Health Plan Wins Landmark Legal Battle against Federal Agencies over Medicare Advantage Bonus Payments

In a recent legal victory, SCAN Health Plan emerged triumphant against the Department of Health and Human Services in a federal lawsuit over potential losses of $250 million in quality bonus payments next year. The US District Court for the District of Columbia ruled in favor of SCAN Health Plan, stating that the Centers for Medicare & Medicaid Services (CMS) violated the Administrative Procedure Act in their calculation of SCAN’s 2024 star rating.

This decision means that CMS will now have to recalculate SCAN’s star rating, which is likely to have a positive financial impact on the plan. The lawsuit and subsequent ruling underscore the importance of accurate and fair calculations in determining Medicare Advantage plan payments.

The successful outcome of this legal battle for SCAN Health Plan serves as a reminder of the need for regulatory agencies to be held accountable for their actions. It also emphasizes the importance of transparency and fairness in determining bonus payments for Medicare Advantage plans. This victory demonstrates that fighting for what is fair and just in the healthcare industry can lead to positive outcomes, even in complex legal battles.