Medical Insurance Expert Witness Testimony Allowed

Plaintiff filed suit against the State of New Jersey regarding a Medicaid issue.  The defendant hired a Medical Insurance Expert Witness to provide testimony.  The plaintiff filed a motion to exclude this expert witness testimony, which was denied by the court.

Facts:  This case (NEW JERSEY PRIMARY CARE ASSOCIATION, INC. v. STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES et al – United States District Court – District of New Jersey – September 12th, 2018) involves a Medicaid issue.  In 2011 the state changed its methodology used to calculate wraparound payments and the plaintiff filed suit against the state.  The defendant hired Medical Insurance Expert Witness Billy Willwee to provide testimony on their behalf.  The plaintiff filed a motion to exclude this expert witness testimony.

Discussion:  In his report, Millwee opined that New Jersey has put into place a reasonable process to manage FQHC (Federally Qualified Health Centers ) wraparound payments and that a responsive process for appeals seems to be working for a majority of FQHCs.  In order to come to his conclusion, Millwee reviewed numerous documents, including the plaintiff’s expert report, deposition transcripts and certifications of numerous state personnel, and prior court opinions, orders, and filings.

The plaintiff argues that Millwee is not qualified to offer an opinion in this case as he has no experience with FQHCs.  They argue that he based his opinion on his general experience with Medicaid managed care and ignored the FQHC’s position in the overall plan.  The state argues that Millwee is fully qualified to offer his opinion based on years of experience with Medicaid in numerous capacities, in both the public and private sectors.  The court agrees with the state and opines that based on his experience with Medicaid, he is sufficiently qualified to offer an opinion in this case.

The plaintiff also argues that Millwee’s expert report is not reliable because 1) it is not based on sufficient data or facts and that 2) he did not apply any of his expertise to the facts.  The plaintiff alleges that Millwee only reviewed the written description of the wraparound process, did not perform an independent review of claims information and did not consider the declarations of health center representatives and other data.  The state argues that Millwee only needed to have good grounds for his opinions and was not required to review the plaintiff’s declarations.  In addition, the state noted that Millwee did apply his expertise to the data supporting his opinion.  The court again agrees with the state opining that Millwee’s report was sufficiently reliable and that the report satisfies the reliability part of Daubert.

The court also opines that Millwee’s report is connected to the issues in the case and will be helpful to the trier of fact.

Conclusion:  The motion to exclude the expert witness report of Billy Willwee is denied.