23 Fla. L. Weekly Supp. 632a
Online Reference: FLWSUPP 2306GONZInsurance — Discovery — Interrogatories — Objections to interrogatories regarding identity of person who made decision to sue insurer, other suits to which provider is party, average amount accepted by provider as full and final payment for CPT codes at issue for six-month period surrounding dates of service, identity of other entities that provider billed for CPT codes at issue in six-month period and payments accepted from those providers, calculation and payment of 20% co-payment, billing procedures and receipt of letter of protection are sustained — Documents — Objections to requests to produce documentation regarding payments accepted from other payors, amounts billed to other payors, identity and credentials of persons who participated in setting provider’s fee schedule or pricing, evidence of methods of setting fees and ensuring that they comport with laws and guidelines, contracts between provider and other payors and letters of protection are sustained — Provider is required to produce schedules indicating fees that it considers to be within usual and customary range for CPT codes at issue
HEALTH DIAGNOSTICS OF FORT LAUDERDALE, LLC, d/b/a STAND-UP MRI OF FORT LAUDERDALE, a/a/o Graciela Gonzalez, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. CONO12-09429(70). May 26, 2015. Honorable John D. Fry, Judge. Counsel: Andrew J. Weinstein, Weinstein Law Firm, Coral Springs, for Plaintiff. Lisa S. Lullove, Roig Lawyers, P.A., Deerfield Beach, for Defendant.
ORDER ON PLAINTIFF’S OBJECTIONSTO DEFENDANT’S DISCOVERY
THIS CAUSE having come on to be heard on May 15, 2015, on Plaintiff’s Objections to Defendant’s Discovery and the Court having heard argument of counsel, having reviewed the Court file, and being otherwise advised in the Premises, it is hereupon ORDERED AND ADJUDGED as follows:
1. On or about May 11, 2015, Plaintiff served its Answers to Defendant’s First Set of Interrogatories, which contained objections that the Court will address separately:
a. Interrogatory # 6 asks the following: “Please provide the names and addresses of the persons who, on behalf of the Plaintiff, made the decision to sue Defendant for the billing at issue in this case, and describe their relationship to the Plaintiff.”
i. Plaintiff responded with the following objection: “The information sought in this request is harassing and is neither relevant nor reasonably calculated to lead to the discovery of admissible evidence.”
ii. Plaintiff’s objection is sustained.
b. Interrogatory #10 asks the following: “List all lawsuits the Plaintiff is a party to, identifying the Defendant, Plaintiff and defense attorneys, the venue where filed, the allegations, and damages claimed as owing.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. First, the information sought is not relevant to the instant case; second, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks. This would potentially take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business. Furthermore, the answer to this interrogatory may be derived or ascertained by reviewing public records maintained by the clerk of court. The burden of deriving or ascertaining the answer is substantially the same for the party servicing the interrogatory as for the party to whom it is directed.”
ii. Plaintiff’s objection is sustained.
c. Interrogatory #14 asks the following: “Identify the average amount that was accepted as full and final payment by the Plaintiff for all the CPT Codes billed by the Plaintiff in the instant claim for the six month period before and after the service(s) at issue in the instant lawsuit.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. First, the information sought is not relevant to the instant case; second, the information sought contains, reflects, references or relates to confidential business or proprietary information or trade secrets and the Defendant is unable to demonstrate a reasonable necessity for the information that outweighs the Plaintiff’s and other party’s interest in maintain the confidentiality of its trade secrets; third, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks. Furthermore, this would potentially take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business.”
ii. Plaintiff’s objection is sustained.
d. Interrogatory #16 asks the following: “Identify all insurers, federal agencies, state agencies, governmental agencies attorneys, patients or other parties that were sent bills by the Plaintiff for the CPT Codes billed by the Plaintiff in the instant claim for the six month period before the services were rendered in the instant lawsuit.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. First, the information sought is not relevant to the instant case; second, Plaintiff is not permitted to provide this information as it would violate the privacy of patients unrelated to this case; third, the information sought was not a factor used by either the Plaintiff or Defendant in this case; and fourth, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks, and in order for the Plaintiff to make a determination as requested, the Plaintiff would have to go back through hundreds if not thousands of files in order to determine whether the files were within the date range that Defendant is seeking and whether the file being reviewed pertains to the same CPT code at issue in this case. Furthermore, this would potentially take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business.”
e. Interrogatory #18 asks the following: “Identify the amount of the payment the Plaintiff has received from each of the parties listed in response to Interrogatory #16, specifically identifying the CPT Codes, the amount billed, the amount accepted, the date accepted, the source of the payment and an explanation if the amount accepted was less than the billed amount.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. First, the information sought is not relevant to the instant case; second, Plaintiff is not permitted to provide this information as it would violate the privacy of patients unrelated to this case; third, the information sought was not a factor used by either the Plaintiff or Defendant in this case; and fourth, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks, and in order for the Plaintiff to make a determination as requested, the Plaintiff would have to go back through hundreds if not thousands of files in order to determine whether the files were within the date range that Defendant is seeking and whether the file being reviewed pertains to the same CPT code at issue in this case. Furthermore, this would potentially take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business.”
ii. Plaintiff’s objection is sustained.
f. Interrogatory #19 asks the following: “Identify the date received, method of payment, amount paid and how the Plaintiff calculated the patient’s 20% co-payment.”
i. Plaintiff responded with the following objection: “Plaintiff objects: vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence.”
ii. Plaintiff’s objection is sustained.
g. Interrogatory #20 asks the following: “Please explain your billing procedures from the time of the treatment, care, or service provided to the patient through the time a billing statement or HCFA or CMS Health Insurance Claims Form was generated and submitted to State Farm.”
i. Plaintiff responded with the following objection: “Irrelevant and not reasonably calculated to lead to the discovery of admissible evidence.”
ii. Plaintiff’s objection is sustained.
h. Interrogatory #21 asks the following: “Did the Plaintiff receive a “letter of protection” or other agreement regarding payment for the bills submitted in this claim?”
i. Plaintiff responded with the following objection: “Irrelevant and not reasonably calculated to lead to the discovery of admissible evidence.”
ii. Plaintiff’s objection is sustained.
2. On or about March 31, 2015, Plaintiff served its Response to Defendant’s Request to Produce, which contained objections that the Court will address separately:
a. Request to Produce #3 asks the following: “Any and all information or documentation evidencing what Plaintiff, or its personnel, accepted as payment, from Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carriers (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc.), private pay, or any other payor other than an automobile insurance carrier, for the CPT code(s) at issue in the instant lawsuit for the year in which said services were rendered.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. Defendant is essentially requesting that Plaintiff provide copies of explanations of review reflecting that the Plaintiff has accepted payment from Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carries (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc), private pay, or any other payor other than automobile insurance carries for services rendered to patients. First, Plaintiff is not permitted to provide copies of these documents as it would violate the privacy of the patients unrelated to this case; second, the information sought was not a factor used by the Plaintiff or Defendant in this case; and third, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks and in order for the Plaintiff to produce the documents requested, the Plaintiff would have to go back through hundreds if not thousands of files in order to determine whether the files were within the date range that Defendant is seeking, whether the file being reviewed pertains to the same CPT codes at issue in this case, and whether the file involved Medicare, Medicaid, or Worker’s Compensation payments. This would take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business.”
ii. Plaintiff’s objection is sustained.
b. Request to Produce #4 asks the following: “Any and all information or documentation evidencing what Plaintiff, or its personnel, billed Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carriers (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc.), private pay, or any other payor other than an automobile insurance carrier, for the CPT code(s) at issue in the instant lawsuit for the year in which said services were rendered.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. Defendant is essentially requesting that Plaintiff provide copies of explanations of review, HCFA forms, or other billing documents reflecting that the Plaintiff has billed Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carries (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc), private pay, or any other payor including other automobile insurance carries for services rendered to patients. First, Plaintiff is not permitted to provide copies of these documents as it would violate the privacy of the patients unrelated to this case; second, the information sought was not a factor used by the Defendant in this case; and third, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks and in order for the Plaintiff to produce the documents requested, the Plaintiff would have to go back through hundreds if not thousands of files in order to determine whether the files were within the date range that Defendant is seeking, whether the file being reviewed pertains to the same CPT codes at issue in this case, and whether the file involved Medicare, Medicaid, Worker’s Compensation payments, etc. This would take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business. Although Plaintiff is unable to provide any of the documentation for the listed reasons above, Plaintiff states that it charges all of its patients the same amount.”
ii. Plaintiff’s objection is sustained.
c. Request to Produce #6 asks the following: “Any and all schedules indicating what fee(s) Plaintiff considers being within the “Usual and Customary” range and/or guidelines for CPT code(s) at issue as identified in your response to Interrogatories or for any other service allegedly rendered to the subject patient/insured.”
i. Plaintiff responded with the following objection: “Overbroad, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. The information sought was not a factor used by either the Plaintiff or the Defendant in this case. Additionally, the information sought seeks the production of documents that contain, reflect, reference or relate to confidential business or proprietary information or trade secrets and the Defendant is unable to demonstrate a reasonable necessity for the documents that outweighs the Plaintiff’s and other party’s interest in maintaining the confidentiality of its trade secrets.”
ii. Plaintiff’s objection is overruled.
d. Request to Produce #8 asks the following: “The names, addresses and credentials of all individuals who participated in setting Plaintiff’s fee(s) schedule or pricing.”
i. Plaintiff responded with the following objection: “The information sought in this request is neither relevant nor reasonably calculated to lead to the discovery of admissible evidence. The issue in a lawsuit for unpaid PIP benefits is whether the charges for the services at issue are reasonable, not how a medical provider determined the charge.”
ii. Plaintiff’s objection is sustained.
e. Request to Produce #9 asks the following: “Any and all evidence of the methods of determining the fee(s) and any ensuring that all fees comport with all state insurance equity laws, UCR guidelines and/or Relative Value Scales.”
i. Plaintiff responded with the following objection: “The information in this request is neither relevant nor reasonably calculated to lead to the discovery of admissible evidence. The issue in a lawsuit for unpaid PIP benefits is whether the charges for the services at issue are reasonable, not how a medical provider determined the charge.”
ii. Plaintiff’s objection is sustained.
f. Request to Produce #15 asks the following: “Any and all contracts or agreements between the Plaintiff and Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carriers (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc.), private pay, or any other payor including automobile insurance carriers that establishes or outlines charges or payments for the CPT codes billed by the Plaintiff in the instant lawsuit.”
i. Plaintiff responded with the following objection: “Overbroad, unduly burdensome, vague, irrelevant, and not reasonably calculated to lead to the discovery of admissible evidence. Defendant is essentially requesting that Plaintiff provide copies of explanations of review reflecting that the Plaintiff has accepted payment from Medicare, Medicaid, Worker’s Compensation, PPO, HMO, private insurance carries (such as Blue/Cross, Blue/Shield, Aetna, Cigna, United Healthcare, Humana, etc), private pay, or any other payor including other automobile insurance carries for services rendered to patients. First, Plaintiff is not permitted to provide copies of these documents as it would violate the privacy of the patients unrelated to this case; second, the information sought was not a factor used by the Defendant in this case; and third, the Plaintiff does not maintain its files in a manner to readily ascertain the information that Defendant seeks and in order for the Plaintiff to produce the documents requested, the Plaintiff would have to go back through hundreds if not thousands of files in order to determine whether the files were within the date range that Defendant is seeking, whether the file being reviewed pertains to the same CPT codes at issue in this case, and whether the file involved Medicare, Medicaid, Worker’s Compensation payments. This would take hundreds of man-hours to accomplish and would interrupt the normal course of Plaintiff’s business. Although Plaintiff is unable to provide any of the documentation for the listed reasons above, Plaintiff states that it charges all of its patients the same amount. As for the amount that Medicare is permitted to pay, this information is part of public record and can be obtained from the CMS website.”
ii. Plaintiff’s objection is sustained.
g. Request to Produce #19 asks the following: “Please provide any and all “letters of protection” or other agreements regarding payment of the bills submitted in this claim.”
i. Plaintiff responded with the following objection: “Irrelevant and not reasonably calculated to lead to the discovery of admissible.”
ii. Plaintiff’s objection is sustained.
h. Plaintiff has 20 days to provide a better response to Defendant’s Request to Produce #6.
