UnitedHealth wins Star Ratings lawsuit against Medicare

A federal judge in Texas has ordered the Centers for Medicare & Medicaid Services (CMS) to recalculate UnitedHealth’s (NYSE:UNH) Medicare Star Ratings for the 2025 plan year in a lawsuit filed by the managed care firm’s insurance arm, UnitedHealthcare.

In his ruling delivered on Friday, Judge Jeremy Kernodle ordered the CMS to revise UnitedHealth’s (NYSE:UNH) 2025 Medicare Advantage ratings after removing a call center metric, a contentious issue that has become the subject of another lawsuit filed by UNH’s rival Centene (CNC) in October.

The judge also ordered Medicare to immediately publish the revised ratings on the Medicare.gov website, where federally backed health and drug plans for the 2025 plan year are currently available.

The lawsuit filed by UnitedHealth (UNH) subsidiaries in a Texas district court in September alleged that CMS downgraded the insurer’s Star Ratings after wrongfully considering a single phone call handled by its call center. Centene (CNC), its rival, filed a similar lawsuit a few weeks later in a Missouri district court.

Following the lawsuits, Deputy CMS Administrator Meena Seshamani said in November that the agency plans to tweak the Medicare Star Ratings system so that call center metrics will be given lower weighting.

The five-star quality rating system introduced in 2007 to help consumers compare Medicare Advantage and Part D plans allows health insurers with top-rated plans to receive bonus payments from Medicare.