22 Fla. L. Weekly Supp. 955b
Online Reference: FLWSUPP 2208TARAInsurance — Personal injury protection — Discovery — Depositions — Scope of inquiry regarding reasonableness of charges and reimbursement levels in community and documents to be produced at deposition
BEACHES OPEN MRI OF TAMARAC, LLC (a/a/o TARAZI, SAMIR), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 502012SC022564XXXXMB. February 25, 2015. Nancy Perez, Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff.
ORDER ON DEFENDANT’S OBJECTIONS TO PLAINTIFF’SNOTICE OF TAKING RULE 1.310(B)(6) VIDEODEPOSITION AND MOTION FOR PROTECTIVE ORDER
THIS CAUSE having come before the Court on February 18, 2015 upon Defendant’s Objections and Motion for Protective Order regarding designated topic numbers 11, 12 and 13 and duces tecum numbers 1, 17, 18, 20, 21, 23, 24, 25 and 26 of Plaintiff Amended Notice of Taking Rule 1.310(B)(6) Video Deposition (the “Deposition Notice”), and the Court having considered the motion, having heard argument of counsel and being otherwise fully advised, it is hereupon
ORDERED that the motion is GRANTED in part, and DENIED in part, as follows:
DESIGNATED TOPICS
1. Plaintiff shall be entitled to conduct inquiry regarding the amounts charged by medical providers in the Community (the geographical area defined by the first three digits of the zip code where Plaintiff provided the medical services for the benefit of Samir Tarazi — 333XX) who practice in the same specialty area as the Plaintiff (i.e., diagnostic imaging providers), for the Relevant CPT Code Procedures (72195 and 72148) during the Relevant Period (from January 13, 2012 through May 13, 2012, which is 60 days prior to the March 14, 2012 date of service up through and including 60 days after the date of service) (as identified in designated topic number 11 of the Deposition Notice), as well as the amounts allowed by Defendant for the charges of those medical providers in the Community (as identified in designated topic number 12 of the Deposition Notice) and reports/charts/audits to which Defendant is privy as it relates to amounts charged by diagnostic imaging providers in the Community for CPT Code Procedures 72195 and 72148 from from January 13, 2012 through May 13, 2012 (as identified in designated topic number 13 of the Deposition Notice).
2. Plaintiff shall be entitled to conduct inquiry regarding designated topic numbers 1-10 and 14-19 of the Deposition Notice, to which Defendant raised no objection at the hearing.
DOCUMENTS TO BE PRODUCED
3. Defendant shall not waive any applicable privilege, but shall bring the entire Personal Injury Protection (PIP) claim file (pre-litigation and post-litigation) maintained by Defendant, including any computerized records, as identified in duces tecum item number 1 of the Deposition Notice, in order to be able to refer to such records and answer questions at the deposition. Defendant need not produce documents from its claim file for which a claim of privilege is asserted, but shall file an applicable Privilege Log for such documents.
4. Defendant announced on the record of its withdrawal of objections to the following duces tecum item numbers, for which Defendant shall produce such responsive documents that may exist:
17). Any data and data compilations, analysis, spreadsheet(s), formula(s), average(s), survey(s), research, information and investigation(s) relied upon by Defendant in determining or calculating the “approved amounts” of the Charges/Submitted Amounts for the Relevant CPT Code Procedures.
18). To the extent that they exist, surveys of medical providers in the Community, that evidence, show or indicate the charges of medical providers in the Community for providing the Relevant CPT Code Procedures during the Relevant Period.
20). Any data or data compilations that reflect reimbursement levels for the Relevant CPT Code Procedures in the Community, during the year in which Plaintiff rendered the medical services to the Patient.
21). A chart, report, matrix, graphic depiction, spreadsheet or other visual display that reflects the amounts charged by medical providers who practice in the same specialty area as the Plaintiff, for providing the Relevant CPT Code Procedures in the Community, during the Relevant Period. The chart, report, matrix, graphic depiction, spreadsheet or other visual display responsive to this request must include the name of the medical provider, the location (address) of the medical provider, and the amount charged for the Relevant CPT Code Procedures.
5. Defendant’s objections to the following duces tecum items are SUSTAINED, the Motion for Protective Order is GRANTED without prejudice, and Defendant need not produce documents responsive to the following duces tecum items at deposition, except however, that Plaintiff shall not be precluded from re-visiting these requests after the deposition —
23). A copy of any and all executed agreements/contracts between Defendant and Mitchell Medical, Mitchell International and any other third party auditing vendor if utilized to adjust, process or facilitate the adjusting or processing of the Claim and in effect during the Relevant Period.
24). As applicable, any and all documents that contain the business rule that was applied to Plaintiff’s bills pursuant to which Defendant determined the allowed amount for a Relevant CPT Code Procedure based upon (a) 75 percent of the hospital’s usual and customary charge, (b) 200 percent of the allowable amount under the participating physicians schedule of Medicare Part B or (c) the workers’ compensation fee schedule.
25). Any and all documents that evidence, demonstrate or show that Defendant “auto-processed” the Claim or that Defendant did not “auto-process” the Claim.
6. Defendant’s objections to the duces tecum item number 26 is OVERRULED, the Motion for Protective Order is DENIED, and Defendant shall produce the following no later than March 6, 2015 —
A chart, report, matrix, graphic depiction, spreadsheet or other visual display using Decision Point software or similar software that reflects: (1) the medical providers in the Community that have performed the Relevant CPT Code Procedures, during the Relevant Period, and who have billed Defendant for those procedures; (2) the amounts that other medical providers have charged for performing the Relevant CPT Code Procedures, during the Relevant Period; (3) the amounts that Defendant has allowed as reasonable, approved or authorized charges for medical providers in the Community that have billed Defendant for the Relevant CPT Code Procedures, for procedures performed during the Relevant Period; and (4) the amounts that Defendant has paid medical providers in the Community that have billed Defendant for the Relevant CPT Code Procedures, for procedures performed during the Relevant Period.
7. With respect to those duces tecum item numbers 2-16, 19, 22 and 27, which are not previously addressed in this Order and to which Defendant raised no objection at the hearing, Defendant shall provide such responsive documents that may exist.
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