Managed Care Organizations (MCO’s) often contract with State Health Departments to provide care for dually eligible Medicaid and Medicare patients pursuant to requirements established by the federal Centers for Medicare & Medicaid Services (CMS).  Care coordinators provide case management services on behalf of the MCO to various populations.

Managed Care Organizations is a vague term for normal people but some examples include:

• Aetna/CVS Health
• Anthem, Inc.
• Health Care Service Corporation (Blue Cross Blue Shield)
• BMC HealthNet
• CareSource
• Centene
• Cigna
• Humana
• Independence Health Group
• Molina Health
• Tufts Health
• UnitedHealth Group
• WellCare

If you work or have worked for an MCO in the past three (3) years and are/were:

1. Classified as exempt from overtime (you did not receive overtime pay and likely did not clock in and out for your schedule work shifts)
2. Paid on a salary basis (your paycheck is the same every pay period regardless of how many hours you worked) and
3. Routinely work over 40 hours per week but are not paid for hours worked over 40 per week

You may be entitled to overtime and backpay! Contrary to popular belief, employees paid on a  salary basis are not automatically exempt from overtime – time and one-half the regular rate of pay for all hours worked over 40 hours in a workweek. Instead, everyone is entitled to overtime unless they fall within particular exemptions established by the FLSA.

Under the Section 13(a)(1) of the FLSA, certain categories of employees can be exempt from the overtime provisions of the FLSA, including employees working in a bona fide administrative, executive, or professional capacity.

An employee’s exempt status depends on whether their job duties qualify the employee for an exemption from federal overtime protections.  Job Title is irrelevant for purposes of determining appropriate exemptions under the FLSA.  For example – just because your job title is “administrator” does not mean you are administratively exempt.  Instead, in order to be exempt under the administrative exemptions, an employer must show that the primary duties of the “administrator” are:

• The employee must be compensated on a salary or fee basis (as defined in the regulations) at a rate not less than $684 per week;
• The employee’s primary duty must be the performance of office or non-manual work directly related to the management or general business operations of the employer or the employer’s customers; and
• The employee’s primary duty includes the exercise of discretion and independent judgment with respect to matters of significance.

 

The United States Department of Labor (“DOL”) Fact Sheet regarding the Administrative Exemption can be found here.  In addition, the DOL issues opinion letters in order to address particular questions or gray areas regarding exemptions and compliance with the FLSA.  While the DOL has not addressed the issue of care coordinators directly – it has found that other similar employees are not exempt employees.

For example, in DOL Opinion Letter FLSA2005-50 (November 4, 2005), the DOL found that “caseworkers” that “provide case management services” and who possessed a bachelor’s degree in social sciences were not administratively exempt employees under the FLSA.  Similarly, in FLSA2007-7 (February 8, 2007), the DOL found that “case managers” were non-exempt whose primary duty “is to meet and to work with consumers to gather information, to assess each consumer’s needs, to assess the costs of care, to prepare a plan of care, and to identify and to implement services to meet the consumer’s needs.”  The DOL emphasized that case managers “do not personally deliver or administer services to the consumers – but are response for planning and helping to obtain those services from third-party service providers.”

Care Coordinators often do similar work to the caseworkers and case managers the DOL has held are not exempt from overtime.  If you have performed care coordination services in excess of forty hours per week without receiving overtime pay in the last three years, you may have a valuable claim for unpaid wages.  We evaluate cases confidentially and at no cost to you.  You can reach us by phone at (617) 338-9400, by email at info@masswagelaw.com, or by filling out the form below.