The judge denied the motion for class certification in its entirety in this case involving claims that a service provider reordered physician diagnosis codes.
A large provider of healthcare services retained Professor Laurence Baker of Stanford University and Cornerstone Research to respond to a motion to certify a class of patients. The plaintiffs alleged that a large healthcare provider reordered physician diagnosis codes when submitting claims for insurance payment, resulting in patient cost sharing for services that should have been provided at no cost to patients.
Professor Baker submitted a declaration for the defendant, showing that it was not possible to ascertain which patients were in the proposed class based on the definitions provided by the plaintiffs. He also demonstrated that, given the heterogeneity in insurers, plans, and the circumstances of putative class members, one could not determine using a common method whether a given class member was affected at all by the challenged conduct, let alone suffered damages.
Professor Baker showed that any determination of impact or damages would require an individualized analysis, patient by patient and service by service, of what the patient’s responsibility would have been under an alternative ordering of codes. Such an analysis could only be done by each specific insurer, since only that insurer would know whether the order of codes may have mattered for a particular patient, and what the impact of an alternative ordering would have been, if any.
Finally, Professor Baker showed that many putative class members would not have been harmed by the challenged conduct.