Healthcare Finance News August 21, 2025
The court says it lacks the ability to ‘second-guess’ CMS’ data collection and scoring methodology.
Elevance Health’s lawsuit against the Centers for Medicare and Medicaid Services over its Medicare Advantage star ratings scores has been shot down by a judge in the Northern District of Texas.
The insurer sued CMS in November, and asked the court to order the Department of Health and Human Services to recalculate its 3.75 score for a specific contract to a 4-star rating. At the time, Elevance said CMS’ calculations were “fraught with statistical variance, which can cause improper impacts on a Medicare Advantage Organization’s (MAO’s) overall star rating.”
CMS has cost Elevance $375 million, according to the original complaint. Star ratings represent billions of...
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