John C. West
Arizona
Lewis Roca Rothgerber Christie LLP
201 East Washington Street
Suite 1200
Phoenix, AZ 85004
Tel: 602.262.5781
Email:
jwest@lewisroca.com
Web:
www.lewisroca.com
John is a top resource for industry leading health care entities who are dominant players in the national health care arena. His representation includes managed care organizations, health plans, provider networks, group health insurers, self-funded and insured employee benefit plans, and payor entities in a wide spectrum of complex health law related matters. He also represents Fortune 500 companies and other business clients in commercial contract disputes, class action, and business litigation matters.
In his more than 40 years of experience, John has counseled clients and litigated matters involving network contracting disputes, provider reimbursement and overpayment recovery, ERISA benefits litigation, Medicare benefits, and related issues. John also has substantial experience representing Medicare Advantage Organizations in regulatory and litigation matters, including provider reimbursement issues, network compliance, termination, member steering, overpayments, and fraud recovery.
A seasoned litigator, John has handled numerous hearings in state and federal courts and numerous arbitrations, administrative hearings, and appeals before the Medicare Appeals Council. John has successfully defended health plans in jury trials in first party breach of bad faith actions.
John is counsel of record in numerous reported decisions that have established important precedent including Spinedex Physical Therapy v. United Healthcare of Arizona, 770 F.3d 1282 (9th Cir. 2014) (ERISA Article III standing, assignment of breach of fiduciary claims, enforcement of anti-assignment provision); United Behavioral Health v. Maricopa Integrated Health System, 377 P.3d 315 (Ariz. 2016) (non-arbitrability of patients’ Medicare coverage claims by provider); Parra v. PacifiCare of Arizona, Inc., 715 F.3d 1146 (9th Cir. 2013) (MA Plan standing under Medicare Secondary Payer Act); and Arizona Department of Administration v. Cox, 213 P.2d 707 (Ariz. App. 2009) (establishing State’s third party recovery rights).
John is ranked by Chambers USA in health care and has been included in Best Lawyers of America in the categories of health care law, health care litigation, and commercial litigation since 2005.
- 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.
- The Best Lawyers in America, Woodward/White, Aiken S.C., Health Care Law, Commercial Litigation, Health Care Litigation, 2005-2022
- Chambers USA, Health Care, 2015-2021
- Martindale-Hubbell, “AV/Preeminent Attorney” rating
- Southwest Super Lawyers, Health Care Law, 2007-2019
- Arizona Business Magazine, Top 100 Lawyers, 2015
- Phoenix Business Journal, Best of the Bar
- Arizona’s Finest Lawyers
Lewis Roca provides cost-effective and comprehensive solutions to participants across the industry, leveraging our considerable experience in transactional, intellectual property, regulatory, and litigation law. We represent a wide range of health care clients – from hospitals to physician groups, long-term care facilities, biotechnology companies, managed care plans, and insurers – who rely on our counsel to succeed.
Our health care team is recognized by Chambers USA, which lauds our “substantial expertise in dispute resolution” and “significant experience representing clients in high-profile class actions and arbitrations.” We devote considerable time to industry participation – from speaking and publishing to keeping apprised of the latest trends – which enables us to offer clients concrete, up-to-the-minute advice.
The firm is committed to exceeding clients’ expectations through Experience Amplified, six principles that guide our work with clients and provide feedback mechanisms for continuous improvement.