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Humana is again trying to win its lawsuit against the Centers for Medicare and Medicaid Services over its star ratings designation.
On Wednesday, Nov. 26, the day before Thanksgiving, Humana filed a notice of appeal with the federal court in Texas, against Robert F. Kennedy Jr., the secretary of the Department of Health and Human Services.
Humana appealed to the U.S. Court of Appeals for the Fifth Circuit. The brief, two-page notice gives no basis for the appeal.
WHY THIS MATTERS
High scoring Medicare Advantage star ratings are worth millions-plus to insurers. CMS gives bonuses to plans that score 4 stars or above.
In its original lawsuit, Humana argued there were potential errors in CMS' calculations of industry cut points. Humana narrowly missed getting higher cut points on a small number of measures, the company said, a factor that lowered its star ratings and cost it more than $1 billion in bonuses.
One contract decreased to a 3.5-star rating from a 4.5-star rating in 2024.
Humana's second lawsuit focused on CMS' handling of three customer service phone calls. CMS had call "surveyors" that placed test calls to evaluate centers' compliance with regulatory requirements. Three test phone calls lowered the star ratings of at least a dozen of Humana's largest plans. Humana said the calls were handled by CMS in a manner inconsistent with the agency's own regulations.
Humana also argued that CMS’ “no-callbacks policy” was unlawful. Humana said the policy unfairly penalized plans whose call centers were disconnected before members could receive assistance.
Judge Reed O'Connor disagreed, saying CMS' determinations on the calls were not arbitrary and that a no-callbacks policy did not violate federal law.
The Texas court also said that Humana "did not exhaust the administrative appeals process."
Humana did appeal to CMS to improve the former's Medicare Advantage star ratings, but CMS rejected that appeal.
THE LARGER TREND
Thirty-four Medicare Advantage plans earned 5 stars in the 2025 Medicare Advantage and Part D Star Ratings for 2026 released by the Centers for Medicare and Medicaid Services in October.
This compares with only seven plans that received the highest rating for the 2025 plan year and 38 contracts that received 5 stars for 2024.
Email the writer: SMorse@himss.org