Furthermore, the judge’s decision criticized Elevance’s arguments as “perplexing” and based on a “fundamental misapplication of rounding rules,” reinforcing the court’s deference to CMS’s expertise in data collection and statistical analysis for these ratings.
A federal judge in Texas struck down Elevance Health’s lawsuit that argued the government unfairly lowered its Medicare Advantage quality ratings — a decision that could cost Elevance $375 million in bonus revenue.
U.S. District Judge Mark T. Pittman, appointed by President Trump in 2019, chastised Elevance’s legal arguments as “perplexing” and said the health insurance company was ignoring basic math. He said the Centers for Medicare and Medicaid Services, the federal agency that regulates Medicare Advantage plans and assigns star ratings to every plan, correctly followed the law.
The decision marks yet another loss for the Medicare Advantage industry, which has aggressively sued the government over its ratings calculations in a bid to recapture billions of dollars in potentially lost revenue.
Herman, B. (2025, August 19). Elevance loses lawsuit over Medicare Advantage quality ratings. STAT. https://www.statnews.com/2025/08/19/elevance-loses-medicare-advantage-star-ratings-lawsuit/
Elevance Health loses Medicare Advantage star ratings suit to CMS. (2025, August 20). Fierce Healthcare. https://www.fiercehealthcare.com/payers/elevance-health-loses-medicare-advantage-star-ratings-suit-cms
Pifer, R. (2025, August 20). Elevance loses Medicare Advantage star ratings suit. Healthcare Dive. https://www.healthcaredive.com/news/elevance-loses-medicare-advantage-star-ratings-lawsuit-texas/758068/
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