Lawsuits against CMS’ Medicare Advantage star ratings pile up as Aetna files complaint
Another major medical insurer has filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS), challenging its 2027 star ratings for Medicare Advantage plans.
This time, it is CVS Health’s Aetna filing a complaint, following legal actions taken by Alignment Healthcare and Centene earlier this month.
Much like the previous two lawsuits, Aetna is taking issue with specific metrics CMS uses to grade privatized Medicare plans, as part of the Part C version of the federal program.
However, Aetna’s challenge is the most comprehensive—arguing that 28 of the criteria used by CMS to grade plans are unlawful and should be voided. By comparison, the most recent lawsuit by Centene is challenging 17.
Aetna filed its lawsuit in a U.S. District Court in Georgia on Monday, arguing in the complaint that some of the metrics were “unlawfully adopted” and have been previously thrown out by a federal judge.
Clover Health in the backdrop
The challenge by Aetna—and Alignment Health and Centene—is based partially on a July court victory for Clover Health, which successfully earned a judgment against CMS in its challenge of Medicare Advantage plans’ star ratings.
In ruling in favor of the insurer, a judge in Georgia tossed 20 metrics CMS used to grade its plans, with 10 eliminated entirely, on the basis that they cannot be applied consistently. The court left open the possibility that the remaining 10 metrics could be reused so long as they comply with the ruling.
CMS has appealed the judgment altogether, though it did agree to re-evaluate Clover Health’s plans using the eliminated 20 criteria, resulting in a high score for the payer’s health plans.
Aetna is challenging some of the same criteria, and more, which measure everything from reimbursement speed to customer service availability.
A lower star rating can reduce the payments plans receive from CMS over time, something the insurers cite as de facto damages.
"Our lawsuit seeks to ensure that the star ratings program operates as Congress intended and that Alignment is properly compensated for the care we provide," Aetna wrote in a statement. "We respect the judicial process and will present our case in court. Because this matter involves pending litigation, we will not comment on the specific legal arguments beyond our filings."
It’s unclear if the Alignment Health and Centene complaints overlap with Aetna, though all are seeking the same thing—for CMS to adjust its ratings heading into next year.
The star ratings for Medicare Advantage plans were released earlier this month.
No federal court has weighed in on the lawsuits to date, and CMS’ appeal of the Clover Health decision is still pending.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.