In this Optima Health Plan overtime lawsuit, the Siegel Law Group won FLSA conditional certification for non-clinical, non-managerial care management employees denied overtime pay by Sentara Healthcare's health plan subsidiary. In Edwards v. Optima Health Plan, Case No. 2:20CV192 (E.D. Va.), the court recognized that these workers deserved the opportunity to proceed collectively. The firm has recovered $100M+ for workers nationwide and concentrates in challenging the misclassification of healthcare workers.
On March 29, 2021, Judge Arenda Wright Allen granted conditional certification, allowing similarly situated care management employees to join the collective action. The court found that these non-clinical, non-managerial workers were similarly situated in their job duties and exempt classification — meeting the threshold showing required for conditional certification under the FLSA.
Attorney Jack Siegel appeared pro hac vice, bringing claims under the Fair Labor Standards Act for unpaid overtime. Optima Health Plan is part of the Sentara Healthcare system, one of the largest integrated health systems on the East Coast.
The misclassification of care management employees as exempt from overtime is one of the most widespread wage and hour violations in the healthcare and managed care industries. Employers routinely apply the administrative exemption to workers who follow standardized care protocols — but following a protocol is not the same as exercising discretion and independent judgment. This case was particularly notable because the workers were not clinicians and were not managers — yet their employer treated them as exempt.
Under the FLSA, both the administrative and professional exemptions have specific requirements. The administrative exemption requires the exercise of discretion and independent judgment with respect to matters of significance. The professional exemption requires work of a predominantly intellectual character requiring advanced knowledge. Non-clinical, non-managerial care management employees typically satisfy neither test when their duties involve standardized data collection, care coordination, and documentation following established protocols.
The Siegel Law Group has filed 100+ federal overtime lawsuits challenging misclassification across the healthcare industry, including cases against health plans, hospital systems, and managed care organizations.
If you are a care management employee at a health plan, hospital system, or managed care organization and have been classified as exempt from overtime — but you are not a clinician and not a manager — your employer may be violating federal and state overtime laws. Contact the Siegel Law Group to discuss your rights.
Conditional certification means the court allowed the case to proceed as a collective action, enabling other similarly situated care management employees to receive notice and opt into the lawsuit. This is the first step in building a collective case against the employer's misclassification policy.
Generally, non-clinical healthcare workers who perform standardized care coordination, data entry, and documentation tasks are not exempt from overtime. The administrative exemption requires the exercise of discretion and independent judgment, and the professional exemption requires advanced intellectual work. Standardized care management duties typically satisfy neither test.
The administrative exemption allows employers to classify certain workers as exempt from overtime. However, it requires that the worker's primary duty involves the exercise of discretion and independent judgment with respect to matters of significance. Care management employees who follow standardized protocols and assessment tools often do not meet this standard.
Conditional certification allows workers to join together as a group, sharing litigation costs and presenting a unified case. It also authorizes notice to other potentially affected workers who may not know they have claims, expanding the reach of the lawsuit.
After conditional certification, notice is sent to potential opt-in plaintiffs. Workers have a set period to file consent forms to join. After the opt-in period, the case proceeds through discovery, and the employer typically moves for decertification. If the collective survives, the case moves toward summary judgment or trial.
The Siegel Law Group is a national overtime and wage law firm devoted entirely to representing workers denied overtime pay. Where many firms include wage cases as a small part of a broader employment practice, the Siegel Law Group has built its entire practice around overtime litigation — and the results reflect that commitment: $100M+ recovered for workers, 50+ class and collective action certifications, and 100+ federal lawsuits filed in 27+ federal courts nationwide. Founding attorney Jack Siegel is a Bloomberg BNA contributing author on wage and hour law.
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