The insurer argues CMS recalculated a competitor’s ratings after a court ruling but refused to extend the same treatment to Elevance, costing the company an estimated $115 million in 2027 quality bonus payments.
Elevance Challenges CMS’s Star Ratings Decision
In a complaint filed last week, Elevance contends CMS violated a core administrative law principle requiring similarly situated parties to receive the same treatment.
The dispute centers on the Medicare Advantage Star Ratings program, which scores contracts on a five-star scale using quality, compliance, and performance measures.
Those ratings influence consumer enrollment decisions and determine whether Medicare Advantage organizations qualify for Quality Bonus Payments and higher rebate retention.
