The Centers for Medicare and Medicaid Services must recalculate UnitedHealthcare’s Medicare Advantage Star Rating for the 2025 plan year and immediately publish its updated score on Medicare.gov, a federal judge ruled Friday.
Judge Jeremy Kernodle, of the U.S. District Court for the Eastern District of Texas, ruled CMS violated the Administrative Procedure Act of 1946 by improperly reviewing the UnitedHealth Group subsidiary’s foreign language call center services. The Administrative Procedure Act regulates how federal agencies must carry out regulations.
Related: Why 3 Medicare Advantage insurers sued over star ratings
UnitedHealthcare and CMS did not immediately respond to interview requests.
UnitedHealthcare sued CMS over its star rating in September, alleging that the agency's review of its call center services diverged from precedent.
CMS hires secret shoppers to review the call center services of Medicare Advantage insurers. A secret shopper called UnitedHealthcare, requested a French-speaking representative and connected to an employee, the lawsuit alleged. But the secret shopper failed to ask the required introductory question of the UnitedHealthcare representative, according to the complaint. The UnitedHealthcare employee and shopper remained on the line in silence for eight minutes and then the employee disconnected the call, according to the complaint.
In court filings this month, regulators alleged that the secret shopper did not ask the introductory question because he thought he was on hold
“CMS created the guidelines, identified the phases, and specified the criteria for evaluating these calls. The responsibility for any unreasonable or absurd outcomes resulting from the guidelines therefore lies with the agency, not plaintiffs,” Kernodle wrote in the opinion Friday.
Kernodle did hand CMS a win by ruling that regulators did not treat UnitedHealth differently than competitor Elevance Health when reviewing its call center services.
He ordered regulators to recalculate UnitedHealthcare's rating for the 2025 plan year and publish the updated score on Medicare Plan Finder.
The Medicare Advantage star ratings program grades insurers on 40 metrics related to administrative services, patient health outcomes and member experience. Insurers that score at least four out of five stars receive the maximum program bonus, which they use to finance supplemental benefits and zero-premium plans.
Medicare Advantage insurers Humana and Centene have similarly sued the agency over its review of their call center services in the annual quality ratings program. The lawsuits are pending.
CMS also faces ongoing complaints from Elevance Health and Blue Cross Blue Shield of Louisiana over the 2025 star ratings, but their cases center on different complaints.
