CMS has denied an appeal from Humana to raise its 2025 star ratings, the company disclosed in an April 15 court filing.
Humana saw its Medicare Advantage star ratings drop significantly from 2024 to 2025, which will hurt the company’s 2026 revenues. Star ratings determine the bonuses CMS pays to MA plans.
Humana filed its lawsuit in October 2024 challenging the ratings in federal district court in Texas.
In an April 15 filing, attorneys for Humana said CMS had denied its request for reconsideration of its star ratings. The denial will be final as of April 28, unless CMS Administrator Mehmet Oz overturns the hearing officer’s decision.
Attorneys for the federal government previously said the lawsuit should be dismissed because Humana had not exhausted all of its administrative appeal options. In the April 15 filings, attorneys wrote the company has now exhausted its options, and the lawsuit should be allowed to continue.
Humana has argued that CMS did not follow its own regulations in its methodology for calculating ratings, and alleged the agency did not provide Humana with necessary data to determine why cut points moved upward for 2025.
Several other insurers have challenged their star ratings in court.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.