Plaintiff filed a lawsuit against defendant related to a personal injury claim. The defendant hired a Medical Billing Expert Witness to provide expert witness testimony. The plaintiff has filed a motion to exclude this expert from testifying. The court denied the motion to exclude.
Facts: This case (Collins v. Menard, Inc. – United States District Court – Northern District of Illinois – August 21st, 2019) involves a personal injury claim. The plaintiff argues that she was injured when a shopping cart made contact with her hip outside of a Menard’s home improvement store. The parties do not dispute that the cart struck the plaintiff. The parties do dispute the nature, cause, and extent of the plaintiff’s injuries. The defendant has retained Medical Billing Expert Witness Barbara King to provide testimony in this case. The plaintiff has filed a motion to exclude this expert from testifying.
Discussion: Ms. King was hired by the defendant to review the plaintiff’s medical bills and evaluate their reasonableness. Ms. King opined that the plaintiff’s medical bills were not comprised of usual, customary, and reasonable (“UCR”) charges for the medical procedures that were performed.
The plaintiff has filed a motion to exclude Ms. King’s report and bar her testimony, stating that her opinion was based on “hearsay” data and is therefore unreliable. The plaintiff does not challenge Ms. King’s qualifications nor her relevancy. The plaintiff does assert that Ms. King impermissibly relied on “Medata”, a medical coding database, and that her use of this data from a third-party is composed of hearsay.
The court denies the plaintiff’s motion to exclude and opines that the plaintiff’s objections go the weight and not the admissibility of that opinion and testimony.
First, the court opines that Ms. King has the necessary skill and training to evaluate the plaintiff’s medical bills and render an opinion as to whether they are within the usual, customary, and reasonable cost of similarly situated procedures.
In terms of methodology, Ms. King reviewed the plaintiff’s medical bills to come to a conclusion whether they were at or below the UCR billing of similar services by the same provider type and within the same geographical area.
The plaintiff’s issue with Ms. King’s opinion is her use of a CPT code database, Medata. The court opines that Daubert and Federal Rule of Evidence 703 allows Ms. King to rely on industry standards and other data sources to establish the reasonableness of a medical bill.
While being deposed, Ms. King explained that it is common practice in the field of medical billing, it is common industry practice to use a CPT code database to compare prices among similar services. The court opines that Ms. King is allowed to rely upon a nationwide database of CPT codes to analyze the plaintiff’s medical bills and then form her opinion.
Conclusion: The motion to exclude the expert witness testimony of Barbara King is denied.