Expert Witness’ Limited Testimony on Medical Billing Considered Unhelpful
Posted on October 16, 2024 by Expert Witness Profiler
On June 27, 2019, Plaintiff was involved in a motor vehicle accident with an underinsured driver. At the time of the accident, Plaintiff was covered by an Uninsured and/or Underinsured Motorist (“UM”) policy issued by Defendant. Plaintiff issued a demand to Defendant for settlement at policy limits. On August 26, 2020, Plaintiff filed a civil remedy notice (“CRN”) against Defendant, demanding $100,000 in UM benefits and asserting medical expenses exceeding $145,000.
Defendant retained Nicole Bonaparte to provide expert opinions and testimony on medical coding and billing. Specifically, the parties engaged Bonaparte to testify about the reasonableness of Plaintiff’s medical expenses and the billing practices used in connection with those charges. In her report, she opined that “the charges in this case were above the usual, customary, and reasonable charges in the community for the subject procedures and services.” The Plaintiff then moved to strike Bonaparte as an expert so as to preclude her from testifying at trial.
Medical Billing Expert Witness
Nicole Deniene Bonaparte, C.P.C., became a Certified Professional Coder after completing her Medical Coding Specialist Program in 1998 at the National School of Technology, North Miami Beach. She earned an A.A. degree from Miami-Dade Community College the same year. In 2000, she completed education classes, including ESOL, at Nova Southeastern University. She later received a Corporate Etiquette Consultant Certificate of Completion, specializing in Healthcare Protocol from the Protocol School of Palm Beach. She has extensive knowledge of medical terminology, diseases, surgeries, and insurance and medical billing terminology.
Discussion by the Court
Plaintiff primarily challenges the helpfulness and reliability of Bonaparte’s testimony. The Plaintiff argued that the Court should exclude Bonaparte’s testimony for two reasons. First, they claim her proposed testimony is irrelevant and will not assist the trier of fact in deciding the ultimate issue in this case. Second, they assert that her opinions are not based on reliable methodology.
Plaintiff contended that his medical damages were already litigated in the Underlying Lawsuit, and Defendant is not entitled to relitigate Plaintiff’s damages in this case. In response, Defendant argued that “based on the record and established case law, Bonaparte satisfies each prong necessary to permit her testimony.”
A. Helpfulness
I. Relevance
The Plaintiff argued that the Court should exclude Bonaparte’s testimony because it was irrelevant and would not assist the jury. The Plaintiff contended that the probative value was outweighed by the risk of unfair prejudice and confusion. Also, the testimony could raise doubts about an issue already decided in the underlying case. Defendant countered that Bonaparte’s testimony was essential to “demonstrate that its decisions were based on an objective evaluation of the medical charges and were not made in bad faith.”
However, the Court sided with Plaintiff and held that Bonaparte’s testimony regarding the reasonableness of Plaintiff’s medical expenses and the billing practices used in connection with those charges would not be helpful to the jury and should be excluded. It noted that courts throughout the Eleventh Circuit, including the Eleventh Circuit Court of Appeals, have routinely excluded medical coding and billing experts under Daubert and Federal Rule of Evidence 403. The Court found such testimony irrelevant and unhelpful, as experts in this area are typically unqualified to testify as to the reasonable charges for the myriad medical procedures involved in injury cases.
II. Qualifications
Bonaparte’s curriculum vitae reflects that she holds certificates in medical coding, but does not have a medical education or training. Because Bonaparte holds no medical qualifications that would support her testimony as to the reasonableness of the medical procedures, the Court finds that her limited testimony on medical billing/coding would not be helpful to the jury.
However, Defendant disputed this conclusion, arguing that “an expert’s analysis is required to assist the trier of fact to assess the reasonableness of the medical charges at issue.”
However, Bonaparte is being offered to opine about the reasonableness of charges for medical services assumed to have been delivered rather than about whether the medical services billed reflected medical services delivered. In conclusion, the Court held that Bonaparte’s testimony would not be applicable where there is merely “a conflict over the reasonableness of charges for medical services, assumed to have been delivered.”
Held
The Court granted the Plaintiff’s Daubert motion to strike Nicole Bonaparte as an expert and preclude her from testifying at trial in this matter.
Key Takeaways:
- Bonaparte’s limited testimony on medical billing/coding would not be helpful to the jury because she holds no medical qualifications that would support her testimony as to the reasonableness of the medical procedures.
- Because there is a conflict over the reasonableness of charges for medical services, assumed to have been delivered, Bonaparte’s testimony would not be applicable because Bonaparte is being offered to opine about the reasonableness of charges for medical services assumed to have been delivered rather than about whether the medical services billed reflected medical services delivered.
Case Details:
| Case Caption: | Collazo v. Progressive Select Ins. Co. |
| Docket Number: | 1:23cv22953 |
| Court: | United States District Court for the Southern District of Florida |
| Order Date: | September 23, 2024 |
