- University of Texas School of Law, J.D., 2002
- University of Texas at Austin, B.A., 1998
Navigating between regulatory compliance and litigation, the versatility of John Mill’s healthcare practice and the diversity of his clients provide him with a keen understanding of the unique business objectives and risks facing different segments of the healthcare provider community. Among John’s diverse range of clients are hospitals, ambulatory surgery centers, physicians, medical groups and IPAs, Knox-Keene licensees, pharmacy providers, and ambulance providers.
John’s regulatory compliance work focuses on key issues facing providers that could potentially impede their business operations. He advises clients on managed care and ERISA compliance, voluntary disclosures of possible Medicare over-payments, medical staff and peer review, analysis of business arrangements to ensure compliance with the anti-kickback and Stark laws, and provides regulatory guidance to covered entities and contract pharmacies in connection with the federal 340B program.
John’s deep knowledge of regulatory compliance lends invaluable insight to his litigation practice. John advises healthcare providers on ERISA litigation, commercial litigation, healthcare fraud lawsuits and investigations. In addition to jury trial experience, he has handled numerous arbitrations and administrative hearings. John’s litigation successes include obtaining numerous pre-trial dismissals of lawsuits, including a summary judgment in favor of a large hospital in a civil False Claims Act lawsuit. Additionally, he has obtained favorable settlements for healthcare providers in reimbursement disputes with commercial insurance payors and ERISA plans, won a reversal of a finding of ERISA preemption on appeal, and garnered favorable results for clients following arbitrations and administrative proceedings.
Prior to joining Nelson Hardiman, John practiced at the Los Angeles office of a law firm dedicated solely to the representation of healthcare providers and suppliers, where he focused on managed care litigation, medical staff and peer review compliance and litigation, as well as commercial litigation. John also served as a Law Clerk to the Presiding Justice of the Texas Third District Court of Appeals.
The range of John’s interest outside the firm is just as diverse as his practice. When he’s not guiding clients through their business challenges, he enjoys hiking, sailing, listening to music, reading history and literature, spending time with family, and rooting for Texas Longhorns football.
- Arbitration: Defended an outpatient surgery center in arbitration with a surgeon alleging deceptive marketing practices in violation of the federal Lanham Act and breach of an exclusive services contract. Following an arbitration hearing, 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.
- Benefits Dispute: 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 treatments were medically necessary, and consequently ordered Blue Shield to issue benefits.
- Class Action: 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.
- ERISA Compliance: 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 the 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.
- Healthcare Fraud: Counseled a physician in a dispute with a healthcare district in Riverside County in which the district sued for alleged fraud and fee-splitting, while the physician brought a Section 1983 claim in federal court for violations of the physician's civil rights under the First Amendment and Fourteenth Amendment.
- Managed Care Contract Dispute: Represented a healthcare district in San Bernardino County in a breach of contract lawsuit against a large HMO which refused to refer radiology services to the district. The case ultimately settled favorably, resulting in an improved provider services agreement.
- Overpayment Dispute: Represented rehabilitation center in dispute with a prominent treatment facility concerning alleged overpayments for deficiencies in medical records. Following an aggressive appeal, the facility abandoned the overpayment request in exchange for a corrective action plan.
- Peer Review: 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.
- Peer Review: 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.
- Regulatory Compliance: Advised numerous Southern California hospitals and medical staffs on self-governance issues. John has drafted and revised hospital governing bylaws, medical staff bylaws, and rules and regulations for numerous California hospitals and medical staffs.
- Regulatory Compliance: 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.
- Telehealth Regulations: Advised a telehealth company regarding regulatory and operational issues for providing telemedicine services across state lines.
- Trade Name Dispute: Represented an outpatient surgery center or ASC 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.
- Trade Secret Dispute: Defended a 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.
- Whistleblower: Counseled a physician in a dispute with a hospital concerning the 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.
- Wrongful Termination: Represented an ambulance company in a lawsuit against its outsourced 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.
- Wrongful Termination: 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.
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
- Named Best Lawyer in America for 2016
- Named to Rising Star List by Southern California Super Lawyers in 2009, 2010, 2011, 2013, 2014, 2015
- 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)
- Out-of-Network Providers Beware of Statute Of Limitations While Appealing Health Insurance Claims
- Nelson Hardiman Successfully Opposes Attempt to Consolidate Peer Review Hearing
- Does The Ninth Circuit’s Decision In Spinedex Give A Green Light To Out-Of-Network Co-Pay Waivers?
- Nelson Hardiman Obtains Dismissal of Lawsuit Brought By Hospital District Against Physician
- Ready or Not, a Wave of New Patients is Headed Your Way
- Nelson Hardiman Convinces U.S. Office of Personnel Management to Reverse Blue Shield’s Determination of Lack of Medical Necessity
- Mental Health Providers Alert: Be On the Lookout for Discriminatory Treatment By Insurance Plans!
- Using ERISA Regulations to Challenge Overpayment Demands
- In New Lawsuit, Health Insurers Allege Fraud and Kickbacks Against Out-of-Network Providers Who Forgive Patients’ Financial Responsibility