Updated
Updated · Zacks Investment Research · Jul 4
Elevance Sues CMS Over $115 Million Medicare Ratings Hit
Updated
Updated · Zacks Investment Research · Jul 4

Elevance Sues CMS Over $115 Million Medicare Ratings Hit

2 articles · Updated · Zacks Investment Research · Jul 4

Summary

  • Elevance Health asked a court to overturn a CMS decision it says cost the insurer about $115 million in Medicare Advantage quality bonus payments.
  • The suit alleges CMS recalculated Clover Health's finalized Star Ratings after finding an error, while denying other insurers the same relief and creating an uneven competitive field.
  • Star Ratings drive bonus payments, rebate funding, marketing strength and enrollment, so the case could reshape competitive positioning across Medicare Advantage plans.
  • More than $13 billion in Medicare Advantage quality bonuses is expected this year, and a ruling for Elevance could force CMS to revisit its ratings process across the industry.

Insights

As legal challenges mount, is the multi-billion dollar Medicare Advantage Star Ratings system fundamentally broken?
As CMS battles insurers in court, why is it also granting them billions in favorable payment changes?