A federal court rejected Humana Inc.’s challenge to its 3.5 Medicare Advantage Star Rating, ruling that the Centers for Medicare and Medicaid Services properly counted dropped customer-service test calls when tabulating the score.
Humana had asked the U.S. District Court for the Northern District of Texas to set aside the rating and force CMS to recalculate.
At issue were three test calls made during a CMS study of call center accuracy and accessibility. Two calls disconnected when interpreters were brought on, while in a third, the caller mistakenly believed they were on silent hold.
The insurer argued CMS broke its own rules, failed to provide transparent data, and unfairly enforced a “no-callback” policy that prohibited Humana from reconnecting with test callers. It also sought a ruling that the callback ban was unlawful.
The court disagreed. Judges said the no-callback policy reasonably measures call center performance because resolving inquiries on a single call avoids delays, missed follow-ups, or problems reaching callers from private numbers.
On the silent call, the court found Humana failed to complete required steps of the interpreter test.
The process demands a live representative connection, transfer to an interpreter within eight minutes, and then an accuracy check.
Humana disconnected after just over six minutes, preventing CMS from verifying if an interpreter connection existed.
In its response, Humana said it was disappointed with the decision and is weighing legal options. A company spokesperson stressed that Medicare Advantage serves millions of Americans with affordable, high-quality care, and said quality ratings should be measured consistently and fairly.
For now, the 3.5 Star Rating stands – a score that directly influences plan quality assessments and federal reimbursement levels tied to Medicare Advantage contracts.
