Elevance Health sues Medicare agency over star rating calculations

Health insurer Elevance has taken the US government to court several times over how Medicare health plan quality scores are calculated. The company argued that the Centers for Medicare and Medicaid Services, known as CMS, used an unfair method to set the scores, which decide whether insurers receive bonus payments.

In one case, Elevance missed a four-star rating by a tiny margin and said this cost the company $375 million. A federal judge rejected that challenge, finding no wrongdoing by the agency. However, a separate court ruled in Elevance's favour in 2024, deciding CMS had not followed proper procedures in an earlier case.

Elevance then filed another lawsuit claiming $115 million in damages, saying CMS ignored that earlier court ruling when calculating 2026 ratings.