CLEAVER et al v. AMINA et al
Filing
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MEMORANDUM OPINION on the 52 MOTION in Limine to Exclude Evidence of Certain Medical Bills or Costs and Require Usage of Medicare Billing Rates for Past and Future Medical Damages filed by THE UNITED STATES OF AMERICA. Signed by Chief Magistrate Judge Lisa Pupo Lenihan on 03/15/2012. (jmb)
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
ADAM CLEAVER and MELISSA
HAYBARGER, his wife,
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Plaintiffs,
v.
THE UNITED STATES OF AMERICA and
SURESH P. AMINA, M.D.,
Defendants.
Civil Action No. 08-425
Magistrate Judge Lisa Pupo Lenihan
ECF No. 52
MEMORANDUM OPINION
Currently before the Court for disposition is a Motion in Limine (ECF No. 52) filed by
Defendant, United States of America. Trial in this case is set to begin on July 30, 2012.
I.
Motion in Limine
On November 11, 2011, Defendant, United States of America, filed a Motion in Limine
to Exclude Evidence of Certain Medical Bills or Costs and Require Usage of Medicare Billing
Rates for Past and Future Medical Damages. On December 30, 2011, Plaintiff, Adam Cleaver,
filed a Response in Opposition to Defendant’s Motion in Limine. (ECF No. 54). Plaintiff’s
Response requests two separate rulings, that (1) Plaintiff be permitted to prove the full amount of
the medical bills incurred and not be limited to Medicare billing rates for past damages, and (2)
Plaintiff be permitted to prove the full amount of the medical bills incurred and not be limited to
Medicare billing rates for future damages. The Court will address these issues in seriatim.
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The Defendant’s Motion in Limine requests the Court to preclude the introduction of
medical bills and costs submitted by Plaintiff’s medical care providers that exceed the Medicare
billing rates for past and future medical expenses. Defendant requests that Plaintiff’s recovery
for past and future medical expenses be limited to the amount actually paid by Medicare and
accepted by the medical care providers as full payment for medical services. Defendant relies on
the Pennsylvania Supreme Court case of Moorhead v. Crozer Chester Medical Center, 564 Pa.
156 (2001). In response to Defendant’s Motion in Limine, Plaintiff argues that since Moorhead,
Pennsylvania law has changed on the issue of past medical expenses through the passage of the
Pennsylvania Medical Care Availability and Reduction of Error (MCARE) Act, 40 Pa. Stat. Ann.
§ 1303.508 (2002). Regarding future medical expenses, Plaintiff further rejects Defendant’s
basis for the exclusion of evidence and submits that neither Moorhead nor the MCARE Act
applies.
1.
Evidence of Past Medical Expenses
Plaintiff alleges he endured permanent kidney damage due to the negligence of
Defendants. As a result of the injuries, he has undergone multiple hospitalizations, regular
dialysis, and a kidney transplant. He received Medicare and Social Security Disability benefits
in March 2006. Since that time all of his medical expenses have been covered through Medicare
and the Pennsylvania Department of Public Welfare.
In Pennsylvania it is well-settled that a plaintiff who seeks damages for the cost of
medical services incurred by a tortfeasor is entitled to recover the reasonable value of medical
services. Kashner v. Geisinger Clinic, 432 Pa. Super. 361, 367 (1994). In Moorhead the
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Pennsylvania Supreme Court held that in a medical malpractice action the reasonable value of
past medical services is the amount paid and accepted as full payment for medical services
provided. Id. at 156.1 Defendant contends that the amount paid by Medicare, which Plaintiff’s
healthcare providers accepted as full payment for medical services, constitutes the reasonable
value of Plaintiff’s medical expenses and is the amount that should be presented to the jury rather
than the full amount of the medical bills.
Plaintiff submits that if Moorhead were the controlling precedent concerning the issue of
the reasonable value of past medical services, Plaintiff would be limited to submit the amounts
paid by Medicare and accepted by healthcare providers as payment in full. However, in 2002 the
Pennsylvania legislature passed the MCARE Act which, Plaintiff argues, modified
Pennsylvania’s collateral source rule and, in effect, overruled Moorehead.2
Under the collateral source rule a claimant’s right to damages for past medical expenses
cannot be diminished merely because a collateral source paid for claimant’s medical expenses.
Moorhead, 564 Pa. 156 (quoting Johnson v. Beane, 541 Pa. 449 (1995)). The MCARE Act
precludes a claimant in a medical professional liability action from recovering past medical
expenses paid by a collateral source. 40 Pa. Stat. Ann. § 1303.508(a). The MCARE Act
provides limited exceptions in which a claimant is permitted to recover damages for past medical
expenses despite payments made by a collateral source. 40 Pa. Stat. Ann. § 1303.508(d). One
of the limited exceptions under the MCARE Act will be applied if the claimant’s medical
1.
Prior to Moorhead the amount actually paid for medical services was but one factor for
the jury to consider when determining reasonable value of medical services. Therefore, the amount actually paid
alone did not determine the reasonable value of medical services. Kashner v. Geisinger Clinic, 432 Pa. Super. 361,
367 (1994).
2.
The Court notes that this issue was not addressed in Defendant’s Motion in Limine and
Defendant did not file a Reply Brief.
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expenses are paid by “[p]ublic benefits paid or payable under a program which under Federal
statute provides for right of reimbursement which supersedes State law for the amount of
benefits paid from a verdict or settlement.” 40 Pa. Stat. Ann. § 1303.508(d)(4).
The right to
reimbursement of Medicare payments supersedes state law for the amount of benefits paid from
a verdict or settlement. 42 U.S.C. §1395y(b)(2)(B)(iii) (2011). Therefore, Plaintiff may recover
damages for past medical expenses paid by Medicare.
Pursuant to the MCARE Act a claimant is given the “option to introduce into evidence at
trial the amount of medical expenses actually incurred, but the claimant shall not be permitted to
recover for such expenses as part of any verdict except to the extent that the claimant remains
legally responsible for such payment.” 40 Pa. Stat. Ann. § 1303.508(b). A plain reading of the
MCARE Act indicates that Plaintiff herein shall be permitted to introduce into evidence the total
amount of past medical expenses he actually incurred. Plaintiff’s past medical expenses offered
at trial will not be limited to Medicare billing rates. However, Plaintiff will not be permitted to
recover the medical expenses actually incurred. Plaintiff’s recovery will be limited to the
Medicare billing rates that healthcare providers accepted as full payment. Accordingly,
Defendant’s Motion in Limine to Exclude Evidence of Certain Medical Bills or Costs and
Require Usage of Medicare Billing Rates for Past Medical Damages is denied.
2.
Evidence of Future Medical Expenses
Defendant contends that Plaintiff was granted Medicare benefits based upon his
disability, therefore, Plaintiff’s Medicare coverage will continue as long as he remains disabled.
Due to Plaintiff’s contention that his disability is permanent, Defendant submits that Plaintiff’s
future medical expenses will be covered by Medicare.
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Defendant argues that although
Moorhead only addressed the issue concerning past medical damages, Moorhead’s holding
should be extended to include future medical damages.
Defendant reasons that since the
Plaintiff’s future medical expenses will be covered by Medicare, Plaintiff’s healthcare providers
will be required to accept the Medicare coverage as full payment. Defendant therefore seeks to
exclude evidence of certain medical bills or costs and require usage of Medicare billing rates for
future damages, based on the reasoning that under Moorhead Plaintiff’s reasonable value of
medical expenses will be the Medicare coverage accepted as full payment by healthcare
providers.
Plaintiff argues that Defendant’s reliance on Moorhead relative to future medical expense
damages is misplaced, as the opinion applies solely to past medical expenses. Plaintiff also
counters that whether or not he will have lifelong Medicare coverage is speculative. Plaintiff
submits that he does not know who his future medical providers will be, whether the medical
providers will accept Medicare in the future, whether he will qualify for Medicare in the future,
and whether Medicare itself will continue to exist in the future. If Plaintiff was deemed to no
longer qualify for Medicare coverage he would have no cause of action to enforce a right to
Medicare benefits. Contrary to Defendant’s assertions there is no guarantee that Plaintiff will be
entitled to Medicare coverage in perpetuity.
In Moorhead the Pennsylvania Supreme Court solely addressed the issue of the measure
of compensatory damages for past medical expenses. Id. at 158. Thus, Moorhead does not
automatically preclude parties from presenting evidence of future damages beyond Medicare
payments. This jurisdiction has never extended Moorhead’s holding and rationale to encompass
recovery of damages for future medical expenses. Furthermore, courts have uniformly rejected
the application of Moorhead as a measure of future medical damages.
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See Pa. Trust Co. v.
Dorel Juvenile Grp., Inc., 2011 WL 3740472, *12 (E.D. Pa. Aug. 25, 2011); Watts v. Hollock,
2011 WL 6026998 (M.D. Pa. Dec. 5, 2011). Accordingly, Defendant’s Motion in Limine to
Exclude Evidence of Certain Medical Bills or Costs and Require Usage of Medicare Billing
Rates for Future Medical Damages will be denied. An Order consistent with this opinion will
follow.
By The Court:
Dated: March 15, 2012
______________________________
Lisa Pupo Lenihan
U.S. Magistrate Judge
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