Healthcare DIVE June 4, 2024
The insurer argued the CMS didn’t follow its stated methodology for calculating the quality scores, causing its rating to drop and risking millions of dollars in payments.
Dive Brief:
- Scan Health Plan won a lawsuit that alleged the federal government had improperly calculated its 2024 Medicare Advantage star ratings, which it argued could cost the insurer millions of dollars.
- The case centered around recent changes in how the CMS determined quality measures for the private Medicare plans. Scan alleged the agency didn’t follow its stated methodology, causing its rating to drop “precipitously” to 3.5 stars and risking $250 million in quality bonus payments.
- The U.S. District Court for the District of Columbia ruled for the California-based insurer...
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