22 Fla. L. Weekly Supp. 1163a
Online Reference: FLWSUPP 2210DUPRInsurance — Personal injury protection — Discovery — Insurer is not entitled to discover documents reflecting amounts accepted by medical provider as reimbursement from other insurance carriers pursuant to negotiated rate contracts — Insurer is not entitled to discovery regarding reimbursement accepted by provider from Medicare and Medicaid — Insurer is entitled to discover reimbursement amounts accepted by provider from other PIP carriers, insurance carriers with which provider does not have negotiated rate contracts and cash-paying patients
ORANGE PARK CHIROPRACTIC CENTER A/A/O VICTOR DUPREE, Plaintiff, v. SOUTHERN-OWNERS INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Clay County. Case No. 2014-SC-950-C. April 30, 2015. Timothy R. Collins, Judge. Counsel: Adam Saben, Shuster & Saben, Jacksonville, for Plaintiff. Michael Peacock, Lewis & Leiser, Satellite Beach, for Defendant.
ORDER DENYING IN PART AND GRANTINGIN PART DEFENDANT’S MOTION TOCOMPEL BETTER RESPONSES TOREQUEST FOR PRODUCTION
THIS CAUSE came before the Court for hearing on April 23, 2015 on Defendant’s Motion to Compel Better Responses to Request to Production. The Court, having reviewed the motions and entire Court file, read relevant legal authority, heard argument, and been sufficiently advised in the premises, finds as follows:
The main issue, as framed by the parties, goes to the discoverability of amounts accepted as reimbursements from third-party payors. This Court has the benefit of reviewing Orders from sister courts that have addressed this issue, especially those from the Fourth Judicial Circuit, wherein said amounts have been found non-discoverable and wholly irrelevant to the reasonableness of the charges at issue. This Court finds the reasoning in Physician’s Medical Center a/a/o Rosemarie Heine v. State Farm Mut. Auto. Ins. Co., (Order of Duval County Court Judge Ronald Higbee dated April 6, 2015, case number 16-2014-SC-4611) [22 Fla. L. Weekly Supp. 1063a]; Physician’s Medical Center, Jax, Inc. a/a/o Debra Royal v. State Farm Mut. Auto. Ins. Co., 22 Fla. L. Weekly Supp. 456a (Order of Duval County Court Judge Scott Mitchell dated October 9, 2014); and McGowan Spinal Rehab Center, a/a/o Jaynell Cameron v. State Farm Mut. Auto. Ins. Co., (Order of Duval County Court Judge Brent Shore dated October 15, 2014, case number 16-2014-SC-2059) [22 Fla. L. Weekly Supp. 708a] to be persuasive and well-founded. That is, evidence of reimbursements pursuant to negotiated rate contracts are not relevant or discoverable because such contracts negotiate rates irrespective of the submitted charge. Further, because of the inherent differences with a PIP contract that mandates payment based on reasonable charges, any evidence of reimbursement in a negotiated rate contract to disprove the reasonableness of the medical provider’s charges is comparing “apples to oranges” and not “apples to apples”. Similarly, the Court denies the Defendant’s Motion to Compel Better as it relates to reimbursements for Medicare and Medicaid. These programs are not insurance as its premiums are not based on risk. The reimbursements are based on computations set by fee schedules. The Court grants the Defendant’s motion with respect to reimbursements from other PIP carriers as reimbursements from these carriers goes to the reasonableness of the Plaintiff’s charges, which is an issue in this case.
Therefore, it is ORDERED and ADJUDGED that Defendant’s Motion to Compel Better Response to Request to Produce is DENIED with respect to negotiated rate contract reimbursements, including HMO, PPO, and private health contracts and the production of same. The Motion to Compel Better Response to Request to Produce is DENIED also with respect to Medicare and Medicaid reimbursements. The Defendant’s Motion is GRANTED with respect to reimbursements from PIP carriers and reimbursements from third-party payors that do not have negotiated rate contracts as well as cash-paying patients for a three-month period before and after the dates of service at issue. As to the other discovery sought in the Defendant’s motion, the Plaintiff agrees to provide better responses within twenty (20) days of the signing of this Order without opinion from this Court.
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