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

Docket No.
26-12553
Appellate Court
Eleventh Circuit

Goal

  • Compel agency action
  • Declaration that agency action is unlawful
  • Vacate agency action

Litigation Content

Why This Matters:

Why this Matters:

A Medicare Advantage organization (MAO) alleges that the Centers for Medicare and Medicaid Services (CMS) miscalculated the 2026 Star Rating for their Medicare Advantage plans in violation of the Administrative Procedure Act and nondelegation doctrine. Specifically, the MAO 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. On appeal, the defendants argue that the district court erred in finding that CMS had used the wrong data to calculate the MAO’s Star Rating

Potential Impact:

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.

2 Major Filings

Litigation Information

Current Status

Briefing is ongoing

Important Date

Defendants' Opening Brief Due