Episode #8
Clover's Ripple Effect: The New Wave of Medicare Advantage Star Ratings Litigation
In this episode of Health Law Simplified , Elizabeth Lippincott and Sandy Durkin revisit the landmark Clover Health decision and explore the growing wave of litigation that is following in its wake. What began as a challenge by a single Medicare Advantage organization has quickly evolved into a broader legal battle with potentially significant implications for Star Ratings, quality bonus payments, and CMS's authority to administer the program. The discussion covers new lawsuits filed by Elevance, SCAN, and Alignment Health, and the different aspects of the Clover ruling on which they rely. Elizabeth and Sandy break down the legal theories underlying these cases, including statutory authority, administrative law, and the post- Loper Bright environment, where courts are taking a more active role in reviewing agency actions. They also discuss why these challenges differ from prior Star Ratings lawsuits and how they could reshape future litigation strategy. Finally, the episode examines the practical implications for Medicare Advantage organizations. From actuarial modeling and financial forecasting to quality bonus payments and long-term business planning, health plans face increasing uncertainty as courts, CMS, and potentially Congress weigh the future of the Star Ratings program.
