SCAN Health successfully sues HHS for bonus payment victory

In a recent federal lawsuit, a private Medicare Advantage plan, SCAN Health Plan, came out victorious against the Department of Health and Human Services. The lawsuit was regarding the potential loss 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 in their motion for summary judgment. Judge Carl Nichols wrote a memorandum opinion stating that the Centers for Medicare & Medicaid Services violated the Administrative Procedure Act in their calculation of the 2024 star rating for SCAN.

This ruling has significant implications as it means that the CMS will now have to re-calculate SCAN’s star rating. This decision will likely have a positive financial impact on SCAN Health Plan, ensuring that they receive the quality bonus payments they are entitled to. The lawsuit and subsequent ruling highlight the importance of accurate and fair calculations in determining Medicare Advantage plan payments.

Overall, this legal victory for SCAN Health Plan is a reminder of the importance of holding regulatory agencies accountable for their actions. It also emphasizes the need for transparency and fairness in the process of determining bonus payments for Medicare Advantage plans.SCAN Health Plan’s successful outcome in the lawsuit demonstrates the importance of fighting for what is fair and just in the healthcare industry.