CVS Health Sues CMS Over Medicare Advantage Star Rating Methodology
What happened
CVS Health filed a complaint in Georgia district court challenging the federal government's Medicare Advantage star rating methodology. The company argues that the methodology is illegal because regulators relied on improperly adopted measures to calculate scores for 2027. The lawsuit asks the court to vacate star ratings for dozens of CVS Health contracts and force the federal government to recalculate the scores without the disputed measures.
From healthcaredive.com
Why it matters
The star ratings determine competitive advantages and lucrative bonus payments for Medicare Advantage operators. CVS Health is seeking to prevent a potential revenue loss exceeding $2 billion resulting from its falling quality scores. This action follows similar litigation brought by Clover Health regarding CMS measures.
From healthcaredive.com
Who's involved
- CVS HealthFiled the lawsuit challenging the federal government's scoring methodology.
- Clover HealthPreviously sued the government, setting legal precedent cited by CVS Health.
- MedicareThe federal health insurance program whose star ratings are being challenged.
- CMSThe federal agency whose scoring methodology is the subject of the lawsuit.
Who could feel it
Possible knock-on effectsThese are possibilities Brind reasoned out, not predictions, and not advice. Most are not stated in any report.
- UnitedHealth GroupSpeculative
Other Medicare Advantage insurers could see their revenue stability affected by the outcome of the legal challenge.
- AetnaSpeculative
Other Medicare Advantage insurers could see their revenue stability affected by the outcome of the legal challenge.
- HumanaSpeculative
Other Medicare Advantage insurers could see their revenue stability affected by the outcome of the legal challenge.
Keep exploring
The entities involved
-
Clover Health
U.S. healthcare company
Nothing else this week.
-
CVS Health
company
-
Medicare
US federal health insurance