23 Fla. L. Weekly Supp. 295c
Online Reference: FLWSUPP 2303TYREInsurance — Personal injury protection — Discovery — Insurer’s representative — Provider entitled to conduct deposition of insurer’s designated corporate representative and conduct inquiry regarding methodology, basis, facts, and calculations to determine reasonableness and payment of charges at issue — Provider entitled to depose representative regarding reimbursement levels in same county where service was performed, as reflected by amounts insurer paid similarly placed providers for same CPT codes 10 days prior to and after date of service in instant case
PORT CHARLOTTE HMA, LLC, D/B/A PEACE RIVER REGIONAL MEDICAL CENTER, A FLORIDA CORP., (a/a/o Tyree, Alyscia), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 20th Judicial Circuit in and for Charlotte County. Case No. 13-000601 SP. January 13, 2015. Peter A. Bell, Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff.
ORDER ON DEFENDANT’S AMENDEDMOTION FOR PROTECTIVE ORDER ANDOBJECTIONS TO DUCES TECUM
THIS CAUSE came before the Court on June 17, 2014 upon the Defendant State Farm Mutual Automobile Insurance Company’s Amended Motion for Protective Order and Objections to Plaintiff’s Duces Tecum. In response to Plaintiff’s Notice of Taking Fla.R.Civ.P. 1.310(B)(6) Deposition of State Farm (the “Notice”), State Farm produced litigation adjuster David Bossone as its designated representative to testify as to certain of the topics designated in the Notice. State Farm did not produce Mr. Bossone to testify as to the designated topic numbers 4 and 5, moving for a protective order as to those topics. Topic numbers 4 and 5 provide as follows —
4. The methodology, basis, facts and calculations to determine the reasonableness and payment of charges at issue in the claim in which the above referenced suit was filed.
5. Reimbursement levels in the same county where the service was performed, as reflected by the amounts which State Farm has paid other similarly placed providers in the same county where the service was performed for the same CPT codes that are at issue in this case, during the period of time of December 1, 2007 through December 31, 2007 and during the period of time from 10 days prior to the date of service in this case until 10 days after the date of service in this case.
In addition, State Farm objected to producing documents responsive to the following numbered requests that were part of the Duces Tecum attached to the Notice —
8. Random sampling of at least ten (10) Explanation of Reviews/Benefits (“EOR”) of reimbursement levels in the same county where the service was performed as reflected by the amounts which Defendant has paid other similarly placed providers, for the same CPT codes that are at issue in this case, during the period of time December 1, 2007 through December 31, 2007 (five EORs for the 10 day period prior to the date of service in this case and five EORs for the 10 day period after the date of service in this case) (Defendant may redact any privileged material therein).
9. Random sampling of at least ten (10) bills and/or EORs evidencing usual and customary charges for the same CPT codes in the same county where the service was performed (Defendant may redact any privileged material therein).
The Court reviewed Defendant’s Amended Motion for Protective Order and Objections to Plaintiff’s Duces Tecum, considered the argument of counsel and was otherwise fully advised. Accordingly, it is hereupon
ORDERED as follows:
1. Defendant’s Amended Motion for Protective Order is GRANTED in part and DENIED in part, and Defendant’s Objections to Plaintiff’s Duces Tecum are SUSTAINED in part and OVERRULED in part, as set forth below.
2. Defendant’s Amended Motion for Protective Order is DENIED as to designated topic number 4 and Plaintiff shall be entitled to conduct a deposition of Defendant’s designated corporate representative and conduct inquiry regarding the methodology, basis, facts and calculations to determine the reasonableness and payment of charges at issue in the claim in which the above referenced suit was filed.
3. Defendant’s Amended Motion for Protective Order is DENIED as to designated topic number 5 and Plaintiff shall be entitled to conduct a deposition of Defendant’s designated corporate representative and conduct inquiry regarding reimbursement levels in the same county where the service was performed, as reflected by the amounts which State Farm has paid other similarly placed providers in the same county where the service was performed for the same CPT codes that are at issue in this case, during the period of time from 10 days prior to the date of service in this case until 10 days after the date of service in this case.
4. Defendant’s Amended Motion for Protective Order is GRANTED as to designated topic number 5, to the extent that Plaintiff shall not be entitled to conduct inquiry regarding reimbursement levels in the same county where the service was performed for the month of December 2007.
5. Defendant’s Objections to Plaintiff’s Duces Tecum are OVERRULED as to request numbers 8 and 9, and Defendant shall produce the documents identified in those requests for the time period of 10 days prior to the date of service in this case until 10 days after the date of service in this case.
6. Defendant’s Objections to Plaintiff’s Duces Tecum is SUSTAINED as to request number 8, to the extent that Defendant shall not be required to produce the requested documents for the month of December 2007.
