Topics
More on Medicare & Medicaid

CMS appeals UnitedHealthcare's star ratings win

UnitedHealth had won its case over a secret shopper phone call that lowered its MA star rating from 5 to 4 stars.

Susan Morse, Executive Editor

Photo: Alex Wong/Getty Images

The Centers for Medicare and Medicaid Services has appealed UnitedHealthcare's win over its Medicare Advantage star ratings score.

CMS filed the appeal on Tuesday in federal court for the Eastern District of Texas. 

It is appealing the November 22, 2024 order mandating CMS recalculate the MA 2025 star ratings without consideration of a secret shopper call used to determine UnitedHealth's score.

CMS gave no reason for the appeal in the court filing.

WHY THIS MATTERS

At stake are millions of dollars in bonus payments when plans lose one star in the 5-star system. To receive a bonus payment, a plan must achieve a rating of at least 4 stars.

UnitedHealth won its case over lowered star ratings in October 2024 when the court ruled as unlawful CMS's decision to include the disputed call in the 2024 Call Center Monitoring Performance Metrics for Accuracy and Accessibility Study.

UnitedHealthcare claimed that its ratings were lowered on the basis of that one phone call. A 4-star rating, rather than a 5-star rating, on this single metric would cause them substantial losses, both financially and in the number of members signing up for plans, according to UnitedHealthcare.

The court granted in part UnitedHealth's motion for summary judgment and denied in part its cross motion for summary judgment.

THE LARGER TREND

Other insurers have also sued CMS over lower star rating scores.

In November, Elevance sued after winning a lawsuit in June 2024 over star ratings calculations.

Centene, which also sued over the call measure, said CMS held a single call that never reached its call center, against the company.

Humana also filed a lawsuit over the calculation of cut points that determine the number of stars.
 

Email the writer: SMorse@himss.org