11 Star Ratings lawsuits, and why the arguments now go beyond Clover

Eleven Medicare Advantage plans are asking federal courts to rework their 2027 Star Ratings, and the 2028 quality bonus payments and rebate retention tied to those ratings add up to about $3.9 billion by the plans’ own estimates. Six of the plans filed between October 30 and November 6: MediGold in Ohio, then Blue Cross & Blue Shield of Rhode Island, Jefferson Health Plans, Elevance Health, Banner Health and Verda Healthcare in Washington, D.C. The newest arguments reach past the measures at issue in Clover. For plans with contracts hovering at the 4-star line, these cases are especially relevant as you evaluate your 2027 results and prepare for 2028.

The 11 cases at a glance 

The table below lists every 2027 Star Ratings case filed so far, in filing order. Filing dates, courts, and measure counts follow Becker's Payer Issues tracking of the complaints. The dollar figures are each plan's own estimate of 2028 bonus payments and rebate retention, and no court has tested any of them. 

What the newest filings argue

Elevance Health filed on November 6 in the U.S. District Court for the District of Columbia. It challenges 11 measures across 12 contracts and puts the 2028 impact at about $516 million. Elevance argues CMS adopted the measures without required rulemaking and cites Azar v. Allina Health Services. It also makes an argument about data. Two medication adherence measures, D08 for diabetes medications and D10 for statins, draw on Part D prescription drug event data, which Elevance says falls outside the only sources the statute permits for Star Ratings: HEDIS^®, the Health Outcomes Survey and CAHPS.

The third argument is about consistency. After the Georgia court ruled for Clover in May, CMS removed the disputed measures from Clover's 2027 ratings, even though the court order covered 2026, while keeping all 11 in Elevance's 2027 ratings. Elevance argues CMS would have no reason to strip the measures from Clover if they were lawful.

This is Elevance's second Star Ratings case this year. On August 27, Judge Lisa Godbey Wood of the Southern District of Georgia denied Elevance's request to force a recalculation of its 2026 ratings, finding the plan had not shown imminent, irreparable harm and pointing to its delay in bringing the case. She also found Elevance substantially likely to succeed on its claims that the measures are unlawful, and she accepted CMS's reason for treating Clover differently, since Clover held an enforceable judgment from the same court. Her reasoning bears directly on the consistency argument in the new case. The 2026 case is now in summary judgment briefing.

Jefferson Health Plans filed on November 4 and challenges three medication adherence measures the Georgia court also found unlawful in Clover's case. According to The Philadelphia Inquirer, two Jefferson plans fell from 3.5 stars to 3 and a third fell from 3 to 2.5, a drop the plan values at $43 million in 2028 payments across about 31,500 members in eastern Pennsylvania and South Jersey. Jefferson said the case is not about quality of care or a challenge to the Star Ratings program itself.

Blue Cross & Blue Shield of Rhode Island, Banner Health, Verda Healthcare and MediGold challenge between 9 and 18 measures each, with estimates running from about $20 million to about $98 million. 

What the cases mean for plans outside the courtroom

Recalculations so far have followed litigation. The Georgia court ruled for Clover on May 27, finding CMS used data sources outside its statutory authority for 10 measures and adopted 10 others without notice-and-comment rulemaking. CMS then issued a June 17 memo describing a voluntary recalculation of 2027 quality bonus ratings using only HEDIS^®, CAHPS and Health Outcomes Survey data, with a hold-harmless provision. We covered the ruling and the first wave of filings in How the Clover ruling prompted more plans to speak up on Star Ratings and followed CMS's appeal in CMS appeals the Clover Star Ratings ruling: where the Medicare Advantage cases stand.

If courts order recalculations for the plans suing, their 2027 ratings and the 2028 bonus payments tied to them would change, while published ratings for other plans stay where they are unless CMS acts more broadly. Plans competing in the same counties also feel a competitor's half-star gain in benefits, marketing and enrollment, so a case you are not part of still reaches your market. 

Timing and runway

CMS released the 2027 ratings on October 8, and they set 2028 bonus payments. Bids for 2028 are due June 7, 2027, so several decision points arrive before the money moves. CMS's appeal of the Clover decision is pending at the Eleventh Circuit, the 2027 cases were filed within the past five weeks in four federal courts, and Elevance's 2026 case in Georgia is moving through summary judgment briefing. Each ruling adds detail to the picture plans will budget against.

The RISE Star Ratings Master Class brings these cases into one room. The program runs December 14 to 16 at the Fairmont Scottsdale Princess in Scottsdale, Arizona, and includes State of Play: Where the Star Ratings Litigation Stands Today on December 15, along with sessions on the CY 2028 proposed rule and its effect on your Stars strategy. 

HEDIS^® is a registered trademark of the National Committee of Quality Assurance (NCQA) and any reference thereto by RISE Health does not imply any endorsement by NCQA of RISE Health and its offerings.