A lawsuit filed by Clover Health alleged CMS gave an “unlawful” 2026 Star Rating determination to the insurer. After weighing a potential transfer of the case to a federal court in Washington, D.C., the judge decided to keep the Georgia venue May 6.
Clover wanted to keep the case in southeast Georgia since the region’s older residents are “most harmed by CMS’s action,” a Clover filing from March said. CMS and HHS said a Washington, D.C., location would be efficient and convenient.
Requests for summary judgment are pending for the case, as well. Clover has also consistently pushed for the court to vacate the rating and CMS to grant a new one by May 29, just ahead of the MA plan bid deadline at the start of June.
“Given this court’s familiarity with this action, the present procedural posture and Clover’s requests to expedite adjudication, the court holds that maintaining the present forum favors efficient resolution of this matter and would allow Clover to avoid any administrative delays which may stem from transfer,” the May 6 order said.
Clover’s lawsuit dates back to November. The complaint said roughly $120 million in quality bonus and other payments was at stake due to the Star Ratings issue.
The original complaint alleged Administrative Procedure Act violations and outlined “errors” with several Star Ratings measures, a handful of which CMS is cutting in the coming years, according to the final 2027 Medicare Advantage and Part D rule, released in April. Some measures on the chopping block address appeals decisions, customer service and call centers. Medication adherence measures are not slated to be removed.
A CMS official said excluding several measures from Clover’s calculation would not lead to the insurer’s requested 4-star rating, instead holding the rating at 3.5 as previously determined. Clover disputed this in a subsequent filing.
Becker’s contacted CMS and HHS for comment and will update this story if more information becomes available.
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