What happened: Jefferson Health entities allege CMS calculated their 2027 star ratings using three measures a federal court already ruled unlawful
Who’s involved: Health Partners Plans (Thomas Jefferson University subsidiary) v. HHS and CMS
What’s at stake: approximately $43 million in lost rebate retention across 2028, according to the complaint
Why it matters: the suit tests whether CMS can keep applying measures a court struck down – and whether one insurer should get different treatment from the rest
Where it stands: complaint filed November 4, 2026, in the US District Court for the District of Columbia; no ruling yet
A federal court voided 20 Medicare Advantage star rating measures in May. CMS dropped them from one insurer’s score. According to a new lawsuit, it kept right on using three of those same measures to rate everyone else.
Thomas Jefferson University and three subsidiary insurers – Health Partners Plans, Partners Insurance Company, and Partners Insurance Company of New Jersey (collectively the “Jefferson Health entities”) – filed suit against the Department of Health and Human Services and CMS on November 4 in the US District Court for the District of Columbia.
The dispute traces back to a ruling in the US District Court for the Southern District of Georgia. In May 2026, that court found that 20 measures CMS had used to calculate Clover Insurance Company’s 2026 star rating were unlawful. Ten relied on data CMS had no legal authority to use. The other ten were never put through the public comment process the law requires before CMS can adopt new quality measures.
The court ordered CMS to recalculate Clover’s rating without them. CMS complied within two weeks.
Three of those voided measures – D08 (medication adherence for diabetes medications), D09 (medication adherence for hypertension), and D10 (medication adherence for cholesterol) – are the ones Jefferson Health is now challenging. The complaint says CMS used all three to calculate the Jefferson Health entities’ 2027 star ratings, published on October 8, 2026.
Then comes the twist. When CMS calculated Clover’s 2027 star rating, the complaint alleges, the agency voluntarily left out the measures the Georgia court had struck down for 2026. Every other Medicare Advantage organization, the suit says, was rated using the full set – including the measures a federal court had already voided.
“CMS compounded its unlawful actions both by ignoring the Clover precedent in calculating the 2027 Star Ratings for the JHP Entities (and all other MAOs but Clover), and by giving Clover special treatment for 2027,” the complaint states.
The financial stakes turn on half a star. Medicare Advantage contracts rated below 3.5 stars retain 50% of the rebates CMS pays them. Those rated at 3.5 or above – but below 4.5 – keep 65%. According to the complaint, without the three challenged measures, Contracts H9207 and H1619 would each climb from 3.0 to 3.5 stars, and Contract H3124 would rise from 2.5 to 3.0.
That half-star difference, the filing says, amounts to approximately $43 million in lower rebate retention across 2028. Those are funds the Jefferson Health entities say they could otherwise put toward supplemental benefits, premium reductions, and quality improvement for their more than 31,000 enrolled members across Pennsylvania and New Jersey.
The complaint also points to reputational and competitive harm. CMS publishes star ratings through its Medicare Plan Finder tool, which beneficiaries and brokers check during enrollment. Lower ratings, the suit says, may lead brokers and third-party marketing organizations to “deprioritize or refuse to market lower Star plans,” cutting the Jefferson Health entities’ visibility in the marketplace.
Employers and plan sponsors that offer Medicare Advantage options to retirees may similarly treat star ratings as a stand-in for quality, the complaint alleges, further squeezing the Jefferson Health entities’ ability to compete.
The Jefferson Health entities are asking the court to throw out their 2027 star ratings for all three contracts and order CMS to recalculate them without the three challenged measures. They also want CMS to adjust their 2028 rebates and let them revise any bids already submitted.
Meanwhile, CMS’s appeal of the original Clover ruling is pending in the Eleventh Circuit, with oral argument set for the week of January 18, 2027. How that appeal lands could reshape the landscape for this case and every other star rating challenge in the pipeline.
The growing wave of star rating litigation puts a practical question in front of Medicare Advantage compliance teams and broker networks: which version of the ratings should they be planning around?
The allegations in this complaint have not been tested, and no court has ruled on the merits.
