21 Fla. L. Weekly Supp. 278a
Online Reference: FLWSUPP 2103BANIInsurance — Personal injury protection — Discovery — Medical provider is ordered to produce documents relating to negotiated rates, billing practices, data utilized to calculate usual and customary charges, method of calculating charges for CPT codes billed, Charge Master and Charge Master team members, ordering of radiology procedures by emergency department physicians, and performance reviews of physicians who treated insured, subject to execution of mutually agreeable confidentiality agreement
ST. JOSEPH’S HOSPITAL OF PORT CHARLOTTE, FLORIDA, INC a/a/o KARA BANIAK, Plaintiff, vs. ARTISANS AND TRUCKERS CASUALTY COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 502012SC014185XXXXSB. October 29, 2013. Honorable Reginald Corlew, Judge.
ORDER ON PLAINTIFF’S OBJECTIONS TO DEFENDANT’S SECOND REQUEST TO PRODUCE
THIS CAUSE having come before this Court, on Plaintiff’s Objections to Defendant’s Request to Produce, and the Court having heard arguments of counsel and the Court being otherwise fully advised in the premises, it is hereby
ORDERED AND ADJUDGED that:
1. With regard to Paragraph number one (1) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any and all contracts, writings or agreements that Plaintiff has entered into evidencing negotiated rates with health insurance companies, HMOs, PPOs, EPOs, PIP insurance companies, Work compensation entities, Medicare and Medicaid or any other entity for the CPT code(s) billed for the patient listed in Plaintiff’s Complaint,” Plaintiff’s objections are overruled. Plaintiff must produce the amounts it was reimbursed from health insurance companies, HMOs, PPOs, EPOs, POSs, PIP insurance companies, worker’s compensation entities, Medicare and Medicaid, any other entities not listed, and self-pay patients for the period three months before the date of service at issue and three months after the date of service at issue for the CPT codes billed in this case. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
2. With regard to Paragraph numbers five (5) and six (6) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which request “any and all written policies, procedures, manuals or other documents which express the billing practices and/or requirements of Plaintiff when billing a cash paying patient/individual, PPO, HMO, EPO, POS or other managed care entity for the CPT codes billed for the patient listed in Plaintiff’s Complaint,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
3. With regard to Paragraph number fourteen (14) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “all data utilized and/or relied upon in calculating the usual and customary charge in the community for the CPT codes billed for the patient listed in Plaintiff’s Complaint,” Plaintiff’s objections arc overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
4. With regard to Paragraph number fifteen (15) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation evidencing the method and/or calculation used by Plaintiff to determine the charge for each CPT code billed for the patient listed in Plaintiff’s Complaint,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
5. With regard to Paragraph number sixteen (16) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation evidencing the method and/or calculation used by Plaintiff to determine the charge for each CPT code billed for the patient listed in Plaintiff’s Complaint,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
6. With regard to Paragraph number twenty-nine (29) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any and all Charge Masters, CDM or Charge Description Master maintained for 2008 and 2009 for the CPT codes billed in this case,” Plaintiff’s objections are overruled. Plaintiff must produce any and all Charge Masters, CDM or Charge Description Master maintained for the period three months before the date of service at issue and three months after the date of service at issue for the CPT codes billed in this case. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
7. With regard to Paragraph number thirty (30) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation, forms or correspondence indicating the members of the Charge Master Team or committee responsible for setting the charges at issue in this case,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
8. With regard to Paragraph number thirty-one (31) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation, forms or correspondence indicating any update, review or analysis of the Charge Master for the CPT codes at issue in this case,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue for the CPT codes billed in this case. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
9. With regard to Paragraph number thirty-two (32) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any and all data or documentation used to set the charges for the CPT codes at issue in this case for the Charge Master,” Plaintiff’s objections arc overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue for the CPT codes billed in this case. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
10. With regard to Paragraph number thirty-three (33) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any and all data or documentation referencing the mark up on the Charge Master for the CPT codes at issue in this case,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue for the CPT codes billed in this case. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
11. With regard to Paragraph number thirty-seven (37) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation reflecting benchmarks for ordering radiology procedures by emergency department physicians,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
12. With regard to Paragraph number thirty-eight (38) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation requiring the ordering of certain radiology procedures by emergency department physicians,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
13. With regard to Paragraph number thirty-nine (39) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation reflecting quotas for ordering radiology procedures by emergency department physicians,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said doctunentation is subject to the execution of a mutually agreeable confidentiality agreement.
14. With regard to Paragraph number forty (40) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any documentation reflecting bonusing for ordering radiology procedures by emergency department physicians,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
15. With regard to Paragraph number forty-one (41) of Exhibit “A” of Defendant’s Second Request to Produce to Plaintiff which requests “any and all physician performance reviews of the emergency department physician that provided medical treatment to the patient listed in Plaintiff’s Complaint,” Plaintiff’s objections are overruled. Plaintiff must produce any documentation it has responsive to said request for the period three months before the date of service at issue and three months after the date of service at issue. Production of said documentation is subject to the execution of a mutually agreeable confidentiality agreement.
16. Plaintiff shall provide the requested documentation within forty-five (45) days from the date of this order.
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