJ.","paragraph_id":"para_40"},{"text":"______________________________________","paragraph_id":"para_41"},{"text":"Opinion by Fader, C.J.","paragraph_id":"para_42"},{"text":"______________________________________","paragraph_id":"para_43"},{"text":"Filed: July 10, 2025","paragraph_id":"para_44"},{"text":"The General Assembly enacted the Confidentiality of Medical Records Act,","paragraph_id":"para_45"},{"text":"Md. Code Ann., Health-Gen. §§ 4-301 – 4-310 (2023 Repl.; 2024 Supp.), to protect the","paragraph_id":"para_46"},{"text":"privacy of patients and maintain the confidentiality of medical records by establishing rules","paragraph_id":"para_47"},{"text":"for the maintenance and disclosure of those records. As part of that scheme, the","paragraph_id":"para_48"},{"text":"Confidentiality Act establishes a right of access for certain persons who request in writing","paragraph_id":"para_49"},{"text":"to see, receive, or copy records. The Act permits health care providers to charge limited","paragraph_id":"para_50"},{"text":"fees to certain persons for copying and providing the information requested, one of which","paragraph_id":"para_51"},{"text":"is a “preparation fee” not to exceed $22.88 for medical record “retrieval and preparation.”","paragraph_id":"para_52"},{"text":"At issue here is whether a health care provider may charge that fee for conducting a search","paragraph_id":"para_53"},{"text":"that does not lead to the production of any medical records. We hold that the","paragraph_id":"para_54"},{"text":"Confidentiality Act does not permit a fee in that circumstance.","paragraph_id":"para_55"},{"text":"BACKGROUND","paragraph_id":"para_56"},{"text":"A. Factual Background1","paragraph_id":"para_57"},{"text":"In February 2020, Janice Hollabaugh, the petitioner and cross-respondent,","paragraph_id":"para_58"},{"text":"authorized her attorney to request her medical records from a health care provider for use","paragraph_id":"para_59"},{"text":"in pursuing personal injury claims. That provider contracted with MRO Corporation, the","paragraph_id":"para_60"},{"text":"respondent and cross-petitioner, to fulfill the request. MRO then sent Ms. Hollabaugh’s","paragraph_id":"para_61"},{"text":"attorney a document titled “Cancellation Invoice.” The ambiguously written document","paragraph_id":"para_62"},{"text":"1 Because Ms. Hollabaugh appeals the circuit court’s grant of a motion to dismiss,","paragraph_id":"para_63"},{"text":"we “assume the truth of, and view in a light most favorable to the non-moving party, all","paragraph_id":"para_64"},{"text":"well-pleaded facts and allegations contained in the complaint, as well as all inferences that","paragraph_id":"para_65"},{"text":"may reasonably be drawn from them[.]” RRC Northeast, LLC v. BAA Maryland, Inc., 413","paragraph_id":"para_66"},{"text":"Md. 638, 643 (2010).","paragraph_id":"para_67"},{"text":"2","paragraph_id":"para_68"},{"text":"states: “Your request for Medical Records has been cancelled. The medical facility has","paragraph_id":"para_69","court_paragraph":2},{"text":"completed the search and retrieval of the requested records. This invoice is for the","paragraph_id":"para_70"},{"text":"Search/Retrieval Fee if applicable in your state.” It is unclear why MRO identified the","paragraph_id":"para_71"},{"text":"request as being canceled, but it is plain from the allegations in the complaint that the","paragraph_id":"para_72"},{"text":"request was canceled by MRO and not by Ms. Hollabaugh or her attorney.","paragraph_id":"para_73"},{"text":"Although MRO did not produce any records, it charged Ms. Hollabaugh’s counsel","paragraph_id":"para_74"},{"text":"a fee of $22.88 “for searching for her Medical Records.” Ms. Hollabaugh’s attorney paid","paragraph_id":"para_75"},{"text":"the fee, and she reimbursed him in full.","paragraph_id":"para_76"},{"text":"B. Procedural History","paragraph_id":"para_77"},{"text":"In August 2022, Ms. Hollabaugh filed a putative class action lawsuit in the Circuit","paragraph_id":"para_78"},{"text":"Court for Baltimore County. Count I of the first amended complaint alleges that the fee","paragraph_id":"para_79"},{"text":"MRO charged for searching for her medical records violates § 4-304(c) of the Health-","paragraph_id":"para_80"},{"text":"General Article, which is the provision of the Confidentiality Act authorizing, among other","paragraph_id":"para_81"},{"text":"things, the $22.88 fee for record “retrieval and preparation.”2 She seeks damages equal to","paragraph_id":"para_82"},{"text":"the alleged overpayment.","paragraph_id":"para_83"},{"text":"After an unsuccessful attempt to remove the case to federal court, MRO moved to","paragraph_id":"para_84"},{"text":"dismiss, arguing among other things that § 4-304(c) authorizes a fee for records searches","paragraph_id":"para_85"},{"text":"that do not result in the production of records, and that Ms. Hollabaugh lacks standing to","paragraph_id":"para_86"},{"text":"2 The complaint also alleges violations of the Maryland Consumer Protection Act","paragraph_id":"para_87"},{"text":"and the Maryland Consumer Debt Collection Act, and requests a declaratory judgment and","paragraph_id":"para_88"},{"text":"“money had and received,” in addition to actual damages. Those claims are not at issue in","paragraph_id":"para_89"},{"text":"this appeal.","paragraph_id":"para_90"},{"text":"3","paragraph_id":"para_91"},{"text":"sue because her attorney, not Ms. Hollabaugh herself, made the records request and paid","paragraph_id":"para_92","court_paragraph":3},{"text":"the fee. The circuit court determined that Ms. Hollabaugh had standing but concluded that","paragraph_id":"para_93"},{"text":"§ 4-304(c) authorized MRO’s fee. The circuit court thus granted MRO’s motion to dismiss.","paragraph_id":"para_94"},{"text":"The Appellate Court of Maryland affirmed on both issues. Hollabaugh v. MRO","paragraph_id":"para_95"},{"text":"Corp., No. 1049, Sept. Term, 2023, 2024 WL 2858350, at *1 (Md. App. June 6, 2024).","paragraph_id":"para_96"},{"text":"The court held that Ms. Hollabaugh had standing, id. at *3-4, but it determined that","paragraph_id":"para_97"},{"text":"§ 4-304(c) authorized MRO’s search fee, id. at *10. Although the court concluded that","paragraph_id":"para_98"},{"text":"both parties proposed facially reasonable interpretations of the statute, it determined that","paragraph_id":"para_99"},{"text":"Ms. Hollabaugh’s reading was inconsistent with the statute’s stated “purpose” to permit","paragraph_id":"para_100"},{"text":"providers to charge a “reasonable cost-based fee” for record retrieval and preparation. Id.","paragraph_id":"para_101"},{"text":"at *5-10.","paragraph_id":"para_102"},{"text":"We granted Ms. Hollabaugh’s petition for a writ of certiorari to decide whether the","paragraph_id":"para_103"},{"text":"Confidentiality Act authorizes MRO’s search fee, and we granted MRO’s cross-petition on","paragraph_id":"para_104"},{"text":"the issue of whether Ms. Hollabaugh has standing to raise that claim.","paragraph_id":"para_105"},{"text":"STANDARD OF REVIEW","paragraph_id":"para_106"},{"text":"This Court reviews without deference the grant of a motion to dismiss for failure to","paragraph_id":"para_107"},{"text":"state a claim. Elsberry v. Stanley Martin Cos., LLC, 482 Md. 159, 178 (2022). In its","paragraph_id":"para_108"},{"text":"review, the Court “must assume the truth of, and view in a light most favorable to the non-","paragraph_id":"para_109"},{"text":"moving party, all well-pleaded facts and allegations contained in the complaint, as well as","paragraph_id":"para_110"},{"text":"all inferences that may reasonably be drawn from them[.]” RRC Northeast, LLC v. BAA","paragraph_id":"para_111"},{"text":"Maryland, Inc., 413 Md. 638, 643 (2010).","paragraph_id":"para_112"},{"text":"4","paragraph_id":"para_113"},{"text":"DISCUSSION","paragraph_id":"para_114","court_paragraph":4},{"text":"I. STATUTORY BACKGROUND","paragraph_id":"para_115"},{"text":"The Confidentiality Act seeks to protect the privacy of patients and ensure the","paragraph_id":"para_116"},{"text":"accuracy and confidentiality of medical records by establishing “clear and certain rules”","paragraph_id":"para_117"},{"text":"for health care providers’ maintenance and disclosure of records. See 1990 Md. Laws, Ch.","paragraph_id":"para_118"},{"text":"480 (preamble). The Act’s preamble identifies the policy concerns underlying it, including","paragraph_id":"para_119"},{"text":"the significant emotional and financial harm that may result from improper use or","paragraph_id":"para_120"},{"text":"disclosure of records and patients’ need to access records so as “to make informed","paragraph_id":"para_121"},{"text":"decisions concerning their health care” or to correct inaccurate or incomplete information","paragraph_id":"para_122"},{"text":"about themselves. See id. The Act regulates a wide swath of conduct related to the","paragraph_id":"para_123"},{"text":"maintenance and disclosure of medical records, including confidentiality requirements","paragraph_id":"para_124"},{"text":"(Health-Gen. §§ 4-302, 4-307); permitted, mandatory, and good faith disclosure (id.","paragraph_id":"para_125"},{"text":"§§ 4-305, 4-306, 4-308); authorization for disclosure (id. § 4-303); operations related to","paragraph_id":"para_126"},{"text":"the State-designated health information exchange (id. § 4-302.3); the establishment of a","paragraph_id":"para_127"},{"text":"Protected Health Care Commission (id. § 4-310); and, as most relevant here, fees that may","paragraph_id":"para_128"},{"text":"be charged for accessing records (id. § 4-304(c)).","paragraph_id":"para_129"},{"text":"Section 4-304 of the Confidentiality Act governs medical records requests. Section","paragraph_id":"para_130"},{"text":"4-304(a) establishes a right of access to certain medical records for “person[s] in interest,”","paragraph_id":"para_131"},{"text":"which includes, among other people, an “adult on whom a health care provider maintains","paragraph_id":"para_132"},{"text":"a medical record” and “an attorney appointed in writing” by such an adult, id.","paragraph_id":"para_133"},{"text":"§ 4-301(n)(1), (6). With some exceptions, a health care provider is required to comply","paragraph_id":"para_134"},{"text":"5","paragraph_id":"para_135"},{"text":"with a request from a person in interest to receive a copy of a medical record.3 Id.","paragraph_id":"para_136","court_paragraph":5},{"text":"§ 4-304(a)(1)(i)-(ii).","paragraph_id":"para_137"},{"text":"Section 4-304(c) regulates the fees a provider may charge for complying with such","paragraph_id":"para_138"},{"text":"a request. Pursuant to subsection (c)(2), a private provider may require a person in interest","paragraph_id":"para_139"},{"text":"“to pay for the cost of copying . . . a reasonable cost-based fee for providing the information","paragraph_id":"para_140"},{"text":"requested.” Id. § 4-304(c)(2)(ii). Subsection (c)(3) then identifies the specific types and","paragraph_id":"para_141"},{"text":"amounts of fees a provider may charge a person in interest “for a copy of a medical","paragraph_id":"para_142"},{"text":"record[,]” separately addressing hard copy and electronic records. Id. § 4-304(c)(3)(i). For","paragraph_id":"para_143"},{"text":"hard copy records, subsections (c)(3)(i) and (ii) authorize three fees: (1) “a fee for copying","paragraph_id":"para_144"},{"text":"and mailing not exceeding 76 cents for each page of the medical record”; (2) “a preparation","paragraph_id":"para_145"},{"text":"fee not to exceed $22.88 for medical record retrieval and preparation”; and (3) “[t]he actual","paragraph_id":"para_146"},{"text":"cost for postage and handling of the medical record[.]”4 For electronic records, subsection","paragraph_id":"para_147"},{"text":"(c)(3)(iii) similarly authorizes three fees: (1) “[a] preparation fee not to exceed $22.88 for","paragraph_id":"para_148"},{"text":"electronic format medical records retrieval and preparation;” (2) “[a] per-page fee of 75%","paragraph_id":"para_149"},{"text":"of the per-page fee charged [for hard copy records] that may not exceed $80;” and (3) “[t]he","paragraph_id":"para_150"},{"text":"3 Section 4-304(b) requires providers to “establish procedures for a person in interest","paragraph_id":"para_151"},{"text":"to request an addition to or correction of a medical record,” and requires providers, within","paragraph_id":"para_152"},{"text":"a reasonable time, to make the requested change(s) or provide a detailed written notice of","paragraph_id":"para_153"},{"text":"refusal to the person in interest, among other things. Health-Gen. § 4-304(b).","paragraph_id":"para_154"},{"text":"4 It is not readily apparent how the “mailing” portion of the 76-cent per-page fee for","paragraph_id":"para_155"},{"text":"“copying and mailing” and the separate fee for the “actual cost for postage and handling”","paragraph_id":"para_156"},{"text":"interact.","paragraph_id":"para_157"},{"text":"6","paragraph_id":"para_158"},{"text":"actual cost for postage and handling[.]”5 At issue here is the $22.88 “preparation fee” for","paragraph_id":"para_159","court_paragraph":6},{"text":"“medical records retrieval and preparation,” which is identical for hard copy and electronic","paragraph_id":"para_160"},{"text":"medical records.6","paragraph_id":"para_161"},{"text":"5 The full text of subsection (c)(3) is:","paragraph_id":"para_162"},{"text":"(3)(i) Except as provided in subparagraph (iii) of this paragraph, for a copy","paragraph_id":"para_163"},{"text":"of a medical record requested by a person in interest or any other authorized","paragraph_id":"para_164"},{"text":"person under paragraph (2)(ii) of this subsection, a health care provider may","paragraph_id":"para_165"},{"text":"charge a fee for copying and mailing not exceeding 76 cents for each page of","paragraph_id":"para_166"},{"text":"the medical record.","paragraph_id":"para_167"},{"text":"(ii) In addition to the fee charged under subparagraph (i) of this","paragraph_id":"para_168"},{"text":"paragraph, a hospital or a health care provider may charge:","paragraph_id":"para_169"},{"text":"1. Subject to the fee limitations that apply to persons in interest","paragraph_id":"para_170"},{"text":"under 45 C.F.R. 164.524 and any guidance on those limitations issued","paragraph_id":"para_171"},{"text":"by the U.S. Department of Health and Human Services, a preparation","paragraph_id":"para_172"},{"text":"fee not to exceed $22.88 for medical record retrieval and preparation;","paragraph_id":"para_173"},{"text":"and","paragraph_id":"para_174"},{"text":"2. The actual cost for postage and handling of the medical record.","paragraph_id":"para_175"},{"text":"(iii) Subject to the fee limitations that apply to persons in interest under 45","paragraph_id":"para_176"},{"text":"C.F.R. 164.524 and any guidance on those limitations issued by the U.S.","paragraph_id":"para_177"},{"text":"Department of Health and Human Services, a hospital or a health care","paragraph_id":"para_178"},{"text":"provider that uses or maintains the requested medical records in an","paragraph_id":"para_179"},{"text":"electronic format may charge for an electronic copy of a medical record","paragraph_id":"para_180"},{"text":"in an electronic format requested by a person in interest or any other","paragraph_id":"para_181"},{"text":"authorized person:","paragraph_id":"para_182"},{"text":"1. A preparation fee not to exceed $22.88 for electronic format","paragraph_id":"para_183"},{"text":"medical records retrieval and preparation;","paragraph_id":"para_184"},{"text":"2. A per-page fee of 75% of the per-page fee charged by a health care","paragraph_id":"para_185"},{"text":"provider under subparagraph (i) of this paragraph that may not exceed","paragraph_id":"para_186"},{"text":"$80; and","paragraph_id":"para_187"},{"text":"3. The actual cost for postage and handling of the electronic format","paragraph_id":"para_188"},{"text":"medical records.","paragraph_id":"para_189"},{"text":"Health-Gen. § 4-304(c)(3).","paragraph_id":"para_190"},{"text":"6 Section 4-304(c)(4) allows the fees authorized under (c)(3) to be “adjusted","paragraph_id":"para_191"},{"text":"annually for inflation in accordance with the Consumer Price Index,” except for the fee for","paragraph_id":"para_192"},{"text":"7","paragraph_id":"para_193"},{"text":"II. STANDING","paragraph_id":"para_194","court_paragraph":7},{"text":"We begin with MRO’s contention that Ms. Hollabaugh lacks standing to bring her","paragraph_id":"para_195"},{"text":"claim because her attorney, rather than Ms. Hollabaugh herself, requested her records and","paragraph_id":"para_196"},{"text":"paid MRO’s fee. “A litigant must have standing to maintain a judicial action.” Long Green","paragraph_id":"para_197"},{"text":"Valley Ass’n v. Bellevale Farms, Inc., 432 Md. 292, 313 (2013). “Standing, in its most","paragraph_id":"para_198"},{"text":"conventional sense, refers primarily to who may ‘invoke the judicial process in a particular","paragraph_id":"para_199"},{"text":"instance.’” In re Jacobson, 256 Md. App. 369, 393-94 (2022) (quoting State Ctr., LLC v.","paragraph_id":"para_200"},{"text":"Lexington Charles P’ship, 438 Md. 451, 502 (2014)). A plaintiff’s standing “may be","paragraph_id":"para_201"},{"text":"grounded on a statute conferring a legal interest or privilege.” Long Green Valley Ass’n,","paragraph_id":"para_202"},{"text":"432 Md. at 313.","paragraph_id":"para_203"},{"text":"Ms. Hollabaugh’s claim is grounded in the Confidentiality Act, which regulates the","paragraph_id":"para_204"},{"text":"fees health care providers may charge persons in interest to comply with medical records","paragraph_id":"para_205"},{"text":"requests, Health-Gen. § 4-304(c), and provides, in § 4-309(f), that “[a] health care provider","paragraph_id":"para_206"},{"text":"or any other person who knowingly violates any provision” of the Confidentiality Act is","paragraph_id":"para_207"},{"text":"“retrieval and preparation” of a medical record in hard copy or electronic format under","paragraph_id":"para_208"},{"text":"(c)(3)(ii) and (iii). Health-Gen. § 4-304(c)(4)(i)-(ii). The remaining provisions in","paragraph_id":"para_209"},{"text":"subsection (c) further adjust, limit, or prohibit fees in specific circumstances. See id.","paragraph_id":"para_210"},{"text":"§ 4-304(c)(5) (prohibiting fees when the request is made for the purpose of filing or","paragraph_id":"para_211"},{"text":"appealing certain Social Security claims), (6) (prohibiting fees when the request is made","paragraph_id":"para_212"},{"text":"by a government unit or agency or court-appointed guardian ad litem in criminal or juvenile","paragraph_id":"para_213"},{"text":"delinquency proceedings), (7) (prohibiting a fee greater than $20 per 100 pages for","paragraph_id":"para_214"},{"text":"individuals enrolled in the Maryland Medical Assistance Program), (8) (prohibiting","paragraph_id":"para_215"},{"text":"persons or entities not subject to the subsection and who obtain medical records from","paragraph_id":"para_216"},{"text":"charging a fee greater than those listed in (c)(3)(i)). Subsection (c)(5) was added to § 4-304","paragraph_id":"para_217"},{"text":"in 2021. 2021 Md. Laws, Ch. 157. The law is otherwise unchanged from when","paragraph_id":"para_218"},{"text":"Ms. Hollabaugh’s attorney requested her records.","paragraph_id":"para_219"},{"text":"8","paragraph_id":"para_220"},{"text":"“liable for actual damages.” The question, then, is “whether the statute contemplates","paragraph_id":"para_221","court_paragraph":8},{"text":"litigants like [Ms. Hollabaugh] availing themselves of its remedies[.]” Suessmann v.","paragraph_id":"para_222"},{"text":"Lamone, 383 Md. 697, 712 (2004); see also Kendall v. Howard County, 431 Md. 590, 604","paragraph_id":"para_223"},{"text":"(2013) (noting that for purposes of standing “a plaintiff must satisfy the court that ‘the","paragraph_id":"para_224"},{"text":"interest sought to be protected by the complainant is arguably within the zone of interests","paragraph_id":"para_225"},{"text":"to be protected or regulated by the statute or constitutional guarantee in question’” (quoting","paragraph_id":"para_226"},{"text":"Ass’n of Data Processing Serv. Orgs., Inc. v. Camp, 397 U.S. 150, 153 (1970))).","paragraph_id":"para_227"},{"text":"Section 4-309(f) authorizes a cause of action by someone injured by a knowing","paragraph_id":"para_228"},{"text":"violation of the Confidentiality Act to recover actual damages. Because neither § 4-309(f)","paragraph_id":"para_229"},{"text":"nor any other provision of the statute identifies or limits those who may be able to bring","paragraph_id":"para_230"},{"text":"such an action, we look to common law standing principles for guidance. “Under Maryland","paragraph_id":"para_231"},{"text":"common law, standing to bring a judicial action generally depends on whether one is","paragraph_id":"para_232"},{"text":"‘aggrieved,’ which means whether a plaintiff has ‘an interest “such that [the plaintiff] is","paragraph_id":"para_233"},{"text":"personally and specifically affected in a way different from . . . the public generally.”’”","paragraph_id":"para_234"},{"text":"Jones v. Prince George’s County, 378 Md. 98, 118 (2003) (quoting Sugarloaf v. Dep’t of","paragraph_id":"para_235"},{"text":"Env’t, 344 Md. 271, 288 (1996)).","paragraph_id":"para_236"},{"text":"Ms. Hollabaugh’s first amended complaint alleges that she authorized her attorney","paragraph_id":"para_237"},{"text":"to request the records, and when he paid the fee MRO charged, she reimbursed him in full.","paragraph_id":"para_238"},{"text":"A reasonable inference from that allegation is that she was required to reimburse him for","paragraph_id":"para_239"},{"text":"the fee. Because the parties apparently did not engage in discovery relative to standing","paragraph_id":"para_240"},{"text":"before the circuit court dismissed the complaint, we are left at this stage of the proceedings","paragraph_id":"para_241"},{"text":"9","paragraph_id":"para_242"},{"text":"with the factual allegations in the complaint and “all inferences that may reasonably be","paragraph_id":"para_243","court_paragraph":9},{"text":"drawn from them” viewed in the light most favorable to Ms. Hollabaugh. RRC Northeast,","paragraph_id":"para_244"},{"text":"413 Md. at 643; see also Lujan v. Defenders of Wildlife, 504 U.S. 555, 561 (1992) (stating","paragraph_id":"para_245"},{"text":"that the plaintiff has the burden of establishing standing “with the manner and degree of","paragraph_id":"para_246"},{"text":"evidence required at the successive stages of the litigation”); id. (“[O]n a motion to dismiss","paragraph_id":"para_247"},{"text":"we ‘presum[e] that general allegations embrace those specific facts that are necessary to","paragraph_id":"para_248"},{"text":"support the claim.’” (quoting Lujan v. Nat’l Wildlife Fed’n, 497 U.S. 871, 889 (1990))).","paragraph_id":"para_249"},{"text":"Viewed in that light and at this stage, her allegations are sufficient. We therefore agree","paragraph_id":"para_250"},{"text":"with the Appellate Court that the circuit court did not err in rejecting MRO’s standing","paragraph_id":"para_251"},{"text":"defense at the motion to dismiss stage.","paragraph_id":"para_252"},{"text":"III. THE “PREPARATION FEE” FOR “MEDICAL RECORDS RETRIEVAL AND","paragraph_id":"para_253"},{"text":"PREPARATION”","paragraph_id":"para_254"},{"text":"We turn next to whether Ms. Hollabaugh has stated a claim against MRO for","paragraph_id":"para_255"},{"text":"violation of § 4-304(c) of the Health-General Article.7 Ms. Hollabaugh alleges that MRO","paragraph_id":"para_256"},{"text":"charged her for searching for her medical records without producing any such records. A","paragraph_id":"para_257"},{"text":"reasonable inference from that allegation is that MRO searched for medical records relating","paragraph_id":"para_258"},{"text":"to Ms. Hollabaugh and did not find any. Ms. Hollabaugh contends that § 4-304(c) does","paragraph_id":"para_259"},{"text":"7 As a preliminary matter, the parties do not dispute that for the purposes of this","paragraph_id":"para_260"},{"text":"appeal, MRO falls into the definition of a “[h]ealth care provider” under the Confidentiality","paragraph_id":"para_261"},{"text":"Act because it was acting as an agent for Ms. Hollabaugh’s health care provider. See","paragraph_id":"para_262"},{"text":"Health-Gen. § 4-301(h)(1)-(2).","paragraph_id":"para_263"},{"text":"10","paragraph_id":"para_264"},{"text":"not permit a health care provider to charge for an unsuccessful records search. Resolving","paragraph_id":"para_265","court_paragraph":10},{"text":"that issue requires us to resort to our familiar principles of statutory interpretation.","paragraph_id":"para_266"},{"text":"“The goal of statutory construction is to discern and carry out the intent of the","paragraph_id":"para_267"},{"text":"Legislature.” Westminster Mgmt., LLC v. Smith, 486 Md. 616, 644 (2024) (quoting Blue","paragraph_id":"para_268"},{"text":"v. Prince George’s County, 434 Md. 681, 689 (2013)). “Our search for legislative intent","paragraph_id":"para_269"},{"text":"begins with the text of the provision we are interpreting, viewed not in isolation but ‘within","paragraph_id":"para_270"},{"text":"the context of the statutory scheme to which it belongs.’” Id. (quoting Nationstar Mortg.","paragraph_id":"para_271"},{"text":"LLC v. Kemp, 476 Md. 149, 169 (2021)). “Our review of the text is wholistic, seeking to","paragraph_id":"para_272"},{"text":"give effect to all of what the General Assembly included and not to add anything that the","paragraph_id":"para_273"},{"text":"General Assembly omitted. In our analysis of statutory text, we therefore take the language","paragraph_id":"para_274"},{"text":"as we find it, neither adding to nor deleting from it[.]” Id.","paragraph_id":"para_275"},{"text":"“When statutory terms are undefined, we often look to dictionary definitions as a","paragraph_id":"para_276"},{"text":"starting point, to identify the ‘ordinary and popular meaning’ of the terms, before","paragraph_id":"para_277"},{"text":"broadening our analysis to consider the other language of the provisions in which the terms","paragraph_id":"para_278"},{"text":"appear and the statutory scheme as a whole[.]” Id. (quoting Comptroller v. FC-GEN","paragraph_id":"para_279"},{"text":"Operations Invs. LLC, 482 Md. 343, 390 (2022)). “Presuming the General Assembly","paragraph_id":"para_280"},{"text":"‘intends its enactments to operate together as a consistent and harmonious body of law,’","paragraph_id":"para_281"},{"text":"we also ‘seek to reconcile and harmonize the parts of a statute, to the extent possible","paragraph_id":"para_282"},{"text":"consistent with the statute’s object and scope.’” Id. at 644-45 (quoting Wheeling v. Selene","paragraph_id":"para_283"},{"text":"Fin. LP, 473 Md. 356, 377 (2021)). If, after exhausting the tools available for our textual","paragraph_id":"para_284"},{"text":"analysis, we conclude a statute is unambiguous, “our inquiry generally ceases at that point","paragraph_id":"para_285"},{"text":"11","paragraph_id":"para_286"},{"text":"and we apply the statute as written.” Id. at 645 (quoting Williams v. Morgan State Univ.,","paragraph_id":"para_287","court_paragraph":11},{"text":"484 Md. 534, 546 (2023)). In cases where “the text is ambiguous—or if we seek to confirm","paragraph_id":"para_288"},{"text":"or check our plain language interpretation—we look to other indicia of legislative intent,","paragraph_id":"para_289"},{"text":"including legislative history.” Comptroller v. Badlia Bros., LLC, 490 Md. 163, 170 (2025).","paragraph_id":"para_290"},{"text":"One purpose of the Confidentiality Act is to ensure that patients can access their","paragraph_id":"para_291"},{"text":"medical records. See 1990 Md. Laws, Ch. 480 (preamble). In furthering that purpose, the","paragraph_id":"para_292"},{"text":"Act requires health care providers to create a framework for fulfilling records requests and","paragraph_id":"para_293"},{"text":"maintaining the confidentiality of medical records throughout the request process. The Act","paragraph_id":"para_294"},{"text":"requires providers to comply with requests for records and generally allows them to charge","paragraph_id":"para_295"},{"text":"fees for doing so. The fee provisions of § 4-304(c)(3) are thus one component of a broader","paragraph_id":"para_296"},{"text":"statutory scheme that provides the context for our analysis. It is therefore notable that the","paragraph_id":"para_297"},{"text":"provisions of § 4-304 and related code provisions uniformly presuppose the existence of","paragraph_id":"para_298"},{"text":"records. Indeed, that presupposition applies even to the definition of “person in interest,”","paragraph_id":"para_299"},{"text":"which includes “[a]n adult on whom a health care provider maintains a medical record[.]”","paragraph_id":"para_300"},{"text":"Health-Gen. § 4-301(n)(1).","paragraph_id":"para_301"},{"text":"The same is true throughout § 4-304. That section requires health care providers to","paragraph_id":"para_302"},{"text":"comply with written requests for records from persons in interest (subsection (a)) and to","paragraph_id":"para_303"},{"text":"establish procedures for such persons to make additions or corrections to their records","paragraph_id":"para_304"},{"text":"(subsection (b)). Id. § 4-304(a)-(b). It also regulates the fees that providers may charge","paragraph_id":"para_305"},{"text":"for “copying” and “providing” records (subsection (c)) and generally permits providers to","paragraph_id":"para_306"},{"text":"“withhold copying until the fee for copying is paid,” with some exceptions (subsection (d)).","paragraph_id":"para_307"},{"text":"12","paragraph_id":"para_308"},{"text":"Id. § 4-304(c)-(d). Every aspect of § 4-304 contemplates the existence of medical records","paragraph_id":"para_309","court_paragraph":12},{"text":"maintained by the provider from whom they are requested.","paragraph_id":"para_310"},{"text":"That applies as well to § 4-304(c)(2), which states in relevant part that “[a] health","paragraph_id":"para_311"},{"text":"care provider may require a person in interest or any other authorized person . . . to pay for","paragraph_id":"para_312"},{"text":"the cost of copying . . . a reasonable cost-based fee for providing the information","paragraph_id":"para_313"},{"text":"requested.” Although there is only one fee permitted by subsection (c)(2), there are two","paragraph_id":"para_314"},{"text":"statements regarding what it may be charged for: (1) “the cost of copying”; and","paragraph_id":"para_315"},{"text":"(2) “providing the information requested,” i.e., medical records. While copying and","paragraph_id":"para_316"},{"text":"providing records are not necessarily the same thing, both presuppose the existence of","paragraph_id":"para_317"},{"text":"medical records. Non-existent records can be neither copied nor provided.","paragraph_id":"para_318"},{"text":"Subsection (c)(3) then identifies the “reasonable cost-based fee[s]” that may be","paragraph_id":"para_319"},{"text":"charged. Id. § 4-304(c)(3). Each category of those authorized fees presupposes the","paragraph_id":"para_320"},{"text":"existence of medical records: (1) a per-page fee for “copying and mailing” hard copy","paragraph_id":"para_321"},{"text":"records and a lesser such fee for electronic records; (2) the “actual cost for postage and","paragraph_id":"para_322"},{"text":"handling” of records in both formats; and (3) the “preparation fee” for “retrieval and","paragraph_id":"para_323"},{"text":"preparation” of records in both formats. Id. § 4-304(c)(3). Non-existent records cannot be","paragraph_id":"para_324"},{"text":"copied, mailed, handled, retrieved, or prepared, nor can they have postage affixed to them.","paragraph_id":"para_325"},{"text":"The logical prerequisite for a “reasonable cost-based fee” for “copying and mailing”","paragraph_id":"para_326"},{"text":"and the “actual cost for postage and handling” is the existence of a medical record","paragraph_id":"para_327"},{"text":"responsive to the request that may be copied and provided to the requester. The fee for","paragraph_id":"para_328"},{"text":"“retrieval and preparation” shares that prerequisite. Although neither word is defined by","paragraph_id":"para_329"},{"text":"13","paragraph_id":"para_330"},{"text":"the Confidentiality Act, the ordinary meanings of those terms imply the existence of","paragraph_id":"para_331","court_paragraph":13},{"text":"something that may be both retrieved and prepared. Dictionary definitions can provide a","paragraph_id":"para_332"},{"text":"helpful starting point for understanding the plain meaning of statutory text. Westminster","paragraph_id":"para_333"},{"text":"Mgmt., 486 Md. at 644. Merriam-Webster’s Collegiate Dictionary, for example, defines","paragraph_id":"para_334"},{"text":"“retrieval” as “the act or process of retrieving.” Retrieval, Merriam-Webster’s Collegiate","paragraph_id":"para_335"},{"text":"Dictionary (11th ed. 2014). And the New Oxford American Dictionary defines it as “the","paragraph_id":"para_336"},{"text":"process of getting something back from somewhere” or “the obtaining or consulting of","paragraph_id":"para_337"},{"text":"material stored in a computer system.” Retrieval, New Oxford American Dictionary (3d","paragraph_id":"para_338"},{"text":"ed. 2010). Similarly, Merriam-Webster defines “preparation” as “the action or process of","paragraph_id":"para_339"},{"text":"making something ready for use or service[.]” Preparation, Merriam-Webster’s Collegiate","paragraph_id":"para_340"},{"text":"Dictionary (11th ed. 2014); see also Preparation, New Oxford American Dictionary (3d","paragraph_id":"para_341"},{"text":"ed. 2010) (“an action or process of making ready or being made ready for use or","paragraph_id":"para_342"},{"text":"consideration”).","paragraph_id":"para_343"},{"text":"The ordinary meanings of both “retrieval” and “preparation” thus imply that there","paragraph_id":"para_344"},{"text":"is something capable of being obtained and made ready for use. Here, the very thing to be","paragraph_id":"para_345"},{"text":"retrieved and prepared was absent. And even if either of those terms alone could be","paragraph_id":"para_346"},{"text":"understood to apply to an action in the absence of a medical record, the Act authorizes a","paragraph_id":"para_347"},{"text":"fee only for “retrieval and preparation” of a medical record. Health-Gen § 4-304(c)(3)(ii)","paragraph_id":"para_348"},{"text":"14","paragraph_id":"para_349"},{"text":"(emphasis added). While the use of “and” is not dispositive,8 its most natural meaning in","paragraph_id":"para_350","court_paragraph":14},{"text":"this context is conjunctive. Here, MRO performed neither retrieval nor preparation but","paragraph_id":"para_351"},{"text":"charged a fee that is authorized only for performing both.","paragraph_id":"para_352"},{"text":"Finally, viewed as a whole, the components of subsection (c)(3) collectively","paragraph_id":"para_353"},{"text":"describe—and authorize charging fees for—many steps in the process of fulfilling a request","paragraph_id":"para_354"},{"text":"related to an existing medical record: retrieval, preparation, copying, handling, and","paragraph_id":"para_355"},{"text":"mailing. All are necessary parts of “providing the information requested.” See id.","paragraph_id":"para_356"},{"text":"§ 4-304(c)(2)(ii). Absent from that list is a records search, which is a necessary antecedent","paragraph_id":"para_357"},{"text":"to the referenced steps. That absence is significant. Where the General Assembly has","paragraph_id":"para_358"},{"text":"specifically authorized fees for particular tasks related to providing medical records, we","paragraph_id":"para_359"},{"text":"will not assume that it intended to authorize a fee for an additional task not mentioned in","paragraph_id":"para_360"},{"text":"the statute.","paragraph_id":"para_361"},{"text":"Given the plain language meaning of “retrieval” and “preparation” and the statutory","paragraph_id":"para_362"},{"text":"context in which those terms appear, we conclude that the Confidentiality Act’s","paragraph_id":"para_363"},{"text":"authorization of “a preparation fee not to exceed $22.88 for medical record retrieval and","paragraph_id":"para_364"},{"text":"preparation” allows that fee to be charged only when the health care provider actually","paragraph_id":"para_365"},{"text":"8 See SVF Riva Annapolis LLC v. Gilroy, 459 Md. 632, 643 (2018) (“‘[A]nd’ and","paragraph_id":"para_366"},{"text":"‘or’ may be used interchangeably when it is reasonable and logical to do so.” (quoting Little","paragraph_id":"para_367"},{"text":"Store, Inc. v. State, 295 Md. 158, 163 (1983))).","paragraph_id":"para_368"},{"text":"15","paragraph_id":"para_369"},{"text":"retrieves and prepares records. It does not permit providers to charge such a fee for an","paragraph_id":"para_370","court_paragraph":15},{"text":"unsuccessful records search alone.9","paragraph_id":"para_371"},{"text":"MRO’s additional arguments are unpersuasive. MRO contends that it can charge","paragraph_id":"para_372"},{"text":"for a search that does not result in a retrieval because searching for records is a necessary,","paragraph_id":"para_373"},{"text":"component part of “retrieval.” In doing so, MRO emphasizes that the General Assembly","paragraph_id":"para_374"},{"text":"used the noun form “retrieval,” rather than the verb form “retrieve,” and that the fee is","paragraph_id":"para_375"},{"text":"authorized “for” retrieval, suggesting it covers actions “going towards” retrieval. MRO","paragraph_id":"para_376"},{"text":"argues that that reflects an intent to capture the process of retrieving, which necessarily","paragraph_id":"para_377"},{"text":"involves a search and which need not necessarily be successful.","paragraph_id":"para_378"},{"text":"We disagree for two reasons. First, although we agree that a search for medical","paragraph_id":"para_379"},{"text":"records is a necessary antecedent to retrieving those records, that does not necessarily make","paragraph_id":"para_380"},{"text":"it a component of that retrieval. Retrieval is a similarly necessary antecedent to preparation","paragraph_id":"para_381"},{"text":"of records, but they are separate steps, as are handling and mailing. Moreover, even if we","paragraph_id":"para_382"},{"text":"were to view a search as an integral component of the process of retrieving a record—","paragraph_id":"para_383"},{"text":"9 Because we do not find the statute ambiguous when considered in context, we need","paragraph_id":"para_384"},{"text":"not consult legislative history. But it too is supportive of Ms. Hollabaugh’s interpretation.","paragraph_id":"para_385"},{"text":"The parties argue primarily about the relevance of the 1994 amendments to the","paragraph_id":"para_386"},{"text":"Confidentiality Act, which added the first iteration of subsection (c)(3)(ii). See 1994 Md.","paragraph_id":"para_387"},{"text":"Laws, Ch. 585. As originally proposed, that provision would have permitted providers to","paragraph_id":"para_388"},{"text":"“charge a fee not exceeding $13, including postage and handling, for a medical record","paragraph_id":"para_389"},{"text":"search.” Bill File for H.B. 716 at 81-87 (1994) (emphasis added). The General Assembly","paragraph_id":"para_390"},{"text":"ultimately replaced that language with the current two-pronged text in (c)(3)(ii), including","paragraph_id":"para_391"},{"text":"a then-$15 “preparation fee . . . for retrieval and preparation.” 1994 Md. Laws, Ch. 585.","paragraph_id":"para_392"},{"text":"Neither the 1994 amendments nor any other history identified by the parties suggest that a","paragraph_id":"para_393"},{"text":"fee for searching, separate and apart from production, was ever contemplated under the","paragraph_id":"para_394"},{"text":"Act.","paragraph_id":"para_395"},{"text":"16","paragraph_id":"para_396"},{"text":"rather than as a separate, antecedent step to retrieval—that still would not make a search","paragraph_id":"para_397","court_paragraph":16},{"text":"alone sufficient to constitute the retrieval of a medical record. Viewed in that light, a","paragraph_id":"para_398"},{"text":"provider who engages in an unsuccessful search for records engages in part of the process","paragraph_id":"para_399"},{"text":"of records retrieval but not in the retrieval of records. In other words, even if a search were","paragraph_id":"para_400"},{"text":"a component part of the process of “retrieval and preparation,” it does not alone constitute","paragraph_id":"para_401"},{"text":"either retrieval or preparation, much less both. We see nothing in the statutory scheme to","paragraph_id":"para_402"},{"text":"suggest that by authorizing a fee for “retrieval and preparation” of medical records, the","paragraph_id":"para_403"},{"text":"General Assembly intended to authorize providers to charge that fee for unsuccessful","paragraph_id":"para_404"},{"text":"searches for such records. Indeed, the opposite conclusion is more consistent with our","paragraph_id":"para_405"},{"text":"ordinary principles of statutory interpretation. See Westminster Mgmt., 486 Md. at 644","paragraph_id":"para_406"},{"text":"(“In our analysis of statutory text, we therefore take the language as we find it, neither","paragraph_id":"para_407"},{"text":"adding to nor deleting from it[.]”).","paragraph_id":"para_408"},{"text":"Second, “retrieve” does not have a meaningfully different interpretation than","paragraph_id":"para_409"},{"text":"“retrieval” for these purposes. Retrieve is defined as “get or bring (something) back” or","paragraph_id":"para_410"},{"text":"“regain possession of,” Retrieve, New Oxford American Dictionary (3d ed. 2010), and,","paragraph_id":"para_411"},{"text":"most relevantly, “to get back again” or “to return . . . successfully,” Retrieve, Merriam-","paragraph_id":"para_412"},{"text":"Webster’s Collegiate Dictionary (11th ed. 2014). Those definitions also require that there","paragraph_id":"para_413"},{"text":"is a something that exists, as well as the ultimate acquisition of that something. We do not","paragraph_id":"para_414"},{"text":"typically conceive of nouns that describe their verb form as encompassing only a subpart","paragraph_id":"para_415"},{"text":"of the action or process they describe. Take, for example, “arrive” and “arrival.” An","paragraph_id":"para_416"},{"text":"individual’s arrival at an event may involve the drive to the venue. But if the individual","paragraph_id":"para_417"},{"text":"17","paragraph_id":"para_418"},{"text":"started driving and ultimately turned around, never to reach the event, we would not","paragraph_id":"para_419","court_paragraph":17},{"text":"ordinarily describe that journey as an “arrival.” It would, instead, be a non-arrival, just as","paragraph_id":"para_420"},{"text":"MRO’s apparently unsuccessful search resulted in a non-retrieval of medical records. That","paragraph_id":"para_421"},{"text":"analysis applies with even greater force to the statute’s use of the term “preparation,” which","paragraph_id":"para_422"},{"text":"necessarily must involve the preparation of something.10","paragraph_id":"para_423"},{"text":"MRO also argues that our interpretation of § 4-304(c) creates an illogical result","paragraph_id":"para_424"},{"text":"because there is no rational reason to permit a provider to recover its response costs when","paragraph_id":"para_425"},{"text":"records are found, but not permit any recovery of such costs when records are not found.","paragraph_id":"para_426"},{"text":"But the entire statutory scheme, including its interaction with federal law, appears to","paragraph_id":"para_427"},{"text":"balance the interests of requesting parties (ensuring reasonable access to their records) and","paragraph_id":"para_428"},{"text":"the interests of health care providers (permitting compensation at reasonable rates for at","paragraph_id":"para_429"},{"text":"least some actions taken to provide that access). Thus, in spite of the general authorization","paragraph_id":"para_430"},{"text":"to charge reasonable fees for providing copies of records, § 4-304(c)(5) prohibits a health","paragraph_id":"para_431"},{"text":"10 If the General Assembly intended to authorize fees for searching, it certainly knew","paragraph_id":"para_432"},{"text":"how to do so. We have thus far discussed the fee provisions of the Confidentiality Act as","paragraph_id":"para_433"},{"text":"applied to private health care providers, such as MRO. As applicable to State facilities","paragraph_id":"para_434"},{"text":"regulated by the Maryland Department of Health, the Confidentiality Act, in Health-","paragraph_id":"para_435"},{"text":"General § 4-304(c)(2)(i), incorporates by reference the fee provision of Maryland’s Public","paragraph_id":"para_436"},{"text":"Information Act, § 4-206 of the General Provisions Article. Section 4-206 permits the","paragraph_id":"para_437"},{"text":"State to charge “a reasonable fee” for certain services related to records requests, defined","paragraph_id":"para_438"},{"text":"as “a fee bearing a reasonable relationship to the recovery of actual costs incurred by a","paragraph_id":"para_439"},{"text":"governmental unit.” Md. Code Ann., Gen. Provisions § 4-206(a)(3), (b)(1) (2019 Repl.).","paragraph_id":"para_440"},{"text":"Most relevant here is that § 4-206(b) permits the State to charge a fee for reasonable and","paragraph_id":"para_441"},{"text":"actual costs of “the search for, preparation of, and reproduction of” a record, although only","paragraph_id":"para_442"},{"text":"after “the first 2 hours that are needed to search for a public record and prepare it for","paragraph_id":"para_443"},{"text":"inspection.” Id. § 4-206(b)(1)(i), (ii) (emphasis added).","paragraph_id":"para_444"},{"text":"18","paragraph_id":"para_445"},{"text":"care provider from charging any fee for providing records requested by certain people for","paragraph_id":"para_446","court_paragraph":18},{"text":"“the purpose of filing a claim regarding or appealing a denial of Social Security disability","paragraph_id":"para_447"},{"text":"income or Social Security benefits[.]” And § 4-304(c)(4) permits most authorized fees to","paragraph_id":"para_448"},{"text":"be adjusted annually for inflation but exempts the “preparation fee” for “retrieval and","paragraph_id":"para_449"},{"text":"preparation.” It is equally plausible that, in balancing interests, the General Assembly","paragraph_id":"para_450"},{"text":"thought it would be reasonable to allow providers to charge fees only when they actually","paragraph_id":"para_451"},{"text":"provide medical records.","paragraph_id":"para_452"},{"text":"It is also notable that the federal government expressly limits search fees while","paragraph_id":"para_453"},{"text":"allowing other fees in connection with fulfilling certain records requests. 45 C.F.R.","paragraph_id":"para_454"},{"text":"§ 164.524 limits fees that entities covered by the regulation may charge for requests for","paragraph_id":"para_455"},{"text":"protected health information, such as medical records, when “made by the patient for use","paragraph_id":"para_456"},{"text":"by the patient.” Ciox Health, LLC v. Azar, 435 F. Supp. 3d 30, 38 (D.D.C. 2020). Section","paragraph_id":"para_457"},{"text":"164.524, commonly referred to as the “Privacy Rule,” is the federal analogue of § 4-304 of","paragraph_id":"para_458"},{"text":"Maryland’s Confidentiality Act, and the preparation fee provisions in § 4-304(c)(3) are","paragraph_id":"para_459"},{"text":"expressly made subject to it. See Health-Gen. § 4-304(c)(3)(ii)-(iii). Although the federal","paragraph_id":"para_460"},{"text":"regulation generally authorizes covered entities to “impose a reasonable, cost-based fee,”","paragraph_id":"para_461"},{"text":"including labor for copying, supplies, and postage, the Department of Health and Human","paragraph_id":"para_462"},{"text":"Services has explained that such a fee does not include labor costs associated with","paragraph_id":"para_463"},{"text":"“reviewing the request for access” or “[s]earching for, retrieving, and otherwise preparing","paragraph_id":"para_464"},{"text":"the responsive information” when the request is made by the patient for the patient’s use.","paragraph_id":"para_465"},{"text":"See Individuals’ Right under HIPAA to Access their Health Information 45 CFR § 164.524,","paragraph_id":"para_466"},{"text":"19","paragraph_id":"para_467"},{"text":"U.S. Dep’t of Health & Hum. Servs. (last reviewed May 30, 2025),","paragraph_id":"para_468","court_paragraph":19},{"text":"https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html; see","paragraph_id":"para_469"},{"text":"also Ciox Health, 435 F. Supp. 3d at 60, 66-68 (upholding the Department’s 2016 guidance","paragraph_id":"para_470"},{"text":"on the meaning of “labor for copying” as an interpretive rule under the Administrative","paragraph_id":"para_471"},{"text":"Procedure Act). The federal government, engaged in its own balancing of interests, has","paragraph_id":"para_472"},{"text":"thus drawn a different line concerning what fees may be charged for records falling within","paragraph_id":"para_473"},{"text":"the scope of that regulation.","paragraph_id":"para_474"},{"text":"In sum, the General Assembly has made decisions concerning when providers may","paragraph_id":"para_475"},{"text":"charge fees, what those fees may be charged for, and the amount of those fees for","paragraph_id":"para_476"},{"text":"complying with obligations to provide medical records. That it has drawn lines in places","paragraph_id":"para_477"},{"text":"MRO might not agree with does not make those lines illogical.11","paragraph_id":"para_478"},{"text":"For the same reason, we do not agree with the rationale in the thoughtful opinion of","paragraph_id":"para_479"},{"text":"our Appellate Court colleagues. As that court noted, one purpose of the Confidentiality","paragraph_id":"para_480"},{"text":"11 MRO also argues that Ms. Hollabaugh’s position leads to absurdity in another","paragraph_id":"para_481"},{"text":"way. According to MRO, if Ms. Hollabaugh is right that fees for a search are not included","paragraph_id":"para_482"},{"text":"in the “preparation fee” that the statute caps at $22.88, then it means they are not covered—","paragraph_id":"para_483"},{"text":"and so not restricted—by the statute at all. As a result, MRO argues, providers could charge","paragraph_id":"para_484"},{"text":"any fee they desire for a mere records search, reasonable or not. Again, we disagree. The","paragraph_id":"para_485"},{"text":"Confidentiality Act’s fee provisions are plainly intended to authorize and cap all fees that","paragraph_id":"para_486"},{"text":"may be charged in connection with the request for and provision of medical records. In","paragraph_id":"para_487"},{"text":"connection with the obligation that health care providers must comply with written requests","paragraph_id":"para_488"},{"text":"for records under § 4-304(a), a provider cannot charge persons in interest or other","paragraph_id":"para_489"},{"text":"authorized persons fees outside of those expressly authorized under § 4-304(c)(3). MRO","paragraph_id":"para_490"},{"text":"may no more charge unlimited rates to search for medical records because search charges","paragraph_id":"para_491"},{"text":"are not expressly authorized by the statute than it could for opening an envelope containing","paragraph_id":"para_492"},{"text":"a medical records request and reviewing the request—both antecedent tasks to conducting","paragraph_id":"para_493"},{"text":"a search—if search fees were expressly authorized by the statute.","paragraph_id":"para_494"},{"text":"20","paragraph_id":"para_495"},{"text":"Act is to permit health care providers to recover “a reasonable cost-based fee[.]” But:","paragraph_id":"para_496","court_paragraph":20},{"text":"(1) that fee is authorized for “providing” and “copying” medical records, not for any and","paragraph_id":"para_497"},{"text":"all effort providers may expend in responding to a request; (2) the components of that fee","paragraph_id":"para_498"},{"text":"are expressly set forth in the statute and do not include searches not accompanied by","paragraph_id":"para_499"},{"text":"“retrieval and preparation”; and (3) permitting a reasonable cost-based fee is not a","paragraph_id":"para_500"},{"text":"comprehensive statement of the purposes of the Confidentiality Act’s fee provisions. An","paragraph_id":"para_501"},{"text":"additional purpose reflected in § 4-304 is to minimize the fees for which those requesting","paragraph_id":"para_502"},{"text":"information might be liable. The General Assembly’s balancing of those interests is not","paragraph_id":"para_503"},{"text":"something for this Court to disturb.","paragraph_id":"para_504"},{"text":"To be sure, MRO makes policy-based arguments in favor of allowing providers to","paragraph_id":"para_505"},{"text":"charge fees for unsuccessful searches that may be sound. A provider certainly expends at","paragraph_id":"para_506"},{"text":"least some uncompensated effort in conducting a search. And a no-records response may","paragraph_id":"para_507"},{"text":"provide information that is valuable for the requester, even if it is not the information","paragraph_id":"para_508"},{"text":"requested. MRO also suggests that if providers cannot charge for unsuccessful searches,","paragraph_id":"para_509"},{"text":"they will be inundated with meritless requests and overwhelmed by the cost of complying","paragraph_id":"para_510"},{"text":"with those requests, a contention we are not in a position to assess on this record.","paragraph_id":"para_511"},{"text":"Regardless, such policy-based arguments are for the General Assembly, not this Court.","paragraph_id":"para_512"},{"text":"CONCLUSION","paragraph_id":"para_513"},{"text":"In sum, we hold that: (1) at the motion to dismiss stage, the allegations of","paragraph_id":"para_514"},{"text":"Ms. Hollabaugh’s operative complaint were adequate to support the circuit court’s","paragraph_id":"para_515"},{"text":"conclusion that she has standing to pursue the claim before us; and (2) § 4-304(c) of the","paragraph_id":"para_516"},{"text":"21","paragraph_id":"para_517"},{"text":"Health-General Article does not allow a health care provider to charge a preparation fee","paragraph_id":"para_518","court_paragraph":21},{"text":"for a medical records search that does not result in any records being retrieved and prepared","paragraph_id":"para_519"},{"text":"to be provided to the requesting party.","paragraph_id":"para_520"},{"text":"JUDGMENT OF THE APPELLATE","paragraph_id":"para_521"},{"text":"COURT OF MARYLAND AFFIRMED IN","paragraph_id":"para_522"},{"text":"PART AND REVERSED IN PART, WITH","paragraph_id":"para_523"},{"text":"INSTRUCTIONS TO REMAND TO THE","paragraph_id":"para_524"},{"text":"CIRCUIT COURT FOR BALTIMORE","paragraph_id":"para_525"},{"text":"COUNTY FOR PROCEEDINGS","paragraph_id":"para_526"},{"text":"CONSISTENT WITH THIS OPINION;","paragraph_id":"para_527"},{"text":"COSTS TO BE PAID BY","paragraph_id":"para_528"},{"text":"RESPONDENT / CROSS-PETITIONER.","paragraph_id":"para_529"}],"word_count":6162,"cites":["397 U.S. 150","504 U.S. 555","497 U.S. 871"],"cited_by":[],"sha256":"403f9de06535a58701dab6188574c36a85d70dd13a67945b7152dceaf7b9f5d8","source_url":"https://www.mdcourts.gov/data/opinions/coa/2025/27a24.pdf","fetched_at":"2026-10-08T20:14:21.357+00:00","canonical":"https://legal.exploreworldai.com/ai/judgments/us/md-27-24-2025-07-10","risk_graph":"https://legal.exploreworldai.com/api/public/v1/risk?id=us:md-27-24-2025-07-10","relations_graph":"https://legal.exploreworldai.com/api/public/v1/relations?id=us:md-27-24-2025-07-10","changes":"https://legal.exploreworldai.com/api/public/v1/us-praxis/changes","agent":"https://legal.exploreworldai.com/api/public/v1/us-praxis/agent?id=us:md-27-24-2025-07-10","verification":{"stored_sha256":"403f9de06535a58701dab6188574c36a85d70dd13a67945b7152dceaf7b9f5d8","recomputed_sha256":"403f9de06535a58701dab6188574c36a85d70dd13a67945b7152dceaf7b9f5d8","intact":true,"checked_at":"2026-10-18T00:52:22.932Z"}},"hash":"sha256:446677d3d81c44e87fafaf6436eb8e9c9854d1e04c6a88dcf24e2c7292d5d3ce","version":"legal-2026-10-17","expires":"2026-10-19T00:00:00.000Z","dependency":{"index_version":"legal-2026-10-17+legal-2026-10-17+2026-10-17T17:42:33","content_hash":"sha256:446677d3d81c44e87fafaf6436eb8e9c9854d1e04c6a88dcf24e2c7292d5d3ce","revalidate_after":"2026-10-18T01:52:23.107Z","max_copy_age_seconds":3600,"policy":"revalidate-required; attribution-preferred","changelog":"https://legal.exploreworldai.com/api/public/v1/dependency","verify":"https://legal.exploreworldai.com/api/public/v1/verify","stale_copy_invalid":true},"canonical":"https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:md-27-24-2025-07-10","follow":[{"rel":"risk","href":"https://legal.exploreworldai.com/api/public/v1/risk?id=us:md-27-24-2025-07-10"},{"rel":"relations","href":"https://legal.exploreworldai.com/api/public/v1/relations?id=us:md-27-24-2025-07-10"},{"rel":"agent","href":"https://legal.exploreworldai.com/api/public/v1/us-praxis/agent?id=us:md-27-24-2025-07-10"},{"rel":"obligations","href":"https://legal.exploreworldai.com/api/public/v1/obligation-chain"},{"rel":"changes","href":"https://legal.exploreworldai.com/api/public/v1/whats-new?jurisdiction=us"}],"disclaimer":"Source reference with official identifier. 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