Emergency Physician Services of New York v. UnitedHealth Group, Inc.
- John Koeltl
- 1:20-cv-09183
- U.S. District Court · Southern District of New York
- 3
In Emergency Physician Services v. UnitedHealth Group, Judge Netburn granted discovery of negotiated payment rates and denied discovery of service costs.
The plaintiffs and defendants in the discovery dispute, particularly the plaintiffs’ obligations to produce payment-rate information and their non-obligation to produce service-cost documents.
What happened
In Emergency Physician Services of New York v. UnitedHealth Group, Inc., the defendants sought documents about payment rates and the costs of providing emergency medical services.
The court ruled that the payment-rate information was relevant to determining a reasonable rate for the services, including rates accepted from Medicare Advantage and managed Medicaid plans. It found that the costs of providing the services were not relevant to that question, and that self-pay rates were not relevant because of their unique challenges.
Magistrate Judge Sarah Netburn granted the defendants’ request for documents about payment rates from market participants and denied their request for documents about service costs. The court also directed the clerk to terminate three listed motions.
The detailed version
- Emergency Physician Services of New York v. UnitedHealth Group, Inc. · No. 1:20-cv-09183
- John Koeltl
- July 1, 2022
Background
The court held a conference on June 27, 2022, to address discovery disputes. It reserved a decision on the defendants’ motion to compel the plaintiffs to produce documents concerning two categories of information: payment rates from certain market participants and the costs of rendering emergency medical services.
Payment-rate documents
The court granted the defendants’ motion as to payment-rate documents. It explained that relevance in discovery is broadly defined and that the defendants were entitled to obtain rates the plaintiffs accepted from market participants that paid negotiated rates for the same emergency services at issue in the lawsuit. This included rates from government-negotiated plans. The plaintiffs were therefore required to produce market data concerning accepted payment rates from Medicare Advantage plans and managed Medicaid plans.
The court stated that rates accepted from self-pay patients were not relevant to establishing a reasonable rate because of the unique challenges associated with those rates.
Cost documents
The court denied the defendants’ motion as to documents concerning the plaintiffs’ service costs. It considered the question closer but rejected the defendants’ reliance on language from another case concerning whether a plaintiff had stated an unjust-enrichment claim. That language did not address how a reasonable rate should be measured.
The court instead relied on authority defining the reasonable value of services as what someone normally receives for the service in the ordinary course of business from the community served, or the average charge for the services. It also cited New York law defining the usual and customary cost of physician services by reference to the eightieth percentile of charges for the particular service by providers in the same specialty and geographical area. Based on that reasoning, the court ruled that the plaintiffs were not required to produce documents about their service costs.
Disposition
Magistrate Judge Sarah Netburn granted the defendants’ motion to compel production of documents concerning payment rates from the specified market participants and denied the motion to compel production of documents concerning the costs of the plaintiffs’ services. The clerk was requested to terminate the motions at ECF Nos. 150, 152, and 153.
Read the full 3-page opinion on CourtListener, the free public archive maintained by the Free Law Project.