- Docket No.
- 2:26-cv-00061
- District Court
- Georgia Southern — Brunswick
Goal
- Compel agency action
- Declaration that agency action is unlawful
- Vacate agency action
Issues
Litigation Content
Why This Matters:
Why This Matters:
A health insurer alleges that the Centers for Medicare & Medicaid Services (CMS) violated the Administrative Procedure Act in declining to recalculate the 2026 star ratings for five of their Medicare Advantage contracts. The insurer argues that federal officials must use a recalculation methodology that is consistent with Clover Insurance Company v. Department of Health and Human Services et al., where the same court held that CMS improperly relied on 20 measures when calculating the star rating for a different Medicare Advantage insurer. This insurer asserts that (1) CMS must adopt the same methodology for all insurers; and (2) challenges the same 20 measures as improper under the Administrative Procedure Act. Star ratings, which are designed to assess a plan’s quality, affect whether a plan is eligible for the Medicare Advantage program and whether the plan can receive bonus payments.
Potential Impact:
Potential Impact:
Challenges to the Medicare Advantage star ratings methodology could undermine the program’s ability to accurately convey quality to consumers and fairly allocate significant financial incentives to health plans, potentially impacting beneficiary benefits and market competition.