John Mills

John A. Mills is an associate with Fenton Nelson's Litigation and Compliance Groups. He has been recognized as a “Rising Star” by Southern California Super Lawyers for his expertise in managed care and ERISA litigation and compliance, medical staff peer review, and fraud and abuse matters.

Mr. Mills has a wide range of experience representing and advising healthcare professionals, hospitals, ambulatory surgery centers and other provider clients in a variety of business and civil litigation and regulatory matters. His clients have benefited from his expertise in areas such as managed care and ERISA compliance, Medicare and Medicaid reimbursement,  and employment law.  He also has extensive experience defending fraud and abuse investigations and compliance counseling. 

Prior to joining Fenton Nelson, he practiced at Hooper, Lundy & Bookman P.C., where he acquired significant experience representing healthcare providers in civil litigation and regulatory compliance matters.  Mr. Mills has lectured and published a number of articles on health law issues such as managed care and ERISA compliance and reimbursement, medical staff organization and self-governance, peer review procedure and confidentiality, and Medicare audits.  For several years, he has served as a Teaching Assistant for a Health Law course in the UCLA School of Public Health.
Mr. Mills earned his Juris Doctorate in 2002 from the University of Texas School of Law, where he served on the Texas Law Review as an Editor of the Texas Rules of Form. After graduating from law school, he clerked for the Chief Justice of the Texas Third District Court of Appeals in Austin.  He received a Bachelor of Arts degree in History with Highest Honors from the University of Texas at Austin in 1998.

In the area of reimbursement litigation, Mr. Mills brings extensive experience, including the following highlights:

• --Represented out-of-network ambulatory surgery centers in federal putative class action against United Healthcare and numerous ERISA plans for alleged failure to reimburse the surgery centers according to a proper UCR methodology set forth in the plans.

• --Represented out-of-network ambulatory surgery center in litigation against Blue Cross and ERISA plans for failure to reimburse in amounts corresponding to representations that Blue Cross made to the surgery center during the benefits verification process.  The case settled favorably for the surgery center.

• --Represented out-of-network hospital in litigation against Blue Cross and ERISA plan for violating a provision of the Knox-Keene Act by failing to pay for emergency treatment provided to Blue Cross member.  In a published appellate opinion in this case, Coast Plaza Doctors Hosp. v. Blue Cross of California, 173 Cal.App.4th 1179 (2009), the court held that the Knox-Keene provision was not subject to ERISA preemption because it fell within ERISA’s savings clause.  The case ultimately settled favorably.

• --Represented out-of-network hospital in litigation against Blue Cross and ERISA plans alleging that, by sending benefit payments directly to the patients, the payers were breaching a duty to send benefits payments directly to the provider pursuant to assignment.  The hospital successfully defeated the defendants’ ERISA preemption defense.

• --Represented hospital in litigation against a HMO in a breach of contract dispute, concerning the HMO’s refusal to allow its physicians to refer radiology cases to the hospital.  The case settled favorably for the hospital.

• --Represented numerous other contracted and non-contracted providers in payment disputes with commercial payers that ended in pre-litigation settlement.

 

Mr. Mills is admitted to practice in California and Texas.