Leapfrog Group’s legal defeat underscores challenges of rating hospital quality

STAT News – Friday, March 13, 2026
By Tara Bannow

What began as a spat between five Florida hospitals and a safety ratings group has grown into a First Amendment test with implications for any company involved in producing public ratings.

A federal judge found that The Leapfrog Group, an influential nonprofit known for its hospital quality and safety scores, violated Florida’s consumer protection law by unfairly penalizing hospitals that didn’t take its surveys. The judge ordered Leapfrog to withdraw its ratings on those hospitals and change its methodology for rating them, among other remedies.

Leapfrog plans to appeal. The group’s CEO, Leah Binder, said in an interview with STAT that the ruling is “outrageous” and shuts down free speech.

“If in fact this law will protect businesses from ratings and reviews critical of it, then we have a much bigger problem than Leapfrog,” Binder said. “We have a very big problem because we have a wide variety of ratings organizations from Moody’s to Consumer Reports to lots of others.”

The case resurfaces complicated questions of how to measure hospital quality and what to do when hospitals don’t want to be measured. They’re questions that divide even those within the hospital safety world, with some standing fully behind Leapfrog, and others urging the company to do better.

Heather Havericak, the CEO of Delray Medical Center, one of the five for-profit Tenet Healthcare hospitals that sued Leapfrog, said in an interview with STAT that her hospital was in compliance with the measures the survey asked about. She said it just became too burdensome to report the data, especially after the Covid-19 pandemic. Delray and the four other hospitals last reported to Leapfrog in 2021, and their scores have since fallen to Ds and Fs.

“We just thought that we could use these resources that are scarce and valuable to really drive those outcomes,” Havericak said, “and we didn’t really feel at that time that Leapfrog was bringing us that value because it didn’t have complete data.”

Tenet generated $1.4 billion in profit for its shareholders and over $21 billion in revenue last year. It owns 50 hospitals nationwide.

Testimony and evidence presented during a January 2025 trial indicated that Leapfrog’s changes were designed to punish hospitals and compel them to participate in the surveys, factors that influenced the judge’s ruling. Most of Leapfrog’s revenue comes from allowing hospitals to license logos and other materials that promote their scores. It also does consulting for hospitals looking to improve their scores, and receives grants.

Therein lies a fundamental problem with hospital ratings: deciding who pays for them. When Leapfrog was founded in 2000, the idea was for it to be funded by large employers who wanted to ensure they were sending their workers to reputable facilities. That plan fizzled and Leapfrog instead turned to making money from giving ratings. Some of its money still comes from large employers, including health insurers.

“I do think it’s a really bad look for Leapfrog, honestly,” said Carol McLay, immediate past president of the Association for Professionals in Infection Control and Epidemiology. “It does feel like they’re pressuring hospitals to take the surveys and I do see this as a conflict of interest because they make money off it.”

The ruling, from Donald Middlebrooks of the Southern District of Florida, has garnered detractors. One is Barak Richman, a business law professor at George Washington University. He thinks it’s a misapplication of the consumer protection law, Florida’s Deceptive and Unfair Trade Practices Act. The law is designed to protect people from companies that aren’t forthright. In this case, he said that’s the hospitals, not Leapfrog.

“It’s not supposed to protect the one being evaluated, it’s supposed to protect people being sold to,” Richman said.

The case centers on a change Leapfrog made to its rating methodology in 2024. Leapfrog gives hospitals an A through F letter grade based on 22 safety measures. Twelve of those measures come from survey data, and the rest come from data reported to Medicare. If hospitals don’t take the survey, eight of the metrics are left blank, and the remaining four are assigned to them. Before 2024, nonparticipating hospitals received the average score of participating hospitals on those four measures. After the change, hospitals received the lowest score among participating hospitals.

Not only that, those four measures carry more weight in the overall score of a nonparticipating hospital. Leapfrog said it made the change because the previous methodology gave nonparticipating hospitals an undeserved benefit.

But Middlebrooks’ ruling cited a Leapfrog representative who said the poor scores would be used to “harass” the hospitals that didn’t participate, making Leapfrog into “a Disney villain.” Patrick Romano, a physician who’s a member of Leapfrog’s advisory board, described the methodology as a “backdoor approach to penalizing participation” in an email Middlebrooks cited.

Binder said the judge left out that Romano was clear during the trial that he supports the methodology. Leapfrog’s advisory board did not vote on the methodology before it was implemented.

It’s true that Leapfrog’s methodology doesn’t look good from the outside, but Michael Millenson, president of the consultancy Health Quality Advisors, said in his 40 years of researching health quality, hospitals and doctors haven’t thought any methodology was fair.

“Hospitals and doctors don’t want to be rated, I understand that,” he said. “I wouldn’t want anybody rating me. But let’s have something other than your ads. Is that OK?”

Neither Leapfrog nor the hospitals emerged from the case looking stellar. Some who spoke with STAT criticized the hospitals for not reporting their data to Leapfrog, whose grades are widely used by patients and health insurers. At the trial, there was debate over precisely how much time the surveys take to complete.

“You shouldn’t be too busy to get your patient safety data,” said Michael Ramsay, chief executive officer of the Patient Safety Movement Foundation. “You should know it.”

The judge found Leapfrog’s methodology resulted in multiple forms of harm: to patients if they delayed care or left a hospital against medical advice and to hospitals if they saw less demand and had to field inquiries from health insurers and doctors.

Delray Medical Center’s Havericak said she personally talked to a patient who worried she might die if she had her surgery there because of its Leapfrog score. She was able to convince the patient she would be safe and the surgery — at Delray — was successful.

“There are so many patients like that that myself and my colleagues had to talk to because they’re just scared,” Havericak said.

Middlebrooks ordered Leapfrog to change its methodology for rating the five nonparticipating hospitals that sued, withdraw its ratings for those hospitals, send corrective disclosures to all entities that paid licensing fees, and place corrective disclosures in any materials that promote safety grade licensing in five South Florida zip codes. Binder said Leapfrog will comply, and will roll out new methodology for all nonparticipating hospitals for its fall 2026 ratings.

Richman, of George Washington University, said it’s hard for him to imagine the ruling will stand. The implications are too broad considering all the groups that issue ratings.

“The good news is this means my law school can now sue U.S. News & World Report” for its dip in the ratings, he said.

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