Florida Blue is suing federal health agencies over Medicare ratings. | Jacksonville Daily Record
Published on December 31, 2024 at 12:43 pm
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The insurer Florida Blue, based in Jacksonville, has filed a lawsuit against federal health agencies, arguing that key quality ratings didn’t properly take into account disruptions caused by major flooding in Broward County in 2023
Florida Blue, formally named Blue Cross & Blue Shield of Florida, filed the lawsuit Friday in U.S. district court in Washington, D.C., contending that lower federal ratings will cause it to lose tens of millions of dollars and can affect seniors’ enrollment decisions.
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The case centers on Medicare Advantage plans and a Medicare prescription-drug plan offered by Florida Blue and on what is known as the federal Star Ratings system. Federal officials rate health plans on a five-star scale, make the information available to the public and use the ratings in awarding bonuses to plans.
Florida Blue contends that the U.S. Department of Health and Human Services and the federal Centers for Medicare & Medicaid Services should have made adjustments to the company’s ratings to account for disruptions to health services during April 2023 flooding in Broward County.
Without the adjustments, Florida Blue said its Medicare Advantage HMO and a prescription-drug plan received lower-than-justified scores in ratings released in October. The lawsuit said data showed “substantial declines in doctor visits and prescription refills by members at the time the flooding took place in Broward County.”
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“Florida Blue’s lower ratings negatively impact its revenue and its ability to serve its members,” attorneys for the insurer wrote in the lawsuit. “Specifically, the lower ratings will cause Florida Blue to lose tens of millions of dollars — money it would otherwise be able to put toward greater member benefits.”
The lawsuit said a federal rule, known as the “extreme circumstances rule,” is designed to allow plans to avoid being penalized in the ratings system because of emergency situations. But for the rule to be triggered, the secretary of the Department of Health and Human Services must declare a public health emergency.
While the Broward County flooding caused Gov. Ron DeSantis to issue an emergency declaration and President Joe Biden to declare the county a major disaster area, Health and Human Services Secretary Xavier Becerra did not declare a public health emergency, according to the lawsuit.
The Centers for Medicare & Medicaid Services used 2023 performance data in determining plan ratings for 2025. Those ratings were released in October, the lawsuit said.
Florida Blue’s argument
Florida Blue contends that if the flooding-related disruptions had been properly taken into account, its Medicare Advantage HMO would have received 4.5 stars instead of 3.5 stars and that its Medicare prescription-drug plan would have received three stars instead of 2.5 stars.
Florida Blue also offers a Medicare Advantage preferred-provider organization, or PPO, plan but did not include that plan’s rating in the lawsuit, though it said the plan also was “negatively and materially affected” by the flooding.
“Using CMS’ own reasoning for the extreme circumstances rule, the historic rainfall and flooding in Broward County is exactly the type of event for which a Star Ratings adjustment is necessary,” the lawsuit said.
The lawsuit makes a series of arguments under a law known as the Administrative Procedure Act, including that the use of the rule was “arbitrary and capricious” as applied to Florida Blue’s ratings.
Defendants are the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, Becerra and Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services.
