Pain Management Expert Witness’ Testimony About Billing for Medical Examinations Admitted
Posted on September 13, 2024 by Expert Witness Profiler
This matter involves the Plaintiff insurers’ claim that Defendants unlawfully billed for medically unnecessary and illusory services, misrepresented the nature and extent of the services, and operated in violation of various laws specific to the healthcare and/or insurance sector.
According to the Plaintiff, Titan Defendants agreed to refer patients to the Stein Defendants in exchange for the Stein Defendants providing the patient with a false EMC diagnosis, which enabled the Titan Defendants to provide medically unnecessary chiropractic, physical therapy, and other services to the patient and to receive reimbursement for these services in excess of the ordinary $2,500 limit.
Defendants Joel D. Stein, D.O., P.A. and Joel D. Stein, D.O. (collectively the “Stein Defendants”) procured an expert report from James Padula, which includes the following three opinions that Plaintiffs seek to exclude:
- The billing submitted through Stein P.A. to GEICO by the Stein Defendants was “appropriate.”
- “[T]he therapies and treatments provided [by the Stein Defendants to GEICO insureds] were supported by the examinations and the results of diagnostic testing, and therefore medically necessary . . . .”
- Based on the subjective complaints of the insureds and the objective findings from the testing and examinations, the Stein Defendants’ EMC findings were warranted.
Pain Management Expert Witness
James Padula has over 25 years of experience in treatment of spine and joint pain. Padula completed his Bachelor’s Degree at Villanova University. He graduated from New York College of Osteopathic Medicine with Honors.
He completed his internship at Maimonides Medical Center and residency at North Shore University Hospital at Glen Cove. Padula is trained in interventional Pain Management and Minimally Invasive Surgeries. He also trains physicians in the field of pain management.
Padula is Board Certified in Pain Management.
Discussion by the Court
Plaintiffs argued that Padula’s opinions should be excluded as not based on “sufficient facts and data” under Rule 702 and, therefore, unreliable because he did not review the documents that he would have needed to review in order to render a reliable opinion on the subject topics. In particular, Plaintiffs claimed that Padula only reviewed treatment records for initial examinations, which would provide him a basis for rendering an opinion on whether the billing for initial examinations at Stein P.A. was appropriate, and nothing more.
Padula’s export report stated the following regarding what he reviewed: “I was provided with, and reviewed, 36 [patient files], randomly selected by a blind draw [from the patient files included in the Second Amended Complaint].”
Padula’s Expert Witness Report and Declaration are Inconsistent with Parts of his Deposition Testimony
In his declaration, Padula stated that he reviewed 20 of the 95 claims files compiled by Plaintiffs for their expert witness Merritt’s review. These claim files contained “the medical records of all of the treating doctors and results of diagnostic testing tests, and would have contained other relevant data to this analysis such as crash reports, the results of IME exams, Peer Review Reports, [and] Explanations of Review.”
Plaintiffs cited excerpts from Padula’s deposition testimony to argue that Padula only reviewed treatment records for initial examinations performed at Stein P.A., despite his opinions relating to a broader scope of services and billing. However, the Court held that Padula’s expert witness report and declaration describe a review process that would provide a reliable factual basis by which Padula could opine on the subject issues. Also, to the extent Padula’s expert witness report and declaration are inconsistent with parts of his deposition testimony, this goes to Padula’s credibility, not the admissibility of his opinions.
While Padula subsequently appears to have contradicted himself in his deposition testimony with respect to certain materials, Plaintiffs are asking the Court to credit one source of evidence over another, which is typically a task reserved for the jury. Even further, for many of the materials Padula testified in his deposition to not having reviewed, Padula separately claimed to have reviewed notes summarizing these materials.
Held
The Court denied Plaintiffs’ motion to exclude opinions of Stein
Defendants’ expert James Padula, D.O.
Key Takeaway:
Padula’s expert witness report and declaration might be inconsistent with parts of his deposition testimony but only the jury can ask the Court to credit one source of evidence over another. The Court believed that Padula’s expert witness report and declaration describe a review process that would provide a reliable factual basis by which Padula could opine on the subject issues.
Case Details:
| Case Caption: | Government Employees Insurance Co. Et Al V. Titan Wellness Center Of Fort Myers, L.L.C. Et Al |
| Docket Number: | 0:22cv61648 |
| Court: | United States District Court for the Southern District of Florida |
| Order Date: | August 8, 2024 |
