Elevance sues government over $115 million tied to Medicare Advantage star ratings

STAT News – Thursday, July 2, 2026
By Bob Herman

Elevance Health has sued the U.S. government, alleging that federal efforts to recalculate its Medicare Advantage quality ratings didn’t align with a recent court ruling, costing the health insurer $115 million.

The lawsuit, filed Wednesday in U.S. District Court for the Southern District of Georgia, represents a new tier of drama in the Medicare Advantage program, which is the alternative to traditional Medicare that is run by private insurers.

The suit centers on star ratings, which are supposed to measure the quality of a health plan’s care and customer service. Plans that meet certain quality thresholds get extra taxpayer-funded bonuses and rebates.

But in recent years, insurers have used the courts to try to recoup bonus money when the government says they have fallen short, and now, a lack of clarity in newly computed ratings is exposing the government to more lawsuits.

Last month, the Centers for Medicare and Medicaid Services recalculated all 2026 Medicare Advantage star ratings after a federal court ruled the agency erred in its ratings of Clover Health, another Medicare Advantage insurer. However, instead of removing just the 20 measures the judge said had to be thrown out, CMS removed additional measures. Elevance “scored well” on those extra measures that were removed and therefore lost out on extra funding, Elevance’s attorneys argued in the lawsuit.

Because CMS did not treat Medicare Advantage plans the same as Clover, Elevance claimed the recalculated ratings “disadvantaged” the company.

“CMS had created an entirely new calculation methodology — removing only some of the measures addressed in the Clover decision, retaining other measures that the court had invalidated, and removing additional measures that the Clover decision did not address at all — without providing any explanation or justification for how it selected the measures it chose to remove,” Elevance said in the lawsuit.

Before filing the lawsuit, Elevance asked CMS to redo its Medicare Advantage star ratings in the same manner it did Clover’s. The company said CMS turned down its request on June 26 without a justification.

CMS did not immediately respond to a request for comment.

Elevance is no stranger to disputes in its Medicare Advantage business. The company lost a separate Medicare Advantage star ratings lawsuit in 2025, but won another one in 2024.

Elevance remains embroiled in a separate lawsuit, led by the Justice Department, alleging fraud in its Medicare Advantage plans. CMS also threatened to halt the company’s enrollment of Medicare Advantage beneficiaries, but Elevance paid the government $342 million — far less than it set aside — to stave off the sanctions.

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