Centene is latest to legally challenge Medicare Star Ratings

Centene (NYSE:CNC) has become the latest health insurer to take the U.S. Centers for Medicare & Medicaid Services (CMS) to court over the agency’s Medicare Advantage Star Ratings for next year.

According to a lawsuit filed in the U.S. District Court for the Eastern District of Missouri, the managed care company accused CMS of unfairly downgrading its Star Ratings, leading to a loss of up to $73M in gross revenue.

The Medicare Advantage Star Ratings System is designed to give annual bonus payments to health plans with the highest ratings.

In its lawsuit, Centene (NYSE:CNC) accused CMS of using a single secret shopper call that failed to reach its call center in its Star Ratings calculations, noting that a software issue at the agency was to blame for the failure.

“CMS has decided to hold a single call against [the] plaintiffs, despite the fact that the call never reached [the] plaintiffs’ call center, and there was no call failure due to [the] the plaintiffs,” the company said.

“Rather, the CMS secret shopper’s own call notes show that the shopper’s ‘chat window closed unexpectedly,’ which is a clear failure of CMS’ software,” Centene (CNC) added.

Over the past few weeks, UnitedHealthcare (UNH) and Humana (HUM) have also filed lawsuits against CMS’s Star Ratings calculations for next year.