Medicare Advantage

CVS Medicare Advantage Star Ratings Lawsuit: 28 Measures Challenged

CVS is challenging 28 Medicare Advantage Star Ratings measures and seeking recalculated 2028 payments. Examine the legal arguments, Clover precedent, and implications for payer legal, compliance, quality, and finance leaders.

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TL;DR:
CVS is challenging 28 measures used in its 2027 Medicare Advantage Star Ratings, alleging CMS violated statutory and rulemaking requirements. The company says recalculation could mean more than $2 billion in additional 2028 payments. The lawsuit raises questions about the legal foundations of Medicare's quality-rating system.

What You Need to Know

The change: CVS is challenging the legal basis for 28 measures used in its 2027 Medicare Advantage Star Ratings.
Who is affected: CVS/Aetna and affiliated plans identified in the complaint, with implications for payer legal, compliance, quality, and finance teams.
Why it matters: CVS alleges that excluding the measures would raise the affected contracts' ratings by at least half a star, potentially changing future payments.
What to do first: Identify the statutory authority, data sources, and payment assumptions supporting financially material regulatory scores.
Key dates: CMS published the ratings October 8, 2026; CVS filed suit October 26; the ratings affect 2028 quality-bonus payments.

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