A federal judge has ruled against Florida Blue, deciding the insurer is not entitled to have its Medicare Advantage star ratings reevaluated.
In December, attorneys for Florida Blue filed a lawsuit in federal district court in Washington, arguing CMS did not account for the effects of natural disasters when it calculated the insurer’s star ratings.
The insurer argued severe flooding in Broward County, Fla., in April 2023, caused a significant drop in rates of office visits and prescription refills for its MA members, damaging its star ratings. Though the area was granted state and federal disaster declarations, CMS did not grant an 1135 waiver, designating a public health emergency, for the flooding.
CMS has adopted an extreme-circumstances rule to account for the impact of natural disasters and other uncontrollable circumstances in star ratings for events declared public health emergencies.
In an opinion issued May 16, a judge ruled CMS was neither arbitrary or capricious in its decision not to issue a public health emergency for the flooding. The judge also said that Florida Blue did not prove that the effect of the flooding on its membership was similar to other flooding events declared public health emergencies.
Florida Blue alleged it will lose out on “tens of millions” in bonus payments as a result of the lower ratings.
Several other insurers have challenged their 2025 star ratings in court. CMS revised star ratings for UnitedHealthcare and Centene after a judge ruled the agency must recalculate ratings without including a disputed customer service phone call.
Other challenges to star ratings on different grounds are still pending.
Becker’s has reached out to Florida Blue for comment and will update this article if more information becomes available.
