James LenahanPoth (Jim)

Partner

Irvine + 1.949.553.7586

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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.

Experiência

  • Community Medical Centers wins summary adjudication against medical staffing group on breach of contract claimJones Day secured summary adjudication on behalf of Fresno Community Hospital and Medical Center, a leading provider network in Central California, on its breach of contract claim against a medical staffing group.
  • Eight hospitals reach settlement in arbitration against large health plan for underpaymentsJones Day represented eight hospitals in an arbitration brought against a large health plan for underpayments.
  • Rhode Island hospital successfully resolves claims against commercial insurerJones Day represented a large hospital system's facility in Rhode Island in pursuing a commercial insurer's alleged failure to pay appropriately under the parties' Facility Participation Agreement.
  • California hospitals successfully resolve claims against commercial insurerJones Day represented a large hospital system’s multiple California facilities in pursuing a commercial insurer's alleged failure to pay appropriately under the parties' Facility Participation Agreements.
  • 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.
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    April 2024 Commentary

    California Health Care Providers to Face Greater Headwinds as State Implements Health Care Cost Targets

    August 2022 Alert

    Final Rule Issued to Implement the No Surprises Act's Independent Dispute Resolution Process

    March 2022 Alert

    No Surprises Act Update: Rule Governing Dispute Resolution Process Set Aside

    January 2021 Commentary

    New Law Eliminates 75-Year-Old Antitrust Exemption for "Business of Health Insurance"

    January 2021 Alert

    Health Insurer Secures Judgment Against Health Care Provider for Alleged False Claims

    September 2015 Commentary

    U.S. District Court Issues Ruling on Preliminary Motion to Dismiss Interpreting 60-Day Overpayment Rule

    July 2015 Commentary

    Court of Appeals Affirms $237 Million Judgment Against Community Hospital

    February 2012 Alert

    CMS Publishes Long-Awaited 60-Day Repayment Proposed Rule for Identified Overpayments

    April 2011 Jones Day Publications

    Health Care Compliance and Enforcement Update

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