Expert Testimony on Medical and Prescription Expenses Admitted
Posted on September 9, 2025 by Expert Witness Profiler
Plaintiff Vicenta Vega was allegedly injured when she slipped on water that had accumulated on the floor of a Ross Stores retail store. She sought damages for past and future medical expenses, past and future pain and suffering, past and future physical impairment, past and future scarring and disfigurement, and lost earning capacity.
Ross Stores designated Patrice Morin-Resch as an expert witness. Her report provided “charge benchmark data,” which she described as “actual medians of ʻcharges’ that doctors and other medical providers have submitted to thirdparty payers and shows how these compare to what the providers have invoiced to the Plaintiff.”
She explained that she used “Context 4 Healthcare data to compare charges made by physicians, chiropractors, outpatient facilities, and hospitals” and that, for medications, she uses GoodRx or Drugs.com. The Context 4 Healthcare data comes “from various clearinghouses that collect the charge information after it is sent from the provider before it is dispatched to a third-party payer,” and Morin-Resch narrowed the data by service date, zip code, and medical code. She explained that her “work is not limited to merely uploading the Context 4 Healthcare comparative fees into a spreadsheet”; she analyzed and compared the billing codes used in medical documentation to determine whether they are correct.
She provided a report that reflected different percentiles showing how much medical providers billed for the same service in the same year and geographic location. As she explained, 50 percent of providers charge equal to or less than the 50th-percentile dollar amount; 60 percent of providers charge equal to or less than the 60th-percentile dollar amount, and so on. The report also included the amount that Medicare paid for those services.
Plaintiff Vicenta Vega filed a motion to strike the testimony of Morin-Resch.
Medical Billing Expert Witness
Patrice Morin-Resch has authored textbooks on medical billing and coding, edited the American Medical Association’s CPT® (Current Procedural Terminology) codebook, and trained thousands of people on the use of CPT® coding.
Discussion by the Court
The report included Morin-Resch’s opinion as to whether the amounts billed by twelve of Vega’s providers were usual, customary, and reasonable when compared with the data compiled from Context 4 Healthcare, Medicare, GoodRx, and Drugs.com.
Vega argued that Morin-Resch’s proposed testimony is irrelevant and based on unreliable data and methodology because it relied on data from Context 4 Healthcare, Inc., Medicare, GoodRx, and Drugs.com and applied a percentile-based methodology to determine the reasonableness of charges.
In response, Ross Stores argued that the data supporting Morin-Resch’s proposed testimony is relevant and reliable and that her methodology reflected her knowledge and expertise. Although Ross Stores spent much of its response reiterating Morin-Resch’s qualifications as an expert, Vega did not challenge her proposed testimony on that basis.
Relevance
Vega argued that Morin-Resch’s opinion, which relied on data from Context 4 Healthcare, Medicare, GoodRx, and Drugs.com, is not relevant because Ross Stores cannot show that Vega had access to services or medications at those prices or that prices available through discount programs are the “benchmark” for reasonableness. Vega specifically asserted that she was not eligible for Medicare and that she did not have a Drugs.com discount card.
However, the Court held that Morin-Resch’s opinion about the reasonableness of charges, based on aggregated data from Context 4 Healthcare, Medicare, Drugs.com, and GoodRx and combined with her own knowledge of billing practices, is relevant to the amount Vega may recover for her medical expenses. That is true even if Vega personally could not access services or
medications at the prices charged to other customers.
Reliability
Vega argued that Ross Stores cannot show that Morin-Resch reviewed the data underlying the Context 4 Healthcare reports or that the data has been peer-reviewed or relied on by others to establish usual, customary, and reasonable charges for medical care.
Ross Stores argued that Morin-Resch reviewed the Context 4 Healthcare data to prepare her report and that its data has been used by hundreds of healthcare organizations over the course of decades. Morin-Resch’s report confirmed that she reviewed the report provided by Context 4 Healthcare. According to the Court, her review of the data underlying the report is not determinative of the reliability of her testimony based on that report.
Methodology
Vega challenged Morin-Resch’s conclusion that charges exceeding the 80th percentile are not reasonable because, in her view, there is an insufficient basis to draw the line between reasonable and unreasonable at 80%.
Ross Stores argued that Vega mischaracterized Morin-Resch’s opinion and overlooked the value added by her expert analysis. It pointed to Morin-Resch’s assessments of the billing codes used by Vega’s medical providers, which allowed her to provide additional commentary on how those providers billed. It also noted that Morin-Resch did not reach a blanket conclusion that bills were unreasonable because they exceeded the 80th percentile; instead, she discussed each service billed and compared it to the percentiles, noting that one provider billed 2.33 times the 80th percentile for similar services.
Morin-Resch’s report supported Ross Stores’ position. Morin-Resch’s methodology entailed downloading data from Context 4 Healthcare; filtering it by date, location, and billing code; and extrapolating percentiles from the results. Morin-Resch then analyzed the billing codes used by Vega’s providers, compared them to documentation showing the care Vega actually received, and made corrections as necessary to the billing codes that should have been applied. Morin-Resch then compared the prices charged to Vega with prices charged for the same services, as reflected by the Context 4 Healthcare data. While Vega may be able to criticize the report when it is presented to the jury, the Court held that she cannot show that Morin-Resch employed “no methodology.”
Held
The Court denied Vega’s motion to strike the testimony of Ross Stores, Inc.’s expert witness Patrice Morin-Resch.
Key Takeaway:
Daubert’s “general acceptance” factor goes to whether a theory or technique is reliable. “A proponent need not prove to the judge that the expert’s testimony is correct,” but only that it is based on reliable methods. That means it does not matter, at this stage, whether Morin-Resch is correct that a given charge for a medical service is unreasonable. What matters is how she reached that conclusion, and her report makes that sufficiently clear.
Case Details:
| Case Caption: | Vega V. Ross Stores Inc., Et Al. |
| Docket Number: | 4:24cv733 |
| Court Name: | United States District Court, Texas Eastern |
| Order Date: | September 08, 2025 |
