UnitedHealth successfully sues CMS over disputed phone call
UnitedHealth Group has successfully sued the Centers for Medicare & Medicaid Services (CMS) over its Medicare Advantage star ratings, with a federal judge ordering the agency to recalculate the ranking assigned to the insurer’s health plans.
The court’s decision means the 2025 star ratings for UnitedHealth’s Medicare Advantage plans are now vacated, as the judge agreed that CMS violated the Administrative Procedure Act of 1946 by not addressing a dispute over a single phone call.
The disputed call was made by CMS to UnitedHealth’s customer support for Medicare Advantage plans, with the agency reporting that the call was unsuccessful. A judge sided with UnitedHealth’s attorneys, who argued that it was unjust for CMS to factor this single, eight-minute call into their rating.
Further, it was revealed that problems with the call may have stemmed from an error by CMS, not the insurer.
UnitedHealth initially filed a complaint with CMS in September, after the test call resulted in its Medicare Advantage customer service being rated four stars instead of five. After CMS refused to adjust its decision and defended its process, the insurer ultimately filed a lawsuit. Other insurers, including Centene, Elevance Health, Humana and Blue Cross Blue Shield of Louisiana, are pursuing similar legal actions.
The ruling in favor of UnitedHealth could set a new precedent for Medicare Advantage star ratings going forward. Up to now, a single unsuccessful phone could officially lower an insurer's rating. The single act might cost an insurer millions. In the future, such single-cause effects may no longer be allowed.
The court ordered: “Defendants shall recalculate plaintiffs’ 2025 star ratings without consideration of the disputed call and shall immediately publish the recalculated star ratings in the Medicare Plan Finder.”
During the proceedings, it was revealed that CMS outsourced its test calls to a private third party. The judge ruled that the agency acted improperly by allowing contractors to ultimately determine a star rating for customer support.
The full decision can be found here.
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.