22 Fla. L. Weekly Supp. 859a
Online Reference: FLWSUPP 2207LIPGInsurance — Personal injury protection — Discovery — Insurer is not entitled to discover documents reflecting amounts accepted by medical provider as reimbursement from self-pay patients, workers’ compensation carriers, Medicare and Medicaid and from other private health insurers with which provider has negotiated rate contracts — Insurer is entitled to discover reimbursement amounts accepted by provider from other PIP carriers
MELBOURNE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-MELBOURNE, a Florida corporation (a/a/o Lipgens, Paula), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Brevard County. Case No. 05-2013-SC-025139. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Vitoria, Janet), Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-024690. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Turgeon, Alfred), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-024685. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Smith, Diamond), Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-025141. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Banks, Shanai), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-021741. MELBOURNE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-MELBOURNE, a Florida corporation (a/a/o Lewis, Frantzis), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-025140. MELBOURNE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-MELBOURNE, a Florida corporation (a/a/o Knerick, Lori), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-024674. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Donalson, Eric), Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-024662. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Johns, Isaac), Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-021744. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Dejesus, Zairylee), Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-024666. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Keller, Steven), Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-021743. ROCKLEDGE HMA, LLC d/b/a WUESTHOFF MEDICAL CENTER-ROCKLEDGE, a Florida corporation (a/a/o Butler, Kiona), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. Case No. 05-2013-SC-024664. January 21, 2015. A.B. Majeed, Judge. Counsel: Robert Goldman, Florida Advocates, Dania Beach, for Plaintiff.
ORDER ON DEFENDANT’S MOTION TOCOMPEL BETTER RESPONSES TO DISCOVERYAND MOTION FOR SANCTIONS
THIS CAUSE having come before the Court on January 5, 2015, upon the Defendant’s Motion to Compel Better Responses to Discovery and Motion for Sanctions, and the Court having considered the motion, having heard argument of counsel, and being otherwise fully advised, it is hereupon
ORDERED as follows:
1. In these consolidated PIP cases, Defendant seeks discovery from the Plaintiff as to amounts accepted by the Plaintiff from private health insurers, including HMOs and PPOs, self-pay patients, Worker’s Compensation carriers, Medicare and Medicaid. This court has previously ruled that a PIP insurer such as the Defendant is not entitled to such discovery, which is neither relevant nor reasonably calculated to lead to the discovery of admissible evidence on the issue of reasonableness of charges at issue in a PIP case. D. Badolato, P.A. d/b/a Premier Urgent Care (a/a/o Gwendolyn Floyd) v. State Farm Mutual Automobile Ins. Co., 22 Fla. L. Weekly Supp. 399a (Brevard Cty. Feb. 25, 2014). See also Hillsborough County Hospital Authority v. Fernandez, 664 So.2d 1071 (Fla. 2nd DCA 1995) [20 Fla. L. Weekly D2650b] (evidence of contractual discounts from HMOs, PPOs, Medicare, Medicaid and worker’s compensation, standing alone, is insufficient to prove that a hospital’s charges are unreasonable); Palms MRI Diagnostic Imaging Centers, Inc. (a/a/o Frank Sirker) v. State Farm Mutual Automobile Ins. Co., 21 Fla. L. Weekly Supp. 1069a (Broward Cty. May 19, 2014) (a medical provider’s negotiated rates with other insurers is not relevant to a determination of what a PIP insurer must pay the medical provider).
2. However, amounts accepted by the Plaintiff from other PIP insurers for the same CPT Codes at issue in these consolidated cases for the period of October 11, 2010 – October 1, 2011 is relevant and reasonably calculated to lead to the discovery of admissible evidence on the issue of the reasonableness of Plaintiff’s charges in these consolidated cases.
3. Accordingly, within sixty (60) days from the date of entry of the Order, Plaintiff shall produce such information regarding PIP insurer reimbursements for the period of October 11, 2010 – October 1, 2011 in 4 cases for each of the following CPT Codes: L0120, 72070, 72100, 72125, 9928325, 96372, J1885, 70450, 90714, 90471, 7045059, 7048659, 72040, 72100, 72131, 81003, 7204059, 7210059, 99282, 36415, 80053, 82150, 83690, 86026, 73260, 74177, Q9967, 72040, 73610, 73630, 29515, 99283, 9928225, 85025, 71260 and 72020.
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