CMS, Humana Stick to Their Guns in Latest Exchange of Star Ratings Legal Briefs
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Feb 20, 2025
As Humana Inc. pursues a Star Ratings lawsuit against the federal government with an estimated $3 billion in quality bonus revenue at stake, a new filing maintains that three disconnected calls should be excluded from the calculation of certain measures. In what one analyst called the “strongest counter-argument that CMS has made in any of the Medicare Stars lawsuits,” the Trump administration’s Feb. 7 response to Humana’s prior motion for summary judgment argued that Humana’s case is vastly different from other Stars-related legal challenges.
Prior to CMS’s October release of the 2025 Star Ratings, Humana disclosed that the percentage of members enrolled in highly rated plans would plummet from 94% to 25% in 2025 — which it attributed to “narrowly missing higher industry cut points on a small number of measures,” including call center measures. Humana appealed the measures via the administrative process, then sued the federal government after the publication of the Star Ratings, claiming it was “denied an opportunity to determine why the measure-level cut points moved so suspiciously in the 2025 scores” and that the agency “refused to share information necessary for Humana to verify the agency’s work in time to make corrections.” Humana alleged that CMS violated the Administrative Procedure Act (APA) by failing to follow its own regulations when administering the ratings.
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