Alignment Healthcare Inc. v. Department of Health and Human Services et al.

Why This Matters:

A Medicare Advantage organization alleges that the defendants’ methods for calculating and adjusting scores for the star ratings program violates the Administrative Procedure Act and nondelegation doctrine. Specifically, the plaintiff alleges that the agencies relied on bad data science that produces arbitrary and capricious results and unlawfully delegated certain functions to external entities. 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. The plaintiff appeals a decision granting in part and denying in part their motion for summary judgment.

Potential Impact:

Medicare beneficiaries seeking information about Medicare Advantage plans rely on federal star ratings. Ensuring that these ratings are accurate and not inflated helps beneficiaries find affordable plans and avoid unnecessary expenses.