This is an automobile negligence case alleging that the Plaintiffs, Fred Young and Jeff Firman were permanently injured in a rear-end collision by an employee of the Defendant, Panera, LLC.
Plaintiff filed a motion to exclude or limit the testimony of Defendant’s medical billing expert, Keyona White. Plaintiffs argued White’s testimony should be excluded because her testimony is irrelevant, unhelpful to the jury, and because coding “experts” are generally unqualified to testify as to the reasonable charges for the myriad medical procedures involved in injury cases.
Medical Billing Expert Witness
Keyona White has nearly 20 years of experience in health information management and as a medical billing and coding professional, with specialized expertise in inpatient, outpatient, ancillary, radiology, and CDI services. She is responsible for the revenue cycle management of over 20 facilities in a large national healthcare system and is proficient in both federal program requirements and hospital compliance program obligations. Her extensive experience with coding and compliance analysis for pricing of medical services, along with applicable geographic considerations for similar services in the community, provides her with the bill review expertise needed to audit billing records in the context of clinical settings.
Discussion by the Court
The Court held that White is a coding expert. She has no expertise in the reasonableness of medical procedures or their associated costs. She offers no opinion that any bills submitted were fraudulent or billed under incorrect codes such that a correct code would yield the accurate billing value for the services rendered.
Moreover, the data underlying her opinions is drawn from national averages or mean billing rates across a number of reimbursement scenarios (i.e., Medicare, insurance, self-pay, etc.). Defendant, it seems, does not intend to call a witness to opine that Plaintiffs should have shopped around to find the least expensive fees for the medical services or treatments they were prescribed. Additionally, the mean billing rates Defendant proposes the jury should consider appear skewed by a myriad of factors, including Medicare billing requirements, insurance rates paid for the service rendered, and geographical differences in rates charged.
The Court added that if this testimony were admitted, the trial would devolve into side disputes about the fairness of the various providers’ billing practices—practices over which Plaintiffs had no control. This would be extremely confusing to the jury.
Also, Defendant has not raised a defense of collusion or fraud in the submission of medical bills, and White is not offered as a witness on that issue.
Finally, Defendant has secured a medical expert to opine on several issues, including the reasonableness of the amounts charged for Plaintiffs’ treatments. If White were qualified to testify on that point, which she is not, any testimony she would offer would be cumulative and, for that reason as well, would be unduly prejudicial.
Held
The Court granted Plaintiff’s Daubert motion to exclude or limit the testimony of Defendant’s medical billing expert, Keyona White.
Key Takeaways:
- To begin with, White lacks expertise in the reasonableness of medical procedures or their associated costs.
- Finally, if White’s testimony were admitted, the danger of unfair prejudice on these points would far outweigh any probative value the average or mean coding values would offer in this simple car accident case.
Case Details:
| Case Caption: | Fred Young Et Al V. Panera, Llc |
| Docket Number: | 8:22cv2894 |
| Court: | United States District Court, Florida Middle |
| Order Date: | August 1, 2024 |
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