It’s at least the fifth insurer to turn to the courts in a bid to hike its ratings for next year.
CVS is the latest in a growing list of insurers turning to the courts in a bid to hike their 2027 MA star ratings, after the quality scores slipped for many operators, threatening the lucrative bonus payments and other competitive advantages the ratings represent.
To date, at least four other insurers — Alignment Healthcare, Healthfirst, SCAN Health Plan and Centene — have sued the government over their 2027 stars.
The lawsuits cite a judge’s ruling last spring in a case brought by insurer Clover Health alleging that 20 measures the CMS used to determine 2026 scores were illegal. However, the CMS still used half of the contested measures in calculating ratings for the coming year for every insurer except Clover.
At the time, experts said that decision opened the agency up to litigation. And now, insurers that saw their stars degrade are rushing through the door.
That includes CVS, which saw the percentage of members in MA plans rated four stars or above drop from 84% in 2026 to 67% in 2027.
“This Complaint does not ask the Court to break new ground; that is because this Court already considered and disposed of identical legal arguments in [the Clover suit],” CVS argued in its complaint filed in Georgia Southern District Court — the same court that ruled in favor of Clover in May.
The lawsuits all make near-identical legal arguments: that the CMS calculated the scores using measures that were beyond the agency’s statutory authority to consider or adopt without proper notice-and-comment rulemaking, in violation of the Administrative Procedure Act.
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