Elevance loses Medicare Advantage star ratings lawsuit

Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers — reporting on how money influences those businesses and shapes what we all pay for care. He is also the author of the Health Care Inc. newsletter. You can reach Bob on Signal at bobjherman.09.

A federal judge in Texas struck down Elevance Health’s lawsuit that argued the government unfairly lowered its Medicare Advantage quality ratings — a decision that could cost Elevance $375 million in bonus revenue.

U.S. District Judge Mark T. Pittman, appointed by President Trump in 2019, chastised Elevance’s legal arguments as “perplexing” and said the health insurance company was ignoring basic math. He said the Centers for Medicare and Medicaid Services, the federal agency that regulates Medicare Advantage plans and assigns star ratings to every plan, correctly followed the law.

The decision marks yet another loss for the Medicare Advantage industry, which has aggressively sued the government over its ratings calculations in a bid to recapture billions of dollars in potentially lost revenue.