Health Plan Weekly

‘A Very Big Deal’: UnitedHealth’s Star Ratings Court Win Has Industrywide Implications

  • Nov 27
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    Nov 27, 2024

    In a development that one expert calls a “huge victory for the industry,” a federal judge has ordered CMS to recalculate UnitedHealthcare’s 2025 Medicare Advantage Star Ratings without factoring in a lone “secret shopper” call that downgraded the ratings of several of the insurer’s plans. Wall Street analysts also predicted that the ruling could be a boon for one specific MA-focused insurer: Humana Inc., which filed a lawsuit against CMS for a similar issue.

    In an opinion issued Nov. 22, Judge Jeremy Kernodle of the U.S. District Court for the Eastern District of Texas partially granted UnitedHealth’s motion for summary judgment, agreeing with the insurer that CMS violated the Administrative Procedure Act (APA) when it assigned a 4-star rating to the performance of UnitedHealth’s call center.

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    • Leslie Small

    Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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Reporter, Radar on Medicare Advantage and Spotlight on Market Access

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