CMS Star Ratings Upheld in Humana Medicare Advantage Lawsuit; Class Actions Impact Insurer Litigation

Humana Inc. has faced legal challenges after the Centers for Medicare & Medicaid Services (CMS) lowered its Medicare Advantage star ratings, with a federal court affirming CMS's decision as reasonable following Humana's second lawsuit.

The Sixth Circuit court upheld a lower district court's decision to certify a class in related litigation, distinguishing it from other federal circuits like the Third, Fourth, Seventh, and Ninth, which have blocked similar class certifications in cases against Progressive. Additionally, litigation trends indicate a surge in lawsuits against insurers over inaccuracies in provider directories, with allegations including nonexistent medical professionals or outdated network information. In a separate case, a court ruled that Evanston breached its duty to defend insured parties when denying coverage despite evidence supporting a possible claim.

The insurance sector also faces scrutiny related to alleged fraudulent practices involving investor deception in entertainment funding, with Medicaid authorities considering intervention to recoup overpayments. These developments underscore ongoing regulatory and legal challenges within the U.S. insurance market, emphasizing the critical role of accurate compliance and transparency in insurer operations.