23 Fla. L. Weekly Supp. 345a
Online Reference: FLWSUPP 2304GALLInsurance — Personal injury protection — Discovery — Medical provider is required to produce computer generated procedure report reflecting amounts billed and accepted by provider for CPT codes at issue from all payors for one year before and after dates of service — If provider provides sufficient evidence that it is unable to provide computer generated report, it will be required to produce explanations of benefit or other documents showing amounts billed and accepted for CPT codes at issue from each and every payor
JACKSONVILLE SPINE & INJURY CENTER, P.L., a Florida Corporation as assignee for Gallman, Keyla, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2013-SC-003463, Division CC-O. April 23, 2015. Ronald Higbee, Judge. Counsel: Rinaman & Associates, P.A., Jacksonville, for Defendant.
ORDER ON DEFENDANT’S MOTION TO COMPELBETTER RESPONSES TO DEFENDANT’S DISCOVERYAND PLAINTIFF’S REPLY AND MOTION TO STRIKEAND/OR MOTION FOR MORE DEFINITE STATEMENT
THIS CAUSE came before the Court at the October 7, 2014 hearing on Defendant’s Motion to Compel Better Responses to Defendant’s Discovery and Plaintiff’s Reply and Motion to Strike and/or Motion for More Definite Statement, and the Court being otherwise fully advised in the premises, it is Ordered and Adjudged as follows:
1. Plaintiff brought this Personal Injury Protection (“PIP”) action against Defendant on August 6, 2013 for purportedly underpaid PIP benefits for dates of service April 16, 2008 through November 3, 2008.1
2. On or about February 2, 2014, Defendant propounded to Plaintiff its first Request to Produce and Interrogatories.
3. On or about March 10, 2014, Plaintiff filed a Motion to Extend Time in Which to Respond to Defendant’s Request for Production and Defendant’s Interrogatories.2
4. On or about March 20, 2014, Plaintiff provided responses to Defendant’s Request to Produce.
5. On or about March 27, 2014, Plaintiff provided verified responses to Defendant’s Interrogatories.
6. On or about April 1, 2014, and pursuant to Local Rule 88-2, counsel for Defendant sent a good faith letter to counsel for Plaintiff advising of the insufficiency of Plaintiff’s responses. Counsel for Defendant advised that Plaintiff provided boilerplate objections to many of its requests on reasonableness of the charge. Defendant requested Plaintiff contact Defendant to respond by April 8, 2014 or to request an additional extension for Plaintiff to provide better responses. Plaintiff did not contact Defendant within this time frame, causing Defendant to file a Motion to Compel Better Responses on July 24, 2014.
7. Plaintiff did not produce any documentation evidencing reasonableness of the charge in response to Defendant’s Request to Produce, and in fact, provided blanket objections for many of its responses. Defendant sought reasonableness of the charge information to use as evidence of the usual and customary payments accepted by the provider, which is permitted by the Florida Statutes, which states, in pertinent part:
“F.S. § 627.736(5) Charges for treatment of injured persons.
(a)1. Any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance may charge the insurer and the insured only a reasonable amount . . . [i]n no event, however, may such a charge be in excess of the amount the person or institution customarily charges for like services or supplies. With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute . . .”.
8. The interrogatories and the documents requested were propounded by Defendant to obtain evidence on the reasonableness of Plaintiff’s charge and the amount of payment Plaintiff believes to be reasonable for a certain service. Plaintiff’s assertion that Defendant’s payment is unreasonable — the very reason for bringing this lawsuit — is without merit unless Plaintiff can provide supporting documentation to prove what amount is reasonable. For additional support, the information requested by Defendant is frequently permitted by Florida Courts. Beaches Open MRI of Jacksonville (a/a/o Coreen Morehouse) v. State Farm Mutual Auto. Ins. Co., 20 Fla. L. Weekly Supp. 665a (Duval Cty. Ct. Jan. 23, 2013)(finding that “[w]here provider has burden to prove that care rendered and amount charged were reasonable, related and necessary, information regarding amounts provider receives from other entities, billing procedures, and setting of charges is discoverable”); Flagler Hospital, Inc. (a/a/o Mitchell Ball) v. MGA Ins. Co., 18 Fla. L. Weekly Supp. 610b (St. Johns Cty. Ct. Mar. 18, 2011)(compelling plaintiff produce to defendant reimbursement rates accepted from different payors for same or similar charges at issue in case); Hollywood Chiropractic & Acupuncture (a/a/o Jacqueline Burgos) v. UAIC, 20 Fla. L. Weekly Supp. 1095a (Broward Cty. Ct. Aug. 8, 2013)(ordering medical provider to provide better responses to discovery concerning payments accepted); Pembroke Pines MRI (a/a/o Elixardo Ramirez) v. United Automobile Ins. Co., 20 Fla. L. Weekly Supp. 629a (Broward Cty. Ct. Mar. 18, 2013)(requiring plaintiff produced amounts reimbursed to plaintiff by HMO and PPO health insurance companies); Bigley & Associates, P.A. d/b/a Premier Orthopedics of Orlando (a/a/o Justin Pierre) v. Progressive Express Ins. Co., 15 Fla. L. Weekly Supp. 917a (Orange Cty. Ct. June 18, 2008)(objections to producing documents showing amounts paid to physician overruled).
9. At the hearing on October 7, 2014, counsel for Plaintiff argued that the information sought by Defendant is not relevant because the only issue was whether Defendant was entitled to rely on permissive payments language under Florida Law and the insurance policy. This Court finds Plaintiff’s argument unpersuasive.
10. Based on the above-cited case law and argument from both Counsel, this Court finds that Plaintiff must produce within forty-five (45) days from the date of this Order a computer-generated procedure report, or other similar document, for the CPT codes at issue. The document must include the amount Plaintiff billed and accepted from each and every payor, including, but not limited to, in and out-of-network health insurance companies; cash paying patients and/or their representatives; Medicare; Medicaid; Worker’s Compensation insurers; federal and state agencies; disability insurers; and any other party that paid Plaintiff, from May 19, 2007 through November 3, 20093 for the CPT codes at issue in this case.
11. If Plaintiff provides sufficient evidence that it is unable to provide a computer-generated procedure report, Plaintiff shall be required to produce at least one explanation of benefit/review, or other document evidencing amounts billed and accepted by Plaintiff, for each CPT code at issue in this case from each and every in-network and out-of-network health insurance companies, as well as cash paying patients from May 19, 2007 through November 3, 2009. Plaintiff shall produce this information within forty-five (45) days of the date of this Order. Again, this provision is only relevant if Plaintiff provide sufficient evidence that it is unable to provide a computer-generated procedure report as described in number ten (10) above.
12. As Plaintiff did not provide any evidence at the October 7, 2014 hearing regarding its burdensome argument, the Court will reserve its ruling on a burdensome determination.
13. With respect to Plaintiff’s Reply and Motion to Strike and/or Motion for More Definite Statement, the Court denies Plaintiff’s Motion and refers to F.S. 627.736(10)(d) (2008), which states in pertinent part, “[t]o the extent the insurer determines not to pay any amount demanded, the penalty shall not be payable in any subsequent action.”
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1On October 3, 2014, Plaintiff withdrew dates of service April 16, 2008 through May 16, 2008 from issue. Accordingly, the dates of service at issue are May 19, 2008 through November 3, 2008.
2On or about March 24, 2014, after counsel for both parties entered an agreed order, this Court executed an agreed order for Plaintiff to respond to Defendant’s discovery within forty-five (45) days from the date of the order.
3In Defendant’s discovery requests, Defendant requested documentation from April 16, 2007 through November 3, 2009 (one year before the first date of service at issue to one year after the last date of service at issue). Because Plaintiff has withdrawn dates of service April 16, 2007 through May 16, 2007, this Court finds that the relevant time period should reflect the actual dates of service at issue, May 19, 2008 through November 3, 2008.
