Blue Cross and Blue Shield of Massachusetts is the latest insurer to sue CMS over what it says was an unfair calculation of its 2025 Medicare Advantage star ratings.
In a lawsuit filed March 7 in the U.S. District Court for the District of Columbia, BCBSMA alleged that CMS used an unlawful methodology to calculate its ratings, leading to a drop from a 4-star rating to a 3.5-star rating and the loss of $35 million in potential revenue.
The lawsuit argues that CMS’s methodology, which compares adjusted scores to a national average and makes further adjustments if they deviate beyond a set range, is illegal. BCBSMA is requesting that the court order CMS to recalculate its star ratings without the disputed adjustment.
CMS has faced at least a half-dozen lawsuits over its methods used to calculate the 2025 Medicare Advantage star ratings, including from Alignment Health, Humana, Louisiana Blue, and Florida Blue.
UnitedHealthcare and Centene successfully challenged their 2025 star ratings. Both companies alleged "secret shopper" phone calls that never connected to call centers were wrongfully included in their ratings. The agency later revised ratings for several UnitedHealthcare and Centene MA contracts.