John C. West

Representative Matters

• Representation of health plans in actions for recovery of overpayments to providers, having secured arbitration awards and settlements under ERISA and common law theories of recovery.
• Representation of health plans in defense of actions by non-contracted providers for payment of out of network claims denied due to provider waiving of patient cost share responsibility (copayments and deductibles), billing fraud and coverage issues.
• Representation of health plans and plan administrators in numerous actions brought by providers under ERISA § 502 for the recovery of plan benefits, including actions for payment of out of network claims as network benefits, disability, behavioral health, and claims related to emergency air transportation.
• Representation of ERISA, Medicare and State plans in enforcement of plan subrogation and reimbursement rights over third party recoveries.
• Counsel for claims administrator and numerous employer sponsored health plans in putative class action brought by chiropractor and plan participants for reimbursement of treatment denied as “experimental and unproven” addressing issues relating to Article III standing, assignment of breach of fiduciary duty claims, exhaustion, enforceability of plan limitation periods, and purported ERISA violations.
• Counsel for health plan in defense of provider contract claim arising out the allocation of taxes under the Affordable Care Act.
• Counsel for behavioral health plan in successful action to block arbitration of multiple individual benefit claims under provider contract’s arbitration provision that were, at bottom, coverage denials and subject to mandatory Medicare administrative procedure.
• Counsel for health plan in arbitration on issue whether Medicare based reimbursement under MA Plan includes capital costs for “new hospitals” when paid on a cost basis and not prospectively under IPPS Pricer.
• Counsel for health plan in arbitration award denying provider’s claim for $25 million in damages for alleged improper network termination.
• Counsel for health plan in successful defense of putative class action for improper termination of Medicare Advantage product within service area.
• Counsel for health plan in putative class actions alleging wrongful rescission of class members individual policies for purported failure to comply with Arizona law.
• Counsel for health plan in defeating class certification for alleged misrepresentation in the sale of individual plans as group plans and alleged failure to disclose fees.
• Counsel for self-funded ERISA plan in recovery against stop loss carrier that contested the ERISA plan administrator’s eligibility determination.
• Counsel for health plans in defense of actions brought under False Claims Act.

Trials

• Successful defense of health insurer in eight day jury trial in which plaintiff claimed breach of contract and insurance bad faith in insurer’s denial of coverage of narcotic pain medications over a six year period.  The plaintiff sought compensatory and bad faith damages exceeding seven figures.  Unanimous defense verdict.  Court awarded health insurer $350,000 in attorneys’ fees. 
• Successful defense of MA Plan in jury trial brought by MA plan member seeking compensatory and punitive damages claiming that placement in lower level of care caused physical injury and was in breach of duty of good faith and fair dealing.
• Defended MA Plan in a seven-week jury trial brought by survivors of a deceased member claiming the plan intentionally delayed acceptance of the member into a facility in order to shift financial responsibility to a capitated provider group (settled in week seven).

Administrative

• Representation of Medicare Advantage plans in benefit actions before Administrative Law Judge and Medicare Appeals Council.
• Representation of health plan in successful bid protest over state funded health plan leading to contract award covering 100,000 participants.

Related News

Distinctions

The Best Lawyers in America - Woodward/White, Aiken S.C. - Healthcare Law, Commercial Litigation, Healthcare Litigation, 2005-2020
Chambers USA - Healthcare, 2015-2019
Martindale-Hubbell - "AV/Preeminent Attorney" Rating
Southwest Super Lawyers - Healthcare Law, 2007-2019
Arizona Business Magazine - Top 100 Lawyers, 2015
Phoenix Business Journal - Best of the Bar
Arizona's Finest Lawyers

Other Info