The federal government inappropriately lowered the 2024 Medicare Advantage star ratings of SCAN Health Plan, which led to the health insurance company in California losing hundreds of millions of dollars in bonuses from the government, a judge ruled Monday.
The decision will lead to more than $250 million funneling back into SCAN, which covers 270,000 Medicare Advantage enrollees. And it opens the door for other Medicare Advantage plans to potentially recoup huge sums of taxpayer-funded bonuses — even though many independent experts believe the quality rating system is flawed and doesn’t appropriately gauge quality of care for older adults and people with disabilities.
The Centers for Medicare and Medicaid Services, the federal agency that oversees all Medicare programs, said it does not comment on litigation. In an interview, SCAN CEO Sachin Jain told STAT that if the company had not gotten its expected bonus money, it would have had to shave benefits and reduce what it pays hospitals and doctors.
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