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Court of Appeal Holds that Expert Reliance on Medicare Reimbursement Rates does not Violate Collateral Source Rule

April 8, 2019

Stokes v. Muschinske
(B280116, April 8, 2019)

The Court of Appeal has held that an expert testifying on the reasonable value of medical services may rely upon Medicare reimbursement rates without violating the collateral source rule.

The plaintiff in a personal injury action opted to seek medical treatment from a doctor who accepted a lien against the plaintiff’s anticipated judgment as payment. At trial, the plaintiff sought to recover the full amount “billed” by his medical providers.  The defense challenged the reasonableness of those charges through the testimony of an expert who based his opinions on Medicare reimbursement rates. The jury rendered a verdict largely in favor of the defense and the plaintiff appealed.

On appeal, plaintiff claimed that the defense expert’s testimony violated the collateral source rule.  The Court of Appeal disagreed, holding that the evidence regarding Medicare reimbursement rates “merely provided context and background information” on plaintiff’s past medical treatment “and on some aspects of [the defense expert’s] calculations of past and future medical expenses.  They were helpful and even necessary to the jury’s understanding of the issues.”


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For more information, please contact Steven Fleischman and Barry R. Levy .

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