Elevance Health is suing the feds over its recent recalculations for the 2026 Medicare Advantage star ratings.
The Centers for Medicare & Medicaid Services revealed in late June that it would recalculate the latest round of star ratings following a court victory for MA insurer Clover Health. CMS said it would only update scores for plans that would see an increase.
In the new lawsuit, filed last week in a Georgia court, Elevance argues that CMS refused to recalculate its scores with the same methodology that was applied to Clover. In Clover's case, the courts rejected 20 measures, and Elevance Health said that it was also negatively impacted by those measures.
Elevance said that if it were given the same adjustments as Clover, the company would see $115 million more in quality bonus payments. The impact of the star ratings calculations also "extends beyond the financial," as it also affects the competitive positioning of its plans.
"By giving Clover a recalculated, more favorable Star Rating while refusing to extend that same recalculation to Elevance, CMS has directly disadvantaged Elevance in markets where the two MAOs compete for the same Medicare beneficiaries," Elevance said in the lawsuit.
The company argues that if the courts determined those measures as invalid in calculations for Clover Health, then that same logic would extend to other MA insurers as well.
In a statement to Fierce Healthcare, a company spokesperson said Elevance believes "all Medicare Advantage organizations should be evaluated under a consistent methodology and treated equitably."
"Our legal action seeks to ensure that the same standards are applied fairly across similarly situated plans," they said. "Consistent application of the rules is essential to maintaining the integrity of the Star Ratings program for beneficiaries, providers and health plans."
Elevance said in the complaint that before choosing to sue, the company sent a written request to CMS to have its scores recalculated in line with the methodology used for Clover Health. The agency rejected that request, and is now asking the courts to compel them to make the new calculations.
There has been no shortage of legal drama around the most recent rounds of star ratings following changes to the methodology that led to significant score declines for a slew of payers. These lawsuits have seen mixed success.