Learing v. Anthem Companies, Inc., The

CourtDistrict Court, D. Minnesota
DecidedFebruary 28, 2022
Docket0:21-cv-02283
StatusUnknown

This text of Learing v. Anthem Companies, Inc., The (Learing v. Anthem Companies, Inc., The) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Learing v. Anthem Companies, Inc., The, (mnd 2022).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA

Christine Learing, individually and on behalf Case No. 21-cv-2283 (KMM/JFD) of all others similarly situated,

Plaintiff,

v. ORDER

The Anthem Companies, Inc.,

Defendant.

This matter is before the Court on Plaintiff Christine Learing’s Motion for Conditional Certification (Dkt. No. 25). The Court held a hearing on the motion on January 28, 2022. Caroline Bressman and Rachhana Srey, Esqs., appeared for Plaintiff, and Kevin Young and Lennon Haas appeared for Defendant The Anthem Companies. For the reasons set forth below, the Court grants the motion and directs the parties to meet and confer over the form of the notice and notice distribution plan. I. Background This case is a putative collective action brought pursuant to the Fair Labor Standards Act (“FLSA”).1 (Compl. ¶ 1, Dkt. No. 1.) Plaintiff seeks to represent a collective of medical management nurses and nurses with similar job titles whom, she alleges, Defendant misclassified as exempt from overtime pay and to whom Defendant failed to pay proper

1 Plaintiff also brings a putative class action for state law claims under the Minnesota Payment of Wages Act and Minnesota Fair Labor Standards Act, but that part of the case is not relevant to the motion for conditional certification of the FLSA collective action. overtime compensation for the past three years. (Id. ¶ 4.) Defendant is an insurance company. (Id. ¶ 14.) According to Plaintiff, Defendant uses several job titles (medical

management nurse, utilization review nurse, utilization management nurse, and nurse reviewer) for the same job, but the primary duty is the same: to conduct utilization reviews, also known as medical necessity reviews, for insurance coverage purposes. (Id. ¶ 23.) This work consists “of reviewing medical authorization requests submitted by healthcare providers against pre-determined guidelines and criteria for insurance coverage and payment purposes.” (Id. ¶ 24.) Plaintiff worked for Defendant as a medical management

nurse, conducting medical necessity reviews, from September 2018 to July 2021. (Id. ¶ 20.) In the motion at hand, Plaintiff asks the Court to order conditional certification of a collective, authorize notice to putative collective members, and order Defendant to provide a list of collective members with names, addresses, telephone numbers, emails, partial social security numbers, job titles, and dates of employment. (Pl.’s Mem. Supp. at 2–3,

Dkt. No. 27.) Plaintiff proposes to define the FLSA collective as: All persons who worked as Medical Management Nurses, Utilization Management Nurses, or Utilization Review Nurses, or in similar job titles who were paid a salary and treated as exempt from overtime laws, and were primarily responsible for performing medical necessity review[]s for Defendant in Minnesota from three years prior to the filing of this Complaint through judgment.

(Id. at 8.) In support of her motion, Plaintiff submitted declarations from seven individuals (Kathy Burke, Kimberly Friedrich, Lisa Davis Herron, Tammy Hoff, Roger Marturano, Katherine Reichert, and Plaintiff) that described their job duties, salaries, and hours. (Bressman Decl. Ex. A, Dkt. No. 28-1.) The declarations aver the following similar facts:

• All seven individuals worked in person in Anthem’s Eagan, Minnesota, office location before March 2020, and from home after March 2020. • They performed utilization reviews, also known as medical necessity reviews, which consisted of reviewing medical authorization requests submitted by healthcare providers and applying guidelines and criteria set by Defendant for insurance coverage and payment. • They used Defendant’s case management system, guidelines, criteria, policies, and procedures in performing the utilization reviews. • Defendant set productivity quotas for the medical necessity reviews and audited their compliance with guidelines. • The individuals determined whether an authorization request met the criteria provided by Defendant. If it did, they could approve it, but if it did not, they sent the request to a medical doctor for review. • They worked more than 40 hours a week, were not required by Defendant to track their hours, and did not receive overtime pay. • They were paid a salary and were treated by Defendant as exempt from the requirements of the FLSA and Minnesota law. • They each named several other utilization review nurses and medical management nurses, including each other, who—based on their personal knowledge, observations, and experiences—they believe performed similar duties and did not receive overtime pay. • They trained with other nurses in similar positions and personally experienced being trained on the same topics as other nurses. (Id.) The seven individuals had the following job titles: utilization review nurse (Burke, Friedrich, and Marturano), medical management out-patient utilization management registered nurse (Herron), utilization management nurse (Hoff), medical management nurse I and II (Learing), and utilization review management nurse (Reichert). (Id.) Defendant opposes the motion, supported by additional declarations. The Court will consider the declarations only to the extent the materials do not contradict Plaintiff’s evidence and would thus require the Court to make credibility determinations or resolve factual disputes. See Chin v. Tile Shop, LLC, 57 F. Supp. 3d 1075, 1083 (D. Minn. 2014)

(Nelson, J.). Kristie Head, R.N., works for Amerigroup, an Anthem subsidiary, as a manager of nurses in the Nurse Medical Management (“NMM”) family of jobs, who perform utilization management reviews for Blue Cross Blue Shield of Minnesota. (Def.’s Ex. A ¶ 3, Dkt. No. 38-2.) Her current position is Manager I of Amerigroup’s Minnesota Medicaid team. (Id. ¶ 4.) Ms. Head averred that the differences among NMM duties are

comparable to the differences among duties of nurses who work in clinical settings. (Id. ¶ 7.) The various types of utilization reviews may differ, for example, as to the medical procedure under review, clinical information, guidelines, and interaction with providers. (Id.) The reviews may be for inpatient or outpatient treatment, and NMMs are not cross- trained on the two types of treatments. (Id. ¶ 9.) Some NMMs have more administrative,

supervision, or training duties than others. (Id. ¶¶ 13–15.) Some NMMs specialize in certain procedures (such as neo-natal) or types of benefits based on their prior experience. (Id. ¶ 17.) Cynthia Stokes, R.N., also works for Amerigroup as a manager of a team of NMM nurses who perform utilization management reviews for inpatient treatment for patients in

Neonatal Intensive Care Units. (Def.’s Ex. B (Stokes Decl.) ¶ 3, Dkt. No. 38-3.) Ms. Stokes also attested that NMMs use different guidelines for evaluating request for inpatient and outpatient treatment. (Id. ¶ 10.) They must have the clinical knowledge and judgment to understand the particular procedures and files they are reviewing. (Id. ¶ 13.) Defendant also refers to statements made in two declarations filed in another case, Canaday v. The Anthem Companies, No. 1:19-CV-1084 (W.D. Tenn.). (Def.’s Mem.

Opp’n at 2–3, Dkt. No. 38.) These declarations were not filed in this case, however, and the Court does not consider the excerpts quoted in Defendant’s memorandum. II. Legal Standards Under 29 U.S.C. § 216(b), an employee may bring an action for unpaid overtime compensation “for and in behalf of himself or themselves and other employees similarly situated.” Each employee must give consent in writing to become a party. Id. Given this

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