Federal Court Orders CMS to Recalculate Medicare Advantage Star Ratings After Clover Health Victory

Summary

A federal court ruling in favor of Clover Health has forced CMS to recalculate its 2026 Medicare Advantage Star Ratings, with broader implications for the entire MA program. The U.S. District Court for the Southern District of Georgia found that CMS improperly included twenty measures in Clover's rating calculation, ten of which relied on data sources not authorized by Congress. The decision challenges CMS's long-standing practice of using "encounter data" alongside traditional "chart review" data, potentially affecting how all MA plans are rated. The ruling could lead to significant changes in Star Ratings methodology, impacting quality bonus payments, plan rankings, and beneficiary choices across the Medicare Advantage marketplace.

Source

bskyFederal Court Orders CMS to Recalculate Medicare Advantage Star Ratings After Clover Health Victoryjdsupra.com