Centene Sues US Over Medicare Advantage Ratings

Centene Corporation has filed a lawsuit against the Biden administration in the US District Court for the Eastern District of Missouri, claiming that a software malfunction during a call center evaluation led to an unfair downgrade of its Medicare Advantage star ratings. The company alleges that this downgrade could result in a loss of up to $73 million in revenue and potentially drive enrollees away from its plans. Centene argues that the rating reduction was due to a failed call initiated by a CMS 'secret shopper', which was improperly scored as unsuccessful due to a software issue on the caller's end. The star ratings, which range from one to five, significantly impact government funding for the plans, making this a critical issue for Centene. The lawsuit highlights the ongoing tensions between health insurers and regulatory agencies over the accuracy and fairness of performance measurements. Centene is not alone in this battle, as other major insurers like Humana and UnitedHealthcare have also challenged similar rating downgrades.