E-Alert Case Updates

Trial Court Excludes Evidence of Medical Bills in Excess of Payments by Medicare/Medicaid

Jadine Acker v. Specialty Hospital of Washington-Hadley, LLC
No. 2018 (Superior Court of the District of Columbia July 19, 2013)
by Gregory S. Emrick, Associate
Semmes, Bowen & Semmes (www.semmes.com)

Defendants, Specialty Hospital of Washington-Hadley, LLC (“Specialty Hospital”), filed a Motion in Limine as to the amounts of the medical bills that were not covered by payments from Medic are and/or Medicaid. Judge Cordero of the Superior Court of the District of Columbia granted the motion.

Plaintiff, Jadine Acker, allegedly fell from her hospital bed and fractured her right hip while in the care of Defendants. She sued for medical malpractice. Plaintiff was a Medicare and Medicaid recipient, which paid for $191,734.39 of the total $581,662.09 in resulting medical bills. Defendant contended that the amounts not paid by Medicare and/or Medicaid were not owed by Plaintiff, and permitting the evidence to be a part of the case would result in a “windfall” for the Plaintiff. Plaintiff argued that the Defendants’ position violated the collateral source doctrine.

In July 19, 2013 Order, Judge Cordero started by analyzing the District of Columbia’s collateral source doctrine, noting that the “doctrine applies in cases where a third party is involved a plaintiff may be entitled to ‘benefit and judgment’ from the tortfeasor and/or the collateral source. The collateral source doctrine is used to allow a plaintiff to recover additional compensation because he ‘contracted’ for it. The goal of the collateral source doctrine is to ensure the ‘amount of damages owed by a tortfeasor’ is not ‘reduce[d]’ if a ‘tort victim has received benefits from a collateral source.’” Judge Cordero then noted that the reduced payments were made under the contracts between Medicare/Medicaid and Specialty Hospital, which obligated it to accept set rates for its services, and write-off any excess. “Thus […] the application of the collateral source rule would, in this case, result in a double payment by the alleged tortfeasor.”

The Court then held that because the collateral source rule did not apply, “the evidence admissible to the jury is only the amounts actually paid by Medicare/Medicaid. […] Evidence of medical expenses beyond what was paid by Medicare/Medicaid is inadmissible.” As July 19, 2013, trial in this matter is set for April 7, 2014.