23 Fla. L. Weekly Supp. 342a
Online Reference: FLWSUPP 2304WALLInsurance — 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 — Provider may identify payors by abbreviations to prevent release of proprietary information or trade secrets
PHYSICIANS MEDICAL CENTER, INC., as assignee for NORMA C. WALLING, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2013-SC-003085, Division CC-L. November 13, 2014. Michelle Kalil, Judge. Counsel: Rinaman & Associates, P.A., Jacksonville, for Defendant.
ORDER OVERRULING PLAINTIFF’S OBJECTIONS TOEXHIBIT “A” OF DEFENDANT’S NOTICE OF TAKINGDEPOSITION DUCES TECUM
THIS CAUSE came before the Court at the October 29, 2014 hearing on Plaintiff’s Objections to Exhibit “A” of Defendant’s Notice of Taking Deposition Duces Tecum of Plaintiff’s Person with Most Knowledge of Billing, and it appearing that good and sufficient grounds have been shown for Overruling Plaintiff’s Objections, 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 June 3, 2013 for underpaid PIP benefits for dates of service May 11, 2011 through June 15, 2011.
2. On or about September 4, 2014, Defendant issued a Notice of Taking Deposition Duces Tecum of the Person with the Most Knowledge of Billing at the Plaintiff s Office.
3. On or about September 16, 2014, Plaintiff filed Objections to Exhibit “A” of Defendant’s Notice of Taking Deposition Duces Tecum (Person with the Most Knowledge of Billing).
4. Plaintiff objected on the grounds that the requests were “irrelevant, unduly burdensome, overly broad, confidential, and requesting proprietary content governed by F.S. §408.061(8), and that the Plaintiff’s software was not capable of generating a CPT code procedure report.
5. Plaintiff objected to providing evidence of reasonableness of the charge in response to Defendant’s Notice of Deposition Duces Tecum. 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. [D]etermination 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, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service, treatment, or supply. (Emphasis added.)
6. Defendant requested Plaintiff produce a computer-generated procedure report from its billing software delineating every instance of amounts Plaintiff charged and accepted for the CPT codes at issue in this case. This Court determines that the relevant time frame for the procedure report shall encompass a year before and after the dates of service at issue, May 11, 2010 through June 15, 2012.
7. This Court finds that Section 627.736(5)(a)(1) is clear in that it allows Defendant to engage in the above-mentioned discovery to defend itself on the issue of reasonable charge, including information from “automobile and other insurance coverages.”.
8. Finally, Plaintiff’s counsel stated that Defendant should not be allowed to obtain or discover trade secret contracted rates the Plaintiff has with HMOs and PPOs because it is an inappropriate comparison. However, F.S. §627.736(5)(a)(1) permits reference to many indicators of reasonable rates for the same services in this community, which is not limited to PIP insurance. In an effort to prevent any risk of release of proprietary or trade secrets, in Plaintiff’s report, Plaintiff may identify the health insurers by “HMO #1,” “HMO #2,” “PPO #1,” “PPO #2,” “cash payor,” “bodily injury claim,” etc., to correspond directly with the appropriate payor. Each payor may be assigned their own abbreviation, which must be denoted properly. This is not a requirement, and the Plaintiff may release the names of the HMOs and PPOs if it so chooses.
9. Based on the above-cited case law and argument from both Counsel, this Court finds that Plaintiff must produce a computer-generated procedure report, or other similar document, for the CPT codes at issue for May 11, 2010 through June 15, 2012 at the Deposition of the Plaintiff’s Person with Most Knowledge of Billing. The document must include the amount Plaintiff billed and accepted from all payors, 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 11, 2010 through June 15, 2012 for all CPT codes at issue in this case.
