Medicare Advantage Insurer Sues HHS Over Rating Calculation

A Medicare Advantage insurer sued the Biden administration claiming that regulators improperly calculated the company’s quality ratings, which if not corrected would terminate the company’s participation in the Medicare Advantage program.

In its complaint, filed Monday in the US District Court for the District of Columbia, Chicago-based Zing Health claimed the Centers for Medicare & Medicaid Services disregarded its own regulations when calculating the 2024 star ratings. Zing said the CMS used “simulated and rerun” data from 2023 instead of actual prior year performance data as required.

“CMS disregarded the plain text of its own regulation and adopted an ...