ROBERT B. KUGLER, District Judge.
This matter comes before the Court on Defendant Transitions Recovery Program's ("Defendant" or "Transitions") Motion to Exclude certain exhibits that Plaintiff Horizon Blue Cross Blue Shield of New Jersey ("Plaintiff" or "Horizon") submitted in support of its Motion for Partial Summary Judgment. (Doc. No. 119.) For the reasons stated herein, Defendant's Motion will be
Plaintiff is a not-for-profit health service corporation that provides health coverage and benefits for its subscribers in New Jersey. Plaintiff authorizes the payment of subscribers' claims subject to the conditions, limitations, and exclusions contained in its health benefits plans. Defendant is a drug and alcohol treatment center located in Florida, which provided treatment to subscribers of Plaintiff's health benefit plans, and submitted claims to Plaintiff for payment of that treatment. Plaintiff alleges that, between January 2002 and March 2008, Defendant submitted 8,652 claims to Plaintiff that contained diagnoses of alcohol dependency—a diagnosis whose treatment receives broader coverage from Plaintiff's plans than is afforded to treatment of other substance abuse dependencies and behavioral disorders. Plaintiff alleges that it conducted an audit of Defendant's records and concluded that Defendant misrepresented non-alcohol-related diagnoses as alcohol dependencies in order to receive Horizon's broader coverage.
After extensive discovery and related disputes, on July 26, 2013, Plaintiff filed a Motion for Partial Summary Judgment, along with a Certification prepared by Christine S. Orlando, the attorney "principally responsible for the representation of Plaintiff Horizon Blue Cross Blue Shield of New Jersey." (Certification of Christine S. Orlando ("Orlando Cert.") ¶ 1). Attached to Ms. Orlando's Certification were a number of exhibits. (
(Pl.'s Mot. for Summ. J. at 2.)
As stated above, Ms. Orlando submitted a number of exhibits to her Certification that set forth specific patient information and data. Defendant moved to strike Exhibits R, T, X, BB, EE, II, LL, PP, SS, and VV (the "Challenged Exhibits"), which purported to set forth the health insurance claims submitted by Defendant to Plaintiff for Patients B.C., C.H., V.F., T.G., M.P., S.K., C.E., S.N., H.H., and K.A. (Doc. No. 95). In its Opinion granting Defendant's Motion, the Court found that plan data for certain patients had not been made available to Defendants at the time they deposed Jim Howell ("Howell"), Plaintiff's Lead Investigator who was entrusted with the investigation and handling of this matter. Defendant was consequently unable to adequately question Howell concerning how Plaintiff calculated its damages and how Howell arrived at the numbers found in a document he prepared (the "Howell Findings and Calculations"). Similarly, Defendant was unable to question Howell at his original deposition regarding apparent discrepancies in the amounts set forth in the Howell Findings and Calculations and the Challenged Exhibits. Because this left Defendant without the ability to accurately determine how much Plaintiff actually sought in damages, or rely upon any number computed by Plaintiff, on March 27, 2014, the Court issued an Order and Opinion granting Defendant's Motion to Strike. (Doc. Nos. 104, 105.) Therein, the Court granted an additional thirty day period for discovery with respect to the Challenged Exhibits and related damages figures, denied Plaintiff's Motion for Partial Summary Judgment without prejudice, and ordered that the parties refile dispositive motions at the conclusion of the additional discovery period. On April 11, 2014, Plaintiff requested a thirty day extension for discovery, due to Ms. Orlando being out of the office on maternity leave, (Doc. No. 107), which the Court granted on April 25, 2014. (Doc. No. 109.)
Transitions served upon Horizon a Notice of Depositions Pursuant to Fed. R. Civ. P. 30(b)(6) on May 5, 2014, demanding Horizon produce a corporate representative to testify about Exhibits R, T, X, Y, Z, BB, CC, EE, FF, II, LL, MM, PP, SS, and VV to Ms. Orlando's Certification, as well as "all documents produced to [Defendant's attorneys] via electronic mail on May 5, 2014 by [Plaintiff's attorney], including, but not limited to, the contents, creation and purpose of same." (Ex. D to Werner Cert., Notice of 30(b)(6) Deposition.) According to Defendant, the deposition was a "waste of time," because Horizon produced Howell, who had "no knowledge of who created the challenged exhibits, how they were created or who had determine what the `appropriate' diagnosis was for purpose of conducting the calculations therein." (Def.'s Br. at 5.) Plaintiff contends that Howell was an adequate 30(b)(6) representative, as he reviewed the summaries found in the Challenged Exhibits prior to the deposition, and was produced to "clarify any mathematical inconsistency." (Pl.'s Opp'n at 12-13.) According to Horizon, Howell was able to explain how the damages calculations in the Challenged Exhibits were derived, but was not asked to do so, as Transitions focused primarily on ascertaining the identity of the individual(s) that compiled the exhibits. (
Following what Transitions considered a failed attempt to obtain the information it sought by way of deposition, Defendant served additional interrogatories, requests for production, and requests for admission on May 22, 2014. (Def.'s Br. at 5.) Defendant also requested a sixty day extension for discovery on May 27, 2014, due to the issues that arose when Plaintiff produced Howell as its 30(b)(6) representative to testify concerning the damages listed in the Challenged Exhibits, how they were created, when they were created, and by whom or at whose direction they were created. (Doc. No. 110.) After a phone conference with the parties, the Court granted a sixty day extension for discovery on May 30, 2014. (Doc. No. 111.)
Based on information provided in Plaintiff's responses to the interrogatories, Defendant served notices of deposition for Randi Vuich, a paralegal at Connell Foley, and Robert Norcia, a former intern at Connell Foley, on July 1, 2014. (Def.'s Br. at 7; Ex. I to Werner Cert., 30(b)(1) Deposition Notices.) Rather than produce Mr. Vuich or Mr. Norcia, Horizon sent Certifications from the same on July 15, 2014. (
Thereafter, Defendant requested a scheduling conference to determine how the parties should move forward with motion practice, (Doc. No. 116), which was held before Magistrate Judge Williams on August 21, 2014, and at which the deadline was set for Defendant's Motion to Exclude certain exhibits on or before September 19, 2014. (Doc. No. 118.) On September 19, 2014, Transitions filed the instant Motion to Exclude any "damages calculations" for patients V.F., T.G., M.P., S.K., and C.E. (the "Unaudited Patients"), which are found in Exhibits X, BB, EE, II, and LL, respectively (the "Unaudited Patient Exhibits"), pursuant to Fed. R. Civ. P. 37(c) and (d). (Doc. No. 119.) Transitions argues that it continues to be denied a meaningful opportunity to examine and challenge these documents. As this Motion is fully briefed, the Court turns to the parties' arguments.
Rule 26(a) requires voluntary disclosure by the parties of "a computation of each category of damages claimed by the disclosing party." Fed. R. Civ. P. 26(a)(1)(A)(iii). Parties are obligated under Rule 26(e) to supplement any disclosures they have made:
Fed. R. Civ. P. 26(e). If a party fails to comply with Rule 26(a) or (e), "the party is not allowed to use that information or witness to supply evidence on a motion . . . unless the failure was substantially justified or is harmless." Fed. R. Civ. P. 37(c)(1).
In deciding whether to impose sanctions against a plaintiff under Rule 37(c)(1), the Court considers four factors: (1) prejudice or surprise to the defendant; (2) the ability of the plaintiff to cure the prejudice; (3) the likelihood of disruption; and (4) the plaintiff's bad faith or unwillingness to comply.
Rule 37 is "written in mandatory terms and is designed to provide a strong inducement for disclosure of Rule 26(a) material."
Transitions argues that it is still "completely in the dark as to how and when the damage calculations relative to the Unaudited Patients were performed; including ... who made the diagnoses upon which those calculations were based." (Def.'s Br. at 1.) Accordingly, it requests that this Court exclude the Unaudited Patient Exhibits, due to Horizon's alleged failure to comply with its obligations under Rule 26.
Regarding whether Plaintiff complied with Rule 26, the Court finds that Plaintiff has so complied, and exclusion under Rule 37(c) is inappropriate. As stated above, Rule 26(a) requires that a party provide "a computation of each category of damages claimed by the disclosing party—who must also make available for inspection and copying as under Rule 34 the documents or other evidentiary material ... on which each computation is based." Fed. R. Civ. P. 26(a)(1)(iii). Additionally, Rule 26(e) provides that a party must supplement a disclosure made under Rule 26(a) if it learns that the original disclosure was incomplete, if additional corrective material is newly available, or if ordered by the Court. Fed. R. Civ. P. 26(e)(1).
Horizon argues that it was unable to provide the damage calculations for the Unaudited Patients until the close of discovery, when Transitions produced the treatment records for those patients. (Pl.'s Opp'n at 19.) Thereafter, Plaintiff apparently relied on the same explanation of how it extrapolated the damages in its own previous audit results to explain how it calculated the damages for the Unaudited Patients. (
However, assuming Plaintiff had failed to provide materials in accordance with Rule 26, the Court still finds that the circumstances favor admitting the challenged evidence. Transitions argues Plaintiff's failure to provide the information supporting its damages calculations for the Unaudited Patients was not substantially justified. Based on the four factors considered under Rule 37(c)(1), the Court does not agree.
First, it does not appear that Transitions would be unduly prejudiced or surprised by the admission of the Unaudited Patient Exhibits, as Plaintiffs apparently employed the same methodology for calculating these damages as they did for calculating the damages for the unchallenged patient damages. It appears that Horizon even described the methodology and reasoning behind its damages calculations, including its decision to rely on the diagnoses of Transitions own experts and witnesses, in its Motion for Partial Summary Judgment. (
First, Plaintiff contends that Transitions was supplied, via certification and interrogatory answers, with detailed explanations as to how each spreadsheet in the Challenged exhibits was created, and with a step-by-step explanation of the mathematic calculation employed in response to this Court's March 27, 2014, Order. (Pl.'s Opp'n at 20.) The Court finds that Horizon did comply with that Order, having already provided Transitions with the plan information discussed in the Court's accompanying Opinion, and having provided Howell to testify as a 30(b)(6) representative to discuss and clarify how the damages calculations were made in the Challenged Exhibits, and explain any discrepancies.
Apparently, however, Defendant is no longer concerned with the method of calculating the damages, i.e., the mathematics. Instead, its concern is over
In the July 24 Letter Horizon claimed that, by Defendant's own assertions and the testimony of Norton Lee Barchan, Transitions only treated patients who primarily received treatment for alcohol or substance abuse. (
Horizon went on in the July 24 Letter to describe how Dr. Baxter and Dr. Deerfield each found the five Unaudited Patients had primary diagnoses of drug dependency, and that Steven Kahn, M.D. and Richard Seely, M.D. submitted claims coded for drug dependency for patients V.F., T.G., and M.P. (July 24 Letter at 3-4.) In its brief, Horizon points out that all of the Unaudited Patients were treated by Dr. Kahn, and he testified that treating physicians list their diagnosis on Axis I in order or importance, with the principal diagnosis listed first. (Pl.'s Opp'n at 16-17, 21.) Each of the Unaudited Patients was diagnosed by Dr. Kahn on Axis I with substance dependency as the principal diagnosis, (
Horizon relied upon the health insurance claims submitted by Transitions, (
Based on the foregoing, it appears Plaintiff told Transitions
Accordingly, the Court finds that Plaintiff complied with its July 17, 2014, Order that it "provide [Transitions] with information pertaining to the five unaudited patients such that Defendant can determine who made the diagnosis determination for this five patients and why such diagnosis was made,
In light of the factors considered under Rule 37(c)(1), the Court finds that Plaintiff's actions were harmless and none of the factors weigh in favor of exclusion. All of the information, including the principal diagnoses on which Plaintiff rely, is in the record and is readily ascertainable by Defendants. Accordingly, the Court will not bar Plaintiff's use of the Unaudited Patient Exhibits in a subsequent motion.
For the reasons stated above, Defendant's motion will be