The Legal Battle Over Medicare Advantage Ratings
The Centers for Medicare & Medicaid Services (CMS) is challenging a court ruling that mandated increased star ratings for UnitedHealthcare’s Medicare Advantage plans in 2025. The appeal was filed on January 21, though specific grounds weren’t disclosed.
Background of the Dispute
UnitedHealthcare initiated legal action in September, contesting the validity of a secret-shopper phone call in their ratings assessment. The company argued this evaluation method violated established guidelines.
Court’s Initial Ruling
Judge Jeremy Kernodle sided with UnitedHealthcare in November, determining that CMS had breached its own protocols. The ruling required recalculation of UnitedHealth’s MA contract ratings, excluding the disputed call evaluation.
Impact and Related Cases
Following the court decision, CMS adjusted ratings for multiple UnitedHealthcare MA contracts. Similar modifications were made for Centene’s MA contracts after their parallel legal challenge regarding secret shopper calls.
Discover the latest payers’ news updates with a single click. Follow DistilINFO HealthPlan and stay ahead with updates. Join our community today!
