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June 07, 2024

SCAN Health Plan Successful in CMS Medicare Advantage Star Rating Lawsuit

On June 3, 2024, the U.S. District Court for the District of Columbia ruled in favor of SCAN Health Plan, a California-based insurer, in an action challenging its 2024 Medicare Advantage Star Rating of 3.5, as determined by CMS. In its complaint, SCAN alleged that CMS failed to adhere to its stated methodology and, as a result, improperly calculated SCAN’s MA Star Rating, threatening approximately $250 million in quality bonus payments that would have otherwise been due to SCAN. In the ruling, the United States District Judge granted SCAN’s motion for summary judgment and barred CMS from using the “3.5-star Star Rating in determining SCAN’s eligibility for quality bonus payments.”

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