State Farm Insurance Co v Bowling.
The Second District Court ruled medical billing and coding experts can testify as to fabricated or exaggerated medical expenses. The court found coding experts have “specialized knowledge” and training to provide opinions on whether bills are properly coded, and whether they correspond to medical records that documented the purported treatment.
Howell v Hamilton Meats and Provisions,
In California it was ruled that an injured plaintiff whose medical expenses are paid through a private insurance could only recover the contractually adjusted amount which was actually paid, not the full amount billed.
Hahnemann Hospital v Sonya Dudnick
In NJ, a hospital brought action against a former patient to recover the balance due on a bill for medical services. In the hospital’s collection action, the former patient failed to establish that charges reflected in bill were not usual, customary, and reasonable and the court ruled against the Defendant. The Plaintiffs attorney brought to trial the hospital custodian of records who testified as to the reasonableness of the medical bill. The court ruled that the Plaintiff’s foundation witness, as the custodian of records with knowledge of the billing procedures, was qualified to testify as to the charges incurred by defendant as contained in the hospital’s bill.