CMS faces another star ratings lawsuit, this time from UnitedHealthcare

Another significant legal headache related to star ratings is on the table of the federal government just days before open enrollment begins.

UnitedHealthcare companies in various states are suing the Centers for Medicare & Medicaid Services (CMS) for decreasing the insurer’s star ratings unfairly. They are looking for an injunction and corrected ratings before Oct. 15.

The plaintiffs allege one metric, call center customer service performance, was downgraded based on an “arbitrary and capricious assessment” of one phone call that lasted eight minutes. It caused the insurer to earn a four-star rating on the call center measure instead of a five-star rating.

UnitedHealthcare said the star ratings downgrade would “misinform millions of current and potential customers” from choosing their plans, the insurer said in the lawsuit.

The health plan said the CMS test caller never asked the required introductory question, so the call center worker never provided the required response.

On two separate occasions, UnitedHealthcare requested the call be invalidated. CMS agreed to invalidate two other calls in question but chose to uphold the call at the center of the lawsuit. UnitedHealthcare complained CMS’ final decision Sept. 24 to not remove the call ignored its arguments previously brought to the agency.

Star ratings help consumers pick the best Medicare Advantage plan for them. High star ratings, based on performance from several years prior, are crucial for health plans in attracting and enrolling new members. Next year’s star ratings will be published Oct. 10, with open enrollment starting five days later.

In June, the feds agreed to rework Medicare Advantage quality measures after it lost court cases against SCAN Health Plan and Elevance Health. A judge sided with SCAN after the court determined a secret shopper phone call, that decreased its rating from 4.5 to 3.5 stars, resulted in inappropriate calculations.

Humana is appealing some of its 2025 star ratings results. One contract representing 90% of its Medicare Advantage plans dropped from 4.5 stars to 3.5 stars, prompting its stock to plunge Wednesday.

The UnitedHealthcare lawsuit was first reported by Bloomberg Law. It was filed by UnitedHealthcare on Sept. 30.