Med. Ctr., Inc. v. Bowden

• Decision Date: 01 November 2018
• Docket Number: A18A1249
• Citation: 348 Ga.App. 165,820 S.E.2d 289
• Parties: The MEDICAL CENTER, INC. v. BOWDEN.
• Court: Georgia Court of Appeals

348 Ga.App. 165

820 S.E.2d 289

The MEDICAL CENTER, INC.

v.BOWDEN.

A18A1249

Court of Appeals of Georgia.

November 1, 2018

Reconsideration Denied November 14, 2018

Paul Douglas Ivey Jr., Lindsey Bowen Mann, Atlanta, Robert Calhoun Martin Jr., Columbus, William N. Withrow Jr., Lauren King Dimitri, Columbus, for Appellant.

Charles A. Gower, Charles Austin Gower Jr., Columbus, Michael Brian Terry, Michael Rosen Baumrind, Frank Mitchell Lowrey IV, Atlanta, for Appellee.

Miller, Presiding Judge.

In this case, we consider whether the trial court properly granted class certification to a group of uninsured patients who received medical care following an accident and who then had a hospital lien placed against any potential tort recovery to recoup the cost of their medical care. After a thorough review of the record, we conclude that the trial court properly granted class certification.

Danielle Bowden, Jacqueline Pearce, Karla Jasper, and Christian Sprouse were injured in separate, unrelated auto accidents and treated at The Medical Center, Inc. (TMC), a Columbus hospital. Due to their lack of insurance coverage, TMC placed a lien on any recovery they obtained as a result of their accidents to cover the bills for their medical services, as permitted under OCGA § 44-14-470. Bowden sued TMC, alleging that the amount TMC charged for medical care was unreasonable and thus the lien the hospital placed on any financial recovery she received was excessive. Bowden later moved to add Pearce, Jasper, and Sprouse as plaintiffs and requested class certification under OCGA § 9-11-23.

TMC opposed class certification, moved to exclude the Plaintiffs’ expert testimony that the amounts charged were unreasonable, and sought summary judgment on the substantive claims. The trial court granted the motions to add plaintiffs and for class certification, admitted the expert’s testimony, and denied TMC’s motion for summary judgment. TMC now appeals on all three grounds. We conclude that (1) the trial court properly admitted the testimony of the Plaintiffs’ expert; (2) the Plaintiffs satisfied their burden to show class certification was proper; and (3) summary judgment was not warranted except as to the claims under the Uniform Deceptive Trade Practices Act ("UDTPA"), OCGA § 10-1-372, and the Georgia Racketeer Influenced and Corrupt Organizations Act ("RICO"), OCGA § 16-14-4. Accordingly, we affirm the trial court’s orders admitting the expert’s testimony and granting class certification, and we affirm the trial court’s denial of TMC’s motion for summary judgment on the claims of unjust enrichment, unconscionability, breach of contract, fraud, negligent misrepresentation, attorney fees, and punitive damages. We reverse the trial court’s order denying summary judgment with respect to Bowden’s claims arising under the UDTPA and the RICO Act.

A. Background

In 2011, an Enterprise rental car in which Bowden was a passenger was involved in an accident. Bowden, who was 21 years old at the time and who did not have health insurance, was taken by ambulance to TMC in Columbus, Georgia. There, she received emergency medical treatment that included surgery for a broken leg

. TMC billed Bowden a total of $21,409.59 for her medical care and filed a hospital lien for that amount under OCGA § 44-14-470 (b).¹ This lien attached to any recovery Bowden received from her accident.

In 2012, Enterprise filed a complaint in interpleader against Bowden and TMC and paid its liability policy maximum amount of $25,000 into the registry of the trial court. Bowden answered the complaint and filed a cross-claim against TMC, alleging that her bill of $21,409.59 was grossly excessive and did not reflect the reasonable value of her medical treatment.² Bowden asserted claims against TMC for unjust enrichment (or alternatively, breach of contract), fraud, negligent misrepresentation, and violations of the Uniform Deceptive Trade Practices Act ("UDTPA"), OCGA § 10-1-372, and the RICO Act, OCGA § 16-14-4.³ As relief, she sought compensatory damages, attorney fees, punitive damages, and dismissal of TMC’s lien. See Bowden v. The Medical Center , 297 Ga. 285, 286-288 (1), 773 S.E.2d 692 (2015) (" Bowden II ").

After Bowden filed her cross-claim, the parties engaged in a lengthy discovery dispute, and the trial court granted Bowden’s motion to compel discovery of evidence regarding patient billing, liens, and the rates TMC charged for each service. The Medical Center v. Bowden , 327 Ga. App. 714, 761 S.E.2d 116 (2014) (" Bowden I "). TMC appealed, and this Court reversed, finding the discovery sought was not relevant. The Supreme Court of Georgia granted certiorari and ultimately concluded that such evidence was relevant to the reasonableness of the costs and liens. See Bowden II , supra, 297 Ga. 285, 773 S.E.2d 692.

On remand to the trial court, TMC provided the requested discovery. Thereafter, Bowden filed two amended complaints and petition for class action. In her amended complaint, Bowden restated her original claims and added a request for injunctive relief for the class. She later moved to add as plaintiffs Pearce, Jasper, and Sprouse. In support of her petition for class certification, Bowden submitted the deposition of an expert accountant, Lamar Blount. TMC opposed class certification and submitted the deposition of its own expert, William Cleverley.

The trial court conducted a hearing on the petition for class certification and heard testimony from both Bowden’s expert and TMC’s expert, each of whom opined about the reasonableness of TMC’s charges and the feasibility of determining damages should the trial court certify the class. The trial court concluded that the testimony of Bowden’s expert was admissible and that the named Plaintiffs satisfied the criteria for class certification. The trial court also denied TMC’s motion for summary judgment. This appeal followed.

B. TMC’s payment structure

Before we consider the issues on appeal, we first describe the billing process TMC employs.

Hospitals set their rates by calculating a "chargemaster rate," like the sticker price of a new car, for each service provided, and that rate applies to all patients receiving that particular service. The hospital determines its chargemaster rate by factoring in the cost of the service along with the overall costs of operating the hospital. Every patient is charged the chargemaster rate, but very few patients actually pay that amount because insurance companies, including Medicare, Medicaid, and other third-party payers, negotiate a reduced reimbursement rate.⁴ Thus, for patients with insurance, the insurance company will reimburse TMC pursuant to the negotiated rates. Additionally, Medicare and other government programs have a set methodology used to calculate their reimbursement amounts.

Patients without any insurance or third-party payment source are billed the full chargemaster rate. For the relevant years pre-dating this lawsuit, the percentage of TMC patients who paid less than the chargemaster rate was 98.84 percent, while only 1.16 percent paid the full rate. Regardless of the reimbursement scheme, and despite the chargemaster rates, TMC collects, on average, about 33 percent of the chargemaster rate.

To place this rate in context, the evidence shows that Bowden’s bills totaled approximately $21,000. Because she lacked any insurance, she was billed that full amount. Had she been covered by Medicaid, the hospital would have received $9,895.24 for reimbursement. Medicare would have reimbursed $11,238.11, and Blue Cross/Blue Shield PPO would have paid $10,644.

When an uninsured patient is unable to pay the full amount billed, the hospital may take out a lien under OCGA § 44-14-470 against any recovery that patient receives from a third-party tortfeasor. Virtually every state has a similar lien statute. See Howard v. Willis-Knighton Medical Center , 924 So.2d 1245, 1253 (La. Ct. App. 2006).

OCGA § 44-14-470 (b) provides:

Any ... hospital ... in this state shall have a lien for the reasonable charges for ... treatment of an injured person, which lien shall be upon any and all causes of action accruing to the person to whom the care was furnished ... on account of injuries giving rise to the causes of action and which necessitated the hospital ... care .... The lien provided for in this subsection is only a lien against such causes of action and shall not be a lien against such injured person, such legal representative, or any other property or assets of such persons ....

(emphasis added). Thus, the statute permits the hospital to place a lien on any recovery for only the reasonable amount of charges.

Finally, we note that since the inception of this lawsuit, TMC has voluntarily cancelled its lien against Bowden. Additionally, Plaintiffs Jasper and Sprouse have paid their liens. Only Pearce’s lien remains outstanding. We now turn to TMC’s arguments on appeal.

C. Discussion

1. TMC argues that the trial court erred by admitting testimony from Plaintiffs’ expert Lamar Blount because the expert’s opinions lacked both reliability and relevance. We disagree.

OCGA § 24-7-702 governs the admissibility of expert testimony, and it requires that the trial court act as "gatekeeper to ensure the relevance and reliability of expert testimony." (Citation and punctuation omitted.) Scapa Dryer Fabrics , supra, 299 Ga. at 289, 788 S.E.2d 421. The statute specifically provides:

If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education may testify thereto in the form of an opinion or otherwise, if: (1) The testimony is based upon sufficient facts or data; (2) The testimony is the product of reliable principles and methods; and (3) The witness has applied the principles and methods reliably to the facts of the case which have been or will be admitted into

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