{"id":13963,"date":"2025-01-23T09:15:21","date_gmt":"2025-01-23T09:15:21","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=13963"},"modified":"2025-01-23T09:15:21","modified_gmt":"2025-01-23T09:15:21","slug":"cms-appeals-unitedhealthcare-medicare-rating-decision","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/cms-appeals-unitedhealthcare-medicare-rating-decision\/","title":{"rendered":"CMS Appeals UnitedHealthcare Medicare Rating Decision"},"content":{"rendered":"<p class=\"whitespace-pre-wrap break-words\"><strong>The Legal Battle Over Medicare Advantage Ratings<\/strong><\/p>\n<p class=\"whitespace-pre-wrap break-words\">The <a href=\"https:\/\/www.cms.gov\/\" target=\"_blank\" rel=\"noopener\">Centers for Medicare &amp; Medicaid Services<\/a> (CMS) is challenging a court ruling that mandated increased star ratings for UnitedHealthcare&#8217;s Medicare Advantage plans in 2025. The appeal was filed on January 21, though specific grounds weren&#8217;t disclosed.<\/p>\n<p class=\"whitespace-pre-wrap break-words\"><strong>Background of the Dispute<\/strong><\/p>\n<p class=\"whitespace-pre-wrap break-words\">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.<\/p>\n<p class=\"whitespace-pre-wrap break-words\"><strong>Court&#8217;s Initial Ruling<\/strong><\/p>\n<p class=\"whitespace-pre-wrap break-words\">Judge Jeremy Kernodle sided with UnitedHealthcare in November, determining that CMS had breached its own protocols. The ruling required recalculation of UnitedHealth&#8217;s MA contract ratings, excluding the disputed call evaluation.<\/p>\n<p class=\"whitespace-pre-wrap break-words\"><strong>Impact and Related Cases<\/strong><\/p>\n<p class=\"whitespace-pre-wrap break-words\">Following the court decision, CMS adjusted ratings for multiple UnitedHealthcare MA contracts. Similar modifications were made for Centene&#8217;s MA contracts after their parallel legal challenge regarding secret shopper calls.<\/p>\n<p><span data-teams=\"true\">Discover the latest <a id=\"menur1hf\" class=\"fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link payers&#039; news updates\"><strong>payers&#8217; news updates<\/strong><\/a> with a single click. 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Join our community today!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Legal Battle Over Medicare Advantage Ratings The Centers for Medicare &amp; Medicaid Services (CMS) is challenging a court ruling&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/cms-appeals-unitedhealthcare-medicare-rating-decision\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":13964,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[749,754,750,753,748,755,751,752],"class_list":{"0":"post-13963","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-cms-appeal-unitedhealthcare","9":"tag-cms-guidelines-violation","10":"tag-healthcare-legal-battle","11":"tag-healthcare-ratings-dispute","12":"tag-medicare-advantage-star-ratings","13":"tag-medicare-contract-ratings","14":"tag-medicare-plan-evaluation","15":"tag-secret-shopper-controversy","16":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13963"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=13963"}],"version-history":[{"count":3,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13963\/revisions"}],"predecessor-version":[{"id":13985,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13963\/revisions\/13985"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/13964"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=13963"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=13963"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=13963"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}