Insurer Centene sues US over downgrade in Medicare 'star' rating
By Brendan Pierson
Oct 22 (Reuters) -Health insurance company Centene CNC.N accused U.S. regulators of unfairly downgrading the star ratings for its government-funded Medicare plans in a lawsuit on Tuesday.
The company alleged in its complaint, filed in St. Louis, Missouri, federal court, that the lower ratings would cause it to lose customers and up to $73 million in gross revenue, which could be used to reduce premiums and increase benefits for its members.
Centene offers so-called Medicare Advantage plans, which are funded by the Medicare health insurance program for seniors and some disabled people but administered by private insurers.
The U.S. Centers for Medicare and Medicaid Services (CMS) issues star ratings, from one to five stars, for Medicare Advantage plans, to help beneficiaries choose their plans. Plans with higher star ratings may also receive higher payments from the government if they keep costs below certain targets.
Centene said in the lawsuit that CMS docked its scores for the newest star ratings announced this month because of a single failed attempt to connect to its call center through a text-to-voice teletypewriter device. Such devices are used by people who are hard of hearing.
The St. Louis-based company said that, according to notes kept by the "secret shopper" employed by CMS to test the service, the call failed because of a software problem on the caller's end.
As a result, Centene said, seven of its health plans received a lower overall star rating, and four received a lower rating for prescription drug coverage, known as Medicare Part D.
"These are staggering consequences for a single call that never connected to plaintiffs' call center because the CMS secret shopper's (teletypewriter) software 'closed unexpectedly,'" Centene said.
Centene is asking the court to order HHS to recalculate its star rating "immediately" without considering the disputed call.
Despite the rating drop for some plans that Centene described in its lawsuit, the company said in an Oct. 11 disclosure that it had made "meaningful progress" overall in its 2025 ratings. It said that 46% of its Medicare Advantage members were enrolled in plans with star ratings of 3.5 star or higher, up from 23% in the previous year.
Humana HUM.N and UnitedHealth UNH.N filed similar lawsuits against CMS, challenging ratings downgrades earlier this month and also alleging that they were unfairly penalized for call center tests.
The case is Centene Corp et al v. Becerra, U.S. District Court for the Eastern District of Missouri, No. 4:24-cv-01415.
For Centene: Catherine Hanaway of Husch Blackwell
For HHS: not available
Read more:
US health agency releases 2025 quality ratings for Medicare plans
(Reporting By Brendan Pierson in New York)
</body></html>
免责声明: XM Group仅提供在线交易平台的执行服务和访问权限，并允许个人查看和/或使用网站或网站所提供的内容，但无意进行任何更改或扩展，也不会更改或扩展其服务和访问权限。所有访问和使用权限，将受下列条款与条例约束：(i) 条款与条例；(ii) 风险提示；以及(iii) 完整免责声明。请注意，网站所提供的所有讯息，仅限一般资讯用途。此外，XM所有在线交易平台的内容并不构成，也不能被用于任何未经授权的金融市场交易邀约和/或邀请。金融市场交易对于您的投资资本含有重大风险。
所有在线交易平台所发布的资料，仅适用于教育/资讯类用途，不包含也不应被视为用于金融、投资税或交易相关咨询和建议，或是交易价格纪录，或是任何金融商品或非应邀途径的金融相关优惠的交易邀约或邀请。
本网站上由XM和第三方供应商所提供的所有内容，包括意见、新闻、研究、分析、价格、其他资讯和第三方网站链接，皆保持不变，并作为一般市场评论所提供，而非投资性建议。所有在线交易平台所发布的资料，仅适用于教育/资讯类用途，不包含也不应被视为适用于金融、投资税或交易相关咨询和建议，或是交易价格纪录，或是任何金融商品或非应邀途径的金融相关优惠的交易邀约或邀请。请确保您已阅读并完全理解，XM非独立投资研究提示和风险提示相关资讯，更多详情请点击 这里。
