Midkiff v. The Anthem Companies, Inc.

CourtDistrict Court, E.D. Virginia
DecidedSeptember 5, 2024
Docket3:22-cv-00417
StatusUnknown

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

Bluebook
Midkiff v. The Anthem Companies, Inc., (E.D. Va. 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF VIRGINIA Richmond Division WINIFRED MIDKIFF, et ai., on ) behalf of themselves and all others ) similarly situated, ) ) Plaintiffs, ) ) v. ) Civil Action No. 3:22-cv-417-HEH ) THE ANTHEM COMPANIES, INC., etal, ) ) Defendants. ) MEMORANDUM OPINION (Granting Motion to Certify Class) THIS MATTER is before the Court on Plaintiffs Winifred Midkiff's (“Midkiff”) and Ardaith Brown’s (“Brown”) (collectively, “Plaintiffs”) Motion for Rule 23 Class Certification (the “Motion,” ECF No. 101), filed on November 30, 2023. The Court heard argument on March 18, 2024. (Minute Entry at 1, ECF No. 175.) Plaintiff Brown brings a Virginia Overtime Wage Act (“VOWA”) claim and requests that the Court certify a class of Nurse Medical Management (“NMM7”) reviewers who worked for Defendants The Anthem Companies, Inc., Anthem Health Plans of Virginia, Inc., and AMERIGROUP Corporation (collectively, “Defendants” or “Anthem”) in Virginia from

July 1, 2021, to the present. (Second Am. Compl. at 14, ECF No. 85; Mem. in Supp. at 1-2, ECF No. 102.)! For the reasons stated herein, the Motion will be granted. I. BACKGROUND A. Factual Background Plaintiffs and the putative class work or worked for Defendants in Virginia as utilization reviewers in one of three positions: NMM I, NMM II, and NMM Senior. (Second Am. Compl. 4, 74; Mem. in Supp. at 5, 18.) Brown worked as an NMM I from May 29, 2018, to November 19, 2022. (Second Am. Compl. { 54.) Plaintiffs allege that the primary responsibility of NMMs was “to perform utilization reviews, also called ‘medical necessity’ reviews, of authorization requests submitted by healthcare providers.” (Mem. in Supp. at 5.) These reviews involved evaluating requests submitted by healthcare providers and determining whether they met certain criteria. (Approval □□

Initial Inpatient Review Quick Reference Guide at 3, ECF No. 102-26; Robinson Dep. at 19:9-19, ECF No. 102-5.) The National Committee for Quality Assurance (“NCQA”) sets uniform standards that are applicable to the reviews and Defendants implemented certain uniform policies to meet them, as detailed below. (See NCQA 2020 Utilization Mgmt. Standards and Elements, ECF No. 102-39.)

! Plaintiffs also bring a Fair Labor Standards Act (“FLSA”) claim, which the Court has conditionally certified. (Second Am. Compl. {{ 83-89; Order at 1-2, ECF No. 44.) This claim is not at issue here. 2 Details related to Midkiff’s employment are omitted because Midkiff's employment with Defendants ended in July 2017, prior to VOWA’s enaction. (Mem. in Supp. at 2 n.1.) Thus, she is not representative of the proposed class. (/d.)

The NMMs followed a step-by-step process to determine whether the criteria were

met, and, if they were, the NMMs could approve the request. (Williams Dep. at 29:22— 25, ECF No. 102-7; Gresham Dep. at 19:22-22:23, ECF No. 102-16; see generally Approval — Initial Inpatient Review Quick Reference Guide.) Ifthe criteria were not met, the reviewers were required to send the request to a Medical Director for a final determination. (Approval — Initial Inpatient Review Quick Reference Guide at 3.) The NMMs were not permitted to deny any authorizations themselves. (Utilization Mgmt. Operational Guideline at 1, ECF No. 102-29.) NMMs of any level could also act as “preceptors” available to answer questions from NMM trainees. (March 18, 2024 Tr.

at 90:16, 91:17-19, ECF No. 179.) Defendants required NMM Is, NMM IIs, and NUM Seniors to have nursing licenses, but some employees performing medical necessity reviews were not licensed nurses. (Brown Dep. at 55:4-7, ECF No. 102-17; Defs.’ Resp. to Pls.’ Req. for Admis. No. 5, ECF No. 102-3.) Pursuant to the NCQA’s uniform utilization management standards, utilization reviewers are not required to be Registered Nurses (RNs). (NCQA 2020 Utilization Mgmt. Standards and Elements at 19.) Valerie Smith (“Smith”}—a member of the putative class who worked as an NMM I, an NMM II, and an NMM Senior—testified that her job duties “didn’t change” between these roles. (Mar. 18, 2024 Tr. at 90:7-14.) In each of these roles, Smith’s primary responsibility was to “review clinical information and match it against criteria.” (Id. at 91:23-24.) Smith also testified that her level of responsibility did not change as she moved between roles. (/d. at 90:19-24.)

Plaintiffs allege that Brown and the putative class routinely worked over forty (40) hours per week to complete assigned medical necessity reviews. (Second Am. Compl. 45.) However, Brown and the other nurses did not receive overtime compensation because Defendants classified them as exempt under the FLSA’s professional and administrative exemptions. (Mem. in Supp. at 18-20.) b. Procedural History Midkiff filed her original Complaint bringing an FLSA collective action claim against Defendants on June 3, 2022. (See Compl., ECF No. 1.) Midkiff filed an Amended Complaint (ECF No. 19) on August 24, 2022, and this Court conditionally certified the FLSA collective on November 10, 2022. (Order at 1-2.) Plaintiffs filed the Second Amended Complaint, which included Brown as a named party and added the VOWA claim, on July 27, 2023. (Second Am. Compl. f§ 1-3.) Plaintiffs moved to certify the VOWA class on November 30, 2023. (Mot. at 1.) Based on the similar role shared by NMMs and the similar alleged treatment of NMMs by Defendants, Brown seeks to certify the following class: Any individual who: (1) worked/works in Virginia for Anthem, Inc. (or one of its subsidiaries) in the Nurse Medical Management I, JI, and/or Senior job title; (2) was/is paid a salary, (3) was/is treated as exempt from overtime laws, (4) worked/works over forty (40) hours during any week, and (5) was/is primarily responsible for performing medical necessity reviews at any time since July 1, 2021. (Mem. in Supp. at 18.) Brown contends that this class, with her as class representative, satisfies the requirements of Federal Rule of Civil Procedure 23. (Jd. at 2.)

II. APPLICABLE LAW Class certification is governed by Rule 23. When determining whether class certification is permissible, the party seeking class certification must first show that it has satisfied certain threshold requirements, including all four (4) of Rule 23(a)’s requirements. Wal-Mart Stores, Inc. v. Dukes, 564 U.S. 338, 345 (2011). A district court

may only certify a class if: (1) the class is so numerous that joinder of all members is impracticable, (2) there are questions of law or fact common to the class; (3) the claims or defenses of the representative parties are typical of the claims or defenses of the class; and (4) the representative parties will fairly and adequately protect the interests of the class. FED R. Clv. P. 23(a)(1}{(4). The Fourth Circuit also imposes a threshold ascertainability requirement for class certification: “[a] class cannot be certified unless a court can readily identify the class members in reference to objective criteria.” Career Counseling, Inc. v. AmeriFactors Fin. Grp., LLC, 91 F.4th 202, 206 (4th Cir. 2024) (quoting EOT Prod. Co.

v. Adair, 764 F.3d 347, 358 (4th Cir. 2014)). Assuming the threshold requirements have been satisfied, the proponent must further demonstrate that the claims fall into at least

one of the three (3) categories of cases appropriate for class certification enumerated in Rule 23(b). FED R. CIV. P. 23(b); EOT Prod. 764 F.3d at 357. “A district court has broad discretion in deciding whether to certify a class.” Thorn v. Jefferson-Pilot Life Ins. Co., 445 F.3d 311, 317 (4th Cir.

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