Admissibility of Medical Billing Expert Testimony in Personal Injury Lawsuit

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Case Background:

In the case of Smith et al v. Johnson et al, which was heard in the United States District Court on May 10th, 2019, the central issue revolves around a dispute concerning medical billing. The plaintiffs incurred substantial medical expenses for their treatment in Arizona and Nevada following a rear-end collision with the defendants. The defendants have enlisted the services of John Anderson, a Medical Billing Expert Witness, to testify in the case. In response, the plaintiffs have submitted a motion to exclude Anderson's expert testimony.



John Anderson possesses a nursing degree and is a registered nurse in the state of Wisconsin. He also holds certification as a legal nurse consultant and has previously provided expert testimony on the reasonable value of medical services in various jurisdictions across the country. The plaintiffs' primary objection pertains to Anderson's professional qualifications. They contend that Anderson lacks the qualifications to opine on whether the charges for the plaintiffs' medical treatment were customary and reasonable in locations such as Las Vegas, Kingman, or Reno since he is neither licensed nor has he practiced nursing in Nevada or Arizona. The court has determined that while Anderson's experience in the medical field provides a foundational basis for his expertise, his lack of specific experience in Arizona and Nevada pertains more to the weight of his testimony rather than its admissibility.

The plaintiffs further argue that Anderson's testimony is unreliable because it relies exclusively on a third-party database without independent verification. Anderson, on the other hand, asserts that he relied on the MCMC's ZEBRA database to formulate his opinions regarding the reasonable value of medical services provided to the plaintiffs. Anderson's methodology involves using the database, in conjunction with his extensive experience in the field of medical billing, to assess the accuracy and reasonableness of charges associated with CPT codes used in the plaintiffs' treatment.

Additionally, the plaintiffs raise concerns about the sample size and reliability of the data inputs used by Anderson in the database. The court concurs with the defendants' argument that the costing associated with CPT codes is a standardized practice within the medical billing industry, making it reasonable for Anderson to rely on such information. Therefore, the court holds that Anderson's proposed testimony meets the reliability criteria outlined in Rule 702.

Lastly, the plaintiffs contest the relevance of Anderson's testimony, asserting that his estimates of reasonable charges for the services provided lack a sufficient understanding of customary charges in the relevant regions and do not result from any specialized training or experience. The court has opined that the plaintiffs' arguments primarily pertain to the reliability of Anderson's methodologies and the underlying data source.



The motion to exclude the expert witness testimony of John Anderson is denied.

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