After Second Loss In Court, Humana’s Contested MA Star Rating Will Stick
Humana had disputed its 2025 Medicare Advantage rating from the Centers for Medicare and Medicaid Services, which gave it a 3.5 out of five. A federal court ruled Tuesday that CMS doesn't have to recalculate it.
The Centers for Medicare and Medicaid Services doesn鈥檛 have to recalculate Humana鈥檚 2025 Medicare Advantage star ratings, a federal court ruled Tuesday. Humana, second in Medicare Advantage market share, alleged the agency improperly evaluated its foreign language call center services and assessed a 3.5 out of five rating. The U.S. District Court for the Northern District of Texas rejected the argument. (Tepper, 10/14)
The CMS quietly released anticipated star ratings data Thursday night. Humana and Aetna saw enrollment in highly rated plans fall, while Elevance鈥檚 and Centene鈥檚 stars improved and UnitedHealthcare鈥檚 stayed stable. (Pifer, 10/10)
In other health industry news 鈥
The Centers for Medicare and Medicaid Services is slated to publish regulations setting Medicare reimbursements for outpatient care in 2026 over the coming weeks. The final rules for physician services, hospital outpatient procedures, home healthcare and dialysis also are expected to enact significant new changes, including new policies on 鈥渟ite-neutral鈥 outpatient reimbursement, 340B Drug Pricing Program payments and the system that calculates physician fees. (Early, 10/14)
Cleveland Clinic and venture capital firm Khosla Ventures will jointly invest in and create health tech companies, the organizations said Tuesday. As part of this arrangement, Khosla and Cleveland Clinic Foundation鈥檚 venture capital arm will equally invest in healthcare startups, said Dr. Hal Paz, operating partner of Khosla Ventures. Khosla and Cleveland Clinic also plan to create their own joint company, with Khosla leading technical development and recruiting while Cleveland Clinic handles clinical operations. (DeSilva, 10/14)
Johnson & Johnson announced Tuesday it intends to separate its DePuy Synthes orthopedics business into a stand-alone company. The company said it expects to complete the separation within 18 to 24 months. (Dubinsky, 10/14)
The Lucy Daniels Center, which has provided mental health services for young children in the Triangle for 35 years, is breaking ground Friday on an expansion that will nearly triple the number of children the nonprofit can serve. (Fernandez, 10/15)
Also 鈥
JPMorgan Chase & Co. Chief Executive Officer Jamie Dimon said he expects the bank鈥檚 health costs to rise 10% next year, a sign of how employers are grappling with higher spending on medical services and prescription drugs. The biggest US bank already spends about $3 billion per year on employee medical costs, Dimon said Tuesday during a third-quarter earnings call. (Smith, 10/14)
