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Litigation should not be the strategy to achieve Star Rating reform. It is the alarm, not the repair.
Over the past two years, one health plan after another has taken the federal government to court over its Medicare Advantage quality scores—and won. UnitedHealthcare, Centene, Elevance Health, Alignment Health, and our own SCAN Health Plan have all prevailed; Humana lost twice and is litigating still; Blue Cross Blue Shield of Louisiana, CareFirst, and Clover Health have pressed claims of their own.
The challenges have confronted everything from mishandled secret shopper calls to whether the Centers for Medicare and Medicaid Services (CMS) followed the proper rulemaking process for certain stars measures. The common thread is not that insurers resent the grades they received. Rather, it is that a program meant to grade the quality of Medicare Advantage plans has become so convoluted and contradictory that even the program’s own administrator can no longer consistently apply the grading system.