Humana renews challenge to downgrade of US Medicare 'star' ratings
Humana, in the lawsuit in Fort Worth, Texas, federal court, says the lower ratings could cause it to lose customers and potentially billions of dollars in bonus payments from the government, which would have been used to reduce premiums and increase benefits for its members.
U.S. District Judge Reed O'Connor in Fort Worth dismissed those claims last week, finding Humana had failed to exhaust all of its out-of-court options to challenge the ratings.
In the new lawsuit, Humana says it has in recent months exhausted an administrative appeals process, giving the insurer standing to sue.
"A final Star Rating determines legal rights and obligations, and legal consequences flow from them," the company said.
The U.S. Department of Health and Human Services, which oversees Medicare, did not immediately respond to a request for comment.
Humana is one of the largest providers of Medicare Advantage plans in the U.S., which are funded by the Medicare health insurance program for seniors and some disabled people but administered by private insurers.
The U.S. Centers for Medicare and Medicaid Services, which is part of HHS, issues star ratings for the plans, from one to five stars, to help beneficiaries choose.
Plans with higher star ratings receive higher payments from the government if they keep costs below certain targets. Those bonus payments can be worth hundreds of millions or billions of dollars.
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