In a lawsuit filed Oct. 22, Centene asked a federal judge to require CMS to recalculate its star rating without including a secret shopper phone call Centene says never reached its call center.
CMS conducts secret shopper calls to score plans’ customer service functions, including text-to-voice teletypewriter services. These services are often used by individuals with hearing or speech disabilities.
In its lawsuit, Centene alleged the agency included a call that never reached its call center, due to no fault of its own. Centene alleged the secret shopper’s notes show the “chat window closed unexpectedly,” which Centene called a “clear failure of CMS’s software.”
CMS’ score on teletypewriter availability is based on only a handful of secret shopper calls, Centene alleged, and plans must have a 100% success rate for calls for a 5-star score.
Star ratings determine whether plans are eligible for bonus payments from CMS. The inclusion of the call in its ratings will cause Centene to lose out on $73 million in revenue, the company estimated.
Several other insurers have challenged CMS’ star ratings in court. UnitedHealthcare also disputed the inclusion of a secret shopper phone call it says never connected to its call center.
Humana filed a more sweeping lawsuit, alleging CMS did not follow its own regulations in its methodology for calculating ratings. Blue Cross Blue Shield of Louisiana also sued the agency, alleging it used an “entirely different and new methodology” not subject to formal notice and rulemaking.
For 2025, just seven plans received a five-star rating from CMS, down from 38 in 2024. The overall average rating was 3.92, down from 4.07 the previous year.
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