Blue Cross and Blue Shield of Massachusetts has lost its legal challenge against CMS over the methodology used to calculate its 2025 Medicare Advantage star ratings.
In a Nov. 3 ruling from the U.S. District Court for the District of Columbia, Judge Trevor McFadden denied BCBSMA’s motion for summary judgment, effectively siding with CMS and closing the case.
“We are disappointed in the court’s ruling. While we still believe in the merits of our case and are evaluating our next course of action, we respect the court’s decision,
a spokesperson for the insurer told Becker’s.
The lawsuit, originally filed in March, alleged that CMS used an unlawful methodology that caused the BCBSMA’s MA contracts to drop from 4 stars to 3.5 stars, costing the company an estimated $35 million in lost payments. The company argued that CMS’ use of “case-mix adjustments” to account for demographic factors outside a plan’s control, and its reliance on a weighted national average when comparing plan scores, violated federal rules.
In its 17-page opinion, the court rejected those claims, finding that both CMS’ case-mix adjustment and its method for calculating national averages were consistent with agency rules and guidance.
CMS has faced many lawsuits from insurers over its methods used to calculate the 2025 MA star ratings. UnitedHealthcare, Centene, and Alignment Health successfully challenged their ratings, while Elevance, Humana, BCBS Louisiana, and Florida Blue did not.
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