Clark v. Centene Co. of Texas

104 F. Supp. 3d 813, 2015 U.S. Dist. LEXIS 61636, 2015 WL 2250387
CourtDistrict Court, W.D. Texas
DecidedMay 11, 2015
DocketCase No. A-12-CA-174-SS
StatusPublished
Cited by6 cases

This text of 104 F. Supp. 3d 813 (Clark v. Centene Co. of Texas) is published on Counsel Stack Legal Research, covering District Court, W.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clark v. Centene Co. of Texas, 104 F. Supp. 3d 813, 2015 U.S. Dist. LEXIS 61636, 2015 WL 2250387 (W.D. Tex. 2015).

Opinion

ORDER

SAM SPARKS, District Judge.

BE IT REMEMBERED on the 2nd, 3rd, and 4th days of February, 2015, the Court held a bench trial in the above-styled cause, and the parties appeared in person and through counsel. During trial, the Court heard testimony from the following witnesses: Robin Lorie DeSalvo; Karen Calabrese; Margueriette Schmoll; Rita Valdez; Cynthia Cantu; Cordelia Garcia; Shelly Cattoor; Sherri Hodsdon; and Esmeralda Cazares-Baig. At the close of Plaintiffs’ evidence, Defendant Centene Company of Texas, L.P. filed its Motion for Judgment on Partial Findings [# 149] in open court, which the Court carried. Having considered the evidence and testimony presented at trial, the arguments of counsel, the parties’ briefs, and the governing law, the Court enters the following findings of fact and conclusions of law.

Background

This case is a Fair Labor Standards Act (FLSA) collective action to recover unpaid Overtime wages brought by Plaintiffs Kathy Clark, Amy Endsley, Susan Grimmett, Margueriette Schmoll, and Kevin Ulrich, a group of utilization review nurses (URNs) formerly employed by Defendant Centene Company of Texas, L.P. (Centene). As Centene URNs, Plaintiffs were responsible for assessing medical authorization requests submitted by healthcare providers for purposes of insurance coverage and payment. There are two types of URNs: prior authorization nurses, who review outpatient service requests, and concurrent review nurses, who review inpatient service requests. Unlike prior authorization nurses, who typically work in the office, concurrent review nurses typically travel to hospitals and perform some on-site work, and both types of URNs can perform work from home. All URNs are responsible for the same basic tasks: reviewing medical authorization requests to determine whether a medical procedure requested by a healthcare provider is medically necessary. At Centene, URNs complete authorizations by entering their reviews into a computer program called “CCMS.”

The Court conditionally certified the collective action on May 8, 2013. See Order of May 8, 2013[#62]. Following discovery, Centene simultaneously moved to de-certify and for summary judgment, see Mot. Summ. J. [# 110]; Mot. Decertify [# 111], and Plaintiffs cross-moved for partial summary judgment on liability, see Mot. Partial Summ. J. [# 113-1], In its motion to decertify, Centene argued. Plaintiffs were not substantially similar to one another because they worked in different settings (some at home, some in the office, some in hospitals, some in.-a combination of the three), in different cities, and for different bosses, and because Plaintiffs’ individual workloads and schedules varied. The Court found those differences did not bear on the merits of Plaintiffs’ claims, particularly in light of the fact Centene sought summary disposition of the litigation by arguing all Plaintiffs possessed and applied medical knowledge, performed utilization review, interpreted Centene policies and guidelines, received similar instructions, worked without daily oversight, and were performance-audited based upon Centene’s internal standards. Id. at 24-25. The Court noted, in addition to the above, that Plaintiffs were universally classified as exempt based not- upon an individualized assessment of their jobs, but rather, upon the formal Centene job descriptions that applied to all URNs. Id. at 25. Consequently, the Court denied Cen-tene’s motion to decertify.

[819]*819Further, the Court granted summary judgment in favor of Plaintiffs as to liability, finding Centene improperly classified URNs as exempt from overtime under the FLSA. See Order of Sept. 2, 2014 [# 127]. However, the Court found genuine issues of fact remained concerning (1) whether Centene willfully violated the. FLSA, thereby extending the limitations period from two years to three, and (2) Centene’s good-faith defenses under 29 U.S.C. §§ 259 and 260. See id. The case therefore proceeded to bench trial on the issues of-damages, willfulness, and good faith.

A. Summary of the Evidence

Twenty-six (26) named and opt-in plaintiffs, who variously worked in Centene’s Austin, Dallas, Corpus Christi, San Antonio, and Lubbock offices, were part of the litigation at the time of trial.1 The parties stipulated to the cities of employment, dates of employment, types of reviews (concurrent or prior authorization) primarily performed, and consent filing dates for each of the twenty-six plaintiffs. In their case-in-chief, Plaintiffs called the following witnesses: adverse witness Robin Lorie DeSalvo, a former URN and former supervisor of URNs at Centene; six Plaintiffs— Karen Calabrese, Margueriette Schmoll, Rita Valdez, Cynthia Cantu, Cordelia Garcia, and Sherri Hodsdon; and adverse witness Shelly Cattoor, Centene’s senior di: rector of compensation. Following the close of Plaintiffs’ case, Defendants called Esmeralda Cazares-Baig, Centene’s senior vice president of complex care operations who previously worked as the vice president of medical management for utilization review, and then rested. Both parties also offered a number of documentary" exhibits. A brief summary of the testimony-presented by each witness and documentary evidence- related to that testimony follows.

1. Robin Lorie DeSalvo

.. Robin Lorie DeSalvo worked for Cen-tene as a supervispr of utilization management, from January 2011 through October 2012. Prior to that time, DeSalvo worked as a URN.2 In DeSalvo’s role as a supervisor, her primary responsibility was. to assess the productivity of URNs and ensure that in reviewing their assigned medical authorization requests, URNs stayed within “turn-around times,” or TATs. TATs, DeSalvo explained, are mandated under Texas law and under National Committee for Quality Assurance (NCQA) standards for utilization management, and require a submitted authorization request be completed within a specified time frame. Cen-tene can be fined if its URNs fail to meet TATs.

DeSalvo testified all Centene URNs are required -to review forty authorization requests per day, no matter how long it takes them to do so. DeSalvo stated if URNs completed those requests, they could choose to take additional authorizations and continue working if they wanted to do so. DeSalvo also confirmed Centene had no mandatory timekeeping system for its URNs, and agreed URNs were not required to track their hours through CCMS. DeSalvo acknowledged during periods of time in which CCMS was down or experiencing technical problems, nurses were expected to keep working.

DeSalvo testified that in 2009, Centene had a large backlog of unreviewed authori[820]*820zation requests that required URNs to work extra hours. During that-year, DeS-alvo worked as a URN alongside Plaintiff Margueriette Schmoll, and was supervised by Elizabeth England; according to DeS-alvo, England required URNs to come into work on Saturdays. DeSalvo statéd in 2010, Centene hired temporary workers to help address the backlog of authorizations. As of 2011, DeSalvo testified the primary driver of overtime was TATs, and in 2012, the primary driver of overtime was Cen-tene’s expansion, which created a 50% increase in the workload borne by URNs.

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104 F. Supp. 3d 813, 2015 U.S. Dist. LEXIS 61636, 2015 WL 2250387, Counsel Stack Legal Research, https://law.counselstack.com/opinion/clark-v-centene-co-of-texas-txwd-2015.