EQHealth Solutions Unpaid Overtime Lawsuit - Salaried Care Coordinators

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IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF LOUISIANA MELISSA RUSSELL, AND ALL OTHERS SIMILARLY SITUATED,

Plaintiff, v.

Civil Action No.

EQHEALTH SOLUTIONS, INC.,

Defendant.

ORIGINAL COLLECTIVE ACTION COMPLAINT Plaintiff Melissa Russell (“Plaintiff” or “Russell”) brings this action individually and on behalf of those similarly situated against Defendant eQHealth Solutions, Inc. (“EQS” or “Defendant”), and in support shows the Court the following: I. 2.

SUMMARY

This is an opt-in collective action brought pursuant to the Fair Labor Standards Act,

29 U.S.C. § 201, et seq, (“FLSA”).

3.

Defendant employed Plaintiff and the FLSA Class Members as “CMEs” whose job

duties included (1) communicating with and gathering data from members to document members’ medical circumstances in Defendant’s computer system (“Data Collection”); (2) inputting member data into Defendant’s computer system (“Data Entry”); (3) using established guidelines to maximize utilization of plan resources through application of predetermined criteria (“Care Utilization”); (4) providing information to members and providers regarding plan benefits and resources to address members healthcare needs (“Plan Education”); and (5) and working with members and providers to set up medical care (“Care Setup”) (collectively, “Care Management Work”).

ORIGINAL COLLECTIVE ACTION COMPLAINT

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4.

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Defendant misclassified CMEs as exempt from federal and state mandated overtime

pay, paid them a salary and refused to pay them overtime pay despite them regularly working over 40 hours per workweek (“OT Misclassification Policy”).

II. 3.

PARTIES

Plaintiff Russell worked for Defendant as a “CME” for over 40 hours during one or

more workweeks during the last three years. Defendant referred to Plaintiff’s specific job title in multiple ways during her employment, including referring to her job title as “Care Coordinator,” “Pediatric Care Coordinator,” “Utilization Review Nurse,” and “UM Coordinator.”

4.

Plaintiff brings this action on behalf of those similarly situated pursuant to the FLSA

(“FLSA Class Members”). The FLSA Class Members include, without limitation, such job titles as “Care Coordinator,” “Pediatric Care Coordinator,” “Utilization Review Nurse,” “Utilization Review Coordinator,” and other job titles performing the same or similar work that Defendant subjected to the OT Misclassification Policy.

5.

Defendant eQHealth Solutions, Inc. is a Louisiana corporation that has appointed

Glen J. Golemi, 8440 Jefferson Highway, Suite 101, Baton Rouge, LA 70809 as its agent for service of process.

III. 6.

JURISDICTION AND VENUE

This Court has jurisdiction over Plaintiff’s FLSA claim because that claim arises under

federal law pursuant to 29 U.S.C. § 216(b) and pursuant to 28 U.S.C. § 1331.

7.

Venue is proper in this District pursuant to 28 U.S.C. § 1391 because Defendant

resides in this district and operative facts forming the basis of the suit occurred in this District.

IV. 8.

COVERAGE

At all material times, Defendant acted, directly or indirectly, in the interest of an

employer or joint employer with respect to Plaintiff and the FLSA Class Members.

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9.

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At all times hereinafter mentioned, Defendant has been an employer or joint employer

within the meaning of Section 3(d) of the FLSA, 29 U.S.C. § 203(d).

10.

At all times hereinafter mentioned, Defendant has been an enterprise within the

meaning of Section 3(r) of the FLSA, 29 U.S.C. § 203(r).

11.

At all times hereinafter mentioned, Defendant has been an enterprise engaged in

commerce or in the production of goods for commerce within the meaning of Section 3(s)(1) of the FLSA, 29 U.S.C. § 203(s)(1), in that said enterprise has had employees engaged in commerce or in the production of goods for commerce, or employees handling, selling, or otherwise working on goods or materials that have been moved in or produced for commerce by any person and in that said enterprise has had and has an annual gross volume of sales made or business done of not less than $500,000 (exclusive of excise taxes at the retail level which are separately stated). Plaintiff and the FLSA Class Members specifically handled materials, including computer and other equipment, to conduct medical assessments.

12.

At all times hereinafter mentioned, Plaintiff and the FLSA Class Members were

individual employees who were engaged in commerce or in the production of goods for commerce as required by 29 U.S.C. § 203(e)(1).

V.

FACTUAL ALLEGATIONS

13.

Plaintiff incorporates all allegations previously made in this Complaint by reference.

14.

Defendant has had business operations throughout the United States, including in

Louisiana and this Judicial District, throughout the last three years. Their annual gross volume of sales made and business done exceeded $500,000.00 per year at all relevant times.

15.

Defendant is a “population health management and healthcare IT solutions company”

that provides care coordination and utilization review services to its customers. These services attempt to reduce overall medical care costs through prevention, early detection and coordination between

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various health service providers. Defendant employs salaried individuals who help provide the care coordination and utilization review services to Defendant’s customers. Defendant assigns these “Care Management Employees” or “CMEs” various job titles, including Care Coordinator, Utilization Review Nurse, and Pediatric Care Coordinator. 1 16.

Plaintiff worked as a CME for Defendant from approximately August 2014 to March

17.

As a CME, Plaintiff’s primary job duties included Data Collection, Data Entry, Care

2017.

Utilization, Plan Education, and Care Setup job functions.

18.

These “Care Management Work” job duties did not involve providing nursing care in

a clinical setting or direct medical care to members.

19.

These “Care Management Work” job duties also did not include the exercise of

discretion or independent judgment with respect to matters of significance. Rather, they involved applying and communicating Defendant’s guidelines policies and procedures for the approval and coordination of healthcare benefits.

See e.g. www.eqhs.org/Solutions/eQCare/Care-Coordination-Services (indicating on website that EQS provides care coordination services for purpose of “improving care and reducing costs” and that, “[w]ith handson, face-to-face Care Coordinators, the quality of care is improved and unnecessary spending is reduced, including reduced readmissions for the demographic group responsible for the highest resource utilization rates.”) (last visited January 2, 2019); see also http://bit.ly/EQ-UM (indicating that EQS provides utilization management services to prevent “unnecessary and inappropriate medical care” to maximize the “cost efficacy of healthcare services.”) (January 2, 2019); https://www.eqhs.org/Home-New (“eQHealth Solutions can provide[s] self-insured and other commercial plans with impactful care coordination and utilization management, a complete medical management system to manage your population’s health…. eQHealth provides comprehensive analytics, utilization review and care coordination solutions to help identify and manage high risk Medicare and Medicaid populations.”) (last visited Jan. 2, 2019); https://www.eqhs.org/About (“eQHealth Solutions…is a population health management and healthcare IT solutions company…. Our high-tech and high-touch offerings include innovative medical management systems, face to face community care coordination services, utilization review, clinical data integration and business intelligence analytical reporting – all focusing on increased quality outcomes and optimization of provider and payer networks. eQHealth serves a variety of entities across the US, including federal, state and commercial clients.”) (last visited Jan. 2, 2019).

1

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20.

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As a CME, Plaintiff routinely worked 55 or more hours per week during her

employment.

21.

Defendant did not pay Plaintiff overtime pay for all hours worked in excess of 40

hours per workweek.

22.

Instead of providing Plaintiff with overtime pay, Defendant paid Plaintiff pursuant to

the OT Misclassification Policy that misclassified her as exempt and paid her a salary with no overtime pay for her many hours of overtime work.

23.

Defendant knew that Plaintiff worked in excess of 40 hours per week.

24.

Plaintiff is entitled to receive overtime pay for all the hours they worked in excess of

40 per workweek.

25.

Defendant willfully misclassified Plaintiff as exempt and refused to pay her overtime

pay, despite (1) having awareness of the FLSA’s minimum wage and overtime requirements; (2) routinely receiving complaints from Plaintiff and the FLSA Class Members regarding their pay and not being paid for overtime hours; and (3) paying workers who performed substantially similar, nonexempt duties on an hourly/overtime eligible basis, but choosing not to pay Plaintiff overtime.

VI.

COLLECTIVE ACTION ALLEGATIONS

26.

Plaintiff incorporates all allegations previously made in this Complaint by reference.

27.

Plaintiff brings her FLSA claims as a collective action under 29 U.S.C. § 216(b).

28.

The similarly situated FLSA Class Members are Defendant’s current and former

non-supervisory employees who worked more than 40 hours in at least one workweek over the past three years, who were paid a salary, and whose job duties included (1) communicating with and gathering data from members to document members’ medical circumstances in Defendant’s computer system; (2) inputting member data into Defendant’s computer system; (3) using established guidelines to maximize utilization of plan resources through application ORIGINAL COLLECTIVE ACTION COMPLAINT

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of predetermined criteria; (4) providing information to members and providers regarding plan benefits and resources to address members healthcare needs; and (5) and working with members and providers to set up medical care, or other similar work.

29.

Plaintiff and the FLSA Class Members are similarly situated with respect to their job

duties and pay provisions. All salaried CMEs performed the same or similar job duties: Non-exempt Care Management Work that does not involve (1)providing nursing care in a clinical setting or direct care to Defendant’s customers; or (2) the exercise of discretion or independent judgment with respect to matters of significance. Defendant also subjected the similarly situated Plaintiff and the FLSA Class Members to the same pay provisions: Defendant subjected all salaried CMEs to the OT Misclassification Policy that denied them (1) overtime for all hours worked in excess of 40 hours per week; and (2) one-and-one-half times their regular rate of pay for all overtime hours worked.

Accordingly, the FLSA Class Members are similarly situated to Plaintiff with respect to job duties and pay provisions.

30.

Defendant’s failure to pay overtime compensation at the rates required by the FLSA

results from generally applicable policies or practices and do not depend on the personal circumstances of the FLSA Class Members. As employees paid on a non-exempt basis, Plaintiff and all FLSA Class Members are entitled to overtime at a rate of one-and-one-half their regular rate for all hours worked in excess of 40 per week regardless of their precise job requirements or rate of pay. Although the issue of damages may be individual in character, there is no detraction from the common nucleus of liability facts. The questions of law and fact commonly apply to Plaintiff and all Class Members that worked for Defendant during the statutory time period.

VII. COUNT ONE: FAILURE TO PAY WAGES IN ACCORDANCE WITH THE FAIR LABOR STANDARDS ACT 31.

Plaintiff incorporates all allegations previously made in this Complaint.

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32.

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During the relevant period, Defendant violated and continue to violate Section 7 of

the FLSA, 29 U.S.C. §§ 207, and 215(a)(2) by employing Plaintiff and other FLSA Class Members in an enterprise engaged in commerce or in the production of goods for commerce for workweeks longer than 40 hours without compensating such employees for their work in excess of forty hours per week at rates no less than one-and-a-half times the regular rates for which they were employed.

33.

Defendant acted willfully in failing to pay Plaintiff and the FLSA Class Members in

accordance with the law.

VIII. RELIEF SOUGHT 34.

Plaintiff, individually and on behalf of the similarly situated FLSA Class Members, pray

for judgment against Defendant as follows: a.

For an Order pursuant to Section 16(b) of the FLSA finding Defendant liable for unpaid back wages due to Plaintiff (and those who may join in the suit) and for liquidated damages equal in amount to the unpaid compensation found due to Plaintiff (and those who may join the suit);

b.

For an award of attorneys’ fees, expenses, expert fees and costs incurred by Plaintiff in vindicating her rights under applicable federal law;

c.

For a service payment to the Plaintiff for services provided on behalf of the FLSA Class Members;

d.

For an Order awarding Plaintiff (and those who may be included in the suit) pre-judgment and post-judgment interest at the highest rates allowed by law;

e.

For such other and further legal or equitable relief as this Court deems to be just and appropriate.

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Respectfully submitted, /s/ Michael A. Mahone, Jr. Michael A. Mahone, Jr., Bar No. 32567 THE MAHONE FIRM LLC 5190 Canal Blvd., Suite 102 New Orleans, Louisiana 70124 Telephone: (504) 564-7342 Facsimile: (504) 617-6474 Email: mike@mahonefirm.com JACK SIEGEL* Texas Bar No. 24070621 jack@siegellawgroup.biz SIEGEL LAW GROUP, PLLC 2820 McKinnon, Suite 5009 Dallas, Texas 75201 P: 214.790.4454 www.4overtimelawyer.com TRAVIS M. HEDGPETH* Texas Bar No. 24074386 THE HEDGPETH LAW FIRM, PC 5438 Rutherglenn Drive Houston, Texas 77096 P: (512) 417-5716 travis@hedgpethlaw.com *Application for admission pro hac vice forthcoming ATTORNEYS FOR PLAINTIFF

CERTIFICATE OF SERVICE This is to certify that a true and correct copy of the foregoing document will be served on Defendant along with a copy of the Summons for this Action. /s/ Michael A. Mahone, Jr. MICHAEL A. MAHONE, JR.

ORIGINAL COLLECTIVE ACTION COMPLAINT

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CIVIL COVER SHEET

JS 44 (Rev. 3/99)

The JS-44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE SIDE OF THE FORM.)

I. (a) PLAINTIFFS MELISSA RUSSELL, AND ALL SITUATED UNDER 29 USC 216(B)

(b)

(c)

DEFENDANTS OTHERS

SIMILARLY

County of Residence of First Listed Defendant (IN U.S. PLAINTIFF CASES ONLY)

County of Residence of First Listed Plaintiff (EXCEPT IN U.S. PLAINTIFF CASE)

NOTE:

II. BASIS OF JURISDICTION

PHONE 504-564-7342

(Place and "X" in One Box Only)

 1 U.S. Government Plaintiff

◼

 2 U.S. Government Defendant

 4 Diversity (Indicate Citizenship of Parties in Item III)

3 Federal Question (U.S. Government Not a Party)

IV. NATURE OF SUITE

     

(For Diversity Cases Only) PTF Citizen of This State  1

210 Land Condemnation 220 Foreclosure 230 Rent Lease & Ejectment 240 Torts to Land 245 Tort Product Liability 290 All Other Real Property

PERSONAL INJURY  310 Airplane  315 Airplane Product Liability  320 Assault, Libel & Slander  330 Federal Employers' Liability  340 Marine  345 Marine Product Liability  350 Motor Vehicle  355 Motor Vehicle Product Liability  360 Other Personal Injury

and One Box for Defendant) PTF Incorporated or Principal Place  1 of Business In This State

DEF  1

 2

 2

Incorporated or Principal Place of Business In Another State

 2

 2

Citizen or Subject of a Foreign Country

 3

 3

Foreign Nation

 3

 3

FORFEITURE/PENALTY  610 Agriculture  620 Other Food & Drug  625 Drug Related Seizure of Property 21 USC  630 Liquor Laws  640 R.R. & Truck  650 Airline Regs.  660 Occupational Safety / Health  690 Other

PERSONAL INJURY  362 Personal Injury Med. Malpractice  365 Personal Injury Product Liability  368 Asbestos Personal Injury Product Liability PERSONAL PROPERTY  370 Other Fraud  371 Truth in Lending  380 Other Personal Property Damage  385 Property Damage Product Liability

CIVIL RIGHTS     

DEF  1

Citizen of Another State

TORTS

110 Insurance 120 Marine 130 Miller Act 140 Negotiable Instrument 150 Recovery of Overpayment & Enforcement of Judgment 151 Medicare Act 152 Recovery of Defaulted Student Loans (Excl. Veterans) 153 Recovery of Overpayments of Veteran's Benefits 160 Stockholders' Suits 190 Other Contract 195 Contract Product Liability

REAL PROPERTY      

III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an "X" in One Box for Plaintiff

(Place an "X" in One Box Only)

CONTRACT     

IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE LAND INVOLVED. Attorneys (If Known)

Attorney's (Firm Name, Address, and Telephone Number)

Michael A. Mahone, Jr. THE MAHONE FIRM LLC 5190 Canal Street, Suite 102 New Orleans, LA 70124

eQHealth, Solutions, Inc.,

OTHER STATUTES      

PROPERTY RIGHTS  820 Copyrights  830 Patent  840 Trademark

    

PRISONER PETITIONS

LABOR

SOCIAL SECURITY

◼ 710 Fair Labor Standards

 510 Motions to Vacate Sentence Habeas Corpus:  530 General  535 Death Penalty  540 Mandamus & Other  550 Civil Rights  555 Prison Condition

441 Voting 442 Employment 443 Housing/Accommodations 444 Welfare 440 Other Civil Rights

BANKRUPTCY  422 Appeal 28 USC 158  423 Withdrawal 28 USC 157

Act  720 Labor/Mgmt. Relations  730 Labor/Mgmt. Reporting & Disclosure Act  740 Railway Labor Act ◼ 790 Other Labor Litigation  791 Empl. Ret. Inc. Security Act

 861 HIA (1395ff)  862 Black Lung (923)  863 DIWC/DIWW (405(g))  864 SSID Title XVI  865 RSI (405(g))

    

400 State Reappointment 410 Antitrust 430 Banks and Banking 450 Commerce/ICC Rates/etc.

460 Deportation 470 Racketeer Influenced and Corrupt Organizations 810 Selective Service 850 Securities/ Commodities/Exchange 875 Customer Challenge 12 USC 3410 891 Agricultural Acts 892 Economic Stabilization Act 894 Energy Allocation Act 895 Freedom of Information Act 900 Appeal of Fee Determination Under Equal Access to Justice 950 Constitutionality of State Statutes 890 Other Statutory Actions

FEDERAL TAX SUITS  870 Taxes (U.S. Plaintiff or Defendant)  871 IRS – Third Party 26 USC 7609

V. ORIGIN (Place an “X” in One Box Only) ◼ 1 Original Proceeding

 2 Removed from State Court

 3 Remanded from Appellate Court

 4 Reinstated or Reopened

 5 Transferred from another district (specify)

VI. CAUSE OF ACTION (Cite the U.S. Civil Statute under which you are filing and write brief statement of cause.

Fair Labor Standards Act, 29 U.S.C. Section 201, et seq.

VII. REQUESTED IN COMPLAINT: VIII. RELATED CASE(S) IF ANY

◼ CHECK IF THIS IS A CLASS ACTION

DEMAND $

January 7, 2019

Do not cite jurisdictional statutes under diversity.)

CHECK YES only if demanded in complaint: JURY DEMAND:  Yes ◼ No

(See instructions):

JUDGE Date

 6 Multidistrict  7 Appeal to District Litigation Judge from Magistrate Judgment

DOCKET NUMBER

SIGNATURE OF ATTORNEY OF RECORD

/s/Michael A. Mahone, Jr.

FOR OFFICE USE ONLY RECEIPT # ___________________ AMOUNT ___________________ APPLYING IFP ___________________ JUDGE __________________ MAG. JUDGE ______________________ JS 44 Reverse (Rev. 12/96)

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AO 440 (Rev. 06/12) Summons in a Civil Action

UNITED STATES DISTRICT COURT for the

Middle District ofof Louisiana __________ District __________

MELISSA RUSSELL, AND ALL OTHERS SIMILARLY SITUATED UNDER 29 USC 216(B) Plaintiff(s)

v.

EQHEALTH SOLUTIONS, INC.

Defendant(s)

) ) ) ) ) ) ) ) ) ) ) )

Civil Action No. 19-5

SUMMONS IN A CIVIL ACTION To: (Defendant’s name and address)

eQHealth Solutions, Inc. Through its Registered Agent, Glen J. Golemi 8440 Jefferson Highway, Suite 101 Baton Rouge, LA 70809

A lawsuit has been filed against you.

Within 21 days after service of this summons on you (not counting the day you received it) — or 60 days if you are the United States or a United States agency, or an officer or employee of the United States described in Fed. R. Civ. P. 12 (a)(2) or (3) — you must serve on the plaintiff an answer to the attached complaint or a motion under Rule 12 of the Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiff’s attorney, whose name and address are: Michael A. Mahone, Jr. The Mahone Firm LLC 5190 Canal Blvd., Suite 102 New Orleans, LA 70124

If you fail to respond, judgment by default will be entered against you for the relief demanded in the complaint.

You also must file your answer or motion with the court.

CLERK OF COURT

Date: Signature of Clerk or Deputy Clerk

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AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)

Civil Action No. 19-5 PROOF OF SERVICE (This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (l)) This summons for (name of individual and title, if any) was received by me on (date)

.

’ I personally served the summons on the individual at (place) on (date)

; or

’ I left the summons at the individual’s residence or usual place of abode with (name) , a person of suitable age and discretion who resides there, on (date)

, and mailed a copy to the individual’s last known address; or

’ I served the summons on (name of individual)

, who is

designated by law to accept service of process on behalf of (name of organization) on (date)

; or

’ I returned the summons unexecuted because

; or

’ Other (specify): .

My fees are $

for travel and $

for services, for a total of $

I declare under penalty of perjury that this information is true.

Date: Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:

0.00

.