- University of Texas School of Law, J.D., 2002
- University of Texas at Austin, B.A., 1998
John A. Mills is a partner at Nelson Hardiman and has years of experience representing and advising health care providers in a wide range of regulatory compliance issues and litigation proceedings. John’s practice focuses on managed care and ERISA compliance and litigation, medical staff and peer review, civil False Claims Act and fraud lawsuits, commercial litigation, healthcare fraud investigations, and a wide range of regulatory compliance issues, including corporate internal investigations and voluntary disclosures of possible Medicare over-payments, analysis of business arrangements to ensure compliance with the anti-kickback and Stark laws, and providing transactional and regulatory guidance to covered entities and contract pharmacies in connection with the federal 340B program. John has jury trial experience and has handled numerous arbitrations and administrative hearings.
John’s clients include hospitals, ambulatory surgery centers, skilled nursing facilities, physicians, medical groups and IPAs, Knox-Keene licensees, pharmacies and pharmacists, ambulance providers, and a variety of other businesses and individuals in the healthcare industry. John’s diversity of clients has provided him with a rare understanding of the unique business objectives and compliance risks facing different segments of the healthcare provider community. John’s litigation successes include obtaining numerous pre-trial dismissals of lawsuits brought against his clients, including a summary judgment in favor of hospital in a civil False Claims Act lawsuit, obtaining favorable settlements for healthcare providers clients in reimbursement disputes with commercial insurance payors and ERISA plans, obtaining a reversal of a finding of ERISA preemption on appeal, and obtaining favorable results for clients following arbitrations and administrative proceedings.
Before joining Nelson Hardiman, John was an associate at the Los Angeles office of Hooper, Lundy, and Bookman, a firm dedicated solely to the representation of healthcare providers and suppliers, where he specialized in managed care litigation, medical staff and peer review compliance and litigation, and commercial litigation. John also served as a Law Clerk to the Presiding Justice of the Texas Third District Court of Appeals.
John was nominated a Rising Star by Super Lawyers 6 times in the last 7 years, and was named a Best Lawyer in America for 2016.
- Defended an outpatient surgery center in an arbitration by a surgeon alleging deceptive marketing practices in violation of the federal Lanham Act and breach of an exclusive services contract. Following an arbitration hearing in Los Angeles, the surgeon's Lanham Act and unfair business practices claims were dismissed. The breach of contract claim ultimately settled favorably, and John was able to get his client's insurer to cover a significant portion of the settlement payment.
- Represented out-of-network hospital in litigation against Blue Cross and ERISA plan for violating a provision of the California Knox-Keene Act by failing to pay for emergency services treatment provided to a Blue Cross member. In a published opinion in this case, Coast Plaza Doctors Hosp. v. Blue Cross of California, 173 Cal.App.4th 1179 (2009), the California Court of Appeal, Second District in Los Angeles, 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 hospital's medical executive committee in Bakersfield, California in a peer review hearing involving a surgeon whose privileges were summarily restricted.
- Defended a Los Angeles physician in a misappropriation of trade secrets and interference with contract case by another physician involving disputes over access to patient lists. The case ultimately settled favorably for John's client.
- Represented national provider of pharmacy services and patient in federal lawsuit brought against Blue Shield of California and the federal Office of Personnel Management (OPM) for denial of IVIG treatments provided to a federal employee under the Federal Employee Health Benefits Act (FEHBA). As a result of the federal complaint, OPM conducted an independent review of the claims and determined that the IVIG treatments were medically necessary, and consequently ordered Blue Shield to issue benefits.
- Represented a physician in a dispute with a hospital in Riverside County concerning the hospital's failure to reappoint the physician to the medical staff. Following threats of litigation, the hospital reappointed the physician.
- Counsel for a physician in a dispute with a healthcare district in Riverside County in which the healthcare district sued for alleged fraud and fee-splitting, while the physician brought a Section 1983 claim in federal court for the healthcare district's violations of the physician's civil rights under the First Amendment and Fourteenth Amendment.
- Counsel for a physician in a dispute with a hospital in Riverside county concerning the hospital's summary suspension of the physician's privileges. The physician sued as a whistleblower under California Health & Safety Code section 1278.5 and for discrimination against him in violation of the California Unruh Civil Rights Act.
- Represented out-of-network outpatient surgery centers (ASCs) in federal putative class action against United Healthcare, Ingenix and numerous ERISA plans for alleged failure to reimburse the ASCs according to a proper methodology for calculating the usual, customary and reasonable (UCR) reimbursement as set forth in the plans.
- Represented an outpatient surgery center or ASC located in Valencia in an action against a competing ASC for trade name infringement. John obtained an injunction for his client that prohibited the competing ASC from further using the infringing trade name.
- Represented a healthcare district in San Bernardino County in a breach of contract lawsuit against a large HMO when the HMO refused to refer radiology services to the healthcare district. The case ultimately settled favorably, resulting in the healthcare district obtaining an improved provider services agreement.
- Represented a physician in a medical board investigation in which a patient complained of inappropriate contact. The board closed the case without bringing any accusation or disciplinary action.
- Counsel for a physician in a Osteopathic Board accusation alleging substance abuse and inappropriate prescribing.
- Represented a Long Beach ambulance company in a lawsuit against its outsource human resource provider and liability insurer due to their failure to defend and indemnify the ambulance company in an underlying wrongful termination lawsuit brought by former employees. Following a summary judgment in favor of the ambulance company, the case settled favorably.
- Defended San Bernardino medical group in a wrongful termination action brought by a former physician employee. The case settled favorably for the medical group on the eve of trial.
- Defended an owner and operator of skilled nursing facilities in a dispute over a real estate purchase agreement. The seller alleged that the buyer failed to provide sufficient deposit while the buyer alleged misrepresentations on the part of the seller.
- Represented rehabilitation center in dispute with Promises concerning alleged overpayments for deficiencies in medical records. Following aggressive appeal, Promises abandoned the overpayment request in exchange for a corrective action plan.
- Advised Southern California telehealth company regarding regulatory and operational issues for providing telemedicine services across state lines.
- Advised numerous Southern California hospitals and medical staffs on medical staff self-governance issues. John has drafted and revised hospital governing bylaws, medical staff bylaws, rules and regulations for numerous California hospitals and medical staffs.
- Represented a Southern California university medical center in a petition for writ of mandate to overturn a Medi-Cal audit decision by the Department of Health Care Services (DHCS) regarding whether a clinic operated by the medical center was a Federally Qualified Health Clinic (FQHC). The court determined that the clinic was a FQHC and issued the writ.
- Advised numerous providers concerning their policies and procedures for billing patients and third-party payers so as to be compliant with Medicare, Medicaid, ERISA and California law.
Associations, Memberships & Awards
- Member, American Bar Association
- Member, Los Angeles County Bar Association, Healthcare Section
- Member, American Health Lawyers Association
- Member, California Society for Healthcare Attorneys
- Member, Texas Law Review
- Clerkship: Texas Court of Appeals, Third District (2002-2003)
- Nominated as a Rising Star by Southern California Super Lawyers (2012-2013)
- Secretary, Beverly Hills Bar Association Healthcare Law Committee (2013-2014)
- Using ERISA Regulations to Challenge Overpayment Demands, Southern California Physician (April 2013)
- Using Dispute Resolution to Improve Collaboration Between the Governing Body and the Self-Governing Medical Staff, MedStaff News (November 2012)
- Credentialing by Proxy: The Opportunities and Challenges Presented by New Federal Standards for Credentialing Telehealth Providers, Southern California Physician (November 2012)
- Tips for Getting Paid According to “UCR", Southern California Physician (October 2012)
- Health Insurers Allege Fraud and Kickbacks Against Out-of-Network ASC Providers Who Forgive Patients' Financial Responsibility, Becker's ASC (February 2012)
- Overview of the Fraud-on-the-Market Theory in Private Securities Fraud Class Actions and the U.S. Supreme Court’s Recent Ruling in Erica P. John Fund, Inc. v. Halliburton Co., AHLA (August 2011)
- Providers Should Not Overlook Their Right to Request Documents When Appealing Adverse Benefit Determinations to ERISA Plans , Health Law Perspectives (August 2010) (co-authored with Daron Tooch)
- The LTCH Special Projects: Frustration and Confusion for Providers, Association of Healthcare Internal Auditors, New Perspectives (December 2009)
- Appeals Court Rules That Knox-Keene Act Statute Requiring Health Plans to Reimburse Emergency Care Providers is Saved From ERISA Preemption, Health Law Perspectives (June 2009) (co-authored with Daron Tooch)
- Court of Appeal Expands Reach of Fair Procedure Doctrine, Health Law Perspectives (April 2008)
- Hospital Peer Review Proceedings are Subject to Anti-SLAPP Motions, Court Rules, Health Law Perspectives (October 2006)
- Note, Legal Constructions of Cultural Identity in Latin America: An Argument Against Defining “Indigenous Peoples,” 8 Texas Hispanic Journal of Law & Policy 49 (Spring 2002)