humana files lawsuit against cms over controversial star ratings for 2025

Humana has filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) over the agency's 2025 star ratings.

Background

Humana, along with Americans for Beneficiary Choice, has taken legal action against CMS, claiming that the agency's actions regarding the star ratings are arbitrary and violate the Administrative Procedure Act.

Allegations

Humana argues that CMS has not followed its own regulations, failed to disclose all criteria used for recalculating star ratings, and has not adequately responded to inquiries.

Errors in Calculation

Humana also points out errors in the calculation of two star rating measures that have negatively impacted their ratings.

Importance of Star Ratings

The star ratings system is crucial for Medicare Advantage plans as higher ratings can lead to greater rebates from CMS.

Legal Landscape

Humana's lawsuit follows a similar legal action taken by UnitedHealth Group. Other insurers have also successfully challenged CMS in court regarding star ratings. The outcomes of these legal battles may set important precedents for how star ratings are calculated and contested in the future.

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