Medical Billing Expert Witness Testimony Allowed

Plaintiff filed suit against defendant related to a dispute over medical billing.  Defendants hired a Medical Billing Expert Witness to provide testimony.  Plaintiffs filed a motion to exclude this witness from testifying.  The court denied the motion.

Facts:  This case (Contreras et al v. Brown et al – United States District Court – District of Arizona – May 10th, 2019) involves a dispute over medical billing.  The plaintiff incurred significant medical bills from treatment in Arizona and Nevada after a rear-end collision with the defendant.  The defendants have hired Mary Rossi (Medical Billing Expert Witness) to provide testimony.  The plaintiffs have filed a motion to exclude this expert from testifying.

Discussion:  Rossi holds a degree in nursing, is a registered nurse in Wisconsin, and is a certified legal nurse consultant.  She has previously testified in multiple venues across the country about the reasonable value of medical services.  The plaintiffs first challenge Rossi’s professional qualifications.  The plaintiffs allege that Rossi is not qualified to offer opinions regarding whether the charges for the plaintiff’s medial treatment was usual and customary for Las Vegas, Kingman, or Reno because she is not licensed, nor has she practiced nursing in Nevada or Arizona.  The court opines that Rossi’s experience in the medical field provides a minimal foundation in her area of expertise and that her lack of experience regarding Arizona and Nevada go to the weight of the testimony and not its admissibility.

The plaintiffs also argue that Rossi’s testimony in unreliable because it is derived exclusively from a third-party database whose information she has not verified.  Rossi contends that she relied on MCMC’s ZEBRA database in forming her opinions of the reasonable value of medical services provided to the plaintiff.  Using her methodology, Rossi uses the database, along with her experience in the medical billing field, to assess the accuracy and reasonableness of charges associated with CPT codes provided in the treatment of the plaintiff.

In addition, the plaintiffs question the sample size and reliability of inputs for the database used by Rossi.  The court agrees with the defendants that the costing associated with CPT codes is standardized in the medical billing industry and something that Rossi could reasonably rely on.  Thus, the court opines that Rossi’s proffered testimony is sufficiently reliable under Rule 702.

Last, the plaintiffs challenge the relevance of Rossi’s testimony.  They argue that Rossi’s testimony is irrelevant because her estimates of reasonable charges for the services provided are not based on an adequate understanding of customary charges in the relevant regions, nor the result of any experience or specialized training.  The court opines that plaintiffs arguments go to the reliability of Rossi’s methodologies and underlying data source.

Conclusion:  The motion to exclude the expert witness testimony of Mary Rossi is denied.