Holden v. Cenpatico Behavioral Health, LLC

347 F. Supp. 3d 77
CourtDistrict Court, District of Columbia
DecidedSeptember 22, 2017
DocketCivil Action No. 15-14119-JCB
StatusPublished
Cited by2 cases

This text of 347 F. Supp. 3d 77 (Holden v. Cenpatico Behavioral Health, LLC) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Holden v. Cenpatico Behavioral Health, LLC, 347 F. Supp. 3d 77 (D.D.C. 2017).

Opinion

A. Holden's Pay

Cenpatico maintains that Holden was paid her salary regardless of how many hours she worked each week.12 However, Cenpatico's Rule 30(b)(6) designee, Ms. Muldoon,13 testified that if Holden took more than four hours off and had depleted her vacation, sick and personal time, she would have to make up those hours or they would be deducted from her pay.14 Nevertheless, she also testified that she does not recall any such deductions being made to Holden's pay and that no such deductions were made to other utilization managers' pay during her tenure.15

Cenpatico's "Pay Procedures and Policies" state, among other things:

It is Centene's intent to pay exempt employees on a salary basis. Therefore, Centene prohibits the making of improper deductions from the salaries of exempt employees because of variations in the quality and quantity of the work performed . Unsatisfactory quantities or quality of work will be addressed, not by reductions in salary, but rather through regular performance management methods including the performance evaluation and discipline processes. Other deductions from Exempt employee's salaries that Centene views as improper and therefore are prohibited include the following:
• Absences of less than a full work week occasioned by Centene or by the operating requirements of business;
• Absences of less than two (2) full work weeks caused by jury duty, or attendance as a witness in a judicial proceeding;
*80• Absences of less than a full workweek caused by temporary military leave (although Centene may offset against the regular salary any military pay the employee receives);
• Partial day absences for personal reasons or because of sickness or disability;
[ ] Deductions from exempt employee's salaries are permitted in the following circumstances:
• If an exempt employee works less than a full work week in the initial or final week of employment (exempt employees who work less than 40 hours during their first or last week of employment will be paid a proportionate part of their full salary for the time actually worked);
• Absences caused by sickness or disability (including work-related accidents) taken in accordance with the Company's policies which provide paid time off for sickness or disability;
• Full-day absences caused by sickness or disability if the employee is not yet eligible for sick or disability benefits or sick or disability benefits has been exhausted under the Company's other policies providing pay for those absences;
• Hours taken as unpaid leave under the Family and Medical Leave Act (FMLA);
• Full-day absences for personal reasons other than sickness or disability if the employee is not yet eligible for personal time-off benefits or if those benefits have been exhausted;
• Disciplinary suspensions for infractions of safety rules of major significance;
• Disciplinary suspensions of one or more full days for infractions of written workplace conduct rules of the Company including, but not limited to, violations of the Company's Ant-Harassment; Non-Discrimination; Workplace Violence; Drug and Alcohol; Bulletin Boards, Computer, Electronic Mail[.]
Any exempt employee who believes their salary has been subjected to improper deductions should promptly report their concerns to their DSHRP or the Corporate Payroll department. Any improper deductions will be reimbursed, and there will be no retaliation against any employee who raises any good faith concerns regarding deductions from salary. Otherwise, if you have any questions about your paycheck, please contact your DSHRP or the Corporate Payroll department.16

Holden's final paycheck reflects that a full day of unpaid time was deducted from her salary because she was out sick and had no sick time left.17

*81B. Holden's Job

The utilization manager job description defines the position's purpose as follows:

Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with discharge planning, arrange transportation; provide member assistance and participate in special utilization projects.18

It also listed the following duties:

Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated.
Interact with physicians and social workers for discharge planning.
Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards.
Compile and report daily review activity and facility statistics.
Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community.
Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient.
Track benefit usage and advise appropriate parties of exhaustion of benefits. Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.19

Pursuant to the job posting to which Holden applied, utilization managers were required to have a master's degree in behavioral health or be a Registered Nurse with more than three years of experience in psychiatric and/or substance abuse health care settings including utilization review.20 They were also required to have a working knowledge of utilization review procedures, mental health and substance abuse community resources and network providers.21 Finally, they were required to have an unrestricted license as a Licensed Clinical Social Worker ("LCSW"), Licensed Marriage and Family Therapist ("LMFT"), Licensed Mental Health Counselor ("LMHC"), Licensed Master Social Worker ("LMSW"), License Professional Counselor ("LPC"), or Registered Nurse ("RN") (collectively, the "Clinical Licenses") or hold a PhD or PsyD.22

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Cite This Page — Counsel Stack

Bluebook (online)
347 F. Supp. 3d 77, Counsel Stack Legal Research, https://law.counselstack.com/opinion/holden-v-cenpatico-behavioral-health-llc-dcd-2017.