James LenahanPoth (Jim)

Partner

Irvine + 1.949.553.7586

For more than two decades, Jim Poth has assisted hospitals, health systems, laboratories, and other health care providers in implementing and executing strategies to ensure they receive appropriate reimbursement. His practice has focused on representing health care providers in litigation, arbitration, and negotiations with all types of payors. He has been the lead trial lawyer in dozens of cases for health care providers seeking to collect payment from both commercial and government-sponsored payors. He also has extensive experience in assisting health care providers in contract negotiations and providing advice on utilizing state and federal regulatory requirements to improve contract terms and providers' revenue cycle.

Recent matters Jim has handled include litigation for Cedars-Sinai Medical Center, Dignity Health (now CommonSpirit Health), and Prime Healthcare in challenging inappropriately low reimbursement paid by health plans for out-of-network services based on "reasonable and customary" calculations. He also has represented these same providers in disputing payments made under governing contracts. These cases follow his representation of providers asserting claims of statutory violations and fraud against health plans. He also has represented hospitals in qui tam litigation and disputes involving Medicare Secondary Payor issues, claims regarding fair debt collection practices, and balance billing issues.

Jim is a member of the American Health Lawyers Association (AHLA) and the Healthcare Financial Management Association (HFMA). He has spoken on managed care litigation, collection strategies, and medical records for these organizations.

Experience

  • Dignity Health wins dismissal of 32 casesJones Day secured the dismissal of 32 separate cases brought against Dignity Health's St. Bernardine hospital over spinal implants.
  • Cedars-Sinai obtains dismissal of putative class actionJones Day secured the dismissal of a putative class action brought against Cedars-Sinai Medical Center involving the practice of charging a facility fee to new patients.
  • Catholic Healthcare disputes claim denialsJones Day represented Catholic Healthcare West, a hospital network, in a dispute with Blue Cross of California over the health plan's failure to accept claims for payment and attempts to deny and retract payment based on retro-active termination of patient's policies.
  • Cedars-Sinai in payment dispute with PacifiCareJones Day represented Cedars-Sinai in a multi-million dollar payment dispute with PacifiCare of California over payment on (i) stop-loss claims and line item deletions from bills for services; (ii) pro-ration of per diem payments; and (iii) allegations of unbundling.
  • Tenet HealthSystem challenges contracted ratesTenet HealthSystem's California hospitals is represented by Jones Day in litigation challenging Kaiser Permanente's practice of denying payment based on contracted rates.
  • Tenet in arbitration with Molina over contract claims breachTenet Healthcare Corporation enlisted the counsel of Jones Day to represent its hospital network in an arbitration dispute with Molina Healthcare of California, a Medi-Cal funded HMO, concerning the appropriate payment for patient claims.
  • Tenet secures summary judgment precertification in debt collection putative class actionJones Day was able to secure summary judgment for Tenet Healthcare Corporation's hospital and health system accused of violating the California and Federal Fair Debt Collection Practices Act.
  • Vanguard Health Systems secures dismissal in suit alleging injury and improper billing of Medicare patientsJones Day secured dismissal for Vanguard Health Systems sued under the Medicare Secondary Payer Statute's private cause of action by consumer activist Erin Brockovich and professional guardian Douglas Stalley.
  • Whittier Hospital recovers costs from Blue ShieldJones Day represented Whittier Hospital, an acute care medical facility owned by Tenet Healthcare, in collecting full Medicare reimbursement for Medicare patients covered by Blue Shield after contracts terminated.
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