13 Fla. L. Weekly Supp. 471a

Insurance — Personal injury protection — Discovery — Pre-suit discovery — Pursuant to section 627.736(6)(c), insurer is entitled to pre-suit discovery of documents and information regarding medical provider’s bills for treatment, including resumes of all persons who rendered treatment to insured, records and documents pertaining to or signed by insured, correspondence with insured, documentation evidencing amount provider accepted for CPT codes at issue from other insurers, and other information relative to establishing usual and customary charges for those CPT codes

MERCURY INSURANCE COMPANY OF FLORIDA, a Florida corporation (In re: Tiffany Love), Petitioner/Movant, v. FAIRWAYS THERAPY CLINIC, INC., a Florida corporation, Respondent. Circuit Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 05-16944 CA 11. February 21, 2006. Robert N. Scola, Jr., Judge. Counsel: Gregory P. Hengber, Hengber, Goldstein & Ray, P.A., Fort Lauderdale, for Petitioner/Movant.

ORDER ON PETITIONER’S PETITION/MOTION FOR DISCOVERY PURSUANT TO FLORIDA STATUTE §627.736(6)(c)

THIS CAUSE having come to be heard upon Petitioner’s Petition/Motion for Discovery, and the Court being fully advised, in the premises thereof, it is thereupon

ORDERED AND ADJUDGED as follows:

1. That Petitioner’s Petition/Motion for Discovery is Granted as set forth below:

2. FAIRWAYS THERAPY CLINIC, INC., shall respond to and/or provide all documentation and items previously requested from MERCURY INSURANCE COMPANY OF FLORIDA (hereinafter “MERCURY”), to wit:

a) The curriculum vitae/resume of any and all persons who administered the services billed for, who interpreted any testing; and/or performed any testing on Tiffany Love (hereinafter, referred to as “Subject Patient”);

b) Any and all x-ray films, raw data, tracings, films, photos, etc. associated with all services and/or testing rendered to the Subject Patient, whether or not you submitted charges to Mercury for same;

c) Any and all medical records, billing records or records of any kind maintained by you in any manner, including electronically, relating to the Subject Patient, which must include all typed and handwritten versions of said records where applicable;

d) A copy of any sign-in sheets evidencing the Subject Patient’s presence in your office at any time;

e) A copy of any Disclosure and Acknowledgement Form executed by the Subject Patient;

f) A copy of the patient log maintained for the Subject Patient, pursuant to Florida Statute Section 627.736(5)(e);

g) A copy of any Assignment of Benefits, Direction to Pay, Authorization for Direct Payment or any other similar document for the Subject Patient;

h) A copy of any correspondence, bills, collection letters or any documents or information sent to or provided to the Subject Patient by your office;

i) A copy of any correspondence or other information sent to or provided to your office by the Subject Patient;

j) Copies of licenses of all people and/or entities who participated in the services rendered to the Subject Patient and/or interpreted any diagnostic testing provided to the Subject Patient;

k) Prescription and/or referrals for any treatment, testing, consultation or services for the Subject Patient;

l) Any and all documents signed by the Subject Patient;

m) Any and all information or documentation evidencing what you accepted from Medicare for CPT codes 99204, 97010, 97139, 97035, 97014, 97530, E0230, 99082, 97039, 97124, and 99213 (hereinafter, referred to as “Subject CPT Codes”) in the prior two (2) years;

n) Any and all information or documentation evidencing what you accepted, as payment from Medicaid for the Subject CPT Codes in the prior two (2) years;

o) Any and all information or documentation evidencing what you accepted, as payment, from any and all workers compensation insurers, for the Subject CPT Codes in the prior two (2) years;

p) Any and all information or documentation evidencing what you accepted as payment, from any and all private health care insurers (i.e. Blue Cross/Blue Shield, United Healthcare) for the Subject CPT Codes in the prior two (2) years;

q) Any and all information or documentation evidencing what you billed Medicare for the Subject CPT Codes in the prior two (2) years;

r) Any and all information or documentation evidencing what you billed Medicaid for the Subject CPT Codes in the prior two (2) years;

s) Any and all information or documentation evidencing what you billed Worker’s compensation insurers/carriers, for the Subject CPT Codes in the prior two (2) years;

t) Any and all information or documentation evidencing what you billed private health insurers/carriers (i.e. Blue Cross/Blue Shield, United Healthcare), for the Subject CPT Codes in the prior two (2) years;

u) Any documentation you have evidencing:

i) Any recommendations by peer reviews, consultants, similar providers or other such personnel, including any handwritten notes memorializing said recommendations;

ii) All information utilized by you to determine the Usual, Customary and/or Reasonable amounts charged by you for services rendered to the Subject Patient;

iii) Any and all schedules indicating what fee(s) you consider being within the “Usual and Customary” range and/or guidelines;

iv) A copy of the medical provider(s) fee schedule for each of the specific services that provider provides and/or which were provided to this patient, and the date your fee schedule was last updated and how it was updated;

v) The names, addresses and credentials of all individuals who participated in setting your fee(s) schedule;

vi) Please provide evidence of the methods of determining the fee(s) and assurance(s) used and that they are in harmony with all state insurance laws, UCR guidelines and/or Relative Value Scales (RVU’s);

vii) Any and all surveys, documents and/or other information relied upon by you in setting your charges for services rendered to the Subject Patient.

v) Your office manual on billing procedures; All memos, guidelines and/or instructions to your billing person/department regarding the procedures they must follow when billing; the codes they are to use; and the fees they are to charge;

w) Any and all documents verifying or indicating how much money you paid for the equipment, materials, devices and pads, etc., used to perform any services, testing and/or treatment on the Subject Patient;

x) Any and all documents verifying or indicating the lease terms of the equipment, material, devices and pads, etc., used to perform services, testing and/or treatment on the Subject Patient;

y) Your fee schedule(s) in effect for the prior three (3) years;

z) Please set forth your factual and legal basis for billing the Subject CPT Codes relative to any treatment, testing, services, products or accommodations provided to the Subject Patient.

3. All of the above documents shall be produced, within thirty (30) days of this executed Order at the law firm of Hengber, Goldstein & Ray, P.A. located at 100 N.E. 3rd Avenue, Suite 400, Fort Lauderdale, FL 33301.

4. With respect to MERCURY’s entitlement to attorney fees and costs pursuant to Florida Statute §627.736(6)(c), the Court grants Mercury’s entitlement to attorney fees and costs in an amount to be determined at a later hearing.

* * *