Florida Blue is the latest insurer to sue CMS over its Medicare Advantage star ratings.
In a lawsuit filed Dec. 27 in federal district court in Washington, D.C., attorneys for Florida Blue argued CMS did not account for the effects of natural disasters when it calculated the insurer's Medicare Advantage star ratings.
Severe flooding in Broward County, Fla., in April 2023, caused a significant drop in rates of office visits and prescription refills for Florida Blue Medicare Advantage plan members, the insurer said in the lawsuit.
Though Florida Gov. Ron DeSantis and President Joe Biden declared a state of emergency in areas affected by the flooding, CMS did not grant an 1135 waiver, designating a public health emergency, for the flooding, according to the lawsuit. In 2019, CMS adopted an extreme circumstances rule, to account for the impact of natural disasters and other uncontrollable circumstances in star ratings.
If the flooding in Broward County had been granted public health emergency status, Florida Blue's HMO Medicare Advantage plan would have received a 4.5 star, rather than a 3.5 star rating for plan year 2025, the insurer alleged in the lawsuit. Its Medicare Part D plan would have received a 3 star, rather than a 2.5 star rating, according to the lawsuit.
Florida Blue will lose out on "tens of millions" in bonus payments as a result of the lower ratings, it alleged.
The insurer asked the court to require CMS to recalculate its star ratings, accounting for the impact of natural disasters on its utilization rates.
Several other insurers have challenged CMS' 2025 star ratings in court, on different grounds. In December, CMS upped the ratings for several UnitedHealthcare and Centene plans. The upgrade came after both insurers separately challenged in court the inclusion of "secret shopper" phone calls they say never connected.
Humana and Elevance Health have also challenged their 2025 ratings in court.