UPDATED: July 14 at 1:30 p.m. ET
Alignment Healthcare and SCAN Health Plan are joining Elevance Health in suing the Trump administration over its approach to recalculating the 2026 Medicare Advantage star ratings.
In a complaint filed July 7 in District of Columbia federal court, SCAN Health Plan argues that the Centers for Medicare & Medicaid Services only partially applied the results of a court decision in favor of Clover Health over the most recent round of ratings.
In that ruling, a Georgia judge vacated a set of 10 measures, arguing that CMS had exceeding its statutory authority in implementing them. The courts also tossed a second set of 10 measures, saying CMS had failed to appropriately promulgate the regulations.
However, SCAN argues in its lawsuit that when scores for insurers other than Clover Health were recalculated, CMS only excluded the first set of measures.
"Respectfully, CMS’s decision to determine SCAN’s 2026 Star Rating without applying the Southern District of Georgia’s second holding violates governing law," the complaint reads.
Alignment argues in its own lawsuit, filed July 10, that CMS' failure to adhere to the Georgia court's decision in full for other payers "deprives" the company of more than $50 million payments, and also "imposes significant reputational and competitive harms."
PUBLISHED: July 6 at 2 p.m. ET
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.