Recalculation Ahead: Implications of UnitedHealth's Win Against CMS

Core Points - A federal judge in Texas ordered the Centers for Medicare and Medicaid Services (CMS) to recalculate UnitedHealth Group's Medicare Star Ratings for the 2025 plan year, ruling in favor of UnitedHealthcare in its lawsuit against CMS [1][2] - The judge found that CMS violated the Administrative Procedure Act by incorrectly marking a test call to UnitedHealthcare's call center as unsuccessful, which unfairly impacted the company's star ratings [2] - The ruling may set a precedent for how star ratings are evaluated, particularly regarding the use of private contractors in assessing call center performance [4] Industry Impact - A single unsuccessful call can prevent a plan from achieving a five-star rating, potentially costing insurers millions [4] - The recalculation is likely to result in significantly more quality bonus payments for UnitedHealthcare in 2026, enhancing its ability to attract new members and secure funding [5] - The ruling raises hopes for other Medicare Advantage insurers, such as Humana and Centene, who are also challenging their star ratings [6]