Clover Insurance Company v. Department of Health and Human Services et al.

Why this Matters:

A Medicare Advantage organization alleges that the defendants miscalculated the 2026 star rating for their Medicare Advantage plans in violation of the Administrative Procedure Act and nondelegation doctrine. Specifically, the plaintiff alleges that the agencies exceeded their authority by considering metrics that are unrelated to clinical quality and health outcomes and unlawfully delegated certain measures 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.

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.