from the Circuit Court of the 10th Judicial Circuit, Tazewell
County, Illinois. Circuit No. 11-L-129 The Honorable Michael
D. Risinger Judge, Presiding.
Attorneys for Appellants: Jo T. Wetherill, of Quinn,
Johnston, Henderson, Pretorius & Cerulo, of Peoria, for
Attorneys for Appellee: Todd A. Strong, of Strong Law
Offices, of Peoria, for appellee.
JUSTICE LYTTON delivered the judgment of the court, with
opinion. Justices Holdridge and O'Brien concurred in the
judgment and opinion.
1 In March 2014, plaintiff Dawn Verci filed negligence claims
against defendants Michael High and International Union of
Operating Engineers, Local No. 649. Plaintiff claims that as
a result of defendants' negligence, she was injured and
required to undergo medical treatment costing in excess of $1
million. A majority of plaintiffs medical charges are from
Dr. Richard Kube of the Prairie Spine and Pain Institute and
the Prairie Surgicenter. The reasonable value of the medical
services provided by Kube is a major issue of contention.
2 In January 2019, the trial court entered an order (1)
prohibiting defendants from cross- examining Kube or his
associated medical entities regarding their own cash
advertised pricing at trial and (2) allowing defendants'
billing expert, Rebecca Reier, to testify at trial regarding
her opinions on the reasonable value of Kube's medical
services. Soon thereafter, the parties filed a joint petition
for interlocutory appeal. The trial court granted the
petition and certified two questions challenging the
court's order. We answer both certified questions in the
affirmative and remand for further proceedings.
3 I. BACKGROUND
4 On March 14, 2012, plaintiff filed her first amended
complaint, alleging negligence against each defendant.
Plaintiff claims that, as a result of defendants'
negligence, she was physically injured, required to undergo
medical treatment, and incurred over $1 million in charges
for her treatment. Approximately $800, 000 of plaintiffs
alleged medical expenses arise out of treatment plaintiff
received from Dr. Richard Kube at the Prairie Spine and Pain
Institute and the Prairie Surgicenter. Both entities are
owned and operated by Kube.
5 In discovery, defendants disclosed the identity of an
expert, Rebecca Reier, to present testimony regarding the
reasonable value of plaintiff s medical services. Reier
prepared a report, which was provided to plaintiff. In her
report, Reier reviewed Kube's total charges of $810,
937.04, and concluded that "the Usual, Customary and
Reasonable total charges for the same geographic
area for the same services are approximately $148,
118.00." (Emphasis in original.) One of the bases for
Reier's conclusion was the cash prices advertised by
Prairie Spine and Pain Institute and Prairie Surgicenter on
Healthcare.com. Reier determined that the charges
submitted to plaintiff by Kube are more than 547% higher than
the prices advertised online by both entities for the same
procedures. Sources Reier used in determining the usual,
reasonable, and customary charges for the medical services
plaintiff received include "Fair Health Data
Systems," "Optum National Fee Analyzer
2012-2016-Fair Health Database," and "The American
Hospital Directory CMA and Fair Health Database."
According to Reier's report, "Fair Health collects
charge data from private insurer and health plan
administrators across the country." Plaintiff filed a
motion and later a supplemental motion to bar Reier's
6 Reier was deposed in 2018. She explained that in
determining the reasonable value of medical services, she
relied on three databases: (1) FAIR Health, (2) Optum, which
also uses FAIR Health data, and (3) American Hospital
Directory. She identified FAIR Health as "[t]he primary
database" she used.
7 Reier explained that FAIR Health receives all of its data
from insurance companies. Insurance companies report the
charges they receive from medical providers to FAIR Health,
and FAIR Health separates the data geographically. FAIR
Health then identifies a range of charges, from the 5th to
95th percentile. Outliers are eliminated, so if a provider
charges a very different rate than others, that rate is not
included in the database because it is "not considered
statistically significant by FAIR Health." Reier
determined that a reasonable charge would be at the 75th
percentile, which means "75 percent of all the providers
in this geographic area charge this amount or less." She
chose the 75th percentile because it is her "peer
group's choice among, like, your planners as well as
practitioners and practice managers. It seems to be the
fairest way to identify what everybody in the neighborhood is
8 In the FAIR Health database, providers are identified by
geographical area. FAIR Health does not identify providers by
name. Reier did not reach out to providers in the geographic
area to determine what they charge. She relied exclusively on
the data from FAIR Health. With respect to FAIR Health's
methodology, Reier stated: "[W]e have to bring in the
Fair Health attorneys, because they will be glad to explain
in detail methodology since none of us are
statisticians." She later stated, "I have their,
their standard protocol which I can provide. And as I have
said, if there is a question about their protocol, their data
analysis, um, the attorneys are more than willing to come and
9 Reier also relied on data from Optum. Optum takes the FAIR
Health data and separates it into smaller geographical areas.
Reier did not look at the actual data that Optum collected.
Reier assumes that Optum and FAIR Health correctly performed
their statistical analyses. She has not seen the raw data
used by Optum or FAIR Heath but sees the ...